What People Outside the Beltway Think

ten of the changes needed to make ObamaCare acceptable.

What’s the purpose of the health summit — bringing the president and Republican and Democratic Congressional leaders together? The Republicans hoped it meant we would start over. Toss out the highly defective legislation that has been working its way through the House and Senate and begin anew with a clean slate.
The White House is rejecting that idea. Apparently, all they want is to ascertain the minimum changes they have to accept in order to get a bill passed.
Okay. Here are ten of the changes needed to make ObamaCare acceptable.

1. Establish Equality Under the Law. That means everyone should be treated equally. Specifically: Treat every Medicare enrollee the same. There should be no special subsidy for Medicare Advantage members in Florida, while millions of seniors are losing their coverage in other states.
   Treat every Medicaid enrollee the same. There should be no federal bailout of Nebraska’s Medicaid expansion, while other states are forced to pay their own way.
   Treat every taxpayer the same. There should be no tax on some workers, while exempting others because they happen to be longshoremen or members of other unions.
   
   
2. Drop Individual and Employer Mandates. Remember Barack Obama’s admonition to Hillary Clinton: We should not require people to buy something they cannot afford and then fine them when they don’t buy it. Further, we should not have one set of rules for carpenters, plumbers and bricklayers, while a more generous set of rules applies to employees of every other small business. Accordingly, we should: Replace the mandates with a fair and efficient system of economic incentives. We should provide generous financial support through the federal tax system to make health insurance affordable for every American.
   Give all insurance the same subsidy — regardless of where it is purchased. We should treat all insurance the same — whether it is provided through an employer, purchased in the marketplace or acquired in a health insurance exchange.
   Give every individual the same subsidy — regardless of how insurance is obtained. We should treat all individuals at the same income level the same — regardless of where they obtain their insurance. (See details in my commentary, “Level the Playing Field for U.S. Health Insurance.”)
   
   
3. Encourage Comprehensive Coverage for Seniors. We should encourage rather than discourage Medicare Advantage plans, which give seniors access to the type of broad comprehensive coverage most nonseniors have. We should encourage, rather than tax, employers’ supplemental Medicare benefits.
4. Allow Health Insurance to be Sold Across State Lines. We should encourage a national market for health insurance, allowing the citizens of each state access to the types of products routinely sold in the other 49 states. (See details in the NCPA Brief Analysis, “How to Create a Competitive Insurance Market.”)
5. Encourage Personal and Portable Insurance. We should end the current practice of barring employers from purchasing the type of insurance employees most want and need: insurance they own and can take with them as they go from job to job and in and out of the labor market. (See details in the NCPA Brief Analysis, “Personal and Portable Health Insurance.”)
6. Allow Private Insurance Alternatives to Medicaid and S-CHIP. Instead of trapping more children and more families in public health plans that all too often ration care by waiting, we should make those dollars available to subsidize private coverage which gives patients access to the full range of medical providers and facilities. (See details in the NCPA Policy Report, “Opportunities for State Medicaid Reform.”)
7. Allow Special Health Savings Accounts for the Chronically Ill. One of the most successful Medicaid pilot programs is Cash and Counseling, under which the homebound and disabled manage their own budget and are free to hire and fire those who provide them with services. We should use this experience as a model to liberate the chronically ill and empower them in a newly-competitive medical marketplace. (See details in a previous Health Alert on chronic illness and Health Savings Accounts.)
8. Allow Health Insurance Plans to Specialize in Solving the Problems of the Chronically Ill. Instead of requiring health plans to treat all enrollees as though they were the same, we should encourage special needs plans that specialize in treating the health problems of the chronically ill. (See details in a previous Health Alert on chronic illness and Health Savings Accounts.)
9. Allow Employers and Their Employees to Prefund Post-Retirement Health Care. Although one-third of baby boomer workers have an employer promise of post-retirement health care, almost none of these promises have been funded. We should allow employers to help their retirees obtain personally-owned, portable insurance for their retirees and to build up funds in order to keep their promises. (See details in a previous Health Alert, “What to Do About Early Retirees.”)
10. Enact Sensible Malpractice Reform. Encourage a health care system in which victims of unexpected adverse events are promptly compensated by episode-specific insurance and in which providers and facilities have economic incentives to reduce medical errors — without the need of lawyers, judges, jurors and courthouses. (See details in the chapter, “Five Steps to Liability by Contract,” from the NCPA’s Handbook on State Health Care Reform.)

EMRs in Denmark

by John Goodman

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctor enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago.

What We Can Learn about Organ Donation

by John Goodman

The Problem: Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one…

Some Solutions: Singapore is preparing to pay donors as much as 50,000 Singapore dollars (almost US$36,000) for their organs. Iran has eliminated waiting lists for kidneys entirely by paying its citizens to donate. Israel is implementing a “no give, no take” system that puts people who opt out of the donor system at the bottom of the transplant waiting list should they ever need an organ…

The Evidence: The Iranian system and the black market demonstrate one important fact: The organ shortage can be solved by paying living donors. The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999…

A U.S. Proposal: Nobel Laureate economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the U.S. Payment could be made by the federal government… Moreover, this proposal would save the government money since even with a significant payment, transplant is cheaper than the dialysis that is now paid for by Medicare’s End Stage Renal Disease program.

Double-Count Medicare Savings

CBO: You Can’t Double-Count Medicare Savings

Dec 29, 2009

by John Goodman

Democrats in Congress are claiming that cuts in Medicare spending will both pay for health reform and add to Medicare’s long-term solvency. But a new CBO report says it’s either/or, but not both. [Of course, this also implies that the Medicare and Social Security trust funds are not holding anything of value — Congress has been double-counting there since the inception of those programs.] 

