ObamaCare Sails Into A Hurricane

If you look at the polls today Congress and President Obama are sinking fast but neither side seems to care and the public continues to get angrier. Why is this so?

John Avalon has written probably the most succinct explanation on the status of the health debate I have read in The Coming Liberal Suicide. I do not agree on the co-ops but he got everything else right. Writing about the failure of the leftists in congress to acknowledge a public plan leading to single payer cannot happen in today's budget environment for simple fiscal reasons both CBO and the public have pointed out.

Of the 21 top Democratic House leadership members and chairmen, five come
from districts carried by John McCain, but the average vote in the other 16
districts was 71 percent to 27 percent for Obama. Like Los Angeles’ Maxine
Waters and New York’s Anthony Weiner, they are ideologically and geographically
insulated from the skepticism generating from the great middle of the
country.

It’s a mistake that the architect of Medicaid and Medicare, Lyndon Johnson, never made. A Southern Democrat—sometimes derided by liberals as an “Eisenhower Democrat” when he was Majority Leader of the Senate—understood the need for bipartisan support for any major social reforms: His Medicare bill received the support of 70 House Republicans and 16 Senate Republicans. Even Newt Gingrich got it—his Welfare reforms gained the support of 101 Democrats at the high-water mark of the second Republican Revolution.

Liberals are in deep denial about the source of the president’s falling poll numbers during this summer’s health-care debate. They think the problem—perceptions of arrogant over-reaching liberalism—is the cure. It’s the same self-serving mistake that the extremes always make.

President Obama needs to depolarize the health-care debate. He got off-message because he got off-center. Embracing a bipartisan bill that replaces the public option with a nonprofit co-op will not “muddy” the debate but help clarify it. It will not
be a retreat but a way forward.

Lyndon Johnson once joked that “the difference between liberals and cannibals is that cannibals don’t eat their friends and family members.” In half-century-long history of failed health-care reforms from Harry Truman on down, liberal cannibalism has been as much to blame for defeats as fear-mongering from the far right.

The perfect cannot be the enemy of the good. The goal is to decrease costs and increase coverage. If today’s liberals don’t understand the lesson of their own political history and insist on attacking their president, they will have the failure of
this health-care reform on their hands.

.

5 Factual Errors In Obamacare & One Big Truth

President Obama asked All Americans yesterday to speak with their neighbors about Health Care Reform and to share the facts and since The New York Times cannot be trusted to even discern all the facts fit to print I will share just 5 of my favorite Facts.

• Fact #1 Health Care reform will include coverage for illegal aliens. What Obama is not stating is that he favors immigration reform in 2010 that places illegal immigrants on a glide path to citizenship. In the insurance industry we would call that an error of omission--the failure to mention a material fact.
• Fact#2 Americans already pay taxes to cover the uninsured in Federal Taxes and Local Taxes. Further expanding Medicaid will only add to the unfunded mandates imposed on Americans by Washington as we have all noticed by the emergence of tea parties on the news each evening. To quote the bi-partisan CBO ;

"The tables included in the report summarize our preliminary assessment of the coverage provisions’ budgetary effects and their likely impact on rates and sources of insurance coverage for the nonelderly population. According to that assessment, enacting those provisions by themselves would result in a net increase in federal budget deficits of $1,042 billion over the 2010–2019 period. By 2019, CBO and the JCT staff estimate, the number of nonelderly people who are uninsured would be reduced by about 37 million, leaving about 17 million nonelderly residents uninsured (nearly half of whom would be unauthorized immigrants)."

So lets just say fact #2 is essentially that Americans already know they pay for illegal immigrants today and are mad as hell the supermajority is seeking to increase what they pay by a $trillion while the President and congressional democrats tell us we are uninformed and that any health care reform cannot add to our debt. In America we call that **&%#^%!!! Is it any wonder today's Rassussen Poll shows that 54% of all Americans who fear government will do too much is up ten points from 44% in January... BTW see all my uninsured posts here. Illegal aliens know how to access free health care and thus lack an incentive as well as the income frequently to purchase their own.

• Fact #3 You can keep your coverage and no one will be forced into government run healthcare. Lets once again see what the CBO has to say on this whopper of a lie.

Under the proposal, nearly 90 percent of workers would be employed by firms that
would either have to offer qualified coverage and contribute a significant share
toward the premium or pay a tax equal to 8 percent of their total payroll. That “playor-
pay” penalty would constitute a substantial portion of the average cost of providing
insurance coverage, which has been estimated at about 12 percent of payroll currently
(but which would rise over time). In dollar terms, the penalty would obviously vary
depending on a firm’s payroll; for example, a firm with average wages of $40,000 per
year that did not offer qualified coverage would have to pay a penalty of $3,200 per
worker. Moreover, that penalty would make no direct contribution to those workers’
insurance costs; they would then need to obtain coverage from another source in
order to fulfill the individual mandate.

