Schwartz Criticizes Polis and Government Coercion

The Rocky Mountain News has published Brian Schwartz's Speakout essay on their website on February 26, 2008:

Polis implies he’d represent the worst in us

An ambulance pulls up to a hospital with an uninsured person in need of emergency treatment. Would you donate to a charity that provides medical care in this situation? Would you give because it's right, or because the authorities will punish you if you don't? If you give just to avoid punishment, and live in Colorado's 2nd Congressional District, vote for Jared Polis this November — as he represents you.

Polis pretty much said so himself in a recent Rocky Mountain News Speakout. While arguing for "universal health care," where politicians meddle in choices best left between doctors and patients, Polis writes: "First, let us not delude ourselves into thinking that we have anything close to a 'free market' in health care. A free market would allow the uninsured to die on the hospital doorstep rather than provide them treatment they cannot pay for."

At least Polis recognizes that state and federal laws interfere with a free market. Here he refers to the Emergency Medical Treatment and Active Labor Act ("EMTALA"), which forbids hospital emergency departments from denying care to anyone with an emergency medical condition. Jared Polis thinks that without such a law, such denials would happen routinely, and the uninsured would "die on the hospital doorstep."

According to Polis, a law must compel doctors to treat the uninsured in emergency situations. Is he suggesting that doctors are so heartless and cruel that they would never treat someone for free? Are voters too callous to fund charities committed to funding treatment for the uninsured in emergency situations?

This is unlikely. Consider the Shriners Hospitals for Children. Their 2005 donations exceeded $640 million. Or the Bonfils Blood Center, which has been operating in Colorado since 1943. It reports that "nearly 120,000 blood donors made life-saving donations in 2007." Last year Colorado's "208" Commission on Healthcare reform reported that private philanthropy accounted for almost $200 million in medical care for the uninsured.

Polis writes that we have "made a moral decision not to allow people in our great country to die in this fashion." Not quite. Moral decisions are a matter of choice, not a threat. EMTALA threatens doctors with penalties up to $50,000 for not complying. Hence, EMTALA is effectively a charity funded by the threat of punishment.

So Jared Polis thinks that government must force Colorado citizens and physicians to do the right thing, as we wouldn't do so in a free market. Yet, Jared Polis seeks public office, to represent us, the very people he doesn¢t trust to act morally. If Polis really represents us, then why should we trust him to be ethical? Here lies the fallacy behind the common rationale behind tax-funded charities: "We must use taxes and other penalties to force people to fund these charities because they will not do it on their own." If there aren't enough people who would sufficiently fund the charity by choice, why expect that there would be enough people to elect representatives that would pass laws compelling people to fund that charity?

In any case, government-funded charities are unfair, intolerant, and ineffective.

They are unfair because, just as governments shouldn't subsidize politically-connected businesses, they shouldn’t favor certain non-profits, either.

They show intolerance by forcing all taxpayers to fund someone else's idea of a worthy cause, which leaves them less able to support organizations they themselves judge to be worthwhile.

They are ineffective because, unlike voluntary charities, they are not accountable to their donors, and hence need not demonstrate results to continue receiving money. In fact, the opposite is true. When government charities such as government schools, Medicare, and Medicaid perform poorly, the politically popular solution is to increase their funding, and the opposition is branded as heartless.

Free-market charities are fair, tolerant and effective. Politicians should protect them. But if you prefer politicians who impose their notions of morality on others, vote for Jared Polis.

Brian Schwartz is a resident of Boulder.

Rationing Shell Game in the UK

Because of the rationing inherent in the British socialized medical system, there are long waits for care in their ER's (which they call "A&E" for "Accident & Emergency"). Patients were naturally frustrated and upset, so the government has set a target that A&E departments must treat patients within 4 hours.

Of course, a government decree can't actually conjure up medical care from thin air. Hence, many A&E departments are merely keeping incoming patients in the ambulances for several hours and refusing to let them into the doors of the hospital -- that way they don't count as having "arrived" at the hospital until much later:

Scandal of patients left for hours outside A&E
The Observer, Sunday February 17 2008

Hospitals were last night accused of keeping thousands of seriously ill patients in ambulance 'holding patterns' outside accident and emergency units to meet a government pledge that all patients are treated within four hours of admission.

Those affected by 'patient stacking' include people with broken limbs or those suffering fits or breathing problems. An Observer investigation has also found that some wait for up to five hours in ambulances because A&E units have refused to admit them until they can guarantee to treat them within the time limit. Apart from the danger posed to patients, the detaining of ambulances means vehicles and trained crew are not available to answer new 999 calls because they are being kept on hospital sites.

(Here's a related story.)

Of course, the fundamental problem is the government system of health care, with the inevitable rationing. Once people are deprived of free market medicine, this sort of shell game is all they are left with.

The Business of Health Care

Laura Mazer, a 2nd-year medical student at Emory, has written the following good article on the business of health care, including how bad government policy is destroying the ability of hospitals to provide good service. This essay is the featured article in Winter 2007 issue of the student newspaper The Undercurrent and is reposted here with their permission:

The Business of Healthcare
By Laura Mazer -- Winter 2007

The state of California has lost more than 90 emergency rooms since 1990 -- and with them, the ability to treat hundreds of thousands of patients. In New York City, eight hospitals have shut down since 2003 after facing a financial crisis. And in Atlanta, Grady Memorial Hospital is threatening to join their ranks. Grady is the only level 1 trauma center in the area, and if it closes, it will mean the loss of almost 1,000 beds, nine community health centers, and the training facilities for two medical schools.

The cause of these and other failures throughout the country is obvious. Hospitals are providing care without receiving payment. Like any other business, hospitals have a constant list of bills to pay every month, from diagnostic tests and drugs, to basic supplies and the salaries of sometimes thousands of people. And all too often, they receive no compensation in return.

What drives the nation's hospitals to operate at an obvious deficit, giving away for free a service that is neither cheap nor easy to produce? They do it in part because they are legally required to do so. In 1986, the Emergency Medical Treatment and Active Labor Act made it illegal for a hospital to refuse care in an emergency setting, regardless of ability to pay. The Act essentially transformed emergency rooms into primary care facilities for the uninsured.

In other industries, services provided for free are considered voluntary charity. They are provided only as far as they can be supported by the business's other income, and they are neither legally nor morally required. But in healthcare, any suggestion that a hospital accept only the patients it can afford to treat is greeted with moral outrage.

Hospitals respond to this combination of legal requirements and community expectations by accepting an unsustainable patient mix that inevitably ends in crushing debt. Healthcare has become a multi-billion dollar industry incapable of demonstrating the kind of economic common sense a child with a lemonade stand instinctively displays.

Bankrupt hospitals are serving as eloquent testimony that the basic principles of economics are just as viable for healthcare as for any other industry. So why is it that fiscally responsible hospitals are considered immoral, and prosecuted as illegal? What is it that makes medicine unique?

The answer can be found in the consumer advocacy groups and professional societies that advocate for socialized medicine. In 2001, a task force assembled by the American Academy of Family Physicians proposed a system of 'free' healthcare for all Americans -- to be paid for by Americans, with a payroll tax. They declared, "There are a set of basic services that most people are expected to utilize in their lifetime, and there should be no financial barrier to these."

This is the justification offered by all advocates of socialized medicine, in its various forms. Healthcare is required. It is a basic service. It is necessary for life. How can ability to pay determine access to a requirement for life? In a civilized, industrialized country, the argument goes, it is the government's duty to provide basic necessities to its citizens.

This argument relies on the assumption that healthcare is uniquely important for human survival, that while most industries provide optional goods -- items that improve life, perhaps, but are not required for it -- healthcare is not optional. To live, you must have access to life-saving or life-prolonging therapies.

It is true that healthcare is, in certain circumstances, required for life. A patient in renal failure will die without dialysis every week. A child with a bacterial infection needs antibiotics. But reformers forget that a lack of dialysis is not the only thing that can kill the kidney patient. A lack of food, clean water, shelter, or clothing in the winter will be as deadly to the child as a lack of antibiotics.

