Constitution Still Matters to Some

Federal judge notes that the US Constitution requires that Congress appropriate funds (exercise the power of the purse). Judge further notes that the payments to insurers under the Affordable Care Act were not authorized by such a congressional appropriation. The Executive branch response is par for the current course:

White House Press Secretary Josh Earnest said the administration remained confident it will prevail in the end.

“This suit represents the first time in our nation’s history that Congress has been permitted to sue the executive branch over a disagreement about how to interpret a statute,” he told reporters. “It’s unfortunate that Republicans have resorted to a taxpayer-funded lawsuit to re-fight a political fight that they keep losing.”

Such concern for the funds of the taxpayers, Mr. Earnest. Where is the concern over the astronomical cost of the (not so) Affordable Care Act on those same taxpayers?

No, The Doctor is Not In

The President is in the process of selecting the next Surgeon General. Does it come as any surprise that he’s selected a community organizer?

Dr. Murthy is the 36-year-old president and co-founder of Doctors for America, a group that advocates for Obamacare and gun control laws.

The group calls gun violence “a public health crisis.” It pushes for Congress to ban “assault weapons” and “high-capacity” magazines and calls for spending tax dollars for more gun-control research.

The organization also lobbies for doctors to be allowed to ask patients, including minors, whether they have legal guns in the home. If the patient admits to having guns, Dr. Murthy wants doctors to “counsel them appropriately about safety measures.”

We’ve had a number of Surgeons General over the last 150 years. Most of them were actual doctors, with real medical experience. Most of them understood that they had a calling to help heal the sick and tend to the wounded.

Then again, we’ve had a number of Presidents over the last 150 years, too. Most of them were actual leaders, with real-world experience in solving big problems and putting the needs of a country before themselves.

Misunderstanding Government Funding

From KELO :

The pricetag for Medicaid expansion will cost South Dakota an extra $1.5 million in the first year.  The federal government picks up $58.3 million in 2014.

[…]

The Task Force also points out that if the federal government is unable to pay it’s [sic] share of the expansion, there is a risk that taxpayers could end up footing the entire bill, which will amount to more than $409 million by the year 2020.

Civics 101 is apparently no longer taught.

Taxpayers end up footing the entire bill for Medicaid. Period. If there is risk in this equation for taxpayers, it stands at 100%. Whether they are South Dakota taxpayers or New Mexico taxpayers is, in large part, incidental. Any other understanding of the matter is laughable.

Government only has that which it takes from the governed. As Calvin Coolidge said, “Collecting more taxes than is absolutely necessary is legalized robbery.”

I think he was on to something.

Lost in The Language Tonight

Language is very important–after all, it is how each of us communicates with others. No language = no communication. Spoken and written language are useful because we can use them to communicate highly complex constructs in such a way as to make those ideas approachable by just about everyone who understands the common language. Well, that’s how it ought to work. Peggy Noonan has some useful thoughts on how the rush (on the part of the President’s men and women) toward universal healthcare may well be using big words to confuse those who would otherwise understand:

As she [Sebelius] spoke, I attempted a sort of simultaneous translation, which is what most of us do now when we hear our political figures, translate from their language to ours. “Access health care” must mean “go to the doctor.” But I gave up. Then a thought crossed my mind: Maybe we’re supposed to give up! Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them more obscure and impenetrable. Maybe we’re not supposed to understand.

I shouldn’t pick too hard on Ms. Sebelius specifically. Most people in the administration, and many in government, speak as she speaks, and have for many years. In her case there’s reason to believe it’s a quirk. A New York Times profile recently had her recalling with self-deprecating charm the time her child ran a high fever and she caused a bit of confusion by forgetting to say, “We have to go to the hospital!” and announcing instead, “This unsustainable increase in body temperature requires immediate access to a local quality health-care facility!” I made that up, but it was believable, wasn’t it?

“Maybe we are not supposed to understand.” Maybe Ms. Noonan is on to something here. She goes on:

Do members of the administration speak obscurely because they can’t help themselves, or do they speak the way they speak because they really aren’t all that keen to have people understand them? Maybe they calculate that lack of clarity ensures maximum ability to maneuver. But maybe they should think less about maneuvering. They’re not helping the prevailing sense of national anxiety by speaking in a special lingo all their own. After all, it’s not their health-care system they’re reforming, it is America’s. It would be nice if America were allowed to know what exactly the plan is, and how it would work, and who would pay, and how.

