One Possible Solution for Our Health Care Woes

Exposing the Cost of Health Care
@ the Technology Review

Castlight aims to do as its name suggests: cast light on the actual costs of medical care, so that people can make informed decisions. The company, founded in 2008 by entrepreneurs Giovanni Colella and Todd Park, now chief innovation officer for the U.S. Department of Health and Human Services, offers computer-based tools that let people comparison shop for health care in much the same way they would for airline tickets on Travelocity or for cars on Cars.com.

What a genius idea! If traditional price signals were allowed to function in the health care market, genuine competition would one day force those prices to go down — and that would certainly benefit health care consumers.

Advertisements

A Serious Plan to Replace Obamacare

A Serious Plan to Replace Obamacare
@ The Washington Examiner

Ryan wants to change the government policies that insulate the health care consumer from nearly all costs, thus distorting incentives for doctors and patients alike. Price signals, a staple of any functioning free market, have been muffled in health care, where third parties (insurers and the government) pay roughly 88 percent of health care costs, up from 52 percent in 1960. Because patients don’t pay the bills, most of them have no idea how much services cost, let alone what they are worth. This leaves doctors and hospitals in a competitive vacuum where price and value bear little relation to one another.

Hey! I believe that’s what I said two weeks ago. Fancy that!

I also like Ryan’s suggestion that we untether health insurance from employment through a universal tax credit. People who don’t get benefits at work are getting screwed by the current system, so yes, we do need to fix that.

And PS: No, the Tea Party Audience Did NOT Cheer for the Death of the Uninsured

Take a look at the raw video posted here. There was no ovation. No widespread cheering. It was a couple of loudmouths who spoke without thinking.

And anyway, as I noted in my last post, the premise of Blitzer’s question was false. Everyone has access to care regardless of one’s ability to pay. If a young man totals his car and is brought to the nearest emergency room, he will be treated. That’s the law. The question of payment is broached much later — and often, the hospital will simply say, “Well, based on your financial situation, we’re going to forgive 75% of your expenses. As for the rest, let’s set up a payment plan you can afford.”

Again, this is an area in which the left’s penchant for blatant emotional manipulation really enrages me. I have been uninsured, and at no time during that period did any doctor turn me away. As a matter of fact, my rheumatologist charged me a discounted price for his services, a drug company gave me free medication, and after one hospital stay in 2006, the majority of my bills were covered by charity care. The medical community is not ghoulish. Most people go into medicine because they sincerely want to help people. 

In Which I Respond to One Question from Monday’s CNN/Tea Party Debate

BLITZER: Thank you, Governor. Before I get to Michele Bachmann, I want to just — you’re a physician, Ron Paul, so you’re a doctor. You know something about this subject. Let me ask you this hypothetical question.

A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy, I don’t need it. But something terrible happens, all of a sudden he needs it.

Who’s going to pay if he goes into a coma, for example? Who pays for that?

Ooh! I know the answer! Pick me!

Mr. Blitzer, many hospitals already offer charity care options to uninsured patients — particularly to those whose medical expenses are catastrophic in nature. Only in Psychotic Liberal Fantasy Land would the young man in your hypothetical situation be denied care and left to die.

Of course, the fact that hospitals in the U.S. have to eat the expenses incurred while caring for the indigent and uninsured does translate into higher costs for those who can pay their medical bills. After all, said hospitals do have to balance their checkbooks somehow. But no one has ever explained to my satisfaction how the individual mandate is going to circumvent this problem. When by force of law you obligate your citizens to purchase a service, you increase the demand for that service. When you increase the demand for a service, you increase the price of that service. Supply and demand — it’s not just a theory.

No — what will reduce the cost of health insurance is allowing people greater choice. It’s ludicrous that a young individual in particular should be forced to pay for an insurance plan that covers elective procedures and alternative therapies simply because his state mandates that coverage. Hell, if a guy is healthy and has a good job, he should be allowed to buy a dirt cheap plan that only covers the catastrophic accident/coma/brain cancer scenario.

Let’s let the healthy and reasonably affluent pay for their minor medical incidentals out-of-pocket. At the moment, the true cost of health care is invisible to many people. I suspect that most patients who are insured simply fork over their $20 co-pay and don’t give the matter any more thought. The result? Well, the price of health care – as experienced by the average insured consumer – is artificially capped, and we end up with a health care market that looks very much like the rental market in San Francisco under rent control. People go to the doctor too often for things that don’t really need a doctor’s input, just as some renters in San Francisco snatch up multiple apartments they don’t need just because they can. Consequently, the demand for medical care rises, and so do the costs. Economics 101.  

