Obamacare Waivers

Since its passage 14 months ago, the grand total of year-long Obamacare "waivers" doled out by HHS now stands at 1,372.

Last month, the Obama administration approved 204 new waivers. Of those, nearly 20% (38) are for upscale restaurants, swanky nightclubs and five star hotels in Nancy Pelosi's San Francisco district - the same Nancy Pelosi who, as Speaker, infamously urged the 1000+ pg law's passage because we "need[ed] to find out what's in it."

Aside from the obvious political favoritism going on here, as one lawmaker remarked, "What does it say about the feasibility of the health care law when the administration needs to exempt over 1,000 health plans from its own law?"

Thoughts? Hopefully this will get more reaction than Bin Laden's death did.

Is it me or Obamacare?

There have been a few things happening worth talking about, but no new activity for a while. So here is a question regarding Obamacare: What are the chances that the taxes, etc. that will be collected over the next four years to help pay for Obamacare will be saved up and available to actually help pay for the costs of Obamacare once the four years are up? I believe that whatever gets collected will be spent, and not on Obamacare. Since the Government has no discipline to dedicate and segregate money collected for a specific purpose (see Social Security), we can add those misappropriated dollars (for at least four years) to the cost of the Obamacare bill. What say you?

Health Tort Reform - Conservative?

This is my attempt to catch up to the 29 comments that were on the last post. Rich asked for comments from Devin and me on tort reform. There was some good discussion.

Tort reform is one area where party politics takes, perhaps, a different path than political philosophy.

Republicans like the idea of tort reform. Democrats don't. The plaintiff bar is squarely on the side of Democrats as evidenced by the money they contribute to that party. The defense industry is in the Republican camp. Plaintiff's lawyers and malpractice insurers need each other in order to keep dragging in the huge fees and monster premiums that each side keeps as a reward and shares with the political party that favors them in the never-ending game.

But what about conservatives and liberals? What about libertarianism in the tort-reform debate? For instance, one of the more popular methods of tort reform (and one that has been in place in Utah for several years) is a cap on awards, coupled with a sharing of the spoils with the State. Over a certain level, punitive damages go half to the State, then all to the State after another ceiling is reached. Doesn't sound very conservative to me. Should a doctor be held individually to account, monetarily, for the damage that doctor does to a patient when the standard of care is breached (sounds conservative / libertarian to me), or should a fixed dollar amount be handed out to anyone who can show themselves injured by any healthcare provider in the system?

It is amazing how quickly philosophical consistency is tossed to the side when a short-term opportunity to score points or defend the ball presents itself in the party ballgame. I would be interested to hear how y'all perceive tort reform on a philosophical spectrum, and whether you think philosophical consistency should, in this case, be sacrificed on the altar of political expediency. (Can you tell how I feel by the way I asked the question?)

The Beauties of Health Savings Accounts

In the context of the ongoing debate about how to fix America's health care system, Mitch Daniels, the governor of Indiana, wrote an excellent, timely piece today in the Wall Street Journal that was eye-opening for me. He first highlights the benefits of health savings accounts not with partisan talking points, but with independently cited facts, figures, and good ole' common sense. Here's the link:

http://online.wsj.com/article/SB10001424052748704231304575091600470293066.html?mod=WSJ_Opinion_LEFTTopOpinion

After citing many compelling statistics, he concludes:

"The Indiana experience confirms what common sense already tells us: A system built on "cost-plus" reimbursement (i.e., the more a physician does, the more he or she gets paid) coupled with "free" to the purchaser consumption, is a machine perfectly designed to overconsume and overspend. It will never be controlled by top-down balloon-squeezing by insurance companies or the government. There will be no meaningful cost control until we are all cost controllers in our own right."

For my part, I don't think HSA's are the end-all solution for our broken health care system (tort reform and portability across state lines are necessary as well), but they would certainly go a long way towards controlling and decreasing spiraling costs, as Mitch Daniels has illustrated with Indiana's experience. I recommend that everyone read the article and comment.

When the Shoe is on the other Foot: Reconciliation

There's a lot of talk out there that congressional democrats in the Senate want to use the process known as "reconciliation" to ram the White House's new health care bill through because they lack the 60 votes necessary to end the debate and filibuster. Reconciliation, created in 1974, was originally meant to be a legislative measure aimed at passing proposed presidential budgets through congress without a threat of a filibuster, and it only requires 51 votes instead of 60 to avoid a filibuster and end debate.

Anyway, I came across this video on Breitbart.tv that shows how democratic senators reacted when a republican majority threatened to use reconciliation in 2005, or "the nuclear option," to end a democratic filibuster. It's interesting to see the 180 degree about-face when the shoe is on the democratic foot only 5 years later. I thought Joe Biden's quote from the video was interesting: "I pray God when the democrats take back control we don't make the kind of naked power grab you are doing."



Bottom line: I don't like reconciliation. I don't like it whether it be republicans or democrats who threaten to use it. The filibuster is one of the greatest checks to unbridled tyranny of the majority that this country has, no matter what party controls. What do you guys think?

Another Healthcare Post...more of a dream....