Medicine often focuses only on the physical act of living -- breathing in and out, keeping the heart beating. But human life is more than the functioning of the moving parts. Although healthcare may be the only requirement for a brain-dead accident victim on life support, it is not the only requirement for the rest of us. To live, we need food, we need shelter, we need companionship, and work, and hundreds of other material and spiritual requirements. Healthcare is a necessity -- and after a car accident, or during a flu infection, it may be the most important necessity. But it is not the only requirement for life.

When people talk about a 'right' to healthcare, they mean an entitlement to healthcare. They mean that unlike other goods and services that must be earned through individual work or trade, healthcare should be provided for free.

Medicine is not the only industry that fulfills a necessity for life, so what entitles us to the products of this particular industry, and not others? Why not food or clothes? And why not those products that provide a good life -- feather beds or paintings or tickets to the movies? Or are we entitled to those as well?

The issue goes far beyond healthcare. It is a question of what the government's role should be in providing for its citizens. Should the government collect taxes to provide citizens with whatever goods and services they deem 'necessary?' Or is it the responsibility of individual citizens to work for whichever products and services they can independently earn -- with the government existing to secure their freedom to pursue these ends?

In other industries, Americans balk at the idea of the government stepping in to provide values to its citizens. The dangers and inefficiencies of government-run industries are well understood. We would not tolerate, for example, the government nationalizing the supermarkets. If a grocer decides to provide food to the hungry, most Americans understand that he does so voluntarily, and with his own money.

What we must understand now is that there is no reason to treat healthcare any differently.

American healthcare is failing. It's only a matter of time before hospitals around the country can no longer support themselves, and we are forced to change the system. The only solution is a means of exchange that does not rely on sacrificing the rights of some individuals to obtain values for others. The only solution is a free market.

If we want to save American healthcare, we have a moral and practical obligation to seek less government intervention -- not more.

Laura Mazer is a second year medical student at Emory University. She has a BA in biology from the University of Chicago.

Free-Market Health Insurance Is Not the Enemy

Richard Ralston, executive director of Americans for Free Choice in Medicine, has written the following OpEd on free market health insurance:

Free-Market Health Insurance Is Not the Enemy
By Richard E. Ralston
February 4, 2008

Much of the current debate about health care is between those who want the government to wipe all insurance companies out of existence and those who instead want the government to force everyone to buy regulated private insurance. Both sides ignore the fundamental context for any discussion of health care in America: individual rights and personal choice.

Individuals have the right to incorporate and invest in businesses that provide an important service, like health insurance. Individuals and businesses have the right to make provisions for their medical expenses by seeking the insurance firms that best meet their needs—or not. That is the essential point to remember: governments should never be allowed to destroy such rights—as irrelevant details in the face of the application of naked government power.

Insurance companies do not pay all of every claim, but neither does Medicare. Yet History indicates that Medicare and Medicaid spending is out of control. The administrative costs (that those programs actually count) are a lower percentage of payout because that payout is rising rapidly. When the government is unconcerned with fraud and the rise in total spending, the administrative cost of burning money can be quite low.

Private health insurance is an expensive mess at the moment because we do not have anything approaching a free market in insurance. In that context, contending over claims with an insurance company can be painful. That situation will not be improved if everyone is required to buy private insurance from firms that know that they have to do so.

You cannot buy fire insurance for your home after it catches fire. You cannot buy automobile insurance to pay for your car repairs after the accident occurs. That is not due to greed and the profit motive, but to reality and common sense, and it is not a reason to abolish fire and auto insurance companies. Health insurance coverage for major illness or injuries is seldom available after they have occurred and are being treated. That is a serious problem for many people without insurance, but not a reason to outlaw private insurance.

Inexpensive insurance is impossible for individuals to find in most states—because it is forbidden by law. State regulators do not allow for basic or catastrophic insurance but pile on coverage requirements, which drives up the cost of premiums. State regulators do not allow competition from insurance companies in other states, which drives up the cost of insurance. States and the U.S. government require individuals who struggle to buy their own insurance to pay income and payroll taxes on the funds they use to buy insurance, which further drives up the cost of insurance.

Those who admire the supposed efficiency of government insurance do not count the administrative costs of paying taxes for individuals and businesses, the administrative cost of the IRS and its 100,000+ employees to collect those taxes, the cost on providers of contending with 130,000 pages of Medicare regulations, or the cost of fraud and the lack of cost control. The need to make a profit to stay in business requires insurance companies to restrain costs and weed out fraud.

It is not true, though it is often said, that most industrialized countries have eliminated private insurance. Some have, like Canada, although even there laws prohibiting private insurance have been declared unconstitutional by the Canadian Supreme Court. But most countries with a large government role in medical care have still found it necessary to use private insurance companies to administer care. Examples include Germany, the Netherlands, and Switzerland. Private insurance is still permitted in the United Kingdom, and more than 6,000,000 people there (including more than one-third of the physicians) choose to buy insurance rather than rely exclusively on the National Health Service.

Even though we are contending with the limitations of highly regulated and limited insurance, the last thing we need is to mandate that everyone buy private insurance or eliminate all choices in a single government system. What we need is a free market in private insurance.

Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine.

NY Times on British Health System

The February 21, 2008 New York Times has published an article suprisingly critical of the British socialized National Health Service (or NHS). Here are some excerpts:

Paying Patients Test British Health Care System

...One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist's support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

"He looked at me and said: 'I'm so sorry, Debbie. I've had my wrists slapped from the people upstairs, and I can no longer offer you that service,' " Mrs. Hirst said in an interview.

"I said, 'Where does that leave me?' He said, 'If you pay for Avastin, you'll have to pay for everything'" -- in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

...But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all -- paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.

I blogged about this issue last month ("Better Equal Than Good"). Now that this issue has gotten the attention of the New York Times, perhaps patients like Debbie Hirst and Collette Mills will finally get some justice (and medical care) from the NHS.

Note the central moral issue: Being allowed to spend one's own honestly-earned money on something that will benefit one's own life is considered "unfair" by the British government.

When a government uses force to stop people from acting in their rational self-interest, it is no surprise that the results are misery and death.

(Via Amit Ghate, who has a good post on this topic as well.)

James Schroeder on The Value of Health Care

The February 19, 2008 Grand Junction Free Press printed the following excellent LTE by Dr. James Schroeder:

The value of health care

James K. Schroeder, MD
Grand Junction, CO, Colorado

Value is a word we don't hear often enough in the health care debate. Proponents of universal health care rarely acknowledge the value of health care as a professional service. Stop to consider the time and effort that comprise a medical education. Years of study and long hours are devoted to attaining the basic physician's toolset. Many more years are needed to hone those skills and develop the judgment to use them wisely. This process builds substantial value. When proposing expansion of governmental control, advocates of universal health care blithely discount that value and belittle the quality you desire for yourself and your family. This country already faces massive shortages of primary care physicians in many locations.

Expansion of low-paying programs such as Medicaid and CHP+ will not improve that. In Colorado, expanding Medicaid with its low reimbursements has previously been shown to decrease the number of pediatricians accepting new Medicaid patients. Universal health care advocates are fond of saying that nurse practitioners and physician's assistants will fill that gap. In other words they are admitting from the outset that consumer's access to physicians will be effectively rationed. At the same time they try to equate the "value" of that care as if the consumer is not bright enough to recognize the difference. As it stands, prices for most medical services are determined by the federal government (most insurance companies tie their reimbursement rates to the Medicare-determined value scale). The talent, training and experience of the provider are not even considered.

A better solution would be to return to a competitive market environment. Let the system operate openly so that the value of the service (as provided by any given provider) and the perception of that value (in the view of any given consumer) will determine the monetary cost of that service. Don't expect college-age students to embark on a career in medicine or seasoned physicians to remain in the field if the value of their hard work is not acknowledged.

Schwartz Rebuts Polis

Single-payer advocate and Congressional candidate Jared Polis recently wrote in the Rocky Mountain News:

A free market would allow the uninsured to die on the hospital doorstep rather than provide them treatment they cannot pay for. Having made a moral decision not to allow people in our great country to die in this fashion, let us discuss how to more efficiently provide for sensible universal health care.

Fortunately, Brian Schwartz had a fitting response:

According to Jared Polis, a law is required compel doctors to treat the uninsured in emergency situations. Is Polis saying that doctors are so heartless and cruel that they would not treat someone for free? Is he saying that the electorate as too callous to fund charities to pay such that doctors could treat the uninsured in emergency situations?

