A Short Course in Brain Surgery

Health Reform: More Socialism Than American

By PHYLLIS SCHLAFLY | Posted Tuesday, July 28, 2009 4:20 PM PT

The House Democrats' health care bill is titled America's Affordable Health Choices Act of 2009. No clue is given as to how long we'll have a choice, but it will probably be only until the "public option" chases private insurance out of business.

The bill's subtitle states its purpose as health care for everyone, reducing "the growth in health care spending . . . and for other purposes." Note that the goal is to reduce only the "growth" in spending, and we need to worry about the "other purposes" that will be added by the bureaucrats' rules.

• The bill states health care benefits require "shared responsibility among workers, employers and the government," meaning government will force taxpayers to pay for health care for millions who don't buy insurance because they don't need it or it doesn't cover what they do need (Page 5).

• The bill states that the government will investigate "self-insured employers not being able to pay obligations." Government agents will audit and then harass small-business owners to force them to pay for insurance they cannot afford (Page 22).

• The bill provides for optional "nurse home visitation services" without saying who has power to exercise the option. Purposes include "increasing birth intervals between pregnancies" (a la China's policies to reduce childbirth by married couples), reducing "child abuse, neglect and injury" (giving more authority to the already too powerful Child Protective Services) and promoting school readiness (will home-schooling be scorned?) (Page 768).

• The bill covers family planning — well-known code words for taxpayer-funded contraception and abortion — and will impose mandatory coverage of abortion on demand in all health plans (Page 772).

• The bill provides for "culturally and linguistically appropriate communication and health services" and "shall give priority to applicants that have developed partnerships with community organizations or with agencies with experience in language access." This opens up plenty of funding for health and translation services for illegal aliens (Pages 405 and 407).

• Title II of the bill creates a "Health Insurance Exchange," pretending to be a marketplace for health insurance plans. Of course, so long as the "public option" is subsidized by the taxpayers, it can always undersell private plans (Page 72).

• The government will specify the health benefits that must be included in any plan participating in the Exchange. If all private plans must include all government-specified benefits (Page 84) (which will surely include unwanted benefits that will drive up costs), whatever happened to choice?

• Anyone who does not enroll in an Exchange-participating plan will be "automatically enrolled under Medicaid." The government will thus use force to achieve its goal of universal coverage (Page 102).

• Employers will be subjected to a play-or-pay mandate. Those who do not provide health insurance to their employees must give the government a "contribution" equal to 8% of average wages paid (Page 149).

• Seniors must submit to "advance care planning consultation" (aka end-of-life discussions) every five years, or more often if there is "a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury" (Pages 425 and 429). Will these consultants advise seniors to hurry up and die because they are costing too much money?

• Government bureaucrats will conduct "Comparative Effectiveness Research" to decide the effectiveness of treatments and drugs. That is the exotic label for rationing and, as House Appropriations Chairman David Obey, D-Wis., admitted, drugs and treatments that are "found to be less effective and more expensive will no longer be prescribed" (Pages 502 and 520).

• Government bureaucrats (not the medical profession) shall determine national priorities for research (Page 505).

• Preference in awarding grants or contracts will be given to entities that have trained "the greatest percentage" of public-health workers in the government and that have trained large percentages of "under-represented minority groups" (Pages 909 and 910). Think Acorn!

• The Senate bill's official summary also authorizes "home visits" to "improve immunization coverage." Will Americans tolerate a knock on the door from a government agent demanding that we and our children receive all government-ordered vaccines?

The Democrats' health care bill gives enormous power to bureaucrats to impose uniform, government-defined-benefits insurance, to decide how much we must pay or be hit with fines and penalties, and to determine what treatments are "effective" and will be permitted. This isn't America. This is Marxist socialism.

Copyright 2008 Creators Syndicate, Inc

Study: Tanning Beds as Deadly as Arsenic

Wednesday, July 29, 2009

LONDON — International cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas.

For years, scientists have described tanning beds and ultraviolet radiation as "probable carcinogens."

A new analysis of about 20 studies concludes the risk of skin cancer jumps by 75 percent when people start using tanning beds before age 30. Experts also found that all types of ultraviolet radiation caused worrying mutations in mice, proof the radiation is carcinogenic. Previously, only one type of ultraviolet radiation was thought to be lethal.

The new classification means tanning beds and other sources of ultraviolet radiation are definite causes of cancer, alongside tobacco, the hepatitis B virus and chimney sweeping, among others.

The research was published online in the medical journal Lancet Oncology>>>

Specifics, Please

By INVESTOR'S BUSINESS DAILY | Posted Thursday, July 23, 2009 4:20 PM PT

Health Care: From the president we now know that cops are stupid, doctors are greedy, Republicans don't play nice, people are dying and we're all going broke if we don't embrace socialized medicine in a week or so.

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IBD Exclusive Series: Government-Run Healthcare: A Prescription For Failure

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Everything, in other words, but what Wednesday's press conference was supposed to be about: the health care reforms the president and his party want voted on by the time Congress breaks for another vacation.

Sure, we heard a lot of wonkish rhetoric — this president seems to think all he has to do is talk, and everyone will bend to his will — but there were few specifics.

And a few specifics would be nice before we place our health care system — 17% of the economy — under government control.

We didn't even hear the president explain how he could demand immediate action on bills that he himself hasn't read. (But then, to be fair, the somnambulant journalists in attendance didn't bother to ask.)

This became obvious Monday, when he was asked about a point we brought up in an editorial last week on whether the House bill in effect outlaws new private individual health care insurance the year it becomes law.

