Dr. James Schroeder On FAIR Vs. Single Payer

The August 28, 2007 Grand Junction Daily Sentinel printed the following LTE by Dr. James Schroeder:

Single-payer health plan would be costly and unfair

Imagine every time a shopper goes to the store he encounters an armed bandit. This bandit takes $5 from the shopper and pockets $4. He then gives the remaining dollar to a hungry man nearby. Imagine then that the bandit goes inside the store and forces the grocery store owner to sell a $3 loaf of bread to the hungry man for that $1. The shopper would be outraged. The store would soon go out of business. Understandably, the hungry man would love this arrangement.

Sad to say, this is precisely the Medicaid system that would be expanded under one of the options being considered by the governor’s 208 Commission on health care. If you have not deduced already, the shopper is the taxpayer, the bandit is the government, the hungry man is the Medicaid recipient and the storeowner is the physician. While perhaps admirable to want to feed the hungry man, allowing the government to do it inefficiently and by coercion is economically nonsensical. It also is contrary to notions of individual freedom and responsibility.

I, as a physician, small business owner and taxpayer, feel the brunt of this on multiple levels. I am astounded that while tasked to consider meaningful reform, the commission is considering an expanded version of the current failed system.

The Legislature should debate a variety of reform proposals. One alternative would be the FAIR proposal submitted to the 208 Commission by Brian Schwartz. I urge the taxpayers of Colorado to learn about these issues. Beware the incremental expansion of government-run health care because we as a society will not be able to afford "free" health care.

I am a pediatric cardiologist and have been in private practice in Grand Junction since 2004. I am a former chief of the medical staff of Methodist Children’s Hospital in San Antonio, Texas, and a former army pediatrician. I have experienced many different aspects of health care in America. I am also a native of the Grand Valley.

JAMES K. SCHROEDER

Dr. James Schroeder on 208 Commission

The August 23, 2007 Grand Junction Free Press printed the following LTE by Dr. James Schroeder:

Beware of unintended consequences health care proposals

Allow me to ask you three simple questions: • "Do you want to improve access to health care for children?"

• "Do you want government to have progressively more control over your own health care decisions?"

• "Do you want to pay more taxes than you already do?"

If you answered "yes" to all three questions, then you will probably be in favor of the health care proposals soon to be submitted to the legislature by the governor’s 208 Commission. If, on the other hand, you answered "no" to questions 2 and 3, you might want to educate yourself on the 208 Commission. This group was commissioned to solicit proposals for health care reform and submit a "short list" to the state legislature.

The commission received 31 proposals early this year, narrowed down to 11 semifinalists and then four finalists. Of the four finalists, one calls for universal healthcare, two for massive expansion of Medicaid and at least two entail large tax increases.

Expansion of Medicaid will undoubtedly result in fewer pediatricians accepting Medicaid patients, because Medicaid reimbursement rates to physicians are too low to cover physicians' costs. I would love to hear someone explain how that will improve children's access to quality health care.

I think it is admirable to provide for those who are less fortunate among us. In my practice, I provide a certain percentage of pro bono care for poor families.

Unfortunately, pro bono services cannot be expanded indefinitely. It is just not a model for economic sustainability. Because funding for government charity programs such as Medicaid is finite, expansion of enrollment will lead to limitations on the distribution of services, or rationing.

I urge the public to take the time to learn about this commission. Ask why the only proposal that recommended decreased government intrusion and true free market forces to be introduced into the health care arena was rejected out of hand by the commission. As it stands now, the legislature will not even get a whiff of a free market style proposal. Let your representatives know your wishes in this regard. Do not be drawn in by the heart-rending but fallacious tag line of "helping innocent children."

Beware the unintended consequences of well intended legislation. Otherwise, if you choose to be passive in this matter, accept the end result.

Dr. Schroeder is a pediatric cardiologist, in private practice in Grand Junction since 2004. He is a former chief of the medical staff of Methodist Children's Hospital in San Antonio, Texas, and a former Army pediatrician, and therefore has experienced many different aspects of health care in America. He is also a native of the Grand Valley and a graduate of Palisade High School.

Single Payer Insanity

The August 26, 2007 Colorado Springs Gazette has taken a strong position against "single-payer" health care:

Single-payer insanity
Using chemotherapy to treat the common cold

We'll have time in the months ahead to more carefully dissect the options and recommendations put forward by the Blue Ribbon Commission for Health Care Reform, in response to the fact that many Coloradans lack health care coverage. But our initial response to one of the proposals, with a price tag of $26.6 billion a year, is that somebody hasn't been taking their meds.

Give these people something to clear their heads, stat! Give it to them whether or not they have health insurance!

And get this. Proponents of this single-payer plan, which would be funded with a new payroll tax, along with higher income, alcohol and tobacco taxes, say it will actually "save" us all $4 billion a year, based on the fact that Coloradans now pay an estimated $30 billion a year on medical care.

Sounds like a bargain. Where do we sign up?