I think perhaps the people in the administration speak this way, in part, because that is how they assume professionals in their positions ought to speak. After all, jargon is the province of the “in group” whatever that group may be. I know that jargon is an essential part of my language on a regular basis. One key difference between me and Ms. Sebelius? I’m not an elected or appointed government official who is answerable to the general public.

That aside, there is definitely a component of confusion (perhaps planned) in the information supporting many of the federal government’s recent intrusions, whether we speak of banking, automaking, doctoring or warfighting.

After all, if I (or anyone) says simple things, people might have a clue about what is happening before it happens. That could be downright dangerous. Or, as someone might be saying in a conference room somewhere in the greater DC area right now:

In the event that communciation of non-complex matters is achieved without filtering or obfuscation, members of various political constituencies are more likely to gain knowledge of events before those events have actually been executed in the manner prescribed.

Critical Examples Fail Test

a hospital room somewhereI’m just about through reading Dr. Tom Daschle’s prescription for healing health care here in the US (Critical: What We Can Do About the Health Care Crisis).  I would like to start with what should be an absolute caution to anyone anticipating something approaching universal health care coverage at the national level.

Page 39 talks about the good examples which several states, Massachusetts and California included, have set by implementing or trying to implement universal health care coverage. The problem with that?  These states’ programs are in dire shape:

The collapse of health reform in California and ominous signs from Massachusetts spell big trouble ahead for reforming the nation’s healthcare system no matter who is elected President. The lessons from those states, which have tried hard to bring insurance coverage to all residents, are worth heeding for anyone sitting in the White House next year. They also raise the question of whether it is possible, either fiscally or politically, for states to do the job. Indeed, failure in California and troubles in Massachusetts indicate that the underlying problems that bedeviled reform efforts fourteen years ago are still with us, and could doom yet another attempt to change the American way of healthcare.

Please note that this information was from March of 2008–before the current economic mess became an issue for just about everyone.

Here’s a very current update on what the Massachusetts plan in particular is doing to the health care market in that state:

“More than 340,000 Massachusetts residents have gained health insurance since 2006 under the state’s landmark health care reform law,” said the report, which added, “Employers, insurers, providers, and patients have all done their part to make health care reform a success.

“However,” the medical society’s report continued, “interviews with primary care physicians across the Commonwealth suggest that many of those newly insured people are having trouble finding a doctor.”

The current average wait time to see a primary care physician in Massachusetts is 36 days, up from 34 days in 2007, according to the report.

[…]

The problem of patient overload of the system is being compounded by doctors leaving the state to work elsewhere, said Stergios.

“The strains on doctors who already have higher tort claim costs and face numerous requirements from the state government and insurers may lead even more of our doctors to practice medicine in states that are less restrictive,” Stergios noted.

“Doctors are moving to areas outside of Massachusetts because of fewer restrictions on how they practice medicine, lower costs of practicing medicine, and lower cost of living,” Stergios said.

So, there you have it. The wonderful example of Massachusetts, where people can now wait 36 days to see a primary care physician (that’s more than a month folks) and physicians are leaving the state because they don’t want to deal with the additional hassle and costs. Of course, if the whole nation had this type of coverage, doctors might have little choice about staying–but there is no question that they would be happy to have their choices thus curtailed.

Using the principle of the states as testing grounds for public policy, we have determined that universal health care coverage will cost more, provide less and cause good doctors to head for greener grass. Why would we be so foolish as to try this test on a larger scale? I suppose by so doing, we could create one more entity which is “too big to fail” and continue to throw billions of dollars at it in a futile attempt to make it all better.

Razzle Dazzle This Time

structure of vitamin B6I’m beginning to feel more and more as though I am a vagrant living back-lot at Universal or some other movie studio and that what is currently happening is not really happening but is the result of a soon-to-be infamous scriptwriter and director teaming up for one more horrible sequel.

Then again, I’m pretty certain that the little girl who just came sock-sliding in here from her bedroom is my number one daughter. If that was real, then the rest of this must also be:

. . . since the lessons they learned from the HillaryCare fiasco are political, and not substantive, they are already moving full-speed ahead.