Its pretty clear to me and to most American's that in today's economic environment many businesses faced with a choice between an 8% payroll tax and a 12% cost for health insurance that would rise by 8% annually would drop health insurance in a heartbeat because as a nation we are simply not that bad at simple math. But it gets worse. recall that promise not to raise taxes except on the rich? lets again look at what CBO has to say on the matter of the tax impact of proposed health reform for the average worker.


Workers who get insurance through their employer receive a significant subsidy
because the cost of that insurance is not treated as taxable earnings for the worker and
thus avoids both income and payroll taxes. In most cases, that exclusion applies to the
portion of the premium that workers pay as well as the amount the employer
contributes. On average, that tax exclusion gives workers a subsidy of roughly
30 percent for purchasing insurance through their employer—a subsidy that would be forgone if the employer chose not to offer coverage and the workers instead obtained coverage in the new insurance exchanges.

Bottom line is that the lie that you can keep your present coverage is patently false on multiple levels.

1. It does not account for the behavior rational employers will display faced with a tax or mandate to offer health coverage. Unintended consequences abound in politics.
2. It does not account for the tax impact on workers who not only get to purchase their own heath care when their employer drops coverage but also lose the tax advantage CBO cites at 30% of the value of employer provided health care. I thought it was John McCain who wanted to tax American's on the value of their health care?
3. Access to private insurers for individuals whose employers drop group coverage will be through an exchange created by the federal government which will be up running and ready to guide you in your coverage selection. Really? Sort of like Medicare.Gov does so well now?
4. Self-funded plans will face mandates to cover items which they do not today and employers who have spent years investing in wellness and behavioral incentives to achieve a competitive advantage in their industry and have actually bent their own health care cost curve down will now face audits by the government who has no experience or expertise in achieving the same.

Fact #4 It is the Democratic Majority not Radical Republicans, Insurance companies, Doctors, pharmaceutical Companies and Fringe Elements Bearing False Witness who are obstructing Passage of Health Reform.

Rather than share my own thoughts on this matter let me quote Camille Paglia writing in Salon who very succinctly captures the state of our nation.

But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises -- or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her smooth aplomb under pressure, has clearly gone off the deep end with her bizarre rants about legitimate town-hall protests by American citizens. She is doing grievous damage to the party and should immediately step down.

There is plenty of blame to go around. Obama's aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land. The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities.

You can keep your doctor; you can keep your insurance, if you're happy with it, Obama keeps assuring us in soothing, lullaby tones. Oh, really? And what if my doctor is not the one appointed by the new government medical boards for ruling on my access to tests and specialists? And what if my insurance company goes belly up because of undercutting by its government-bankrolled competitor? Face it: Virtually all nationalized health systems, neither nourished nor updated by profit-driven private investment, eventually lead to rationing.

I just don't get it. Why the insane rush to pass a bill, any bill, in three weeks? And why such an abject failure by the Obama administration to present the issues to the public in a rational, detailed, informational way? The U.S. is gigantic; many of our states are bigger than whole European nations. The bureaucracy required to institute and manage a nationalized health system here would be Byzantine beyond belief and would vampirically absorb whatever savings Obama thinks could be made. And the transition period would be a nightmare of red tape and mammoth screw-ups, which we can ill afford with a faltering economy.

As with the massive boondoggle of the stimulus package, which Obama foolishly let Congress turn into a pork rut, too much has been attempted all at once; focused, targeted initiatives would, instead, have won wide public support. How is it possible that Democrats, through their own clumsiness and arrogance, have sabotaged healthcare reform yet again? Blaming obstructionist Republicans is nonsensical, because Democrats control the White House and both Houses of Congress. It isn't conservative rumors or lies that are stopping healthcare legislation; it's the justifiable alarm of an electorate that has been cut out of the loop and is watching its representatives construct a tangled labyrinth for others but not for themselves. No, the airheads of Congress will keep their own plush healthcare plan -- it's the rest of us guinea pigs who will be thrown to the wolves.

Fact # 5 Health Reform Will Raise Not Lower The Cost of Health Care For The Average American It Will raise Costs

Under the proposed exchanges being considered the government will mandate all benefits which must be offered by either public or private plans and will audit self funded plans. Larger employers who self fund have frequently achieved lower health care costs than insured plans. Thats what happens when you invest in wellness since as I have posted here about 70% of health care costs are attributable to behaviors that we control namely not exercising, smoking, drinking, not eating correctly and all the other things your Mom warned you about. Where I ask in the health reform proposals are the sections which specify the wellness incentives necessary to change the behaviors which drive 70% of the cost? They do not exist today but wait for the regualtions to show up by bureaucratic edict in 5 years along with the junk food taxes,soda taxes, higher alcohol taxes, couch potato tax and BMI tax.

There is an excellent summary here of why health insurance costs so much.