That's sarcasm, in case you didn't catch it. The $26.6 billion guesstimate is $8 billion more than the entire state budget, just to put things in context. And like all such guesstimates, it’s likely to be laughably low when all is said and done.

The relevant number isn't the $30 billion Coloradans spend annually on health care. What matters, for the purpose of this debate, is how much is spent on caring for the indigent, and how much more the taxpayers and the insured spend to cover them. But proponents of a government-centered solution seek to fuzz distinctions by using irrelevant comparisons — and by treating the "uninsured" (whose numbers keep growing, every time we read a news story on the subject) in monolithic terms, in order to generate a sense of crisis.

We'll reserve judgements on the other proposals until we've studied them further. But the single-payer solution amounts to using a howitzer to kill a hummingbird, since just 9 percent of Coloradans are chronically or temporarily uninsured. Another 8 percent counted among the uninsured are 1) illegal immigrants (who qualify for Medicaid in emergencies): 2) individuals who could get coverage through their employers, but don't; 3) people who are eligible for Medicaid but aren't enrolled; 4) people who can probably afford insurance but don't have it.

Once we begin to look at the uninsured more closely, not only does the sense of "crisis" evaporate but one can see that a series of narrowly targeted responses is what’s needed, not a massive overhaul of the system.

At least one commission member also is shaking her head at the notion that we can "save" money with a single-payer system. "They just said we could save money if we go to a singlepayer plan that has a bigger plan of benefits than anything that exists?" asks Linda Gorman, the health care policy analyst at the Independence Institute. "Does that make sense to anybody?"

It apparently makes sense to somebody, or it wouldn't have made the list of options. But this proposal won't be acceptable to most Coloradans. We suspect it was placed on the list as a ploy -- in order to make the other options appear reasonable.

Yes, this plan covers "everyone." But not everyone needs coverage. A minority of Coloradans are contributing to the problem; asking the majority to embrace a socialized health care system in response isn't just unreasonable, it's insane.

If you have a common cold, do you treat it with chemotherapy? Of course not. And if a physician ordered such a treatment, you'd walk out of his office and report him to a medical licensing board. Colorado's uninsured situation is more analogous to a case of sniffles than to terminal cancer, so any treatment we apply should be calibrated accordingly. This proposal constitutes a case of overkill, to say the least.

Schwartz on Medicaid

Brian Schwartz's article on Medicaid was recently published in the August 26, 2007 Boulder Daily Camera. (May require a login.)

He has additional commentary on his blog.

Single Payer Plan Would Destroy Colorado's Economy

The August 24, 2007 Colorado Springs Gazette reports:

The proposal that drew the most attention was the costliest — a Canadian-style singlepayer system in which private insurance plans would be replaced by a government-run system. The $26.6 billion cost, which is $8.4 billion more than the entire current state budget, is $4 billion a year less than the combined annual public and private costs of health care in Colorado.

An analysis of the plan states that imposing a 6 percent payroll tax, raising the state income tax from 4.6 percent to 12.7 percent and significantly increasing alcohol and tobacco taxes would raise $15 billion a year. Combined with other savings and revenue sources, the spending would still be less than the combined amount that employers put to insurance, individuals pay for health care and the government subsidies for medical access for elderly and the poor, according to the report from The Lewin Group.

But the increase in income tax would mean families with an average household income of more than $100,000 could pay more each year, and families that make as much as $250,000 could fork over more than $30,000 a year. Meanwhile, small businesses that often don’t offer insurance would pay thousands of dollars a year more through the payroll tax.

One Colorado small business owner notes:

...Think of the magnitude of the impact of the closure of ten thousand small businesses state wide in the five years after single payer goes into effect. It might take five years because businesses that become marginal will stay around until their lease is up. Businesses that were marginal before single payer becomes law will go negative and fold more quickly.

The business described above had three bad years and still survived. If single payer had been around, it wouldn't have survived one bad year. While it is possible to justify keeping a business alive that breaks even and pays the owner no money in the process, a business that requires the owner to pay money out will close.

In this environment, businesses that close won't be replaced. Anyone recall how in the 1990's Colorado swelled with Californians? Those migrants uprooted themselves and their businesses because California became hostile to business. Those people will move again as Colorado becomes more hostile to business, and more will follow them. There will be a Colorado recession complete with thousands of empty storefronts and houses that can't be sold.

When the Democrats realize that they have destroyed the economy with single payer, they won't back off. The monster they will have created still will have to be fed, and the only way to feed it is with ever higher taxes on the businesses that remain.

How scary is this?

At today's 208 Commission, the Lewin Group presented its final economic modeling results of the four selected health care proposals. After changing various assumptions and doing other bits of "tweaking," the results are as follows:

The Better Health for Colorado proposal has no mandate, but will expand Medicaid/SCHIP and provide premium subsidies for lower income families who do not qualify for Medicaid. It would have an Exchange, a quasi-public administrator. This plan would have a core benefit package with an annual maximum of $35,000. Employers would be mandated to cooperate with payroll withholding and work site enrollment, but would not be required to purchase insurance for their employees. This proposal would cost the state approximately $1 billion in new costs and would be funded by additional tobacco taxes with an increase from 84 cents a pack to $2.00 a pack, and an increase in the alcohol tax, from an increase of 10 cents per six-pack on beer, to an increase of 59 cents per liter of wine, to an increase of $5.03 per liter of spirits -- gin, vodka, etc.