"You know," Obama told a group of hand-selected, sympathetic bloggers, "I have to say that I am not familiar with the provision you are talking about."

Obama isn't the only one who isn't familiar with the "reform" he wants so badly. Tens of millions of other Americans are also trying to make heads or tails out of it — because it's something that will affect each and every one of them.

Fortunately, some people are sorting through the particulars. For example, the Lewin Group, a consulting firm respected for its nonpartisan analysis of health care issues, put out another report this week that found, among other things, that:

• More than 88 million Americans could lose>>>

Weight Of Reality Sinks Health Reform

By CHARLES KRAUTHAMMER | Posted Friday, July 24, 2009 4:20 PM PT

What happened to ObamaCare? Rhetoric met reality. As both candidate and president, the master rhetorician could conjure a world in which he bestows upon you health care nirvana: more coverage, less cost.

But you can't fake it in legislation. Once you commit your fantasies to words and numbers, the Congressional Budget Office comes along and declares that the emperor has no clothes.

President Obama premised the need for reform on the claim that medical costs are destroying the economy. True. But now we learn — surprise! — that universal coverage increases costs. The congressional Democrats' health care plans, says the CBO, increase costs in the range of $1 trillion plus.

In response, the president retreated to a demand that any bill he signs be revenue neutral.

But that's classic misdirection: If the fierce urgency of health care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us on precisely the same path to insolvency that Obama himself declares unsustainable.

The Democratic proposals are worse still. Because they do increase costs, revenue neutrality means countervailing tax increases.

It's not just that it is crazily anti-stimulatory to saddle a deeply depressed economy with an income tax surcharge that falls squarely on small business and the investor class.

It's that health care reform ends up diverting for its own purposes a source of revenue that might otherwise be used to close the yawning structural budget deficit that is such a threat to the economy and to the dollar.

These blindingly obvious contradictions are why the Democratic health plans are collapsing under their own weight — at the hands of Democrats.

It's Max Baucus, Democratic chairman of the Senate Finance Committee, who called Obama unhelpful for ruling out taxing employer-provided health insurance as a way to pay for expanded coverage.

It's the Blue Dog Democrats in the House who wince at skyrocketing health-reform costs just weeks after having swallowed hemlock for Obama on a ruinous cap-and-trade carbon tax.

The president is therefore understandably eager to make this a contest between progressive Democrats and reactionary Republicans.

He seized on Republican Sen. Jim De-Mint's comment that stopping Obama on health care would break his presidency to protest, with perfect disingenuousness, that "this isn't about me. This isn't about politics."

It's all about him. Health care is his signature reform. And he knows that if he produces nothing, he forfeits the mystique that both propelled him to the presidency and has sustained him through a difficult first six months.

Which is why Obama's red lines are constantly shifting. Universal coverage? Maybe not.

No middle-class tax hit? Well, perhaps, but only if they don't "primarily" bear the burden. Because it's about him, Obama is quite prepared to sign anything as long as it is titled "health care reform."

This is not about politics?

Then why is it, to take but the most egregious example, that in this grand health care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays?

Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing—and one-third of everything goes to the lawyers — where do you think that money comes from?

The insurance companies, who then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuit.

Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health care news conference.

Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Didn't Obama promise a new politics that puts people over special interests? Sure.

And now he promises expanded, portable, secure, higher-quality medical care — at lower cost! The only thing he hasn't promised is to extirpate evil from the human heart. That legislation will be introduced this week.

Don't Kill Business To Pay For Health Care

By SEN. SAM BROWNBACK | Posted Friday, July 24, 2009 4:20 PM PT

Small businesses have always been the engine of the American economy and the heart of the entrepreneurial dynamism that characterizes our society.

Even today, in our age of globalization and multinational corporations, small businesses make up more than 93% of all business in the U.S., employ more than half of U.S. workers, and are responsible for 63% of all the new jobs created.

In economic downturns, small businesses are even more important; in the current and most recent recessions, small businesses have been responsible for three out of every four new jobs created.

This makes it all the more disturbing that the Democratic health care reform proposal emerging from the House is funded in part by a surtax of up to 5.4% on high earners. A full third of this new tax revenue would come from small businesses.

As the president has repeatedly said, creating jobs right now is our No. 1 priority.

Why in the world, then, would the Democrats suggest paying for health care reform by raising taxes on the majority of small businesses with more than 20 employees?

Higher tax bills for small businesses could force them to lay off employees or reduce the number of new employees they hire. Job-killing tax hikes are not a prescription for economic recovery.

And the small-business surtax is not the only tax increase being proposed at this perilous time for our economy.

In addition to a graduated surtax on the two top brackets, the Democrats' proposal includes raising the upper-income brackets from 33% and 35% to statuary marginal rates of 36% and 39.6%, as well as bringing back the "hidden tax increases" of PEP (the Personal Exemption Phaseout) and Pease (the limitation on itemized deductions), which raise the effective marginal rates in the top two brackets to 41% for a family of four.

Three-fourths of those affected by these rate changes are small-business owners.

All in all, a risky new burden to place on some of the most productive players in our economy at a time when we need their entrepreneurial spirit the most.

All combined, small businesses could be subjected to federal marginal tax rates as high as 49%, and this does not include state and local tax rates.

A Tax Foundation study found that effective marginal tax rates for small businesses would exceed 50% in 39 states under President Obama's proposal.

At a time when creating jobs should be our first priority, it is vital to minimize harm to small businesses.