This mentality is nicely captured by Tom Daschle, the former Senate Majority Leader who Barack Obama has tapped to run Health and Human Services. “I think that ideological differences and disputes over policy weren’t really to blame,” he writes of 1994 in his book “Critical,” published earlier this year. Despite “a general agreement on basic reform principles,” the Clintons botched the political timing by focusing on the budget, trade and other priorities before HillaryCare.

[…]

Most disturbingly, Democrats are talking up “budget reconciliation” to pass a health overhaul. This process was created in 1974 and allows legislation dealing with government finances to be whisked through Congress on a simple majority after 20 hours of debate. In other words, it cuts out the minority by precluding a filibuster. Mr. Daschle writes that reform “is too important to be stalled by Senate protocol,” and Mr. Baucus has said he’s open to the option.

Any taxpayer commitment this large ought to require a social consensus reflected in large majorities, but Democrats are determined to plow ahead anyway. They know that a health-care entitlement for the middle class will never be removed once it is in place; and that government will then dominate American health-care choices for decades to come. That’s all the more reason for the recumbent GOP to get its act together.

So many things one could say. Suffice it so say that any time someone says that anything is “too important to be stalled by Senate protocol” what is meant is that this will never pass if we let it move slowly enough through the process that people actually pay attention to what is going on. In my support, I call as a witness the $700 billion bailout (which apparently was not read by a number of its signatories).

Here then is the apparent plan: 1) move on this right away, while Obama still has the upswing in popularity from a remarkable inaugural performance; 2) push it through the Senate and House as quickly as is possible under the new majority; 3) get sufficient government control of the health industry in place that it cannot be easily dislodged; and 4) move on to the next most critical effort.

Once again, there may be little that I can do. However, I am doing what I can (and trust that you will keep yourselves informed via this and other sources). This week, I will fill out the paperwork to move from a traditional health insurance plan to one which is fronted with an HSA and only kicks in after very high deductibles are met. If you have not considered an HSA, please do so. (I realize that changes need to be made on the provider side of things for HSAs to be as useful as they could be, but this is a step in the right direction).

Unhealthy Approaches

Taking blood for an infant's PKU testAs noted previously, Tom Daschle spoke on the future of health care in the United States yesterday. While I am still waiting on a copy of his book, I find what he said to be unsurprising and largely in keeping with the thinking that “anything you can do, government can do better.” A few excerpts from his speech are as follows (read the whole thing if you have the time). I know I’m leaving many things out, but I want to comment on just a couple of his points:

But before we define the solution, I think it’s important that we define the problem. It’s important that we’re all on the same page, that we agree what the problem really is. Before we define the problem we have to destroy the myth. And the myth in our country has long been that we have the best healthcare system in the world. Why else would kings and leaders all around the world, people of prominence come to the United States?

Well to a certain extent that is true. But for every king who may come to the United States, there are thousands of people who leave the US to get medical care elsewhere. They call it now medical tourism. Thousands of people leave the United States because the quality and the cost is better in other countries. So how do we explain, well we explain by simply stating that we have islands of excellence in a sea of mediocrity.

[…]

God forbid a plane crash occurs in some airport involving a 747. What happens? Well in this country, the 747 crashes the national transportation safety board is on site within hours and within weeks or months we have a full report as to why it was that these 450 people on that plane were killed. We know because there was extraordinary record keeping. We know because there is extraordinary transparency. We know because there is a framework in place to examine these mistakes and fix them. A combination of the FAA and the NTSB and the transparency that comes with the laws involving aviation and we fix the problem. It’s why we have one of the safest aviation systems in the world.

First, in reference to medical tourism, let it be clear that Americans leave the United States to get medical treatment for a variety of reasons. Some of the most popular ones are as follows: drugs/treatment not approved in US by FDA , procedures are less expensive, procedures are against US laws on moral or ethical grounds (such as those which pertain to “reproductive health”). I do not have a problem with people going elsewhere to spend less (as I will do the same myself within the local context). If they are willing to accept the consequences (not necessarily good ones) of unapproved drugs or unethical procedures, so be it. I do not know if anyone has the numbers, but I would guess that when it comes to critical issues (life and death surgical procedures, for instance) that the United States receives a net inflow of “medical tourists” rather than the opposite. However, whether or not that is the case, this truth remains: there is no reason why we need more federal government intervention in health care to prevent people from going elsewhere for solutions.