Healthy Solutions for Colorado mandates that every Colorado resident of six months or more file proof of health insurance on their state income tax return and at the DMV when they renew their drivers' license or buy tags for their cars. Any person not having proof of health insurance would be denied any vehicle registration and their driver's license plus incur a fine or income tax penalty of $500 per person. There would be subsidies for lower income families. Under the most recent Lewin documents, an individual earning $29,400 would have to pay at least $2,200 per year for the "Core Limited Benefit Plan" or pay a penalty and lose their driver's license. This does not include the copays and the 80% coinsurance payments if they actually use their policy to obtain lab work, x-rays or outpatient surgery. This proposal limits those receiving Core benefits to a maximum of $50,000 per year, and has many other limitations on benefits. This proposal, with a Connector type exchange, "a public/private" administrator, is financed by a nutrition sales tax on all consumable food items with little or no nutritional value (who decides?) including 2 to 5% sales tax on fountain sodas and walk-up coffee locations AND the same increase in alcohol and tobacco taxes as in the Better Health Plan. It would cost the state an additional $1.36 billion dollars.

A Plan for Covering Coloradoans has both individual and employer mandates. Individuals would be required to file proof of health insurance with their income tax return or face an unspecified penalty. Employers would have to offer health insurance to employees or pay an assessment to the state. This expands the Medicaid population to include the elderly and the disable, non-disabled adults and parents of eligible children. All other persons would purchase insurance through a purchasing pool which combines all markets, and all living in the same geographic area would pay the same rate regardless of age. The young and healthy would pay the same as the sick and older. Premium subsidies would be available for families up to 400% of the federal poverty level (about $80,000 for a family of 4). There would be 2 standard plans in the pool, plus two additional plans for those not receiving subsidies. This would be financed by a premium tax on insurers, the employer assessment of $347 per worker, and the alcohol and tobacco taxes identified above. In addition, this plan considers an increase in the income tax and/or property and sales taxes. This plan would cost the state an additional $3 billion dollars.

Colorado Health Services Single Payer Plan -- Eliminates insurance and insurance companies in the state and provides benefits equal to Colorado Medicaid and routine dental visits to all Colorado residents of 3 months or longer. This would cost the state $26.6 billion dollars which does not include another $3 billion of medical services, for example, optician visits, optional eye surgeries (e.g. Lasik), cosmetic treatments and surgeries, and other medical treatments that are not included in Medicaid benefits. The total cost of forcing every one of Colorado's 4.6 million residents into this government health plan would be about $29.6 billion. Lewin's documents say this plan would save the entire population of Colorado $3.5 billion in medical costs, but their documents don't include the $3 billion for medical expenses not paid by insurance, but which was disclosed at today's meeting. To fund this massive program which includes a new medical bureaucracy, Lewin assumed a 6% employer tax on payroll and an increase in the state income tax of 8.1% for a total personal state income tax rate of 12.73% AND an increase in alcohol and tobacco taxes as described in the other plans above.

In addition, the Commission had further discussion on its 5th proposal, which is still in the making. At this point, it will probably have an individual mandate with enforcement provisions, subsidies, and will look very much like one or more of the above four proposals.

There is really nothing new in any of these proposals, just the same tired demands for more government control of medicine and health insurance. There is no reform, just more and more government involvement and control. The scary part is that these commissioners are ignoring the very health care professionals they are counting on to provide these services, viewing the taxpayer-consumer as simply the conduit for more money, and treating the government as if it had rights and the people had none.

Where is the original, fresh, new orientation -- to get people out of and away from government programs that promote dependence and fail to promote accountability? Where is there an attempt to find out why people don't purchase insurance and find ways to encourage its purchase instead of using government force? Where is a plan that treats individuals as owning their bodies and their funds, that treats doctors as owning their practices, and that treats insurance companies as owning their policies? The only plan that provided these and other fresh alternatives, the FAIR plan by Brian Schwartz, which can be found at WhoOwnsYou.org was discarded by the Commission as not easily modeled. Of course not. When the modeling is all about more government, it's difficult to imagine how to model less government intrusion.

Scary, indeed.

Misleading Rankings

Many articles have cited the recent World Health Organization rankings that place the US health care system at 37th, with the implication that American health care system is therefore inferior to other developed countries.

However, John Stossel points out that the criteria used are inappropriate, and hence the final ranking is very misleading:

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.

For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

(Via Ari Armstrong.)

Canada's Backup Health System Is Montana

Blogger Don Surber writes about the recent birth of the Canadian Jepp quadruplets -- in Montana:

...[F]our identical Jepp sisters were born in Great Falls, Mont., instead of Calgary this weekend. The Canadian parents flew 325 miles to get to an American hospital.