Apparently, the answer is "yes." Polis writes that we have "made a moral decision not to allow people in our great country to die in this fashion." Not quite. Moral decisions are a matter of choice, not a threat. EMTALA threatens doctors with penalties up to $50,000 for not complying.

Nearly every physician I've known has gladly waived his or her fee for worthy recipients who haven't been able to afford the bill. I've done so on numerous occasions myself. I don't believe that giving away charity care is the essence of morality (instead regarding it as a tangential issue to the central moral issue of being good at what one does in order to further one's own life and rational values).

But if a patient is a worthwhile human being (and if I can afford the charitable contribution), then I am happy to donate my professional services as a physician. And nearly every physician I know feels similarly.

In contrast a law that forces doctors to provide uncompensated services is just state-sanction theft, and undercuts genuine voluntary charity.

Hsieh LTE in Pueblo Chieftain

The February 17, 2008 edition of the Pueblo Chieftain published one of my LTE's:

Don't mandate insurance

I want to thank The Pueblo Chieftain for its strong editorial against the ill-considered plan by the Colorado Blue Ribbon Commission for Health Care Reform ("Mantra of a crisis").

Their proposed system of mandatory health insurance already has been tried in Massachusetts and is failing. Costs there are already more than three times what was originally predicted, and the Boston Globe reports that it is expected to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

Nor did the program produce the promised savings. Instead, the state is asking the federal government to help with the shortfall.

These government-imposed plans violate the rights of individuals to freely choose what health insurance plans are best for them, and, as a result, lead only to rising costs and rationing. If Coloradans value their lives and their health, they will also reject this deadly proposal.

For more information on genuine free-market health care reform for Colorado, please see www.WeStandFIRM.org .

Paul Hsieh, MD
Sedalia

Lines For Swedish Care Grow Longer

The February 4, 2008 edition of Investors Business Daily notes that rationing and waiting times continue to worsen in Sweden's system of socialized medicine. Here are some excerpts:

Waiting times for care, long a problem in Sweden and too often deadly wherever they're found, are now the longest on the Continent, says European think tank Health Consumer Powerhouse.

...Long waits are a hallmark of government health care anywhere it's employed. When the perception exists that treatment is free (it is not; Swedes pay more than half their gross income in taxes to support the welfare state), system overuse is inevitable. People can think of no reason to self-ration care. They show up in emergency rooms and doctor's offices with conditions for which they wouldn't seek treatment if they paid directly at the time of service.

Swedes are accustomed to cradle-to-grave care provided by the state. But rather than deal with long waits, they're opting for private care, which got a boost from limited reform in the 1990s. In private care, patients self-regulate and put less stress on the system.

Thanks to the profit motive, private health care providers have an incentive to cut waiting times, lest they lose customers to the competition. Government providers have no such motivation.

They do have incentive, however, to ration care when demand gets too high and costs soar. But to do so exposes "universal access" and "equal access" to be inaccurate descriptions. "Restricted access" would be more fitting.

Gorman Letter on The Hill

Linda Gorman has written the following letter on the 208 Commission findings which was published in February 13, 2008 edition of The Hill, a daily newspaper devoted to federal government news:

Panel's report on healthcare is poor model for U.S. policy

By Linda Gorman, Health Care Policy Center director, Independence Institute

Judging from the contents of his op-ed "Congress could learn from Colorado’s 208 Commission" (Feb. 5), Sen. Ken Salazar (D-Colo.) has been misinformed about Colorado’s 208 Commission.

Sen. Salazar implies that commission members found common ground on the "complex and contentious issue" of healthcare reform. They did not. I coauthored one of the two minority reports...

Medicaid and Medicare are the largest generators of uncompensated care in the United States. They are fiscally unsustainable, yet the commission recommended a vast expansion of Medicaid/SCHIP. The recommendations accompanying that expansion would give state government almost complete control over the vast funds in the private markets for health insurance and medical care.

Sen. Salazar talks about partnership and collaboration. He repeats the fashionable assertion that healthcare is "broken."

He does not bother to distinguish between relatively efficient private arrangements and the mess that Medicare and Medicaid have created.

Steven S. Schroeder, former head of the Robert Wood Johnson Foundation, the group that almost bankrupted Tennessee with TennCare and created model legislation that destroyed health insurance markets in Massachusetts, New Jersey and New York, once explained how to run partnerships: "[t]he key to public/private partnerships is to induce the private sector to 'play' on terms that are acceptable to the public sector." Otherwise, "strong incentives -- financial or political -- [are] needed to 'force' cooperation on what were otherwise competing and successful institutions."

Healthcare is too important to be left to public officials interested in forcing cooperation, and a fabricated consensus supported by manufactured factoids is not a good reason to give government virtual control of private healthcare. Real reform means deregulation to reduce costs, and flexible programs enabling people to save so that they can spend their own money on healthcare of their own choice. ...

Golden, Colo.

RMN Against Single-Payer Proposal

In the February 1, 2008 Rocky Mountain News, editorial page editor Vincent Carroll spoke out against the single-payer plan advocated by Congressional candidate Jared Polis:

CARROLL: Polis' rationing plan
By Vincent Carroll, Rocky Mountain News
Friday, February 1, 2008

If you're as rich as Jared Polis, you'll enjoy the world's best health care for the rest of your life no matter what happens to the system on which the rest of us rely. You can afford to roll the dice with a "national single payer health care system," which is what the Democratic candidate for the 2nd District congressional seat has announced he favors.

After all, you'll never experience the rationing of treatment that a single-payer regime inevitably entails.

Rationing? That's for people without a dot.com fortune. The superrich like Polis will simply bypass the insurance system, paying whatever it takes - here or anywhere in the world - for the best treatment money can buy.

Polis says his single-payer plan will involve (a) universal coverage and (b) the "same or better benefits" at (c) a lower cost for "95 percent" of families. He doesn't mention (d), the role of magic spells or incantations to bring this all to pass, but he should have.

"To date, other Western countries have been more successful in covering all citizens at a lower per capita cost, but they have done so only by limiting the availability of high-technology medicine." So writes former Colorado Gov. Richard Lamm and co-author Robert Blank in their recent book, Condition Critical, A New Moral Vision for Health Care. And these guys are on Polis' side of the single-payer debate!

"Every single-payer health system has at its core some form of health-care rationing, including strict limits on expensive care, such as organ transplants, chemotherapy and bone marrow transplants, and long waiting lines for elective surgeries," Lamm and Blank honestly acknowledge.

Do you suppose Polis will ever wait in line for elective surgery or forgo a chemo visit that the government refuses to cover?

Me neither. But he doesn't mind if you do.

Two Good LTEs in Colorado Springs Gazette

The February 13, 2008 Colorado Springs Gazette has printed two good LTE's on the issue of health care reform:

'Right' to care requires someone to provide it

In Sunday's Letters section, Phil Stahl stated that health care should be a right ("Government needed to prevent abuse of system"). Health care is nothing more or less then the services and goods produced by hard-working people. I am certain Stahl did not mean to imply that these people give away their labor without compensation.

If that compensation does not come from the person receiving the goods or service, then it must come from someone else. And that can only happen through voluntary or involuntary means. If it happens through involuntary means, then the threat of force and violence must be used. Rights that we all believe in and cherish such as speech and privacy do not involve taking anything away from someone else. If something you think of as a right can only be obtained by forcibly taking it from others, then it is probably not a right.

Steve Reinschmidt
Colorado Springs

Canada's system fails to provide proper care

Phil Stahl talks of how good the Canadian health system is in his letter. I suggest he visit www.freemarketcure.com/brainsurgery.php and view the 2006 video of an Ontario male with brain cancer.

For people who do not have Internet access, I'll provide a summary: the patient was going to have a four-month wait just to get a validating MRI and upward of an eight-month wait for the surgery under the Canadian health system.

Medical authorities said he would not survive the wait, so he went to Buffalo, N.Y., got the MRI and had surgery done in less than five weeks.

Due to the medical emergency, he asked for reimbursement of the $28K surgery cost from the Canadian government and was turned down.

John R. Tucker
Colorado Springs

Thanks to the Gazette for printing both of those letters.