Obama’s Health Care Fables

Obama’s Fables Sell Health Care To The Gullible
by Michelle Malkin

The tall-tale-teller-in-chief cited mom Stanley Ann Dunham’s deathbed fight with her insurer several times over the years to support his successful push to ban pre-existing condition exclusions by insurers. In a typical recounting, Obama shared his personalized trauma in a 2008 debate:

“For my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”

But there was something fundamentally wrong with Obama’s story. In a recently published biography of Obama’s mother, author and New York Times reporter Janny Scott discovered that Dunham’s health insurer had in fact reimbursed her medical expenses with nary an objection. The actual coverage dispute centered on a separate disability insurance policy.

A White House spokesman insisted to the Times that the anecdote somehow still “speaks powerfully to the impact of pre-existing condition limits on insurance protection from health care costs” — though Dunham’s primary health insurer did everything it was supposed to do and met all its contractual obligations.

I’ve discovered that this kind of fibbing is pretty much a standard Democrat strategy in re: the health care debate. Remember the LJ explosion over Melissa Mia Hall’s recent death? The fact that Hall could’ve easily walked into a number of hospitals in the Fort Worth area and received care and financial aid completely escaped these leftists’ attention. Why tell the truth if it’s politically inconvenient?

Health Economics

What Paul Ryan’s Critics Don’t Know About Health Economics
by Alain Enthoven @ the Wall Street Journal

The Ryan plan isn’t perfect. It proposes that after 2021 the premium-support payments be indexed to the consumer price index, which grows at a lower rate than GDP. The feasibility of that proposal is debatable and negotiable. But instead of seeking common ground, Democrats immediately attacked the entire plan. We now face the kind of partisan brawl that absolutely turns off independent voters.

Personally, I think a growth rate as low as the consumer price index is probably unrealistic. But it is foolish to focus debate now on a formula that will not take effect until 2021. The premium-support payments in the next decade can be decided in the next decade, and reasonable people ought to sit down and work out a compromise.

A more pressing problem is that, in the face of unsustainable federal deficits, 10 years is too long to wait to start cutting costs. Congress should focus on implementing competition in Medicare sooner. The problem with just cutting hospital payments now is that hospitals will continue to shift costs onto private payers.

The 2010 health-care reform’s Independent Payment Advisory Board is unlikely to be effective. Appointed by the president, 15 experts with no financial ties to the health-care industry are supposed to dream up cost-cutting ideas that would go into effect unless overridden by a supermajority in Congress. But the reality is that most waste identification and cutting is local. These 15 central planners are unlikely to do as good a job as hundreds of doctors and managers in local delivery systems working with incentives to improve value for money for their enrolled members.

The IPAB, I feel, is the most problematic aspect of Obamacare. Once again, the Democrats have assumed that government bureaucrats can outperform a widely dispersed, systemic give-and-take regardless of all the history which indicates the contrary.

Liberals Are Innumerate

This post was edited the following morning to add more information.

Given the fact that leftists accept the WHO study mentioned in the last post as unassailable, cite the recent decline in the unemployment rate as proof that Obama’s policies are “working,” and fling around aggregate NAEP and SAT scores in their attempts to argue that Wisconsin governor Scott Walker is the ideological love child of Mubarak and Hitler, this is the only conclusion I can draw: liberals are innumerate. Whence came their data? They have no idea.

Take the unemployment rate, for example. Who counts as employed? Who counts as unemployed? According to the BLS, you pretty much count as employed if you have any job at all, whether it is full-time or part-time. As SABR Matt observes in a reply to one of my posts below, this means that the simple unemployment number doesn’t tell us who is under-employed. How many people have settled for part-time work despite credentials which qualify them for full-time work? How many are settling for less pay than they have received in the past because they have no other choice?

And who counts as unemployed? According to the BLS:

Persons are classified as unemployed if they do not have a job, have actively looked for work in the prior 4 weeks, and are currently available for work. Actively looking for work may consist of any of the following activities:

Contacting:
An employer directly or having a job interview
A public or private employment agency
Friends or relatives
A school or university employment center

Sending out resumes or filling out applications
Placing or answering advertisements
Checking union or professional registers
Some other means of active job search

Passive methods of job search do not have the potential to result in a job offer and therefore do not qualify as active job search methods. Examples of passive methods include attending a job training program or course, or merely reading about job openings that are posted in newspapers or on the Internet.

So it’s not simply a lack of a job that qualifies you as unemployed – you have to actually be looking for work to count. But what about those people who have been jobless so long that they’ve essentially given up? Well, the BLS has a third category for them – “Not in the Labor Force.” If you are not actively looking for work for any reason, you fall into this group.

We need to look now at what has been happening to the labor force participation rate:


Source: BLS

As you can see, over the past several years, it has been crashing precipitously. Almost certainly, this is in part because the “Baby Boomers” are starting to retire, but is there anything else that accounts for the decline? That’s another question we need to answer.