Can you imagine being about to go into labor for four births, and then flying 325 miles to get to the hospital in another country? Incredible. Michelle Lang, Calgary Herald, reported:

Their mother, Calgarian Karen Jepp, was transferred to Benefis Hospital in Montana last week when she began showing signs of going into labour, and no Canadian hospital had enough neonatal intensive-care beds for all four babies.

...It's not like Great Falls, Mont., is a teeming metropolis. With 56,215 people, it is slightly larger than Charleston, W.Va. Calgary has more than a million people. This is like being demoted from the Milwaukee Brewers to the Charleston Alley Cats. (OK, they changed the team’s name to West Virginia Power.)

There is a difference between health care and health insurance. In capitalistic America, the concentration is on health. In socialistic Canada, the emphasis is on paying the bills. The story ended with how much the American hospital charged. Looks like a quarter-million bucks for a 5-day stay. Given that it was the quadruple birth of 2-pound babies two months premature, I’d say it was a bargain.

This is not to piss all over Canada. Nice nation. Great people. I’m sure most Canadians like their health system. Just remember, though, that Canada's backup system is in Montana. Americans spend 15% of their income on health care. That's why Great Falls has enough neo-natal units to handle quadruple births -- and a "universal health" nation doesn't.

After all, they didn't fly Mrs. Jepp to Cuba, did they?

(Via Instapundit.)

More Problems With The Massachusetts Plan

MSNBC reports on still more problems with the much-touted Massachusetts "universal health care plan", which seeks to cover everyone using a mixture of mandates:

The state has already backed off of "universal." About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance — but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won't face a penalty for not getting insurance, but the 100,000 others are in a bind.

"What I'm starting to see," [single mother Maureen] Linehan said, "is the people have to pay for their health care, and now they can't afford to pay their rent."

Because the state is attempting to cover all patients with a government-run system divorced from market incentives, it achieves neither universal coverage, nor cost savings. One might as well attempt to eliminate homelessness by passing a law requiring that all people rent a government-owned apartment.

(Via HealthCareBS.)

Where is the Justice in Single-Payer Plans?

I don't understand the appeal of single-payer proposals to so many otherwise reasonable people. Is it the alleged simplicity? But the plans generally add layers of commissions, agencies, boards and other bureaucrats. The certainty of scheduled payments and prices? The apparent control? But most plans -- as in Canada, England, Tennessee, Vermont and Hawaii border on bankrupting the governments. So what is it? I don't know. But, here in Colorado there were six proposals from different parties advocating a single-payer system to the 208 Commission, including one of the four finalists.

For the uninitiated, a single-payer health plan means that the government -- or a quasi-government agency -- purchases or provides all of the health care within an area or for a population. Medicare is one kind of single-payer plan. England and Canada have another. The plans are financed through taxes (sometimes called assessments) from individuals, employers or on goods and services. There are two basic variations -- 1) where the plan proposes to provide almost unlimited health care benefits at a very low cost (based on the rationale that administrative costs and "evil, outrageous profits" are eliminated); or 2) a tiered plan where the government provides basic services of some benefits, and individuals may purchase more extensive coverage from the greedy, profit-driven insurance companies.

In Colorado, four of these plans propose to offer dental, vision, mental health, rehabilitation and alternative treatments, in addition to the usual medical, surgical and hospital care. Of course, while the patients get unlimited care of every kind and dimension, the doctors are treated with less respect than most fast food workers. (I mean no disrespect for fast food workers or their employers, but that industry is well-known as an excellent entry level into the workforce.) In almost any fast food store, workers will get a raise of their hourly wage based on their experience, attitude, aptitude and skills. So, at any one time, two people working together side by side may well be earning different hourly wages. Both are competent, but one may have two years experience, while another has only worked for six months, one is eager to do and learn while the other is content to just do her job, one has an acquired sensitivity for making perfect burgers while the other makes good burgers -- but they're just not quite up to perfect. Under single-payer logic, both would always and forever make exactly the same amount of money for frying the same number of burgers on any particular shift. They both might get more or both might get less, but would make the same as each other.

Under single-payer plans. all doctors performing a particular procedure or treatment will receive the same fee -- regardless of whether one has just gotten his medical license or has been practicing for 20 years, or whether one surgeon is an artist with real aptitude and flair while another is competent but perfunctory or mechanical. It is the service or treatment or procedure that is what determines the pay scale and not the doctor. Of course, this is exactly what happens with Medicare and Medicaid right now -- and is one reason many doctors opt out of those programs.

Of course, under a true single-payer system -- one that encompasses everyone in a geographical area, doctors can't opt out and continue their profession. So, they quit. And why not? How much joy can a doctor receive from learning new techniques, advocating for his patients, making innovations in her practice when other doctors who do less get paid the same? What kind of justice is that? Why should excellent, wonderful doctors want to practice in a state where they receive no acknowledgment or payment for their excellence, and instead are treated no differently than the barely competent doctor who does the same number of examinations, treatments or procedures?