WSJ on Insurance Mandates

The February 8, 2008 Wall Street Journal published the following OpEd critical of insurance mandates. Here are some excerpts:

To hear some of the presidential candidates, you'd think that health-insurance companies are the driving force behind the growing cost of health insurance. The more likely culprits are our politicians and the laws they pass.

...A health-insurance "mandate" is a legislative requirement that an insurance company or health plan cover (or offer coverage for) common -- but sometimes not so common -- health- care providers, benefits and patient populations. They include:

- Providers such as chiropractors (mandated in 46 states) and podiatrists (35 states), but also massage therapists (four states) and naturopaths (four states);

- Benefits such as mammograms (50 states) and drug abuse treatment (34 states), but also morbid obesity treatment (four states) and wigs for cancer patients (10 states);

- Populations such as dependent students (30 states), but also grandchildren (four states).

Although there were only a handful of state mandates in the 1960s, CAHI's just released "Health Insurance Mandates in the States, 2008" has identified 1,961 nationwide -- up from 1,901 a year ago.

For almost every health-care product or service, there are at least two groups that want insurance to cover it: those who sell the products and services so they can get more business, and those who use the products and services to lower their out-of-pocket costs. Both of these highly motivated groups push state legislators -- and increasingly members of Congress -- to require insurance to cover the care. As a result, government interference in and control of the health-care system is steadily increasing -- and so is the cost of health insurance.

...Fortunately, a few states are recognizing that mandates make health insurance more expensive. At least 10 states now permit mandate-lite policies, which allow individuals to purchase a policy with fewer mandates and so are more tailored to their needs and financial situation. And there are now at least 30 states that require a mandate's cost to be assessed before it is implemented.

Mandates aren't the only things driving up the cost of health insurance. States that require insurers to accept any individual who applies, regardless of their health status, are imposing costly burdens on health insurance. And those costs get passed on to consumers -- if they decide to keep their coverage.

Before politicians jump on the anti-health-insurance bandwagon, they should look at the role they are playing in driving up costs. Making health insurance more affordable would be a lot easier if they would stop legislating what it has to cover.

HB 08-1327 Affordable Health Insurance Choice

Representative Cory Gardner has introduced House Bill 1327 which is a solid move toward a free market in health insurance. It also has the sponsorship of Senator Mitchell.

This bill would allow a Colorado resident to purchase or enroll in a health insurance policy lawfully sold, offered or issued in any other state, from any health insurance company licensed to do business in another state, even if the company is not licensed to do business in Colorado, and even if the policy benefits are different, i.e., more or less, than those benefits required in policies issued by Colorado licensed companies. It would subject these companies to regulation by the Insurance Commissioner only with regard to the enforcement of contractual benefits, including those for prompt payment and the procedure for denial of benefits.

Why is this bill a positive step?

Currently, Colorado residents are required to buy policies 1) with these specific mandated benefits and with policy forms approved by the Colorado Dept. of Insurance, and 2) sold by companies licensed by the State of Colorado. This means that residents are limited to only those policies with all of the benefit mandates and limited to about 35 companies in the individual and small group markets. By necessity, these policies are more limited in benefits and prices than those provided by the hundreds of insurance companies licensed in the various 50 states.

The economic argument for this bill is clear. According to the Council on Affordable Health Insurance 2008 research, Colorado currently mandates 50 benefits, including treatment for alcoholism. However, three surrounding states do not require that treatment benefit. So, if you completely abstain from alcohol, or you know you will never need that coverage, then you could purchase a policy from at least six states including Arizona, Idaho and Wyoming that do not require that benefit. It is estimated that this one benefit raises the cost of health insurance from 1 to 3%. Likewise, if you know you will never need maternity benefits, why buy them? Colorado says that all policies must offer those benefits, but 30 other states make them optional. Maternity benefits also raise the cost by 1 to 3%. Individually, each mandated benefit may not raise the cost of a policy much, but combined, they make a significant difference, costing the consumer from 20% to 50% more, according to CAHI, depending on the mandates involved.

Alternatively, astute individuals would be able to find policies offered in other states that provide benefits that may not be offered in Colorado -- which means they could get insurance for something that is not covered now, and, at the same time, save money on their medical costs. For example, if an individual wanted in Vitro Fertilization covered by insurance and if she could not find a company in Colorado wiling to offer same, she probably could purchase the policy from an insurer outside the state.

In addition to cheaper health insurance, this freedom to purchase policies outside the state could provide peace of mind and the particular benefits that individuals and their families want and in some cases, need.

This bill also offers Colorado residents the opportunity to seek the most affordable and best of the regulatory schemes offered by the 50 various states.

This is a great opportunity for Colorado to lead the nation in allowing its residents greater freedom, real choice, and more personal health insurance, and I urge you to speak up and write about it -- write letters to the editor and op-eds. Let's get people talking about this consumer oriented, free market option to decrease the cost of health insurance. There really is no downside to this bill as it is currently proposed.

The Colorado House Business Affairs and Labor Committee meets next Monday at 1:30 to discuss this bill. The members of that Committee are:
Rosemary Marshall-Chair (D) 303-866-2959 rosemary.marshall.house@state.co.us Joe Rice-ViceChair (D) 303-866-2953 joe.rice.house@state.co.us David Balmer (R) 303-866-2935 david.balmer.house@state.co.us Dorothy Butcher (D) 303-866-2968 Morgan Carroll (D) 303-866-2942 morgancarroll@webaccess.net Mark Ferrandino (D) 303-866-2911 mferrandino@yahoo.com Cheri Jahn (D) 303-866-5522 cheri.jahn.house@state.co.us Larry G. Liston (R) 303-866-2965 larry.liston.house@state.co.us Victor Mitchell (R) 303-866-2948 victor.mitchell.house@state.co.us John F. Soper (D) 303-866-2931 john.soper.house@state.co.us and Amy Stephens (R) 303-866-2924 amy.stephens.house@state.co.us

Technical Credits

In the Year-End Results, the intellectual efforts were stressed and I tried to give credit to all of those in Colorado who used their voice to publicly endorse free market medicine and health insurance.

There are three people who have given of their time, skills and effort to FIRM and I want to publicly acknowledge them. First, Jennifer Armstrong created the distinctive logo of FIRM.

Diana Hsieh created the website and gave FIRM its presence on the web.

John Powers has enhanced it and given it a new look and feel. John is now the webmaster. In addition, John has taken the Leonard Peikoff article "Health Care is Not a Right," and given it a glossy new look and feel in the form of a brochure.

Thanks and kudos to each of you.

Schwartz in Pueblo Chieftain

O February 10, 2008, the Pueblo Chieftain also published Brian Schwartz's OpEd, "Compulsory insurance is collective punishment".

Pueblo Chieftain Opposes 208 Commission

The February 6, 2008 edition of the Pueblo Chieftain included the following editorial against the proposals of the 208 Commission:

Mantra of a crisis
THE PUEBLO CHIEFTAIN

A CLASSIC way to get controversial legislation passed is to declare a "crisis."

That's why a number of politicians and activists have been crying about a "health care crisis" in recent years. After the mantra is repeated in the media long enough, some of the citizenry begin to believe it.

So it's not surprising that Colorado’s Blue Ribbon Commission for Health Care Reform reported last week it will recommend that the Legislature require all state residents to have at least a basic health insurance policy. This is the approach tried in Massachusetts and California and one which is advocated in one form or another by both Democratic presidential candidates, Hillary Clinton and Barack Obama.

Spokesmen for the Blue Ribbon group deny their approach is socialized medicine, but it's clearly a step toward that.

For one thing, their approach would provide a state subsidy on a sliding scale for lower-income Coloradans. Whenever government controls the purse strings, government dictates policy, whether for highways or health care.

The commission doesn't know how this new entitlement would be paid for, saying it was directed by the Legislature not to look at that side of the equation. However, Blue Ribbon members admit it would be expensive - billions in new expenditures, we'd guess.

While a certain percentage of people do not have health insurance, that doesn’t mean they don't get health care. All they have to do is show up at an emergency room and care will be provided.

While that's not the most efficient use of health care resources, it surely doesn't rise to the "crisis" threshold.

How about Massachusetts and California? In the Bay State, officials found out that about one-fifth of the population simply couldn't afford the mandated insurance, so those people were allowed to opt out of the program. As a result, the number of insured increased only marginally.