DISCLAIMER: I am speaking of what I think will happen with our healthcare system at the current pace...not necessarily what this bill leads some to believe will happen.

I am working hard to provide for my family by working full time while taking a boat load of classes, volunteering, researching, and studying for the MCAT. All this in the hopes that 8+ years from today I will be able to replace someone's knee, or treat a small child with chemo. I don't care if this current bill does not have a public option; it is the governments foot in the door. The government doesn't make their influence in programs smaller as time passes.

I feel that I do not have a responsibility to help anyone I don't want to help once I am finally Dr. Jones. Equal access to healthcare? Yea right. I am currently unable to have the house that I consider most comfortable. Should that be the responsibility of my neighbor? Absolutely not. Some people may say they are not parallels of each other. Why not? The materials to build a house cost money, and someone needs to pay for the materials. If I am unable to afford them, why should I feel entitled to access them? Healthcare costs money: research, materials, bedding, buildings, education, marketing, and lots lots more. Why should we think that universal access to healthcare is possible, or in any way self sustainable? Why should it be compulsory for me to sew someone up when they come in my office door? If I am able to have access to government programs like housing, healthcare, food, and all living requirements, why would I work for anything? If I make $5,000 more than what a specific program requires, would I be tempted to make $5,000 less next year to ensure eligibility for those programs?

I'm rambling. My point:

When I am Dr. Jones, I will do my best to provide the best healthcare to my patients. I will study new procedures, diseases, and medications. When someone comes in the door, I will be as prepared as I am able. I will do this in the hopes of running a successful business. One that is rewarding to me in every way. I want financial comfort for my family, and it seems AWESOME that I can achieve that by helping dozens of people each and every day. If someone comes to me and says they cannot afford it, I will help them anyways. Not because the government makes me, but because I have put myself in a financial position to make those decisions, and because I would not be able to sleep that night if I sent someone away.

Is it just me, or is this the only way to keep everything we consider American? To continue the advancements in the medical field. Lets say we have 20 million people who TRULY can't afford health insurance. I believe we are a little below a million doctors in the United States. I think my payroll could allow for 30 free patients per year. The amount of unpaid insurance claims will be higher than that.

Is it possible to revert that far back from where we are as a country? This applies to every industry and service, but is not in hopes of encouraging free-riders.

Don't try to make it compulsory, lets just be good people!

Government Health Care and Roe v. Wade Don't Jibe

A necessary result of any of the major health care bills passing will be an unprecedented access to our private medical records on the part of the federal government. Surprisingly, this gross invasion of our privacy has received little press. The Dems are upset that they can't get a public option to stay on the table, and the GOP is upset that they can't get significant tort reform provisions in the bills.

But the privacy issue will become significant the moment the legislation passes because its Constitutionality will be challenged. Queen Pelosi condescendingly disregarded a challenge to the legality of the insurance mandate by predictably citing the federal government's responsibility to regulate interstate commerce. This tired argument has been used successfully to justify pretty much anything the feds fancy. A challenge to this will barely be considered before it is laughingly tossed aside by the Supreme Court.

No no. This challenge will come in a different form.

Rewind 36 years. The U. S. Supreme Court made what can arguably called the most controversial judgment in the history of our nation in Roe v. Wade. The decision struck down a Texas abortion law as unconstitutional. It did so on the grounds of the implied "right to privacy" the mother has, derived specifically from the due process clause of the Fourteenth Amendment. In other words, the federal government decided that what a person does with her body, and her medical decisions, are between her and her doctor, and the government has no right to meddle in these affairs.

Uh oh.

So, the legislation will be challenged. Either the court will be forced to stand by Roe v. Wade and declare the health care bill unconstitutional, or it will uphold the bill and overturn Roe v. Wade. Is there any other option?

I've got one! This is going to sound a little crazy, but what if we actually function like a republic, and leave these matters to the states? What a novel idea! How constitutionally sound! As the good folks at the Tenth Amendment Center pointed out, "In a truly federal government, Massachusetts could allow same-sex marriages and bar the Ten Commandments from public displays. In a truly federal government, Alabama could display the Ten Commandments in state courtrooms and outlaw same-sex marriages."

Taking issues of this nature from the federal arena and placing them in the hands of the states where they belong is the best way to make the voice of the people heard. Progressives may want to argue that a 7-to-2 court decision made in a stuffy chamber in Washington, D. C. 36 years ago is the proper way to decide what a woman in Utah does with her baby, but I say let the people govern themselves in their own states, and let the federal government do what we told it to do when we created it and ratified our Founding Document.

Fuzzy Med Math?

I just read that the CBO estimated the Sen Finance Committee health reform bill would cost $829 billion (Woo hoo! JUST that much!) over 10 years.
It also will reduce the deficit by $81 billion in 10 years.
I wish our family could celebrate when we spend $8,000 in order to save $800.

How Old are We?