Recently I was listening to a radio program in which the host explained that in a few states health insurance policies issued by Blue Cross/Blue Shield were available at extremely reasonable prices, about $100 a month. The very first caller into the program demanded to know exactly what the annual deductible was in plans like this. When the host said $3,000 to $5,000 the caller responded, that isn't health insurance but catastrophic insurance. It's too expensive and that's why we need health care reform from Washington, he continued.

And there lies one of the problems with the health insurance reform debate. State government mandates and favorable tax treatment in Washington have so distorted the market for health insurance that a generation of Americans now look on medical coverage as something very different from other kinds of insurance that we buy. While we will pay several hundred bucks out of our own pockets to have a plumber come repair a leaky pipe, we'll balk at deductibles and a $50 co-pay for a doctor's visit. We've been schooled in this attitude by politicians who have mandated that health insurance do things that we'd never expect from other kinds of insurance, and by consumer advocates who will demand our legislators do something about a health insurance company that doesn't cover some optional procedure that has nothing to do with life and death.

What effect do you think imposing congresses vision of an appropriate health benefit package including every special interest mandate imaginable on America's largest self-funded employers would have on America's ability to compete in a global economy?

About 20% of the cost of health care for working Americans can be attributed to Prescription Drugs. While the average American does not go to the doctor or hospital each month they do use their health plan for presciption drugs each month on average. The White house proudly announced they had secured $8B in cost reductions annually from the pharmaceutical industry for the next 10 years. In contrast, Medicare spends $800B annually on prescription drugs but the white house deal leaves intact an agreement with pharmaceutical companies and the PBM's that handle Medicare not to negotiate prescription drug prices. This is madness. This is insane. It is incompetence. And one might reasonably question the ethics and judgement of an administration which cuts a deal on pharmaceuticals with parties that are now funding tv ads in support of health reform through an ad agency formerly owned by a current advisor to the president David Axlerod. But I digress, he point not negotiating over drug prices raises costs for Medicare and Senior citizens and makes American companies less competitive

One Big Truth

So why is health reform so urgent now? It's simply a matter of convenience. There is the fiscal crisis followed by the bailouts and the stimulus that all require new taxation. Obama's agenda is Education, Energy and Health Care. On the health care front reform was supposed to bend the cost of Medicare/Medicaid and reduce the deficit but since he cannot overtly mention his intention to tax the hell out of the middle class along with the rich he is going to do so under the guise of cap and trade and health care reform. You see the way health insurance works is that young healthy people subsidize generally older and sicker people. Medicare has a $38T deficit and Part D is just getting rolling. By requiring all Ameicans to purchase insurance through a government exchange including mandated benefits you do not want or need you eliminate the private insurance markets while simultaneously generating all the excess revenue you need to continue the enormous ponzi scheme we all know Medicare to be at its core. Once the insurer's are gone Uncle Sugar can dictate terms while using exploding costs to achieve the holy grail of single payer when the rationing can begin.Madoff gets prosecuted and Obama gets re-elected and the Democrats get to run in 2010 having delivered health insurance reform. Yet Obama and congressional leaders are discovering American's are on to the scam and we are sick of the lies and fingerpointing.

The Real Astroturf In Health Care Reform

The Hill is reporting on the White Houses deal to fund advertising by special interest in support of health reform.

PhRMA has joined Health Economy Now, a coalition that is spending tens of millions of dollars on an advertising campaign aimed at convincing Americans to support a broad restructuring of the country’s healthcare system. Other members include the AARP, the largest advocacy group for retirees; the Advanced Medical Technology Association; the Business Roundtable; Families USA; the Service Employees International Union; and the American Medical Association.

The healthcare coalition’s advertising campaign is also facing scrutiny for hiring two firms that received $343.3 million to handle advertising for Obama’s White House run last year. AKPD Message and Media was run by David Axeldrod until he left at the end of December to serve as a senior adviser to the president. The other firm is GMMB Campaign Group, whose partner Jim Margolis also served as an Obama strategist. Over the weekend, Bloomberg News reported that AKPD still owes Axelrod $2 million, which it is set to begin paying in installments starting on Dec. 31. Axelrod’s son, Michael, also still works there. Calls to AKPD and Health Economy Now were not immediately returned.

"Some may wonder whether White House senior advisers earning millions of dollars paid for in part by the pharmaceutical industry represents the kind of change Americans can believe in,” House Republican Conference Chairman Mike Pence (Ind.) said in a Tuesday release.

PhRMA’s Johnson said his organization was only one member of the Healthy Economy Now coalition, but noted that no one at the association made the decision to hire AKPD and GMMB. “We trust and respect the decisions made by the campaign,” he said. Johnson also denied reports that the coalition would spend $150 million on the advertising campaign, calling them “speculative.” He would not say, however, how much PhRMA planned to spend or how much it had spent on the campaign so far, saying only that it would make a “substantial investment

Great Take On The Nature of Co-op's

Bob Laszewski provides good insight on just how "innovative" a co-op truly is on examination.