Second, in reference to the fine job which the FAA an NTSB would do in the event of a crash I need to say two things: a) you have got to be kidding me if you are considering either of these organizations to be models of efficiency. It took the NTSB more than four years to figure out what might have happened to TWA flight 800. Back in 2001, Fortune had this to say about the FAA:

In 1982 the FAA embarked on a major modernization effort; after 12 years of delays and $1.5 billion in waste, the government declared it “out of control” and shut it down. (The FAA admits to inefficiency.) A semi-private business, the thinking goes, couldn’t afford to waste so much time and money. With less red tape, improvements could be implemented much more rapidly.

To my knowledge, several of the FAA issues which were addressed in that article still remain today. So, Mr. Daschle please do not use the hypothetical collaboration of the FAA and the NTSB as a means of proving how government agencies can efficiently address crises. Such an argument tends to fall off the rails without anyone helping it.

Government “help” in health care is becoming more and more like the medical care of 200 years ago, where the doctor would bleed the patient to make them better. An unknown writer at WizBang has several thoughts as to how we could actually help the health care system get better, instead of effectively killing it off:

  • Get serious about Health Savings Accounts (HSAs). HSAs entice people into the health insurance market, moving away from expensive all-inclusive coverage and toward less expensive, catastrophic coverage. The tax-advantaged medical savings account is used for routine medical expenses. This contains costs by providing an incentive for judicious health care spending. People are in charge of their own money and keep the money they don’t spend.
  • Make insurance portable. If the government is going to be in the business of subsidizing health care, tax credits should be directed to individuals and not to employers. This would allow people the opportunity to shop around, and would allow them to change jobs without worrying about health insurance coverage.
  • Allow people to purchase insurance across state lines. With more options for consumers and more competition between insurance companies, prices would go down and services would improve.
  • Get serious about tort reform: Patients should have access to legal remedies in cases of medical malpractice but the legal system needs to discourage endless, frivolous lawsuits.
  • Don’t move toward socialist or government-run models of health care delivery. You say you think government-run health care is wrong. I agree. Government-run health care leads to lower quality, higher prices and shortages of health care services. For all practical purposes, Medicare and Medicaid amount to government-run health care, so don’t expand Medicare and Medicaid.

I’m liking these ideas–particularly the one regarding HSAs. If more people only knew what health care cost them, they would be more careful in lifestyle decisions and more appreciative of the care they get.

One more thing, and then I’ll let this simmer for a while: Mr. Daschle and Mr. Obama have at times both said that they do not want the government to take over health care entirely, they just want it (government) to use its power to alleviate the problems which currently exist. They speak of “oversight” and “accountability.” What they are conveniently leaving out is how simple it would then be for government to overlook the actual accounting for the increased cost. P.J. O’Rourke has succinctly said: “If you think health care is expensive now, wait until you see what it costs when it’s free.”

Daschle as Mountaineer

One type of mountainNot an image I would have thought of:

Like those extreme mountaineers who risk life and limb for the satisfaction of having scaled a dangerous peak, South Dakota’s Tom Daschle embarks on a treacherous journey as he assumes the mantle of the nation’s secretary of Health and Human Services.

If he succeeds in his quest to overhaul America’s health care system, Daschle will have achieved far more than personal satisfaction, bragging rights and some keepsake photographs. He will have left a far-reaching, indelible mark on United States public policy. If he fails, he will tarnish his professional legacy — equally indelibly — and, no doubt worse in Daschle’s mind, will have left the nation crippled by an unsustainable health care system.

Given the parallel, have we considered whether the mountain needs to be climbed at all? “Just because it’s there” is usually a poor reason to do some mountain climbing. While the health care system is fraught with difficulties, complete government control will only increase the long-term issues. If people from the UK and Canada are coming to the US today to get health care now which is not being provided to them in their countries, why are we so sure that we can get it right by following the same path?

Tom Daschle already tarnished his “professional legacy” when he told South Dakota that he really didn’t care what we thought. His time at HHS may do many things, but that particular damage is not easily, if at all, reversed.