For those who didn't watch last night, Pres. Obama was rudely interrupted during his health care address to Congress. Republican Rep. Joe Wilson shouted "you lie!" when Obama was explaining that illegal immigrants will not be covered under his proposals. I think the childish outburst was totally uncalled for and disrespectful. He rightly issued an apology afterward, saying that he regretted doing that, and that his emotions got the better of him. I also thought that those little papers many Republicans kept waving around were stupid and childish too. It gave me a flashback to my senior year of high school when we played Mountain Crest at their gym in basketball. Their whole student section held up newspapers in front of their faces while we ran onto the court for starting lineups. You'd hope that members of Congress have matured a little since high school.

However, what irritates me is when my liberal classmates and professors pretend that this sort of thing is unprecedented - How dare the minority party disrespect the President like this! My suspicions of a double standard were confirmed today when I saw the Drudge Report. Turns out that Pres. Bush was disrespected, heckled and loudly booed by Dems during his 2005 State of the Union address. So it seems the Dems can't take what they dish out. Does that make it ok for Republicans to retaliate? NO. Wouldn't it be nice if BOTH parties would be mature enough to refrain from disrespecting the President during an address. Or am I asking too much?

The Battle over Health Care Reform

I'll admit that I'm not well-versed on all the issues in this debate, but I know some of you are, so I wanted to get your comments and insights. Here is insight #1 I picked up from a co-worker who is an Iraqi War Vet:

We were discussing the topic of health care over lunch one day. Another co-worker asked him why he hopes Pres. Obama's health care reforms don't pass. He simply replied, "go spend a day at the VA Hospital and I guarantee you wouldn't hope the reforms pass either." He then outlined a long laundry list of the problems he's experienced firsthand that result when the government bureaucracy comes between doctors and their patients. It was a real (scary) eye-opener for me.

Insight #2: On ABC's "Prescription For America" program, completely unbiased as the name indicates, a neurologist really put Obama on the spot. He suggested that elites often propose health care solutions that limit options for the general public while they themselves are secure in the knowledge that if they or their loved ones get sick, they will be able to afford the best care available, even if it's not provided by insurance. The neurologist then asked Obama if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick, noting that various independent studies show that Obama's proposed "public option" would actually limit tests and treatments. Visibly flustered by the question, Obama refused to make the promise and quickly changed the subject. Ouch - I'm sure this didn't help the marketing campaign for Obamacare, especially coming off the heels of Obama's personal physician for 22 years, Dr. David Scheiner, coming out and saying, "I'm not sure he really understands what we face in primary care."

For my part, I'm naturally skeptical of a government takeover of anything (as you'll remember from reading my posts about GM), especially if it comes with a CBO-announced price tag of another 1.6 trillion over the next decade. I'm puzzled why so many believe that more money, higher taxes, and more government involvement in our lives will magically solve all of our problems. Throw more money and more government regulation at the problem, and it will go away. I'm not convinced that this is an effective approach. The patience of the public is growing thin. How many billions/trillions has the government spent trying to turn the economy around? Yet the unemployment rate continues to spike. While I realize there are problems with the health care status quo, things could be much worse . . .

What to do with America's health care system?

Alright Devin, challenge accepted.

Let me make say something first, I believe in capitalism. I think that for the most part, capitalism has led to great advances and truly turned America into what it is today. But there is an area of capitalism that I am frankly absolutely disgusted with. This part is known as health insurance companies. Tell me how this makes sense. Pay enormous health insurance premiums to a company designed to deny you as much health care as possible in order for them to maximize profits. As a future physician and part of the 40 million uninsured Americans, I believe our health care system is tremendously flawed. Talk to any doctor and they will tell you how difficult it is to deal with health insurance companies. Is this patient pre-approved? Does their policy cover the care I need to give them? If they are uninsured, how are they going to pay me? How can I give care to this patient and pay my malpractice insurance premiums? Currently the United States is ranked #1 by the World Health Organization in cost of health care (about $7500 per person per year.) Health care costs represent the largest portion of our GDP (I think around 16%.) But for paying the most for our health care, our system is rated #37 (you may be interested to know that ranking #1 is France, who have a universal health care system and they spend half as much as we do, and are consistently healthier than we are.) According to the Institute of Medicine of the National Academy of Sciences, the United States is the only wealthy, industrialized nation that does not ensure universal coverage. Approximately 18,000 people die each year because they are either uninsured or underinsured (I consider this to be a great irony, since most republicans are the ones adamantly opposed to universal health care while claiming to do anything possible to protect the sanctity of life, until it costs them money.) Stopping the legislation of universal health care are health care lobbyists in Washington, making up 3 times as many members of congress. I believe that a health care system patterned after France's would actually decrease health costs, improve the overall healthiness of all Americans, and improve the quality of life for all of us (for good articles about this from NPR, http://www.npr.org/templates/story/story.php?storyId=92419273 .) I do not think universal health care would mean less quality care. I know some of you have experienced universal health care in other countries (Argentina, England, Canada) and may have had negative experiences which turned you off to the idea. But I think we as Americans can develop a better system that gives high quality health care and targets preventive care to reduce costs that arise from people waiting too long and needing more expensive care. And if universal health care is too socialist for us, what about universal coverage? Mitt Romney was able to do it in Massachusetts, and I think it could work nationwide. I'm interested in everyone's opinions on what can be done to better the U.S. way of giving health care.