In California, someone was paying attention to the costs of Gov. Arnold Schwarzenegger's universal care proposal, one which was a near carbon copy of the Massachusetts scheme. California Senate President Pro Tem Don Perata raised the issue of cost to a state government already running a $14.5 billion deficit.

An independent analysis found the plan would cost much more than proponents claimed. (We haven't seen a similar analysis in Colorado yet.)

When the California Senate Health Committee took a vote on ArnoldCare, the plan died when only one senator voted to send it to the floor. Call it a mercy killing.

It's axiomatic that people want three things out of health care: availability to all, high quality, and low cost. You can have any combination of two of those, but all three are simply impossible, despite what the advocates of a single payer system claim.

One only need to look north of the 49th Parallel to our neighbors in Canada to see the truth of that.

There will be much debate in the Legislature this year over the Blue Ribbon Commission's proposed health-care fixes. While that's going on, we advise readers to keep a tight grip on their wallets.

One thing that I found noteworthy was the fact that the editorial explicitly and correctly identified the 208 Commission's plans as a step towards socialized medicine. This is the term that the advocates of government-run medicine hate the most, precisely because they know it will arouse opposition amongst the citizenry. Good for the Chieftain!

Year - End Results

Today we celebrate the achievements of the FIRM coalition over the past year.

FIRM started at the end of January 2007, and comprises a group of Colorado citizens with diverse careers, interests and ideas about what medicine and health insurance should (and could) look like in Colorado (and in America, for that matter). For some, this is the first time they have ventured into an ethical/political issue in public. Some want to stay out of politics, but are interested in what used to be called "moral suasion," persuading people through moral argument to change their beliefs about a particular issue.

What these people do agree with is that the government should stop regulating, controlling and intervening in decisions that individuals make about what medical procedures they should have, whether to buy health insurance, and if so, what type of health insurance is appropriate for them and their families, and who should be their provider of services, among the thousand other decisions that people make regarding their health every year.

I am very appreciative for all of you who have supported the efforts of FIRM, and want to provide you the tangible record of your efforts. Briefly, in a summary form, they are as follows. From January 30, 2007, to January 31, 2008, FIRM coalition supporters had the following public results:

Letters to the editor -- 48 (including one in "USA Today")
OpEds/Columns -- 26
Citations in Media -- at least 10, perhaps more
Articles/Essays -- 2
Talks/Panel Discussions -- 9
Media appearances -- 6
Formal Proposal Submissions to 208 Commission -- 1
Public statements to 208 Commission -- 17
Letters to 208 Commission during their request for public comments -- at least 5, undoubtedly more
Letter to Colorado Medical Society -- 1
Public Statements to Medical Organizations -- Total 1
Public Statement to Colorado Joint Legislative Committee on Health and Human Services -- 1
Distribution of "Health Care is Not A Right", by Leonard Peikoff -- over 1,000 copies

These are fabulous results. The war is not yet won, and it will be difficult. Last year, at this time, one of the popular ideas in the public was the individual mandate to purchase insurance. This year, at least, it looks like there will not be a push for the individual mandate to purchase insurance in the State of Colorado, and that is due in no small part to the efforts of FIRM supporters -- of their own, individual efforts. Individual mandates are not dead, but they are no longer thriving.

This year, it appears that the effort will be to expand government health insurance to all of the uninsured children in the state, increasing the number of people on government programs that don't work, giving families the illusion of coverage, at an expensive price tag for all, including taxpayers. We expect to see additional restrictions on insurance policies, including benefit mandates and rating issues as well. So there is work yet to do.

Below are the details that support the summary above. I applaud every name on the list, and I also applaud all of you who have written, sent comments and forwarded any of these efforts to friends, family, co-workers, doctors or other health-care providers. Please remember as you read the list, that not everyone on the list may absolutely be in 100% agreement with all aims of FIRM. FIRM is a coalition, and its ideas are expressed in its Statement of Principles and Goals. These individuals have expressed their adherence to some of these goals in these particular writings or public statements.

A special thanks to Paul Hsieh for blogging so diligently and for co-writing with me an excellent article on the state of medicine and health insurance in America.

I have used smaller type so that the blog is not so long.

Letters to the editor -- Total 48 (including one in "USA Today")

Diana Hsieh, Rocky Mountain News, 2/5/2007, "Paul Campos: Health Care"
Brian Schwartz, Denver Post, 3/3/2007, "Universal Health Care"
Richard Watts, Rocky Mountain News, 4/16/2007, "End government health-care meddling"
Richard Watts, Craig Daily Press, 4/19/2007, "Health Care"
Paul Hsieh, Denver Post, 4/24/2007, "Health Care is Not a Right"
Russell Shurts, Rocky Mountain News, 4/25/2007, "Health Care in Colorado"
Richard Watts, Rio Blanco Herald Times, 4/26/2007, "Health Care"
Paul Hsieh, Denver Post, 4/30/2007, "Two Arguments Why Health Care is Not a Right"
Brian Schwartz, Denver Post, 4/30/2007, "Fair Health Care"
Brian Schwartz, Rocky Mountain News, 5/3/2007, "Medical insurance restrictions are costly"
Brian Schwartz, Boulder Daily Camera, 5/3/2007, "Health Care: The government would worsen it"
Ralph Shnelvar, Denver Post, 5/6/2007, "Debating health care systems in U.S., Canada"
Hanah Krening, Denver Post, 5/23/2007, "Proposals to reform health care in Colorado"
Paul Hsieh, Pueblo Chieftain, 5/27/2007, "Socialized Medicine"
Richard Watts, Steamboat Pilot, 5/30/2007, "Too Much Control"
Richard Watts, Rocky Mountain News, 5/31/2007, "Health Care"
Richard Watts, Glenwood Springs Post-Independent, 5/31/2007, "Don't Allow the Government to Dictate Your Health Care"
Gina Liggett, Denver Post, 6/6/2007, "Free Market Health Care Reform"
Gina Liggett, Boulder Daily Camera, 6/9/2007, "There is No 'Right' to Any Health Care"
Gina Liggett, Grand Junction Daily Sentinel, 6/13/2007, "Need vs. Right"
Gina Liggett, Carbondale Valley Sentinel, 6/14/2007, "Need vs. Right"
Gina Liggett, Pueblo Chieftain, 6/17/2007, "Health Panel Stacked Deck"
Brian Schwartz, Denver Post, 6/19/2007, "'Universal' Health Care"
Richard Watts, Grand Junction Free Press, 6/21/2007, "Health Care is Not a Right"
Richard Watts, Boulder Daily Camera, 6/22/2007, "Health Care is Not a Right"
Martin Buchanan, Denver Post, 6/27/2007, "Health Care For All: Whose Responsibility Is It?"
Gina Liggett, Rocky Mountain News, 6/28/2007, "Health Care is Not a 'Right', It's a Need"
Russell Shurts, Rocky Mountain News, 6/29/2007, "Social Responsibility"
Gina Liggett, USA Today, 6/29/2007, "Moore In Denial"
Brian Schwartz, Rocky Mountain News, 7/2/2007, "Health Insurance"
Diana Hsieh, Colorado Springs Gazette, 7/3/2007, "People, not government, responsible for health"
Gina Liggett, Denver Post, 7/6/2007, "Health Care in the US"
Gina Liggett, Northern Colorado Business Report, 7/6/2007, "Free Health Care?!"
Richard Watts, Rocky Mountain News, 7/7/2007, Health Care"
Paul Hsieh, Rocky Mountain News, 7/12/2007, "In-Store Health Clinics"
Diana Hsieh, Rocky Mountain News, 7/17/2007, "Free Market Medicine is the Answer"
Gina Liggett, Colorado Confidential, 7/21/2007, "Health Care"
Paul Hsieh, Denver Post, 7/31/2007, "Rising Health Care Costs"
Richard Watts, Denver Post, 7/31/2007, "SCHIP Program"
Lin Zinser, Rocky Mountain News, 8/7/2007, "Health Care in Colorado"
Brian Schwartz, Rocky Mountain News, 8/13/2007, "Free Markets Key to Affordable Health Care"
James Schroeder, Grand Junction Daily Sentinel, 8/28/2007, "Single Payer Health Plan Would Be Costly and Unfair"
Brian Schwartz, Denver Post, 8/31/2007, "Health Savings Accounts"
Brian Schwartz, Denver Post, 9/7/2007, "Funding Health Care"
Russell Shurts, Grand Junction Free Press, 9/13/2007, "We Shouldn't Be Forced"
Brian Schwartz, Boulder Daily Camera, 9/24/2007, "We Do Not Have Free Market Care"
Brian Schwartz, Boulder Daily Camera, 1/4/2008, "Free Market Health Insurance Needed"
Brian Schwartz, Rocky Mountain News, 1/17/2008, "Politically Controlled Insurance Is a Disease"