Five Steps to Rationing Health Care

by John Goodman

This is Scott Gottlieb on the Senate health bill:

Step One	The Centers for Medicare and Medicaid Services…will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced…when a cheaper medical option will suffice for a given problem and, in turn, when Medicare only has to pay for the least costly alternative.
Step Two	The Senate health-care bill also exempts Medicare’s actions from judicial review, taking away the right of patients to sue the government.

Step Three	Primary-care doctors who refer patients to specialists will face financial penalties under the plan. Doctors will see 5% of their Medicare pay cut when their “aggregated” use of resources is “at or above the 90th percentile of national utilization.”
Step Four	[The plan] imposes new costs on doctors who remain solo, mostly by increasing their overhead requirements [and] the plan offers doctors financial carrots if they give up their small practices and consolidate into larger medical groups, or become salaried employees of large institutions such as hospitals or “staff model” medical plans like Kaiser Permanente… The idea here is that Medicare can more easily apply its regulations to institutions that manage large groups of doctors than it can to individual physicians.
Step Five	The impact of these provisions won’t be confined to Medicare. Private insurance sold in the federally regulated “exchanges” will take cues from Medicare, since they’re both managed from the same bureaucracy.

Cash for Cloture

Dec 28, 2009

by John Goodman

This is adapted from a Dana Milbank column in The Washington Post:

The Louisiana Purchase: $100 million in extra Medicaid money for the Bayou State, requested by Sen. Mary Landrieu (D-La.).

The Cornhusker Kickback:  $100 million in extra Medicaid money, this time for Sen. Ben Nelson (D-Neb.).

U Con:  $100 million meant for a medical center in Connecticut for Sen. Christopher Dodd (D-Conn.)

Gator Aid: A grandfather clause will allow Floridians to preserve their pricey Medicare Advantage program from cuts imposed in the other states.

Handout Montana: Sen. Max Baucus (D-Mont.) secured Medicare coverage for anybody exposed to asbestos — as long as they worked in a mine in Libby, Mont.

Iowa Pork: Sen. Tom Harkin (D-Iowa) won more Medicare money for low-volume hospitals of the sort commonly found in Iowa.

Omaha Prime Cuts: Nebraska’s Nelson won a “carve out” provision that would reduce fees for Mutual of Omaha and other Nebraska insurers.

Dakota Payoff: Sens. Byron Dorgan and Kent Conrad, both North Dakota Democrats, will enjoy a provision bringing higher Medicare payments to hospitals and doctors in “frontier counties” of states such as — let’s see here — North Dakota!

Hawaii Aloha: Hawaii, with two Democratic senators, will get richer payments to hospitals that treat many uninsured people.

Wolverine Bonanza: Michigan, home of two other Democrats, will earn higher Medicare payments and some reduced fees for Blue Cross/Blue Shield.

What socialism means in Vermont:  Sen. Bernie Sanders (I) is getting larger Medicaid payments for his state (neighboring Massachusetts will get some, too).

Healthcare bill passes

Democrat version of the health bill passed the Senate. Jammed through and crammed through and down our throats. Not a single Republican vote. Paid off and threatened Senators the old fashioned Chicago way of Politics. When the American people find out about the shyster dealings of this bill they'll be so stupid as to try and blame the Republicans.

Ronald Reagan-A time of choosing

Reagan at his finest-27 minutes

Franklin Roosevelt had cancer

Dec 1, 2009

by John Goodman

When Franklin D. Roosevelt ran for his fourth term as president, did he and his doctor conceal the fact that he had elevated blood pressure, congestive heart failure and terminal cancer? It appears so.

the Louisiana Purchase.

Staffers on Capitol Hill were calling it the Louisiana Purchase.
On the eve of Saturday's showdown in the Senate over health-care reform, Democratic leaders still hadn't secured the support of Sen. Mary Landrieu (D-La.), one of the 60 votes needed to keep the legislation alive. The wavering lawmaker was offered a sweetener: at least $100 million in extra federal money for her home state.
And so it came to pass that Landrieu walked onto the Senate floor midafternoon Saturday to announce her aye vote -- and to trumpet the financial "fix" she had arranged for Louisiana. "I am not going to be defensive," she declared. "And it's not a $100 million fix. It's a $300 million fix."

Read the rest of the article here

More on the Health Care bill

FYI | Sen. Coburn Weighs the Reid Bill: It’s 20.8 Pounds

Here are some additional findings by the numbers:
2,074 — pages in the bill
$1.2 billion — cost to taxpayers per page
70 — new government programs authorized by the bill
1,697 — times the Secretary of Health and Human Services is given authority to create, determine, or define things in the bill
24 million — people left without health insurance
$8 billion — taxes levied on uninsured individuals
$25 billion — additional Medicaid mandates placed on states
$28 billion — new taxes on employers not providing government-approved plans
$118 billion — cuts to Medicare Advantage
$465 billion — total cuts to Medicare
$494 billion — revenue from new taxes/fees levied on American families and businesses
$2.5 trillion — cost for the first ten years of full implementation of the legislation

Fat cells into stem cells

After performing a liposuction surgery in August 2008, Michael Longaker left the OR with a quart of fat from a patient. But instead of dumping it in a biohazard bin, the Stanford University surgeon took it to his lab. Several weeks later, he and cardiologist Joseph Wu became the first to turn the castaway fat into stem cells.
   In 2007, an international team of scientists showed that, given the right genetic signals, skin cells could transform into pluripotent stem cells--cells that have the ability to become almost any other type of cell. A year later, Longaker and Wu began considering what other cells could make the same transition.  From start to finish, transforming fat cells took just 20 days, compared with eight weeks for skin cells from a patient, and yielded 20 times as many stem cells.
   Collecting cells directly from the patient, while trimming love handles, would eliminate any chance of immune rejection.
  So who needs the embryonic stem cells???