According to the Small Business Administration, one-third of new employer establishments fail within two years, and a major factor in the viability of any small business is its ability to hire employees.

As businesses pass on the plethora of new taxes proposed by the administration in the form of lower wages to workers and higher costs for consumers, the resulting reduction in demand for products and services will lead to further job losses.

The simple fact is that businesses cannot hire new employees — or keep the ones they have — if Uncle Sam takes away more than half of their profits.

And the multitude of tax increases President Obama has planned will harm the economic environment in which businesses operate and workers seek employment.

We must remember that the proposed new tax increases — on everything from energy to small business — will inevitably be passed on to consumers in the form of higher prices, which could reduce the demand for businesses' products and services and force businesses to further scale back on operations and employment.

The bottom line is that the Democrats' proposed tax increases will make it more costly for small businesses to hire and keep people on the payroll.

Congress and the administration should look at policies that promote job growth.

Sen. Brownback, a Republican, represents the state of Kansas.

Politicians, Heal Thyselves!

By INVESTOR'S BUSINESS DAILY | Posted Friday, July 24, 2009 4:20 PM PT

Health Reform: If Democrats in Washington think their health care reform with a public option is a good thing, why have they exempted themselves from it? Why isn't what's good for their constituents good for them?

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During ABC's June 24 infomercial for government-run health care broadcast from the White House, President Obama was asked if he and his family would abide by the restrictions and limitations that came with his proposed reforms.

In what Ed Morrissey at HotAir.com called "Obama's Michael Dukakis moment," President Obama refused to make such a pledge and confessed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care."

There was no commentary about evil insurance companies making excessive profits or greedy physicians and hospitals doing unnecessary tests and procedures to run up your bill.

There was only a dutiful husband and father wanting the best care for his wife and children, as do we all.

Yet here was the president arguing for>>>

Obamacare

Their Own Medicine

• JULY 18, 2009

In the health debate, liberals sing Hari Krishnas to the "public option" -- a new federal insurance program like Medicare -- but if it's good enough for the middle class, then surely it's good enough for the political class too? As it happens, more than a few Democrats disagree.

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Republican Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. Yet all Democrats -- with the exceptions of acting chairman Chris Dodd, Barbara Mikulski and Ted Kennedy via proxy -- voted nay.

In other words, Sherrod Brown and Sheldon Whitehouse won't themselves join a plan that "will offer benefits that are as good as those available through private insurance plans -- or better," as the Ohio and Rhode Island liberals put it in a recent op-ed. And even a self-described socialist like Vermont's Bernie Sanders, who supports a government-only system, wouldn't sign himself up.

Of course, they also qualify now for generous>>>

New Push in H1N1 Flu Fight Set for Start of School

• JULY 18, 2009

By BETSY MCKAY

U.S. health officials are preparing intensively to combat an anticipated wave of outbreaks of the new H1N1 flu when children return to school and the pace of cases picks up.

Identified by scientists just three months ago, the new swine-flu virus has reached nearly every country, spreading tenaciously with what the World Health Organization this week called "unprecedented speed." Rather than die down in the summer as some experts initially expected, it is continuing to proliferate even in countries like the U.S. and U.K. that are in the full bloom of summer, when the march of influenza normally slows down. It is also spreading rapidly in the Southern Hemisphere.

Anne Schuchat, chief of immunization and respiratory diseases at the U.S. Centers for Disease Control and Prevention, said Friday that the agency expects an increase in cases before the normal start of the flu season in mid-autumn, because children are likely to spread it to one another once they go back to school. Infectious diseases normally spread readily among children, and this virus has hit children and young adults harder than the elderly, who normally suffer the heaviest toll from flu.

"We've seen it in camps and military units," Dr. Schuchat said>>>

Government Health Care

Obama's Tax Flip-Flop On Health Benefits

By MICHAEL D. TANNER | Posted Friday, July 10, 2009 4:20 PM PT

The campaign ad was ominous: "John McCain would make you pay income tax on your health insurance benefits. Taxing health benefits for the first time ever."

So warned candidate Barack Obama less than a year ago. In ads and speeches, Obama went on to predict the horrific fallout of McCain's proposal: financial hardship and millions dumped from employer-provided health plans.

Today, spokesmen for President Obama are saying a tax on employer-provided health benefits wouldn't be such a bad thing after all.

Roughly 163 million Americans receive health insurance through their employer. While actually a form of compensation, the value of the employer's contribution to that insurance is not taxed under the federal income or payroll taxes.

This exclusion is a solidly middle-class tax benefit. More than 70% of middle-income, nonelderly Americans have employer-based health coverage. And about half of people with employer-based coverage have family income of less than $75,000.

Now, in a desperate search for $1 trillion to $2 trillion to pay for Obama's medical insurance reform plan, congressional Democrats are considering proposals to limit or repeal this tax exclusion. And the Obama administration says it may go along.

This reversal is far more than a simple case of hypocrisy or jettisoning a campaign promise once it becomes inconvenient.

The McCain proposal that candidate Obama so viciously attacked was part of a plan to shift the overall system toward market-based individual coverage. While it was true that McCain would have eliminated the exclusion for employer-provided health benefits, letting them be taxed like ordinary income, he would have given workers a tax credit for purchasing health insurance on their own or through an employer.

The result would have been that most workers would pay the same or less in taxes, with health markets more efficient and coverage more portable.

The proposals now discussed are nothing more than a naked grab for more tax money. There would be no offsetting tax credit. Workers would simply pay more taxes — a lot more taxes.