This whole debate gets back to the simple question I have not heard any of
the co-op proponents answer: Just how will a co-op turn out to be any different
than North Dakota Blue Cross with its profit percentage of less than 1% and its
board a cross section of the provider, business, and consumer community?

Protestors;Harry Reid Called You an Evil Monger

Harry Reid, the Senate majority leader, characterized people disrupting town halls as "evil-mongers"

Support for Health Care Reform Falls to New Low

Rasmussen poll shows Americans are not drinking the Kool-Aid on health care/insurance reform.

Public support for the health care reform plan proposed by President Obama and congressional Democrats has fallen to a new low as just 42% of U.S. voters now favor the plan. That’s down five points from two weeks ago and down eight points from six weeks ago.
A new Rasmussen Reports national telephone survey shows that opposition to the plan has increased to 53%, up nine points since late June.

More significantly, 44% of voters strongly oppose the health care reform effort versus 26% who strongly favor it. Intensity has been stronger among opponents of the plan since the debate began.

Sixty-seven percent (67%) of those under 30 favor the plan while 56% of those over 65 are opposed. Among senior citizens, 46% are strongly opposed.

The Left Is Self-Destructing Over Health Care reform

Everyone should read Camille Paglia's post on The Obama Healthcare Horror.

Obama seems to be surrounded by juvenile tinhorns, bumbling mediocrities
and crass bully boys.
Case in point: the administration's grotesque
mishandling of healthcare reform, one of the most vital issues facing the
nation. Ever since Hillary Clinton's megalomaniacal annihilation of our last
best chance at reform in 1993 (all of which was suppressed by the mainstream
media when she was running for president), Democrats have been longing for that
happy day when this issue would once again be front and center.

But who
would have thought that the sober, deliberative Barack Obama would have nothing
to propose but vague and slippery promises -- or that he would so easily cede
the leadership clout of the executive branch to a chaotic, rapacious,
solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her
smooth aplomb under pressure, has clearly gone off the deep end with her bizarre
rants about legitimate town-hall protests by American citizens. She is doing
grievous damage to the party and should immediately step down.

The president is promoting the most colossal, brazen bait-and-switch
operation since the Bush administration snookered the country into invading Iraq
with apocalyptic visions of mushroom clouds over American cities.

You can keep your doctor; you can keep your insurance, if you're happy
with it, Obama keeps assuring us in soothing, lullaby tones. Oh, really? And
what if my doctor is not the one appointed by the new government medical boards
for ruling on my access to tests and specialists? And what if my insurance
company goes belly up because of undercutting by its government-bankrolled
competitor? Face it: Virtually all nationalized health systems, neither
nourished nor updated by profit-driven private investment, eventually lead to
rationing.

I just don't get it. Why the insane rush to pass a bill, any bill, in
three weeks? And why such an abject failure by the Obama administration to
present the issues to the public in a rational, detailed, informational way? The
U.S. is gigantic; many of our states are bigger than whole European nations. The
bureaucracy required to institute and manage a nationalized health system here
would be Byzantine beyond belief and would vampirically absorb whatever savings
Obama thinks could be made. And the transition period would be a nightmare of
red tape and mammoth screw-ups, which we can ill afford with a faltering
economy.

As with the massive boondoggle of the stimulus package, which Obama
foolishly let Congress turn into a pork rut, too much has been attempted all at
once; focused, targeted initiatives would, instead, have won wide public
support. How is it possible that Democrats, through their own clumsiness and
arrogance, have sabotaged healthcare reform yet again? Blaming obstructionist
Republicans is nonsensical because Democrats control all three branches of
government. It isn't conservative rumors or lies that are stopping healthcare
legislation; it's the justifiable alarm of an electorate that has been cut out
of the loop and is watching its representatives construct a tangled labyrinth
for others but not for themselves. No, the airheads of Congress will keep their
own plush healthcare plan -- it's the rest of us guinea pigs who will be thrown
to the wolves.

Whats Good For The Goose...

Sign up here if you believe congress should cover themselves under the same health plans they propose for us http://bit.ly/g1Yxr

The Cold Hard Facts About Pre-Existing Conditions

Imagine yourself shopping for car insurance. Would you allow yourself to enter a risk pool where the other members could forgo premium until they had a severe accident and then secure coverage to retroactively cover the damage while you and others paid your premium continuously? Seems a bit unfair, eh? Not too mention that no one would bother paying premium regularly if that was not necessary to secure coverage. And just think what the premium increases would be like in such a risk pool. Brutal. Now imagine Life insurance which can be purchased for someone after they had died or fire insurance after the house was smoldering in ashes. Think those policies would be cheap? Would responsible individuals who wanted to insure against future loss sign on to be part of this risk pool?