OpEds/Columns -- Total 26

Brian Schwartz, Boulder Daily Camera, 2/11/2007, "Government-run auto repair? Yes!"
Ari Armstrong, Boulder Weekly, 2/15/2007, "Colorado Medical Socialism"
Ari Armstrong, "What's Right With Colorado Health Care", 4/8/2007, Independence Institute
Brian Schwartz, Rocky Mountain News, 4/28/2007, "Government controls violate rights, raise costs, cut access"
Paul Hsieh, Rocky Mountain News, 6/2/2007, "Free market holds key to ensuring quality for Coloradans"
Paul Hsieh, Boulder Daily Camera, 6/10/2007, "Socialized Medicine is Wrong for State"
Paul Hsieh, Pueblo Chieftain, 6/10/2007, ""Blue ribbon panel prescribes wrong approach on health care"
Linn and Ari Armstrong, Grand Junction Free Press, 6/11/2007, "Health socializers ignore benefits of liberty, harms of controls"
Brian Schwartz, Denver Post, 8/5/2007, "Don't Model State Reforms on Medicaid: How Should Colorado Lawmakers Fix A Broken
System"
Russell Shurts, Rocky Mountain News, 8/7/2007, "Socialized Medicine Just Another Gang Operation"
Ralph Shnelvar, Boulder Daily Camera, 8/14/2007, "Your Government Doesn't Care"
Brian Schwartz, Boulder Daily Camera, 8/26/2007, "Warning: Medicaid is Hazardous to Your Health"
James Schroeder, Grand Junction Free Press, 8/23/2007, "Beware of unintended consequences of health care proposals"
Linn and Ari Armstrong, Grand Junction Free Press, 9/3/2007, "Reformers demand more labor for politically-run medicine"
Paul Hsieh, Ayn Rand Institute, 9/18/2007, "'Single-Payer' Health Care Is Anything but Free"
Brian Schwartz, Rocky Mountain News, 9/26/2007, "Government Control Is Bad For Your Health"
Linn and Ari Armstrong, Grand Junction Free Press, 10/15/2007, "Insurance Mandates Threaten Your Health"
Linda Gorman, Independence Institute, 10/24/2007, "It's Official: Medicaid Managed Care Does Not Save Money"
James Schroeder, Grand Junction Daily Sentinel, 11/18/2007, "Expanding Medicaid Eligibility Will Mean Fewer Doctors Accept It"
Brian Schwartz, 11/21/2007, Independence Institute, "Ritter's health care cure would prove more crippling to Coloradans"
Linda Gorman, Independence Institute, 12/3/2007, "Health care "reform" in Colorado: Go home and die; it's cheaper"
James Schroeder, Grand Junction Free Press, 12/26/2007, "Here's Your Prescription"
Brian Schwartz, TCS Daily, 1/14/2008, "Compulsory Medical Insurance as Collective Punishment"
Linn and Ari Armstrong, Grand Junction Free Press, 1/21/2008, "More Political Control of Medicine Comes With Higher Costs"
Linda Gorman and Ari Armstrong, Rocky Mountain News, 1/30/2008, "A Very Costly Health Care Solution"
Brian Schwartz, Colorado Springs Gazette, 1/31/2008, "Compulsory Insurance as Collective Punishment"

Citations in Media -- At least 10, perhaps more

Lin Zinser quoted in Colorado Springs Gazette, 5/22/2007, "State health care commission narrows focus"
Paul Hsieh quoted on Mike Rosen Radio show, 6/7/2007
Brian Schwartz cited in Face the State, 8/27/2007, "Does the Effort to Provide Government Health Care For All Kids Leave Too Many
Behind?"
Brian Schwartz quoted in Denver Post, 8/31/2007, "Experts pan health savings accounts"
James Schroeder quoted in Grand Junction Daily Sentinel, 10/12/2007, "Community Discusses Health Care Reform"
Brian Schwartz quoted in Rocky Mountain News, 10/5/2007, "Audience at health care forum backs single-payer proposal"
Ari Armstrong and Brian Schwartz cited in Rocky Mountain News, 10/13/2007, Jason Salzman Column
Brian Schwartz and Paul Hsieh quoted in Colorado Springs Gazette editorial, 1/3/2008, "Health Care, Ho! State Should Avoid Repeat of
Massachusetts"
Linda Gorman cited in Rocky Mountain News, 1/10/2008, "Mandatory Health Plan Participation Opposed"
Linda Gorman and Brian Schwartz cited in Face the State, 1/31/2008, "Minority Report Critical of Health Commission Findings"

Articles/Essays -- Total 2

Paul Hsieh, Colorado Medicine (March-April 2007 issue), "An Open Letter to Colorado Physicians"
Lin Zinser and Paul Hsieh, The Objective Standard (Winter 2007-2008 issue), "Moral Health Care vs. 'Universal Health Care'"

Guest Speaker/Panel Discussions -- Total - 9

Lin Zinser, "The Crisis in Colorado Health Care", 4/17/2007, Colorado Springs Republican Women
Lin Zinser, Aurora Rotary Club, 6/11/2007
Lin Zinser, Grand Junction, 7/19/2007
Lin Zinser, Castle Rock Republicans, 7/20/2007
Lin Zinser, Jefferson County Town Hall Meeting, 8/18/2007
Lin Zinser, Greeley Centennial Rotary Club, 9/6/2007
Lin Zinser, El Paso County Republican Women, 9/17/2007
Lin Zinser, Mesa County Republicans, 9/21/2007
Lin Zinser, Gateway Rotary Club, 9/26/2007

Media appearances -- Total 6

Lin Zinser, 5/10/2007, Amy Oliver Radio Show
Lin Zinser, 5/18/2007, John Caldera TV Show "Independent Thinking"
Brian Schwartz, 6/17/2007, John Andrews Radio Show
Lin Zinser, 7/26/2007, KNZZ Report Radio Show
Lin Zinser, 7/26/2007, Grand Junction TV 5:00 news
Lin Zinser, 9/6/2007, Amy Oliver Radio Show

Formal Proposal Submissions to 208 Commission -- Total 1

Brian Schwartz, "Free Markets, Affordability & Individual Rights"

Public statements to 208 Commission Meetings -- Total 17

Paul Hsieh (read by Lin Zinser), 1/30/2007
Brian Schwartz, 10/4/2007
James Schroeder, 10/11/2007
Lin Zinser, 1/30/2007, 1/31/2007, 2/21/2007, 3/28/2007, 4/27/2007, 5/17/2007, 5/18/2007, 6/19/2007, 7/18/2007, 8/23/07, 9/24/2007,
11/02/2007, 12/13/2007, 1/10/2008

Letters to 208 Commission during their request for public comments -- Total at least 5, undoubtedly more

Lin Zinser, Diana Hsieh, Paul Hsieh, Betty Evans, Richard Watts, and others

Letter to Colorado Medical Society - Total 1

James Schroeder, November 2007

Public Statements to Medical Organizations - Total 1

Paul Hsieh, Arapahoe-Douglas-Elbert Medical Society, 6/21/2007

Public Statement to Colorado Joint Legislative Committee on Health and Human Services - Total 1

Lin Zinser, January 31, 2008

Schwartz on Compulsory Insurance in RMN

Brian Schwartz's recent OpEd on insurance mandates has also been published by the Rocky Mountain News on February 7, 2008:

Health care commission wants to punish you

Remember grade school, when teachers would punish the whole class for the actions of just a few troublemakers? This is collective punishment, which is typically practiced during wartime or under martial law.

Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," it's the law in Massachusetts, and California's State Assembly has approved it. In Colorado, it is central to the "Blue Ribbon" Commission's recommendations, which commissioners [presented] to the General Assembly on January 31.

Politicians peddle compulsory insurance under the guise of eliminating the "cost shift from the uninsured" by making people "responsible." The story is that the uninsured get medical care without paying, which increases premium costs for the insured. So why not simply force everyone to buy insurance? Because it scapegoats the victim and empowers the true perpetrators of our insurance mess: politicians.

According to the Commission's "Baseline Coverage and Spending" report, the cost shift attributable to increased premiums is around $200 million annually. This "free from provider" cost is just $85 per privately-insured resident, or one percent of an average premium.

But the Commission's proposed billion-dollar "cure" is itself a huge cost shift. To encourage compliance with mandated insurance, the Commission's plan includes tax-subsidized premiums and Medicaid expansion. Per privately-insured Colorado resident, the tax increase would cost about $400. Worse yet, Medicaid itself increases insurance premiums by short-changing doctors.

And why expect *this* government bureaucracy to stay within budget? The Boston Globe reports that to contain costs, Massachusetts medical authorities will "probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

Second, holding people "responsible" would mean punishing freeloaders themselves and allowing providers to prevent freeloading. Compulsory insurance is the opposite: it forces the innocent to buy insurance determined by political interests, rather than their own needs. That’s collective punishment.

What if we applied the Commission's rationale to freeloaders who leave restaurants without paying the bill? This certainly increases prices, but forcing all citizens to buy "diner's insurance" punishes the innocent.

Third, government controls already punish the innocent – insured and uninsured alike – by making medical care and insurance prohibitively expensive.

Federal tax policy deeply discounts employer-provided insurance. This chains us to our jobs and employer insurance options. Insurance companies need not please us — they know we must change jobs to buy a competitor’s product. Shall we further pamper insurance companies by forcing everyone to buy their products?

Since income is taxed but premiums are not, consumers end up buying "insurance" that is really prepaid medical care. Insulated from medical costs, patients spend like business travelers on a company expense account, so medical providers need not compete on price.

On the state level, medical providers and disease constituencies lobby to force insurance to include benefits that many customers do not need. For example, Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. How’s that for a cost shift?

These and other mandates increase Colorado premiums by 21 to 54 percent. This dwarfs the one-percent increase attributable to the uninsured. Colorado's Chief Medical Officer told the Washington Post that 2,500 Coloradans lose insurance for every one percent increase in premiums.

When government controls increase insurance costs, the young and healthy drop coverage first. Those remaining have a higher medical risk, so premiums rise again, which again drives out the healthiest remaining customers.

Reformers have some nerve to support policies that make insurance prohibitively expensive, and then make criminals of those who do not buy it.

Compulsory insurance is based on collective punishment, a perverted form of justice found where troops patrol streets and spitballs go splat. It punishes both the insured and uninsured for the misdeeds of politicians. Colorado legislators should not scapegoat the uninsured for the mess they've perpetuated. They should repeal legislation that inhibits the free market from delivering affordable high-quality
medical care.

Brian Schwartz is a resident of Boulder. The author's free-market proposal to the Blue Ribbon Commission is at WhoOwnsYou.org.

Maine's Failed Universal System

StateHouseCall.org reports on more problems with Maine's attempt at universal health care:

Maine has recently joined the growing list of failed state reforms. As with other faillures, the Dirigo Care program was shoved down the throats of a bewildered legislature by an egotistical governor who promised Nirvana.

...But look behind the spin and the report is a devastating examination of a program that was poorly conceived and doomed to fail from the beginning – as many of us had predicted. It finds: 1. After 20 months of operation only 11,000 were enrolled in DirigoChoice (out of a total uninsured population of 136,000), and over two-thirds of these were already covered. 2. Of the small companies eligible to participate, only 2.5% actually did. 3. The financing scheme (a “savings offset payment”) is impossible to measure or implement. 4. Almost as many people (3,600) had disenrolled from the program as were newly insured by it.

Of course, these are continuations of the same problems reported by the New York Times in their April 30, 2007 article, "As Health Plan Falters, Maine Explores Changes".

Ironically, Maine and Hawaii are the two states cited by the left-leaning Commonwealth Fund as having the top two government "universal" health systems. If that's the case, I'd hate to see the badly-run systems.

The key problem, of course, is that the government cannot and should not run universal health care systems, because that necessarily involves violating the individual rights of patients, doctors, and insurers, by forbidding them from contracting for vital goods and services to their mutual advantage according to their own best rational judgment. These undesirable economic consequences are the inevitable result of such government interference in the free market.

Liggett LTE in Boulder Daily Camera

The February 5, 2008 Boulder Daily Camera has published the following LTE by Gina Liggett:

Gina Liggett: Health care is not an entitlement

The 208 Commission has come up with a dressing for Colorado health care with its bandaids and gauze so wadded up into a big mess that it won't begin to staunch the hemorrhage. The criteria the Commission used to evaluate the proposals for reform only considered government-oriented solutions -- eliminating the only proven economic model for efficiency, fairness and innovation: the free market.

What does it take for the Commission and many citizens to see that the central-planning Emperor has no clothes? We are in this health care crisis because of a decades-long meddling by the government, beginning with the 1940s tax preferences given to Blue Cross/Blue Shield. Add in the monstrosities of Medicare and Medicaid and programs like Bush's Prescription Drug Benefit, and you have a health care market that has become so bloated, distorted and inefficient that it's amazing it runs at all.

But it won't for long. The government will not solve our health care problems by continuing to violate individual rights with forced mandates and the expropriated earnings of some to pay for the health care of others.

As a society, we must wean ourselves off this false sense of entitlement that health care is a right. It is a need that should be obtained like any other requirement of life: by paying for it according to your own choice from someone who is willing to provide it.

All government programs must be "grandfathered" out over a period of time, allowing the free market to do what it does best: innovate, provide better choice, and let the consumer and provider decide what they want--not what some bureaucrat's rules allow.

After fifty years, it's time for a new change of clothes.

Gina Liggett, RN, MPH
Denver

Hsieh LTE in Colorado Springs Gazette

The February 5, 2008 edition of the Colorado Springs Gazette printed my LTE, commenting on their good OpEd criticizing the 208 Commission (towards the bottom of the page):

BAD MEDICINE
Health care proposals will backfire on state

I want to thank The Gazette for its strong editorial against the ill-considered plan by the Colorado Blue Ribbon Commission on Health Care Reform ("Health care reform: It's a joke," Jan. 31). Their proposed system of mandatory health insurance already has been tried in Massachusetts and is failing. Costs there are already more than three times what was originally predicted, and the Boston Globe reports that it is expected to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay." The California state legislature has also just rejected a similar plan because it will cost too much.

These government-imposed plans violate the rights of individuals to freely choose what health insurance plans are best for them, and, as a result, lead only to rising costs and rationing. If Coloradans value their lives and their health, they will also reject this deadly proposal.

For more information on genuine free market health care reform for Colorado, please see www.WeStandFIRM.org.

Paul Hsieh, M.D.
Sedalia

Massachusetts Plan Costs Keep Rising

The February 3, 2008 edition of the Boston Globe reports more difficulties with the Massachusetts universal health care plan:

The subsidized insurance program at the heart of the state's healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.

Because of this, the state is looking for more money from the federal government to make up the shortfall, although they admit:

If the state doesn't get all of the federal funds it is seeking, policy makers could face difficult choices: spend more state money or cut back the two programs by reducing enrollment, cutting subsidies, or eliminating benefits.

The Boston Globe had reported earlier on 12/14/2007 that the state would probably have to, "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay".

What's especially interesting is that several of the major presidential candidates want to implement the Massachusetts system on a national scale. But who will the federal government call upon for help when those costs skyrocket out of control? Perhaps the Great Money Fairy From The Sky?

The Massachusetts government needs to re-examine the flawed premise behind their plan: namely that the government should be attempting to provide universal health coverage at all.

Armstrongs On Freedom And Compassion

The February 4, 2008 Grand Junction Free Press has printed the following OpEd by Linn and Ari Armstrong on freedom, compassion, and health care:

Freedom is compassionate ... force is not
By Linn and Ari Armstrong

We've been writing a lot about health policy because it is an extremely important issue that has been at the center of the political table for the past couple of years.