For example, if the income-tax exclusion were repealed, it would impose a $2.3 trillion tax increase over 10 years.

On average, employers pay $8,824 for a worker's insurance. Assuming tax rates of 10% to 38%, that means workers could expect to pay from $882 to $3,353 annually in additional taxes. Those with more expensive health plans, such as unionized auto workers, would face even bigger tax hikes.

Rather than fully repealing the exemption, Congress likely will put a cap on the tax exclusion. It would eliminate the income and payroll tax exclusion only for insurance plans with an above-average value or for workers with incomes above a certain level.

The problem is that, while more politically palatable, such a partial repeal of the exclusion wouldn't raise nearly enough money to pay for medical insurance reform. Eliminating the exclusion only for insurance plans with an above-average value would raise only $165 billion over 10 years.

And all this is only one of the middle-class tax increases Congress is considering to pay the enormous cost of the president's plan. Payroll tax hikes, a value-added tax, income tax surcharges, even taxes on beer and soft drinks are all on the table.

In the words of humorist P.J. O'Rourke: "If you think health care is expensive now — just wait until it's free."

Congress seems determined to pass medical insurance reform no matter what the price. And if the president has to break a few campaign promises and tax the American middle class, the path he is on indicates he is willing to pay up.

Whether middle-class Americans are is a different story.

Tanner is a senior fellow at the Cato Institute and co-author of "Healthy Competition: What's Holding Back Health Care and How to Free It."

Dr. Epstein

Dr. Epstein was a renowned physician who earned his undergraduate, graduate, and medical degrees in his home town and then left for Manhattan, where he quickly rose to the top of his field.
Soon he was invited to deliver a significant paper, at a conference, coincidentally held in his home town. He walked on stage and placed his papers on the lectern, but they slid off onto the floor. As he bent over to retrieve them, at precisely the wrong instant, he inadvertently passed gas.
The microphone amplified his mistake resoundingly through the room and it reverberated down the hall! He was quite embarrassed but somehow regained his composure just enough to deliver his paper. He ignored the resounding applause and raced out the stage door, never to be seen in his home town again.
Decades later, when his elderly mother was ill, he returned to visit her. He reserved a hotel room under the name of Levy and arrived under cover of darkness.
The desk clerk asked him, "Is this your first visit to our city, Mr. Levy?"
Dr. Epstein replied, "Well, young man, no, it isn't. I grew up here and received my education here, but then I moved away."
Why haven't you visited?" asked the desk clerk.
Actually, I did visit once, many years ago, but an embarrassing thing happened and since then I've been too ashamed to return."
The clerk consoled him. "Sir, while I don't have your life experience, one thing I have learned is that often what seems embarrassing to me isn't even remembered by others. I bet that's true of your incident too."
Dr. Epstein replied, "Son, I doubt that's the case with my incident."
"Was it a long time ago?"

"Yes, many years."
The clerk asked, "Was it before or after the Epstein Fart?"

Feeding the Bacteria in Your Gut

• MARCH 31, 2009

By LAURA JOHANNES

We've all heard of healthy bacteria called probiotics, commonly found in yogurts and dietary supplements. A new wave of products now include prebiotics, dietary ingredients intended either to help increase levels of good bacteria naturally found in the body, or to be used in combination with probiotics to improve their efficacy. Scientists say prebiotics do increase levels of good bacteria in the gut, and some research has linked their consumption to health benefits.

Tim Foley

* * *

Think of it as feeding the good bacteria in your body. Food companies are increasingly claiming health benefits for foods containing prebiotics. So far, all the well-established prebiotics are fibers, such as inulin, extracted from chicory roots. They work by providing a food source in the colon that is particularly attractive to healthy bacteria, causing them to grow and squeeze out unhealthy bacteria.

"A prebiotic is to your colon what grass food is to your lawn. It feeds the grass, but not the weeds," says University of Nebraska microbiologist Bob Hutkins.

Prebiotics are being added to beverages, cottage cheese, breakfast cereals, yogurts, kefirs, breads and even chocolate sauce. While more common in Europe, products making prebiotic health claims are beginning to take root in the U.S. General Mills Inc.'s Yoplait Yo-Plus yogurt, introduced in 2007, includes both a probiotic and a prebiotic fiber, which the company says together promote digestive health. Nestle SA last month launched Juicy Juice Immunity, a kid's fruit drink with prebiotic fiber that the company says helps promote good digestion and a healthy immune system. Other health claims being made in the U.S. for prebiotic-containing products include enhanced absorption of calcium and better bone health.

Many scientific studies have shown that prebiotics>>>

Tallying the Cost to Bring Baby Home

• MAY 7, 2009

By ANNA WILDE MATHEWS

Bringing my newborn son home was a joy. Figuring out the hospital bill wasn't.

Cedars-Sinai Medical Center in Los Angeles provided excellent care and thoughtful treatment during my uncomplicated traditional delivery in December. Then the invoices started coming. The hospital sent one for me, and another for my baby. The doctors billed separately. The total charge for three days: $36,625.

People lucky enough to have good health insurance, including me, don't have to come up with such sums. Insurers typically pay a lower, negotiated price for hospital care, and patients pay a portion of that amount. Even people without insurance often get sharp discounts from list prices on their hospital bills.

Still, consumers have a big financial stake in the cost of care. People who get health insurance through their workplaces have been paying higher premiums in recent years, and more people have been enrolling in plans that include very high deductibles. A recent survey by the International Foundation of Employee Benefit Plans found that two-thirds of employers are increasing, or considering an increase in, workers' deductibles, co-insurance and co-payments.