Insurance is designed to protect against an unforeseen future loss. Forcing an insurer to cover a loss which has already taken place is welfare as John Stossell points out in this article. We have a very imperfect health insurance market today. Alas the world is still flawed. In the nirvana that many on the left imagine when everyone is covered by health insurance Pre-existing conditions would all be covered and indeed the insurance industry has agreed with this reform. Theoretically, the problem would be solved. Realistically, costs will increase as the risk pool absorbs individuals with chronic health problems that for many reasons, some within and some out of their control, today lack coverage. Realistically there will be individuals who ignore mandates to buy health coverage as there are today in Massachusetts.

So when insurers are demonized by Nancy Pelosi and other left wing fringe elements just remember no matter how hot the August heat gets no one likes to swim in a pool someones just peed in, or worse.

Follow me on Twitter

The lies are coming so fast and furious I have been posting on Twitter just to keep up with the volume. Follow me at twitter.com/groupguy

The Unintended Consequences of Health Care Reform

Here is an interesting article on the unintended consequences of legislation.

Is it not interesting that in the great social experiment of health care reform happening before our eyes no one seems to be considering in the media how behavior will change with incentives?

For example here is a piece in favor of taxing "cadillac" health plans. Only way that happens is with a union exception given labors ties to the supermajority so don't hold your breath. But if it did the tax revenues would dry up when the deduction did in 90% of the cases.

And whose to say the vast majority of physicians would continue to work with their decisions being questioned by comparative effectiveness data.

Why Do We Need A Federal Insurance Exchange?

A reasonable question to ask is why the country needs a Federal Insurance Exchange as part of Health Care reform? Coupled with a government plan option does anyone seriously suggest there could be a level playing field for private insurers? Would CIGNA and AETNA & Wellpoint agree they would be on a level laying field with United Healthcare when United Health Care ran the Insurance exchange and dictated what benefits were required while monitoring their quality and selecting vendors to assist consumers in navigating their health options? Yeah, that would work.

The simple facts are that the Federal Government has done a very poor job in communicating Medicare & Medicaid benefits and cost options. Anyone else spend hours selecting a Medicare Part D drug plan for themself or a family member by calling Medicare or perusing Medicare.gov? I rest my case.

Kudos to the Heritage foundation for laying out the real rationale for The government Plan in conjunction with the Federal Health Exchange.

California Foreshadows A Questionable & Risky Strategy

According to the WSJ The State of California is doubling the number of uninsured children by booting 915,000 children off Medicaid due to budget shortfalls. Of course, as even the NY TIMES has reported state governors from both parties are universally opposed to additional unfunded mandates for Medicaid as part of Health Care Reform.

Katie Couric interviewed President Obama on 7/21/2009 and lets look at that conversation

Katie Couric: A very big concern for a lot of people is keeping their health care policy in place. But if you create a public insurance plan, what's to keep an employer from telling his or her employees, "You know what? We're not going to provide health insurance. Get the government plan"?

President Obama: Well, first of all, I understand that about 14,000 people every day are losing their health insurance because employers just can't afford it anymore. And they're starting to drop plans. Or they're putting a huge amount of cost onto the employee. And the employee decides I just can't afford this. So that's already happening. And that will continue to accelerate if we do nothing. What we've said is let's set up a public option that people can choose. Although we'll have some rules and regulations around it so that, if you're already getting health insurance from your employer, your employer can't just dump you into the public plan. But ..

Katie Couric: What will happen if, say, my employer tried to do that?

President Obama: Well, essentially, the employer would be informed that certain people would not be eligible for this public option if they've already got health insurance through their employer. Or the employer would have to pay the equivalent of the insurance that he was already providing. So there is going to be mechanisms that prevent people from just dumping folks into the public option. Where the public option becomes important is to make sure that the small business person, who just can't afford health care at all, when they go to what we call an exchange, a marketplace that has private insurers out there, but also a public option, he or she can choose which option works best for them. And, by having that public option, we're putting pressure on the insurance companies to make sure that they are keeping costs as low as possible, and they're giving the highest quality for the best price. What's always interesting to me is folks say that government can't run things. And I actually agree that the private sector does a whole lot of things better than government can. Well, if that's the case, then insurance companies should be able to compete effectively with a public option. As long as it's not being subsidized by the government. And I've already said I wouldn't support a public option if it was simply just a way to have taxpayers subsidize folks heavily.

Katie Couric: Do you favor a government option that would cover abortions?

President Obama: What I think is important, at this stage, is not trying to micromanage what benefits are covered. Because I think we're still trying to get a framework. And my main focus is making sure that people have the options of high quality care at the lowest possible price. As you know, I'm pro choice. But I think we also have a tradition of, in this town, historically, of not financing abortions as part of government funded health care. Rather than wade into that issue at this point, I think that it's appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.

Katie Couric: Do you think any illegal immigrant should be eligible for health care under the new plan?