French Health Care?

David Catron makes the following interesting observations:

French Health Care for the US? Merci, non.

The advocates of socialized medicine, their claims for Canadian health care having been repeatedly exposed as wildly inaccurate, are now promoting a new single-payer paradise: France.

He then proceeds to debunk the myths of the supposed paradise of the French system.

Ralph Shnelvar on Government Commissions

The August 14, 2007 Boulder Daily Camera printed an OpEd by Ralph Shnelvar criticizing some biased methodologies of government commissions. It includes the following analysis of the 208 Commission:

...Another strategy is to charter a commission, but to a) formulate the rules so that a certain conclusion must be reached, and b) pack the commission with your cronies. This is the strategy that was used in Colorado to charter the so-called 208 Commission, which is foreordained to recommend vastly expanded government participation in the healthcare sector.

Unlike most other perfunctory commissions, the foregone recommendations that the 208 Commission will present will do severe damage to Colorado. Let me draw an analogy. Imagine that the year is 1900, and the government is interested in flying people between the Americas and Europe. A Regional Transatlantic Development commission is chartered to investigate "Lighter-than-air craft capable of transatlantic crossings."

It is, of course, packed with representatives of balloon manufacturers, the people least qualified to come up with innovative solutions. You immediately see the problem. Airplanes are left out of any possible solution recommended by the RTD. Of course, RTD will recommend further public funding into dirigibles and blimps, and will state that these are the only feasible solutions to getting people to Europe by air. The next step would be to mandate that only lighter-than-air devices are legal, since they are the only ones deemed to be safe.

It has been my experience in politics over the last few years that this technique of blindsiding the voters by eliminating options early on has become far more prevalent. I've now seen this done over and over again, so that the outcome is guaranteed before any real debate is possible.

...At the state level, the constraints placed on the 208 Commission are such that only massive government intervention that will cause health care rationing, and lower quality for everyone is a possible outcome. The free market solution is completely impossible under 208's mandate. It is, of course, only a free market solution that can truly expand health care opportunities for all Coloradans.

Brian Schwartz LTE in Rocky Mountain News

The August 13, 2007 Rocky Mountain News printed the following LTE by Brian Schwartz:

Free markets key to affordable health care

The Blue Ribbon Commission on Health Care Reform has some nerve. Its favorite plans involve funding government programs by taxing you when purchasing snacks, alcohol and cigarettes ("Healthy living may pay off/Sin taxes could fund statewide medical coverage," Aug. 1).

Yet, as shown by FAIR, my proposal at the commission's Web site, such meddling in our private choices has crippled health-care markets.

First, because the tax code deeply discounts employer-paid insurance, you're essentially stuck with your employer's comprehensive plans. These discourage doctors from competing on price and service. As a captive customer, insurers can afford to mistreat you. Changing insurers requires your finding another job or paying taxes on dollars spent on an individual plan.

Second, mandated insurance benefits significantly increase premium costs, hence making it a crime to purchase affordable insurance. Further, ineffective Medicare and Medicaid programs drive up insurance costs.

Instead of further eroding our freedom, the commission should repeal legislation that prevents free markets from delivering affordable, quality health care.

Brian T. Schwartz, Boulder

Lin Zinser Letter in Rocky Mountain News

The August 7, 2007 online edition of the Rocky Mountain News posted the following letter from Lin Zinser:

Bill Scanlon's August 1 article, "Healthy Living May Pay Off," left out important facts about the plans.

Each plan creates new state bureaucracies, anticipates increased federal health care subsidies to Colorado, and call for new and/or increased taxes.

Moreover, these plans assume that government's role is to ensure that each individual has a doctor (a medical home) and that the patient is forced to seek medical care from that doctor as controlled by the plan.

Many today, even with insurance, choose not to go to doctors until they are so ill they end up in hospitals. The answer is force?

These plans assume that people cannot be informed about healthy lifestyles and alternatives. They assume that people must be forced to limit consumption of junk food, coffee, alcohol, or cigarettes -- or pay higher taxes. These taxes are intended to limit a person’s ability to make her own decisions about what is healthy, proper and good for her in the context of her life.

Civilization began when people used reason rather than force in human transactions. The mark of a developed civilization is the extent to which people are free and are not compelled -- by a king, the Gestapo, a Mafioso, a gang, or a nanny-state -- against their own values and choices. These plans assume government force is the only answer, and they are uncivilized and wrong.

Lin Zinser, Arvada

Republicans and Health Care

FIRM is a non-partisan organization, and hence we are not supporters of either political party, nor any particular political candidate. And although Rudolph Guiliani makes some pretty good points in this recent opinion piece in the August 3, 2007 Boston Globe, others have taken issue with his statement that, "Most Republicans believe in expanding individual choice and decision-making."