It's important for patients to get good information about what they have to pay and why. That's not easy. Before my son was born, it was difficult to figure out what I was going to owe. And I struggled after the birth to learn whether the amounts I was told to pay were appropriate. I could have done a better job at calculating some of my costs. But often, information wasn't available, or was hard to decipher.

My own health plan is a so-called PPO,>>>

In ObamaCare, Middle Class Gets The Shaft

By JEFFREY H. ANDERSON | Posted Wednesday, July 08, 2009 4:20 PM PT

The Obama administration might like to "spread the wealth around," but its proposed "health care reform" wouldn't spread consumer choice around. Rather, it would constrict consumer choice substantially — except for the very rich.

That's the great irony of President Obama's ambitious health care agenda: His administration, which seems to feel little empathy for the rich, is paving the way to a two-tiered system in which only the very rich would have a choice.

Under ObamaCare, the rich would continue to get the care they want — whether here or abroad — by paying for it out of their own pockets. The rest of us would stand in line and wait for rationed care.

Most Americans want consumer freedom. They want to be able to shop for health care value — for the best care, at the best prices. They'd like to have a lot more freedom to shop for such value than they currently have. That's why Democrats are couching their proposed expansion of government-run health care in the language of competition and choice.

Listen to the president as he pitches the centerpiece of that agenda — a "public option," a form of Medicare for all. He says it's merely a way to give Americans another choice: People can buy private health insurance, just like now, or they can instead choose the government option.

But millions of middle-class Americans who are happy with their employer-provided insurance would soon find the choice isn't theirs to make.

The government would make it cheaper for employers to contribute to the government-run option than to keep providing private insurance.

Millions of employers would do the math and pick the government option. The "public option" would provide a choice — for millions of employers, against the wishes of millions of employees.

The Lewin Group, a prominent consulting firm, estimates that a widespread "public option" with Medicare-like reimbursement rates would result in 118 million Americans losing their private insurance and being forced into government-run care. Meanwhile, private insurance wouldn't be able to compete on the uneven playing field that Congress would establish.

In its competition with FedEx and UPS, the Post Office at least has to provide a service. But the "public option" would merely use government's coercive powers to dictate prices and availability of services provided by others — by doctors, nurses, hospitals, etc. Private insurance can't similarly fix prices and would be run out of business.

Lower reimbursement rates, coupled with a dwindling pool of private insurers to whom to pass on costs, would mean lower incomes for medical professionals. The eventual result would be fewer people entering the medical profession.

A two-tiered system would then emerge: The very rich would take their spots like first-class passengers on the Titanic, paying for fine care and not asking the price. The rest of us would take our spots in steerage class, awaiting the inevitable collision between government-run health care and the iceberg of budgetary disaster.

White House budget director Peter Orszag recently opined that "the deficit impact of every other fiscal policy variable" is "swamped" by the deficit-threat posed by Medicare and Medicaid.

Obama's solution? A massive new Medicare-like program!

Medicare may not pay much to doctors, but taxpayers pay plenty to Medicare. As my recent Pacific Research Institute study shows, since 1970, Medicare's costs have risen 34% more, per patient, than the costs of all health care in America apart from Medicare and Medicaid. Medicare's costs have risen $2,511 more per patient.

Across nearly four decades, government-run health care has been far more expensive than privately run care. It comes down to a simple comparison and an obvious verdict: Privately run care offers choice and is cheaper. Government-run care denies choice and is more expensive.

But the particular losers under Obama-Care would be the middle class. The uninsured poor would largely benefit, although they might benefit even more — while hurting others far less — from fixing the unfairness in the tax code and giving them the health care tax-break that millions of insured Americans already enjoy.

The truly rich would be largely unaffected, as they never really needed private insurance anyway. They would continue to pay for the care they want, because they can.

Middle-class Americans wouldn't enjoy that freedom. They would lose their employer-provided insurance and be left with only the government-run "option." And, under a government monopoly, they would get rationed care. And every April 15, they would get a higher tax bill for their troubles, which just might make them feel sick enough to get back in line.

Anderson is a senior fellow in health care studies at the Pacific Research Institute.

The Undercovered

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 08, 2009 4:20 PM PT

Health Care: Having been on the receiving end of a letter-writing campaign, we are acutely aware that many are concerned about the plight of the uninsured. Too bad they're not similarly aware of the facts.

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"It is no longer acceptable to have over 46 million Americans without health care," says one of the letter writers, touching on the recurring theme that it's somehow immoral to let a part of the population go without medical insurance.

The debate over the uninsured generates a lot of heat. That's why more than 50 letters supporting the White House's public option plan were e-mailed to us over an 18-hour period beginning Tuesday afternoon.

What's missing is some light, which is exactly what economists David and June O'Neill provide in a recent report prepared for the Employment Policies Institute.

The O'Neills classified the uninsured in two categories: the "involuntarily" uninsured, made up of those "likely unable to afford" coverage; and the "voluntarily" uninsured, 18- to 64-year-olds who have incomes at or above 2.5 times the poverty line and "likely have the means to obtain health care coverage."

At least 43% of the 46 million, the O'Neills say, belong to the voluntarily uninsured group.

That leaves 27 million Americans who aren't covered because they ostensibly cannot afford it.

There's much more to the story, though. The O'Neills found that:

• One-third of those who are involuntarily uninsured are high school dropouts; only 7% of the privately insured didn't graduate.