President Obama: No.

Katie Couric: No. Why not?

President Obama: First of all, I'd like to create a situation where we're dealing with illegal immigration so that we don't have illegal immigrants. And we've got legal residents or citizens who are eligible for the plan. And I want a comprehensive immigration plan that creates a pathway to achieve that. The one exception that I think has to be discussed is how are we treating children? Partly because, if you've got children, who may be here illegally, but are still in playgrounds, and at schools and potentially are passing on illnesses, and communicable diseases, that's not …

Katie Couric: Aren't getting vaccinated.

President Obama: That aren't getting vaccinated. That's, I think, a situation in where you may have to make an exception.

So its OK for Congress to dump an unfunded mandate on the States in the form of an expansion in Medicaid coverage and eligibility but employers are prevented from dumping people into the government plan? Double standard??? Employers that are hurting get to pay for something that many have been forced to drop or pay afine/tax if they do not. All the 20 somethings who voted for change now get mandated to buy health insurance even if they make under $250,000 because Uncle Sam knows whats best for you and truth be told the way health insurance works is that young healthy people subsidize older, sicker , fatter people. You asked for change.

Who exactly is going to subsidize the government plan if not Taxpayers Mr President?

Why did you duck the abortion question Mr President?

You do not favor covering illegal aliens but we may need to make an exception for their children? Will that exception just cover vaccinations or all primary care? That part of your answer was not clear nor was the pathway to achieve legal status for their parents. Please elaborate as it seems like a thinly veiled effort to buy more votes off.

Freespending Congressmen and President Obama need only look at Governor Scwarzeneggar's popularity and California's current budget deficit to get a vision of what their future holds.

We're From The Government and We're Here To Help You

This spring ARRA committed $20B toward electronic medical records. Physician's who implemented EMR's in a meaningful could qualify for reimbursement toward their investment. Problem was and still is the government has yet to define meaningful use. So theoretically while the ARRA $20B was intended to stimulate the economy its effect has been quite the opposite. Spending on EMR's has evaporated as Doctors have waited for meaningful use to be defined before they invested any money. They are still waiting. Many small businesses that have been providing IT support for physicians including speech recognition paired with EMR's to boost practice productivity and profitability have experienced sales just ceasing.

In today's headlines we learn the cash for clunkers program has no money left. We spent $1B, it worked and $1B more has been allocated but who knows how long that will last so its going to be stopped. Moreover know one bothered to work out the details on how the program would be administered. Welcome to the train wreck. We bailout GM and they send $1Billion to Brazil while laying off 10,000 American citizens and this happens while we have a car czar

If the government cannot handle a few $billion for cash for clunkers what makes you think there is any hope for smooth sailing for a $trillion healthcare reform? No complexity there, right?

The history of federal intervention in Health Care whether its Medicare, Medicaid, Medicare Part D shows a pathetic track record at predicting costs which have been underestimated at an appalling rate.

Its time to visit your congress mans town hall and be heard on health care reform.

Tennessee's Public Health Plan Failure

Given the experiment Tennessee attempted in putting forth a public plan for Medicaid in the mid 1990's one would think that Congress might consider learning from history but the only mention in the media I have seen is at CNSNews.com ;

Tennessee’s Troubled ‘Public Option’ – TennCare – Could Foreshadow
Obama’s Health Care Plan

Monday, July 20, 2009 By Fred Lucas, Staff Writer

(CNSNews.com) – A government-run health insurance plan is
enacted on the promise of increasing competition and bringing down costs, but
over the years, as more people leave their private insurance to take the “public
option,” the cost to operate the government plan skyrockets. Various
litigation ensues, preventing the government’s attempt to reform or cut
benefits. Eventually, dramatic cuts become necessary. This is not a
hypothetical scenario sketched by opponents of the health care overhaul plans
working their way through Congress. Rather, it is the case of what happened with
a state plan in Tennessee. Tennessee is in the process of cutting about
150,000 people from the TennCare program after a reevaluation of enrollee
eligibility to participate in the state-run insurance program. TennCare,
the managed care Medicaid program that began in 1994, now serves about 1.2
million people in the state and has a $7 billion budget. That’s after cuts were
made. Rep. Marsha Blackburn (R-Tenn.) was a Tennessee state senator through
much of the TennCare problems and believes it is a forecast of what would happen
under federal health care “public option” plan. While supporters of the
Tennessee program said it would save money, it wound up eating 38 percent of the state’s budget, she said. “As a result of this, insurance rates for those
who have private coverage were going through the roof,” Blackburn told a
gathering at the conservative Heritage Foundation last week.