In particular, the FreeMarketCure.com weblog notes:

Let's see: When the GOP was in charge of the Senate and the Oval Office, it passed COBRA and EMTALA, two major expansions of government regulation into health care. When the GOP controlled both house of Congress, it passed HIPAA, another big expansion of government regulation into health care, plus a new government health insurance program, the State Children's Health Insurance Program (SCHIP). Now, Republicans like Orrin Hatch and Chuck Grassley are leading the charge for a big SCHIP expansion. Finally, Republican Senator Pete Domenici is pushing for a nationwide "mental health parity" benefit mandate, one that President Bush says he will sign if it passes.

"Most" Republicans believe in believe in expanding individual choice? Heck, I'd settle for half.

Although individual Republicans may vary, I don't see any principled opposition to socialized medicine coming from them as a party. For instance, I agree with the ideas expressed by former Colorado State Senator Mark Hillman in this piece. On the other hand, the health care proposals of high-profile Republicans such as Mitt Romney and Arnold Schwarzenegger are as bad as any that have come from Democrats such as Hillary Clinton or Barack Obama.

Mark Hillman OpEd on Health Care

The August 7, 2007 edition of the Denver Post printed the following OpEd by former Colorado State Senator Mark Hillman. Here are some excerpts:

Rights do not burden others
By Mark Hillman

When we consider drastically altering our expectations of government, we risk undermining the principles on which our country was founded and proving Ronald Reagan's maxim: "Freedom is never more than one generation away from extinction."

Every expansion of government entitlements masquerading as rights - like a "right to health care" - is a dangerous step along this path, no matter how well-intentioned.

...Authentic rights can be enjoyed without permission from anyone else. Freedom of speech or religion or the right to keep and bear arms impose no cost on others or government. Only when competing rights collide must one freedom yield. In these circumstances, the Founders concluded that the proper balance ought to be drawn by the people whom government serves.

However, there is no right to be free from annoyance or irritation. That the mere exercise of our rights bothers someone else is an inevitable consequence of freedom.

Freedom also demands that we refrain from interfering in others' enjoyment of their inalienable rights. Freedom encompasses not simply the opportunity to make choices but the responsibility for those choices. Just because one choice seems wiser or safer doesn't justify using the force of government to require everyone to make the same choice. Likewise, government shouldn't protect those who make irresponsible choices from the consequences of their actions or, worse yet, make someone else bear the cost.

Entitlements, on the other hand, always impose a cost and always interfere with someone else's fundamental freedoms....

...[H]istory has but one example of a country founded on individual freedom. Despite its shortcomings and injustices, America remains a beacon to oppressed people around the world.

...Our vision for the future should emulate the Founders of that freedom - not the empty promises and repressive systems that so many around the world are dying to escape.

Mark Hillman (www.markhillman.com) is a wheat farmer and former state senator.

(Note: I am neither a Republican nor a Democrat, but I agree with Hillman's views on rights. In my opinion, the gradual expansion of entitlements by disguising them as "rights" is one of the biggest threats to the American political system.)

Russell Shurts Opinion Piece in Rocky Mountain News

The August 7, 2007 Rocky Mountain News published the following opinion piece from Russell Shurts:

Socialized medicine another gang operation

By Russell W. Shurts

Let's say your friendly neighborhood gang on successive nights threw rocks through your window, and then on the third day sent a rather menacing member of the gang to your door to offer you the opportunity to buy protection from further intrusions. Would you call what was being offered 'protection,' in the proper sense of that word?

Let's say your friendly neighborhood gang on successive nights threw rocks through your window, and then on the third day sent a rather menacing member of the gang to your door to offer you the opportunity to buy protection from further intrusions. Would you call what was being offered 'protection,' in the proper sense of that word?

Well, for nearly half a century the government has been throwing legalized 'rocks' through your health care system, and today after thoroughly wrecking it their unsavory representatives are offering you 'protection.' In 1965 the same type of people advocating further government intervention in medicine now were successful in convincing Americans to give the government control over all health care provided for those who are indigent or over 65. Prior to the introduction of Medicare and Medicaid in that year, health care spending never exceeded 6% of annual gross domestic product. Today it is 16% and rising. It is not difficult to understand when you make a valuable service 'free,' the demand for that service will rise. When the demand for anything valuable increases, its price inevitably increases, or at least it does if there is any kind of a free market available to trade for it in.

And that's where the government 'protection' comes in; the only way the unsavory representatives know how to lower prices is to mandate them by government force, i.e. to do away with the free market. Unfortunately, as we have seen time and time and time again, reality is not to be denied; not by wishing, not by magic wands and most certainly not by government mandate.

Since the introduction of socialist programs over 100 years ago, we have seen the same pattern repeated over and over and over again. Whatever service or good is either made the property of the state or put under the control of the state immediately becomes a scarce service or good. Remember the endless waiting lines in the Soviet Union? Well, they are being played out right now in the doctor's offices and emergency rooms in every country and state that has put the control of medicine under the government thumb.

There is a word that properly describes what is being offered here: extortion. Your government, however, is not as honorable as your friendly neighborhood gang; because if you buy this kind of 'protection' you will not get more and cheaper health care. You will only get far less effective health care, if you get any at all.