One side of the debate calls for more political control of medicine in the form of more tax spending, more mandates and more political interference. The other side, which we join, points out that existing problems in medicine are the result of just such political force, and the solution is liberty in medicine, a free market that consistently protects individual rights to direct one's resources and interact voluntarily.

In our Jan. 21 column, we argued, among other things, that doctors should not be forced to provide service without compensation. This is hardly a radical claim. For instance, most people don't expect grocery stores to offer "free" food to any comer who claims to need it. However, even though nobody forces them to do so, many grocery stores voluntarily contribute to food banks. We have heard of no proposal to force grocery stores to offer "free" food to whoever demands it, without compensation.

Nor are we unique in thinking that the use of such force would result in widespread abuses. Certainly nobody seriously proposes the nationalization of grocery stores to "solve" the problem of hunger.

Yet some expect us to believe that, while we count on the free market to provide us with other necessities of life, from food to housing to clothing, in health care the proper approach is socialized medicine.

In his Jan. 24 reply, Dr. Michael Pramenko alleges that we are heartless for endorsing a free market in medicine. He offers as examples a man suffering chest pains, an infant born prematurely, and a child with asthma. If these people cannot afford treatment, will they be tossed out in the street? Pramenko is relying upon his readers' sympathy, and the very fact that so many people care about such patients ensures that they will find care in a free market.

A free market means one in which people are free to interact voluntarily. Thus, a free market includes all voluntary charity. For example, as a Shriner, your elder author helps to raise funds for the Shriners Hospitals, which provide care to children at no charge. In a free market, not only would many hospitals and clinics provide services to the poor at no cost or at discounted rates, but many individuals and foundations would provide funds to cover such care.

What is heartless is forcing a doctor to provide care to any person who walks in the door, regardless of the circumstances and without compensation. Such a system invites widespread abuse. Many people who can afford to pay for their care simply skip out on their bills. Some who could afford insurance choose not to buy it; after all, one is guaranteed "free" care by law, at somebody else's expense. Others neglect their health, actively damage their health (as through alcoholism), or ignore lower-cost options because the law grants them "free" yet expensive emergency care.

If Pramenko actually believes that doctors should be forced to offer care, then why stop there? Why not also force grocery stores, clothing stores and so on, to also provide "free" goods to anyone who claims to need them, without compensation?

Why not force private individuals to help others who claim to be in need, without limit? For instance, if somebody knocks on Pramenko's door and claims to need a place to live for a few months, shouldn't Premenko be forced to give the person a home, without compensation, no questions asked? Anybody with common sense can predict the resulting chaos and injustice of any such policy.

In fact, as Lin Zinser and Dr. Paul Hsieh review in an article available at TheObjectiveStandard.com, the law forcing hospitals to offer "free" care has resulted in many emergency rooms shutting down.

Just as all of us have the right to decide whom to help in our own homes and with our own charitable dollars, just as we have the right to offer our labor in return for money, so doctors have the right to decide whom to serve and on what terms, as accepted voluntarily by the patient. No one has the right to demand "free" service from a doctor, or from a grocer, or from anyone. Doctors who wish to provide care at no cost are free to do so, and doctors who wish to work only in exchange for compensation have that right.

But Pramenko is not content merely to leave in place existing unjust laws that harm our health. He wants to impose more such controls. The result will be higher taxes, more political controls placed on doctors, and more rationing for patients. Politically controlled medicine is heartless.

The alternative to Pramenko's heartless, health-harming, politically controlled medicine is a compassionate and just free market in medicine.

Linn is a local political activist and firearms instructor with the Grand Valley Training Club. His son Ari edits FreeColorado.com from the Denver area.

Schwartz on Mandatory Insurance

The January 31, 2008 edition of the Colorado Springs Gazette has printed Brian Schwartz's OpEd, "Compulsory Insurance as Collective Punishment". The piece is not available online, but a PDF copy of the print edition can be found here.

Update: A slightly longer version (including a discussion of the Massachusetts plan) is also available here at the Independence Institute website.

208 Commission Minority Report

The 208 Commission has now presented its recommendations to the Colorado state legislature on health care reform, which includes numerous new forms of government interference in health care and health insurance such as insurance mandates.

However, there is also a noteworthy Minority Report sharply critical of the 208 Commission process and recommendations, written by Commissioners Linda Gorman and R. Allan Jensen. The following is a copy of an Independence Institute Press Release summarizing the key points from the minority report:

MINORITY REPORTS FAULT HEALTH CARE REFORM COMMISSION PROCESS, RECOMMENDATIONS
Contacts: Linda Gorman, (303.279.6536); R Allan Jensen (303.912.5490)

The final report of the Colorado Blue Ribbon Committee for Health Care Reform, presented to the Colorado Legislature on January 31, 2008, includes two minority reports, one written by Commissioner Mark Simon and one written by Commissioners Linda Gorman and R. Allan Jensen. In their report, Gorman and Jensen explain why the Commission has produced inadequate policy recommendations, offer alternative suggestions for real reform, and make three major points:

The Commission did not adopt any of the standard legal or academic methods for uncovering and agreeing on basic facts. As a result, many Commission policy recommendations rest on demonstrably incorrect or unprovable propositions. The lack of fact finding severely hampered the Commission’s ability to discover workable recommendations, for instance;

The Commission asserts that coverage for all will assure medical care for all. Unlike in the U.S., in virtually all health systems that have government imposed coverage for all, shortages of care deny access to basic and advanced medical treatment. The Commission cannot even guarantee that its recommendation for an individual mandate will substantially reduce the number of uninsured. The Commission recommendation for required individual coverage applies only to legal residents of Colorado. A substantial portion of Colorado’s uninsured are illegal aliens;

The Commission states that an individual mandate is enforceable and will eliminate free care to the uninsured. In the only state with an individual mandate, 20 percent of the uninsured were exempted after less than 18 months of operation, and fewer people are voluntarily enrolling than predicted;

The Commission says that health care providers gave $777 million in uncompensated care in 2007. It implies that this is paid for by the privately insured and that spending $1.5 billion on a Medicaid expansion and $550 on insurance subsidies will make people better off by obviating the need for the $777 million in free care. In fact, the largest fraction of that uncompensated care is generated by Medicaid and Medicare.

Many of the most important Commission recommendations have either had no real world tests or have already failed in the real world; The public program expansions recommended by the Commission have not operated as advertised in Massachusetts, the state plan which the Commission recommendations mimic. After roughly 18 months of operation, the Massachusetts health reform is $245 million over its $470 million budget. About 20 percent of people signing up for free care are new, the rest were previously in public assistance programs. There is no way to know how many people are dropping private coverage to participate in the state plan.

The extension of community rating and guaranteed issue to Colorado’s individual insurance market is billed as a way to keep costs lower for those who have chronic conditions, and to make health insurance more widely available. This has not worked in New York, New Jersey, Massachusetts, and other states in which it has been tried. Instead, health insurance has become more expensive and more difficult to get. Private experimentation with new and innovative ways to provide health insurance and health care has been stopped. Colorado already guarantees health insurance to everyone, regardless of medical condition, via a state plan called Cover Colorado.

The Commission majority repeated voted against analyzing reform options that increase consumer choice and accountability in favor of plans that rely on government control As a result, it turned away from considering any of the consumer-directed options known to have improved quality and to have reduced health care costs.

The Colorado Consumer Directed Attendant Support program for Medicaid patients is an example of a Medicaid reform that has both reduced spending on attendants by 20 percent and improved patient care.

Innovative health insurance policies are showing that changes in policy structure can reduce spending and improve care. At Wendy’s International, shifting to a health savings account based consumer-directed plan decreased claims by 14 percent and overall costs, including deposits to employee HSA accounts, by 1 percent in 2005.

The Commission did not discuss reducing state regulations on insurers and health care providers. Professor Christopher Conover of Duke University estimates that excess regulation adds 10 percent to annual health care costs. Dr. Gorman and Mr. Jensen invite the public to closely examine the minority report they authored for further details, and for expanded information.

The full Minority Report can be found here. A related shorter article by Linda Gorman and Ari Armstrong in the January 30, 2008 Rocky Mountain News can be found here.