The full text is here and there is a followup piece today here. My favorite exchange is below;

“I don’t know the degree to which folks here have looked at TennCare or other [state] plans,” Gibbs told CNSNews.com. “I would note that the House bill fully funds additional benefits passed through its legislation on Medicaid. And as you know -- and as others have pointed out during the briefing -- the jurisdiction for that in the Senate is the Finance Committee. They have not yet acted. So I think the fears expressed by the governors, certainly as it relates to the House bill, are unfounded.”Gibbs said it “would be a bit out of my policy depth” to say how similar the public option favored by the president is to TennCare. However, he said that the president has stressed that his plan would be deficit-neutral.

But Rep. Marsha Blackburn (R-Tenn.) was a state legislator through many of TennCare’s problems and said more people should take a closer look at the state’s problems. Blackburn asked Secretary of Health and Human Services Kathleen Sebelius in June to explain what lessons the administration has learned from Tennessee’s experiment with the public option. Sebelius gave a short response last Friday. “We have learned many lessons from the TennCare experience and recognize its goals, but TennCare is not a traditional public option,” Sebelius said.

Blackburn called the statement inadequate. “All the talk has been theoretical – ‘If we do this, it will save money,’” Blackburn told CNSNews.com. “Show me an example where the government delivered care cost less. Every example, the government delivery, it has led to rationing and delays to access. In many cases, health care delayed is health care denied. It is unconscionable not to talk about the lessons learned from the TennCare experience.”

Representative Blackburn is 100% correct. The endgame here is control.

Be Careful What You Wish For

Kaiser Health News has A VERY INTERESTING article about the quite visceral reaction in Massachussetts from average working people who were forced to secure their own health coverage.

A poll by Harvard University and the Blue Cross Blue Shield of
Massachusetts Foundation, published in October 2008, found that 69 percent of
Massachusetts residents approve of the health reform law when it's presented as
"universal coverage" for all state residents. But when the mandate was isolated
on its own merits, only 58 percent approved. That number dropped to 37 percent
among those who were directly affected.

Harvard School of Public Health Professor Robert Blendon, who directed
the poll, cautions policy makers in Washington not to underestimate that
resistance – which, he adds, is likely to be even fiercer in states more
conservative than Massachusetts. "There are parts of this country where there's
sort of the libertarian argument that you just shouldn't make people do things,
period."

From the beginning, Massachusetts lawmakers expected some hostility to
the mandate – and took steps to temper it. One way was to create a
subsidized insurance program called Commonwealth Care for people making up to
three times the poverty level, or $66,000 for a family of four. For those
outside that category, the Connector Authority – an agency in charge of
implementing the reform law – had promised to broker "affordable" private
policies. However, bids from insurers came back much higher than expected; the
average family premium is about $1,000 a month.

Some premiums rose more after the state came up with a list of minimum
benefits every policy had to include, such as prescription coverage. "Here's the
challenge and difficulty at this point," says State Representative John Scibak.
"What the state has determined is affordable, and what the health insurance
providers are offering, don't necessarily
mesh."

Blame Canada

DEATH OF U.S. HEALTHCAREBy DICK MORRISPublished on TheHill.com on May 12, 2009
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When all of America’s top health insurers and providers met at the White House this week and pledged to save $2 trillion over the next decade in health costs, they were pledging to sabotage our medical care. The blunt truth, which everybody agreed to keep quiet, is that the only way to reduce these costs is to ration healthcare, thereby destroying our system.Here’s why:

• Essential to any cost reduction is a cut in doctors’ fees. Congress is trying to cut Medicare fees by 21 percent. But cuts in fees and doctors’ incomes will just discourage people from entering the profession and those already in it from practicing. The limited number of doctors and nurses in the United States is the key constraint on the availability of healthcare. Our national inventory of 800,000 doctors is growing at only about 1 percent a year (18,000 med school graduates annually minus retirements), while the nurse population is stagnant at 1.4 million. To stretch these limited resources so that they can treat 50 million more people is possible only through the most severe kind of rationing.

• As in Canada, the best way to cut medical costs is to refrain from using the best drugs to treat cancer and other illnesses, thereby economizing at the expense of patients’ lives. Forty-four percent of the drugs approved by the Canadian health authorities for use in their country are not allowed by the healthcare system due to their high cost. As a result, death rates from cancer are 16 percent higher in Canada than in the United States. We will pay for the attempt to save $2 trillion with our lives. (And remember, one cannot opt out of the Canadian system and pay for the medications out of pocket.)• The only real way to save money on the scale projected is to ration healthcare services. Optimists say that this can be achieved by increased use of preventive care. But the Canadian experience indicates that when government — or its satellite private insurance providers — ration healthcare, they cut preventive care first. In Canada, colonoscopies are so rationed that the colon cancer rate is 25 percent higher than in the U.S. (even though Canada has a much smaller proportion of poor people, whose frequently bad diets make them more prone to the disease).

The real story on Health Care Reform

Charles Krauthammer has offered tremendous insights into what is really happening with Health Care Reform. Do not miss this column as he is dead on accurate with his assessment.