Russell W. Shurts, Centennial

Dr. Kevin Pho on Medicare

Dr. Kevin Pho, who runs the outstanding KevinMD.com blog, has written the following OpEd on Medicare cuts and the impact on doctors. Here are some excerpts:

Medical practices today essentially function as small businesses. Physicians are responsible for expenses like rent, payroll, employee health insurance and malpractice insurance. These costs are expected to increase 20 percent in the next nine years. During this same time, physician Medicare payments are faced with cuts of 40 percent. Already, some practices lose money every time a Medicare patient is seen. Some may find the link between medicine and money distasteful, but the hard truth is that it is impossible to practice medicine in a business model that is headed for financial disaster.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients. According to a recent survey by the American Medical Association, 60 percent reported that they would have to limit the number of new Medicare patients they treat due to next year's cut. Half would reduce their staff. Fourteen percent would "completely get out of patient care." Some seniors are already faced with calling 20 to 30 providers in the desperate hope that someone will accept Medicare.

As David Catron points out:

...[F]or Medicare patients, there is already a shortage of primary care physicians. For all of you out there clamoring for "single-payer health care," this shortage is a taste of what you will face under such a system.

Medicare is, for all intents and purposes, "single-payer for seniors." Indeed, "Medicare for all" is the battle cry of many single-payer advocates. Well, the system they want for everyone is already vitiating the care of seniors.

Advocates of government-run health care often admonish us not to conflate "single-payer health care" with socialized medicine. For the patient who cannot find a primary care doctor, this is a distinction without a difference.

Brian Schwartz OpEd in Denver Post

The August 5, 2007 Denver Post printed the following excellent OpEd by Brian Schwartz, PhD:

Don't model state reforms on Medicaid
How should Colorado lawmakers fix a broken system?
By Brian T. Schwartz

Colorado's Blue Ribbon Commission for Healthcare Reform recently selected four proposals for further analysis and eventual legislative review. The so-called 208 Commission's goals include improving access, encouraging personal responsibility, and supporting a "financially viable, sustainable and fair" system. Yet, these proposals preserve or expand Medicaid, which fails to meet these goals.

Colorado's Medicaid spending has almost doubled since 1997, eats up 20 percent of your state taxes, and increases prescription drug prices. The National Association of State Budget Officers reports that "increases in Medicaid costs will far outstrip the growth in state revenues into the future." But why should state-level administrators be frugal? For each dollar state taxes compel you to donate, the feds pitch in another by taxing someone else.

One of the four proposals being considered recommends that Medicaid switch from its current "fee-for-service" model - where taxpayers pay doctors at government-set rates - to HMO-style managed care. However, a National Bureau of Economic Research study concluded that switching from "fee-for-service to managed care was associated with a substantial increase in government spending but no observable improvement in health outcomes."

Medicaid and managed care are not insurance, but prepaid health care. Tiny or non-existent copayments and deductibles discourage prudent spending. Medicaid patients spend someone else's money, so providers need not reduce costs. Because the federal tax exemption for employer-paid premiums has transformed insurance into prepaid health care, the privately insured do the same. This tax policy makes medical costs skyrocket.

Medicaid recipients also have poor access to medical care. Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients, who also have greater access to physicians after ER visits. Increasing reimbursement rates won't induce many doctors to see Medicaid patients; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

Medicaid erodes personal responsibility. Many recipients avoid higher-paying jobs and saving money because such admirable behavior disqualifies them from benefits. Hence, Medicaid keeps those it "aids" helpless, on their backs and dependent on government.

Medicaid is a bully. It unfairly competes with private insurers and private charities, crowds them out of the market, and hence forces some to depend on government for inferior health care. Harvard's George Borjas found that Medicaid cutbacks have significantly increased immigrant enrollment in employer-sponsored insurance. And USA Today reports that "many workers choose Medicaid over insurance offered by their employers."

One state proposal advocates significantly expanding Medicaid eligibility. This would further crowd out insurers and subject yet more Coloradans to Medicaid. The "single-payer" proposal advocates squashing private insurance entirely - forcing us all to depend on government for health care. A scary thought, given Medicaid's track record. If Medicaid is as good as its defenders claim, why not let it compete fairly with insurance companies and voluntary charities for customers and donations?

An alternative to Medicaid is consumer-directed health care, which combines low-premium, high-deductible policies with tax-deductible Health Savings Accounts (HSAs). Patients spend their own HSA funds until reaching their deductible, after which the policy's coverage applies. With savings from lower premiums, employers often contribute to employee HSAs, which employees own even after changing jobs. Further promoting consumer choice and affordable insurance entails eliminating laws mandating minimum benefits; these laws criminalize the sale of economical insurance policies. Empowering consumers provides quality, affordability and portability.