• A "disproportionately large" portion — almost 52% — of the involuntarily uninsured are young, 18 to 34.

• Immigrants make up a third of the involuntarily uninsured.

• Almost half of those the authors placed in the involuntary column are single and childless.

• While the uninsured tend to have higher mortality rates, their coverage status is "not likely to be the major factor" because they "have multiple disadvantages that are associated with poor health," such as "education, socioeconomic status and health-related habits like smoking."

Lost in the debate is the key fact that lacking insurance is not the same as lacking access to care. The uninsured do receive treatment, spending roughly 40% of the amount spent on health care by insured Americans each year.

The uninsured are screened for conditions such as cancer, as well. And the services they get are no worse than what they would get under a socialist system.

"When compared with screening rates for Canadians (who largely receive health care coverage through a nationalized, single-payer system), the uninsured in the United States actually compare favorably," write the O'Neills.

These statistics do not make a compelling case for Washington to seize control of 18% of our nation's economy just to make sure a small part of the population has medical insurance.

Punishing the many who are taking care of themselves to reward a few at an absurdly high cost is an abuse of the trust that the voters have put in their elected officials.

Coming Soon: The Nightmare From Up There

By SALLY C. PIPES | Posted Thursday, July 02, 2009 4:20 PM PT

In his recent speech to the American Medical Association, President Obama counseled Americans to beware "dire warnings about socialized medicine and government takeovers; long lines, and rationed care; decisions made by bureaucrats and not doctors."

Unfortunately for the president, there are a few Cassandras whose warnings are worth heeding. Chief among them are the millions of Canadians who have received substandard care at the hands of a government-run health system.

Before America emulates the Canadian model with a new trillion-plus-dollar health plan, it's worth examining whether government-run systems are all they're cracked up to be. As a Canadian by birth, I can assure you they're not.

A "culture of queuing" dominates my native land. In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment, according to the Vancouver-based Fraser Institute.

That's 86% longer than the wait in 1993, when the Institute first started quantifying the problem. In 2008, more than 750,000 Canadians — 2.8% of the population — were on waiting lists.

My mother's case is instructive. In June 2005, she wasn't feeling well and thought she might have colon cancer. She asked for a colonoscopy but was told by her doctor that it was unnecessary. The doctor ordered an X-ray, which revealed nothing.

By December, she was 30 pounds lighter, bleeding — and finally eligible for care. She spent two days in the emergency room and two days in a transit lounge waiting for a room. A colonoscopy revealed advanced cancer. She died two weeks later.

Stories like this of care delayed — and thus denied — are common.

Sometimes they're comical — like the revelation in 1998 that a major hospital had been renting its MRI machine to veterinarians for use on pets, even as people waited for their turn.

In most cases, though, waiting lists are no laughing matter. Former Canadian Member of Parliament Belinda Stronach steadfastly opposed any privatization of Canadian health care while in office.

Yet in 2007, after being diagnosed with breast cancer, she effectively opted out of her beloved public system in order to have surgery in California. For most Canadians, such medical tourism is not an option.

Both Canada and the United States spend ever-greater amounts on health care, thanks to the increased utilization of technology and continuous medical innovation. But the two nations part ways when managing those expenditures.

In the United States' decentralized system, payers compete to drive the hardest bargains with health care providers. In Canada's system, provincial governments dictate what will be spent using global budgets. There's only so much money per person over the course of a year. Rigid budgets naturally lead to rationing.

Sometimes, rationing is implicit. Take my mother's first pass with her doctor. She didn't appear on a waiting list but was denied a colonoscopy all the same. At that time, there were 2,858 people in British Columbia awaiting a colonoscopy. The average wait was nine weeks — five weeks longer than considered clinically safe.

At other times, rationing is explicit. In 2001, government bureaucrats told the Queensway-Carleton Hospital in Ottawa to ration babies. The facility was on track to deliver 2,700 bundles of joy. But officials sought to reduce that number by 600, figuring it would save $600,000.

"We felt we were being kicked out, penalized for providing service," Dr. Paul Legault told the Globe and Mail. "I trained 12 years in order to do obstetrical care, not sit in my office and refuse patients."

Many U.S. politicians seem blind to the failings of a "government-pays" system. Those who recognize these horrors assure us that things will be different here. Obama has promised Americans that they'll be able to keep their current health plan if they like it. And many lawmakers have pledged to "build" on the existing private system.

But many of these health reformers are also committed to creating a public insurance program to compete with private providers. This new government plan would be able to tap the public purse to keep prices artificially low.

As a result, more and more patients would be shifted onto the lower-priced federal alternative — until it's the only option left. This is why most honest analysts admit that a "public option" paves the way for a single-payer system — Medicare for All.

Our neighbor to the north provides a glaring example of what government health care looks like. Let's hope our leaders take a look before it's too late.

Pipes is president and CEO of the Pacific Research Institute. Her latest book is "The Top Ten Myths of American Health Care: A Citizen's Guide."

Plan To Slash U.S. Health Costs May Be Tough Pill To Swallow

By DAVID HOGBERG
INVESTOR'S BUSINESS DAILY | Posted Thursday, July 02, 2009 4:30 PM PT

When someone takes out a scalpel, it's usually going to hurt — a lot.

Yet Peter Orszag, President Obama's budget director, claims the U.S. could slash $700 billion in annual medical costs without affecting quality.

That would make it much easier to pay for sweeping health care reform, which is struggling on Capitol Hill over cost concerns.