At the very center of our economic near-depression is a credit bubble, a
housing collapse and a systemic failure of the entire banking system. One can
come up with a host of causes: Fannie Mae and Freddie Mac pushed by Washington (and greed) into improvident loans, corrupted bond-ratings agencies,
insufficient regulation of new and exotic debt instruments, the easy money
policy of Alan Greenspan's Fed, irresponsible bankers pushing (and then
unloading in packaged loan instruments) highly dubious mortgages, greedy
house-flippers, deceitful homebuyers.

The list is long. But the list of causes of the collapse of the
financial system does not include the absence of universal health care, let
alone of computerized medical records. Nor the absence of an industry-killing
cap-and-trade carbon levy. Nor the lack of college graduates. Indeed, one could
perversely make the case that, if anything, the proliferation of overeducated,
Gucci-wearing, smart-ass MBAs inventing ever more sophisticated and opaque
mathematical models and debt instruments helped get us into this credit
catastrophe in the first place.

He is one of the few syndicated columnists worth reading and he too has discovered the mischief in Obama's health care plan and he knows where all this is heading.

I have always enjoyed The Hunt For Red October. Remember the scene where the admiral (played by Fred Thompson) asks Jack Ryan (Alec Baldwin, a choice Tom Clancy undoubtedly had no input on selecting) what the Russian sub commanders plan is? "The average Russian doesn't take a shit without a plan and a senior commander especially does not act rashly." Well neither does OBAMA. He has a plan. It is Tom Daschle's plan as I wrote about previously.

I am incredulous people can actually view yesterday's health care summit as an open forum on reform. Now in coming weeks when people object to the coming proposals they will be vilified as obstructionists, kulaks( you know the American 21st century version that earns more than $250K) or enemies of the revolution out of touch with the common working people. Well down here in Texas we are common people Mr President and we speak plainly without a teleprompter and I say to you now don't piss down my back and tell me its raining.

Just Saying...

Our Congress has begun to set a new direction for the U.S. economy. According to the Wall Street Journal, (Feb. 26, 2009, page A12), to cover all this planned centralization of power into Washington, D.C., would require taxing every “dime” over $75,000 of all 2006 wage earners, using the most recent year that complete data is available. That amount would barely cover the $4 trillion. Do you think the promises are worth the cost?

Health Care Reform and Brand Drug Rebates; Follow The Money

The Washington Post today in an article by Ceci Connolly reports that budget plans to increase the rebate for brand drugs to Medicaid from 15% to 21% would create $19.5B in savings over 10 years. "This move is expected to spark strong opposition from the industry".

A question the public interest requires an answer to is why the PBM's or insurance companies administering Medicaid would get to keep 85% or 79% of the rebates paid on brand drugs?

Another question would be how does the generic utilization rate under Medicaid compares to the VA which has a formulary primarily populated with generics. I mean, if its a good enough drug for our veterans it should be good enough for medicaid recipients, right?

Last year, CMS required pass through of reimbursement levels paid to the pharmacy. I wonder if they are also viewing what the PBM's bill the plan? I suspect they are not and this is a failure most self-respecting benefit manager in the private sector could ill afford. True transparency requires a view both of what the plan paid as well as what the pharmacy was reimbursed along with complete 100% pass through of all rebates from brands. So lets look at what CMS is doing with a hat tip to Mcdermott, Will & Emery;

CMS has revised an earlier proposal to require Plans who contract with
pharmacy benefit managers (PBMs) to report costs on a pass-through basis. The
negotiated price that must be made available to a member (when, the member is in
a coverage gap, for example) must be the price the PBM pays the pharmacy—not the
price the Part D sponsor pays the PBM. Similarly, CMS proposes to require
Plans to report drug costs based on the price paid to the pharmacy or other
dispensing entity, rather than the price the Plans pay to a PBM. CMS has
taken the position that any net profit to the PBM as a result of a difference between the amount the PBM pays the pharmacy and the amount it collects from Plans is effectively a risk premium paid to shield the sponsor from price variabilities, and is therefore an administrative expense rather than a drug cost. The amount of drug costs affects reinsurance and risk corridor payments to the Part D sponsor. The proposal would be effective for coverage year 2010.

I wonder how much pharma and the PBM's paid lobbyists for that position?

It is common knowledge to savvy benefit managers the the magnitude of their brand rebate is directly correlated to their success in achieving appropriate levels of generic utilization. The bigger the rebate for brands the bigger the problem and the higher the pharmacy trend. Yes, your administrative costs will increase when you eliminate rebates from your PBM and price spreads from your generics but if you couple those efforts with an emphasis on therapeutic infusion you will reduce your overall claim costs. Its OK to have higher retention levels if the services you pay for reduce your claims costs as any decent group man would tell you. The cost of claims dwarfs the cost for truly transparent PBM administration costs. Psst...Washington Post...follow the money...there is a Pulitzer for the individual who exposes this sordid mess.