Patients spending their own money on medical care empowers them to consume wisely, take personal responsibility for their health, and gives doctors incentives to satisfy patients instead of bureaucracies. The RAND Health Insurance Experiment found that patients with the equivalent of consumer-directed plans spent 30 percent less than those with prepaid plans - with negligible effect on their health.

Consumer-driven health care is not foreign to Medicaid. Cash & Counseling programs have high participant satisfaction and Colorado's Consumer-Directed Attendant Support operated 21 percent under budget in its first two years.

Medicaid fails to meet the 208 Commission's criteria for cost, quality, access, personal responsibility, and fairness. The Colorado legislature should choose consumer-directed over authority-directed health care. Health care is too important to be left to government.

Brian Schwartz is an optical engineer in Boulder. This article was adapted from his proposal to Colorado's Blue Ribbon Commission on Healthcare Reform, called FAIR: Free-Markets, Affordability, and Individual Rights. The proposal is available at WhoOwnsYou.org.

Walter Williams on Socialized Medicine

Economist Walter Williams explain why he would much rather trust the marketplace rather than the government to deliver good health care. Here are some excerpts:

"Health Care: Government vs. Private"

... Do we want the government employees who run the troubled Walter Reed Army Medical Center to be in charge of our entire health care system? Or, would you like the people who deliver our mail to also deliver health care services? How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health care system? After all, they are not motivated by the quest for profits, and that might mean they're truly wonderful, selfless, caring people.

As for me, I'd choose profit-driven people to provide my health care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services that I use.

... Our health care system is hampered by government intervention, and the solution is not more government intervention but less. The tax treatment of health insurance, where premiums are deducted from employees' pre-tax income, explains why so many of us rely on our employers to select and pay for health insurance. Since there is a third-party payer, we have little incentive to shop around and wisely use health services.

There are "guaranteed issue" laws that require insurance companies to sell health insurance to any person seeking it. So why not wait until you're sick before purchasing insurance? Guaranteed issue laws make about as much sense as if you left your house uninsured until you had a fire, and then purchased insurance to cover the damage. Guaranteed issue laws raise insurance premiums for all. Then there are government price controls, such as the reimbursement schemes for Medicaid. As a result, an increasing number of doctors are unwilling to treat Medicaid patients.

Here's the full article. (Via Health Care BS.)

Hsieh and Hayden LTE's in Denver Post

The July 31, 2007 Denver Post printed the following LTE's by myself and Richard Hayden:

Re: "Uninsured grow as hospital costs soar," July 27 news story.

The real culprit behind rising medical costs is government interference in medicine. In the sectors of medicine where there is the least government regulation, such as cosmetic surgery and LASIK, we see a continual decrease in prices and improvement in quality. This is the normal pattern of a free market, and something we take for granted in the rest of the economy. Just ask anyone who's bought a DVD player recently.

Instead of more government regulation of medicine, we need less. Free-market plans, such as health savings accounts combined with high-deductible catastrophic insurance, preserve the patient's right to spend his money as he sees fit, and have been proven to cut costs while preserving high-quality medical care.

Free-market medicine is the only genuine cure for rising health costs.

Paul Hsieh, M.D., Sedalia


Re: "Child health care funding is vital," July 22 editorial.

Your editorial claims that the State Children's Health Insurance Program (SCHIP) should be expanded. It indicates that President Bush supports renewing SCHIP but not expanding it, and that Sen. Ken Salazar claims that SCHIP is a moral obligation. But SCHIP, like all entitlement programs, forces some to subsidize the expenses of others.

Each parent has the moral responsibility to care for the health of his or her own children, and parents need to evaluate their decision to have kids based on their ability to finance appropriate care. It is morally wrong to force anyone to subsidize the expenses of someone else's children, whether for health care or any other cost.

Anyone who wishes to help those who cannot afford medical care should do so voluntarily through private charity, not by trying to use the force of government to extort money from others. The funding of SCHIP should be neither renewed nor expanded. Instead, this immoral program should be abolished.

Richard Watts, Hayden

Gina Liggett LTE to Colorado Confidential

The July 21, 2007 edition of Colorado Confidential printed the following LTE by Gina Liggett:

Dear Editor,

Many Americans claim we need government intervention to reform the unaffordable and inaccessible health care system because "health care is a right." The system certainly is a mess, but health care is not a "right" -- it is a "need", like food and shelter. A "right" is not simply possessing what we need for survival regardless of who provides it; it means the freedom to obtain what we need without force. For example, I should be free to buy soup from whomever offers the best quality for the price; but it would be a violation of my neighbor's rights to get a law passed making him pay for my soup. In the same way, a person should be free to purchase health care based on his or her health concerns, but it is not that person's right to give the bill to taxpayers.

The 208 Commission on Health Care Reform will present a final plan to the Colorado Legislature later this year. So far, the 4 runner-up proposals recommend greatly increased government control of health care access and funding. This means that Coloradoans may get some kind of health care, they just won't have the right to obtain it as they individually see fit. Only a free market can provide that right. For more information, visit www.westandfirm.org.

Sincerely,

Gina M. Liggett, RN, MPH
Denver, CO