But divining and adopting best practices is trickier than Orszag may realize, some researchers say.

The head of the Office of Management and Budget draws heavily on the Dartmouth Atlas of Health Care. The atlas has found that Medicare spending varies greatly across the U.S., yet higher spending regions have no better and, at times, worse outcomes than regions that spend less. For example, Miami spends 30% more than Minnesota, but patients aren't any healthier.

Less Is More?

Areas with coordinated care and more primary-care physicians tend to use fewer resources than those with more disjointed care and more specialists.

"We would be on a path toward a much more efficient system," Orszag said recently of achieving health care reform. "When you go to see your doctor, that doctor will have much more information about what specifically is likely to work for your diagnosis, and will have better incentive to be providing high-quality care to you rather than just more care."

But knowing the right treatment is often quite difficult.

"The difference is in the utilization of services that are in the 'gray area' of medicine," said Amitabh Chandra, a public policy professor at Harvard who has worked closely with the Dartmouth Atlas. "These are services that don't lend themselves to clinical trials. Reasonable physicians will disagree over what the right rate of treatment is."

Chandra cites CT scans and MRIs. "They are undoubtedly valuable, but there is an unlimited amount of patients you can perform these procedures on."

Greg Scandlen, head of the conservative Consumers for Health Care Choices at the Heartland Institute, said: "It is often impossible to know ahead of time what is going to work and what won't. The notion that a physician should only deliver services that he knows ahead of time will work ignores real-life conditions."

Chandra largely agrees with that but thinks Orszag understands the nuance and difficulty of eliminating medical waste.

Scandlen is less charitable: "It's offensive that a bean counter like Orszag should Monday-morning-quarterback physician decisions."

Dr. Elliot Fisher, principal investigator at the Dartmouth Atlas, has urged the Obama administration to use the buying power of Medicare and Medicaid to inform patients and incentivize providers to adopt the practices of good organized-care centers like the Mayo Clinic.

"If we're thoughtful about creating incentives for organized systems to form . . . we could get the kind of performance that we want," Fisher recently told NPR.

Scandlen responds: "To say we're going to create some kind of management system that will turn everything into the Mayo Clinic is absurd. Bureaucrats miss the human element of all of this stuff. Mediocre people can take any kind of management system and turn it into something not very good."

The Real World

Even assuming that experts can identify best practices, can they impose their will? Doctors, hospitals, drugmakers and patients will all demand that their treatments, their choices, are approved.

It will be hard to resist the media and political pressure when, say, a patient dies because Medicare did not permit a particular drug or test.

Dr. Richard Cooper of the Wharton School says it is unwise to base policy on the Dartmouth Atlas, as Medicare is a poor measure of total health care spending.

"Higher health care spending results in better health outcomes," Cooper said. "Dartmouth is measuring regional variation in sociodemographic characteristics, not health care spending."

He argues that areas with higher Medicare spending tend to be areas that are poorer, have lower total health care outlays and have more medical problems.

Chandra says Cooper's measures aren't reliable and that his own research suggests that areas with higher Medicare spending also have higher total health spending.

Rushing Ahead In Health Care Wonderland

By THOMAS SOWELL | Posted Monday, June 29, 2009 4:20 PM PT

Most political and media discussions of medical care have an air of unreality reminiscent of Alice in Wonderland. There is an abundance of catch-phrases but remarkably few coherent arguments.

Let's start at square one. Why is there alarm about American medical care? The most usual reason given is because its cost is high and rising.

That is certainly true. We were not spending nearly as much on high-tech medical procedures in the past because there were not nearly as many of them. And we weren't spending anything at all on some of the new pharmaceutical drugs because they didn't exist.

This general pattern is not peculiar to medical care. Cars didn't cost nearly as much in the past, when they didn't have air conditioning, power steering and high-tech safety features. Homes were cheaper when they were smaller, had fewer bathrooms and lacked such conveniences as built-in microwave ovens.

Benefit Fairy

We would like to have all these things without the rising costs that come with them. But only with medical care is such wishful thinking taken seriously, with government regarded as a sort of fairy godmother who will give us the benefits without the costs.

A cynic is said to be someone who knows the price of everything and the value of nothing. If so, then it is political cynicism to point to other countries that spend less on medical care, including some countries where there is "universal health care" provided "free" by their governments.

Cheaper For A Reason

Just as medical care, houses and cars were all cheaper when they lacked things that they have today, so medical care in other countries is cheaper when they lack many things that are more readily available in the United States.

There are more than four times as many magnetic resonance imaging units (MRIs) per capita in the United States as in Britain or Canada, where there are government-run medical systems. There are more than twice as many CT scanners per capita in the United States as in Canada and more than four times as many per capita as in Britain.

Is it surprising that such things cost money?

The cost of developing a new pharmaceutical drug is now about a billion dollars. Neither political rhetoric nor government bureaucracies will make those costs go away.

We can, of course, refuse to pay these and other medical costs, just as we can refuse to buy air-conditioned homes with built-in microwave ovens. But that just means we pay attention only to prices and not to the value of what we get for those prices.

We can even refuse to pay for so many doctors. But that just means that we will have to wait longer to see a doctor — as people do in countries with government-run medical systems.

In Canada, 27% of the people who have surgery wait four months or more. In Britain, 38% wait that long. But only 5% of Americans wait that long for surgery.

Surgery may well cost less in countries with government-run medical systems — if you count only the money cost, and not the time the patients have to endure the ailments that require surgery, or the fact that some conditions become worse, or even fatal, while patients wait.

A recent report from the Fraser Institute in Canada shows that patients there wait an average of 10 weeks to get an MRI, just to find out what is wrong with them. A lot of bad things can happen in 10 weeks, ranging from suffering to death.

Stop, Think

Politicians may talk about "bringing down the cost of medical care," but they seldom even attempt to bring down the costs. What they bring down is the price — which is to say, they refuse to pay the costs.

Anybody can refuse to pay any cost. But don't be surprised if you get less when you pay less. None of this is rocket science. But it does require us to stop and think before jumping on a bandwagon.

The great haste with which the latest government expansion into medical care is being rushed through Congress suggests that the politicians don't want us to stop and think. That makes sense, from their point of view, but not from ours.

Copyright 2008 Creators Syndicate, Inc

Even Paid-For Health Care Plan Would Entrench Budget Woes

By JED GRAHAM
INVESTOR'S BUSINESS DAILY | Posted Monday, June 29, 2009

As analysts project $10 trillion in deficits this decade, President Obama's main path to fiscal fitness is to curb federal health care outlays long term.

Obama's public insistence on budget-neutral reform has put Washington's focus on the difficult job of paying for an expansion of health care coverage. Budget watchdog groups generally approve of this pledge to fully pay for a new health care entitlement, though it's not at all clear that Congress will deliver such a plan.

But using health care cost cuts to finance a big spending expansion — rather than reduce the deficit — may entrench near-term budget problems.

In 2019, with Medicare and Medicaid consuming an extra 2.3% of GDP above 2008 levels, the Congressional Budget Office projects a budget deficit of 5.5% of GDP under the White House plan.

Slowing the growth of these health care entitlements could hold down the deficit, but the administration wants to use projected Medicare savings to pay for near-universal health care.

"In light of the unsustainable path of the federal budget under current law, using savings to finance new programs instead of reducing the deficit would necessitate even stronger policy actions in other areas of the budget," CBO director Douglas Elmendorf wrote this month.

CBO's new Long-Term Budget Outlook says that waiting to address the long-term deficit until 2020 could hike the eventual cost by as much as 20%, or 1.6% of GDP.

Donald Marron, who served on President Bush's Council of Economic Advisers and later as acting CBO director, said that policymakers are attempting to pick what amounts to the "low-hanging fruit" of potential budget savings. Using those "to undertake a major new federal spending program makes it that much harder to address the deficit issue."

Obama's Council of Economic Advisers raised hope early this month that slowing health care cost growth — bending the curve — could help near-term deficits.

But the analysis assumed that health care reform would be paid for "by budgetary savings above and beyond the 'curve benders.' "

Ten days later, the White House released cost-saving measures that appear more tied to just bending the curve. Among them were $75 billion in savings from "better prices for Medicare Part D drugs" and $110 billion from reducing Medicare payments to reflect productivity gains.

Thus, health care savings this decade may be limited — even if reform manages to lower costs.

"Adding 50 million people to the insurance rolls is hard enough without reducing the deficit," said Len Nichols, director of health policy at the New America Foundation.

While Nichols believes bending the cost curve will produce real savings, he sees the moral issue too important "to hold health care reform hostage" to deficit reduction.

CBO notes that savings from trimming federal health care spending growth by 1% a year "would roughly match the cost of an expansion of insurance coverage by the end of the decade and would exceed that cost in the next decade."

Still, depending on how health reform is paid for, expanding coverage may eat into budget savings beyond the first decade.

Elmendorf noted that the biggest cost-saver proposed by the White House — reducing payments to private plans under Medicare Advantage — wouldn't keep pace with the growth in health care costs.

While such issues relate to the timing of potential health care savings, new analyses put into perspective the administration's focus on health care reform as the answer to fixing long-term budget woes.

CBO notes that just 32% of the growth in entitlement costs over the next 25 years is directly tied to health care cost growth. Meanwhile, 56% is tied to aging and 11% to the interaction between these two factors.

"Even if the administration's health reforms were successful beyond their already-optimistic aspirations, if they don't confront the true drivers of entitlement costs it's unlikely they'll fix the problem," wrote American Enterprise Institute resident scholar Andrew Biggs at his blog, Notes on Social Security Reform.

Public debt is on a path to surpass its World War II-induced record of 108.6% of GDP by 2025, Brookings Institution economist William Gale and University of California at Berkeley professor Alan Auerbach conclude in a new paper.

"Even if rising health care costs are an important component of the long-term problem, they are not necessarily 'the' cause of the fiscal gap," they wrote.

They note that per capita health care costs, now rising 2.5% a year, would have to fall 0.5% for 75 years to keep debt stable as a share of GDP.

Study: Mississippi Still Fattest State, But Alabama Closing Gap

Wednesday, July 01, 2009

Mississippi's still king of cellulite, but an ominous tide is rolling toward the Medicare doctors in neighboring Alabama: obese baby boomers.

It's time for the nation's annual obesity rankings and, outside of fairly lean Colorado, there's little good news. Obesity rates among adults rose in 23 states over the past year and didn't decline anywhere, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

And while the nation has long been bracing for a surge in Medicare as the boomers start turning 65, the new report makes clear that fat, not just age, will fuel much of those bills. In every state, the rate of obesity is higher among 55- to 64-year-olds — the oldest boomers — than among today's 65-and-beyond.

Click here to see where your state falls in the obesity rankings.

That translates into a coming jump of obese>>>