In addition to the commonly used unemployment rate, the BLS releases five alternative employment measures, including one that attempts to account for underemployment (U6). Here’s what has happened to those numbers over the past year:

  • U-1 Persons unemployed 15 weeks or longer, as a percent of the civilian labor force:5.8 5.7 5.6 5.5 5.3 5.3
  • U-2 Job losers and persons who completed temporary jobs, as a percent of the civilian labor force: 6.1 6.2 5.8 5.6 5.4 5.4
  • U-3 Total unemployed, as a percent of the civilian labor force (official unemployment rate): 9.7 9.8 9.4 9.0 8.9 8.8
  • U-4 Total unemployed plus discouraged workers, as a percent of the civilian labor force plus discouraged workers: 10.3 10.5 10.2 9.6 9.5 9.4
  • U-5 Total unemployed, plus discouraged workers, plus all other persons marginally attached to the labor force, as a percent of the civilian labor force plus all persons marginally attached to the labor force: 11.0 11.2 10.9 10.7 10.5 10.3
  • U-6 Total unemployed, plus all persons marginally attached to the labor force, plus total employed part time for economic reasons, as a percent of the civilian labor force plus all persons marginally attached to the labor force: 16.8 17.0 16.7 16.1 15.9 15.7

They all seem to be going down, which is good news. But again, the various unemployment rates don’t take into account our ballooning debts and their international context — and our shrinking labor pool should be a grave cause for concern given that we depend on that pool to fund things like Social Security.

In my experience, however, liberals consider contexts and nitty gritty details nothing but a bother to consider. Back when the Wisconsin battle was dominating the news cycle, a number of Facebook leftists – including a friend of mine who, frighteningly enough, is a professor – started passing around claims that states with weaker teachers unions (including those states – like Virginia – which have outlawed collective bargaining) have lower SAT/ACT and NAEP scores. When I jumped in to remind the aforementioned professor that correlation does not equal causation and that aggregate scores tell us virtually nothing because each state has a different socioeconomic composition, he dismissed my comment as a “Fox News phrase” and continued to insist that states with powerful teachers unions do better. His sheer arrogance left me utterly gobsmacked. Someone that ill-acquainted with elementary statistics is not justified in billing himself as an intelligent member of the “reality-based community,” and quite frankly, I fear for the education of the students under his charge.

Left’s Case for Socialized Health Care Based on Bogus Stats

In my travels, I have frequently run into the claim that America is doing worse than other industrialized nations when it comes to our health care. Our political opponents often state, for example, that even though we spend more on health care as a nation, our life expectancies are lower – and they wield such numbers like bludgeons in their war to remake our entire health care system.

If, like me, you need ammunition to take down leftist pro-single-payer shibboleths – and if you have $5 to spare – I recommend reading Commentary‘s devastating critique of the WHO study upon which much of the left’s case is based:

The Worst Study Ever?

World Health Report 2000 was an intellectual fraud of historic consequence—a profoundly deceptive document that is only marginally a measure of health-care performance at all. The report’s true achievement was to rank countries according to their alignment with a specific political and economic ideal—socialized medicine—and then claim it was an objective measure of “quality.”

WHO researchers divided aspects of health care into subjective categories and tailored the definitions to suit their political aims. They allowed fundamental flaws in methodology, large margins of error in data, and overt bias in data analysis, and then offered conclusions despite enormous gaps in the data they did have. The flaws in the report’s approach, flaws that thoroughly undermine the legitimacy of the WHO rankings, have been repeatedly exposed in peer-reviewed literature by academic experts who have examined the study in detail. Their analysis made clear that the study’s failings were plain from the outset and remain patently obvious today; but they went unnoticed, unmentioned, and unexamined by many because World Health Report 2000 was so politically useful. This object lesson in the ideological misuse of politicized statistics should serve as a cautionary tale for all policymakers and all lay people who are inclined to accept on faith the results reported in studies by prestigious international bodies.

As it turns out, the aforementioned life expectancy stats include deaths due to homicides and car crashes in addition to deaths due to natural disease — because, of course, it is totally reasonable to believe that the best health care system in the world should be able to put a poor shooting victim’s brains back in his skull and re-animate, Frankenstein style, his cooling corpse.

Single Issues that Define Presidents

I think a simple way of determining whether a president should be viewed kindly or with scorn…whether they were effective leaders or not…is to figure out what the people think of when they think of a president – what one issue do they tie to each man on the international front…and on the economic front?

For example, if you go back and look at poll results from the last six presidents…you’ll find that it looks something like this (name: national issue / international issue):

Jimmy Carter: Tax hikes and the rise of entitlement spending / Energy Crisis
Reagan: Trickle-down Economics / The downfall of Communist Russia
Bush Sr: Read my lips (oops) / Desert Storm
Clinton: Balanced Budget (including Welfare Reform) / Kosovo and Milosovich
Dubya: No Child Left Behind and Education Vouchers / Operational Iraqi Freedom and the War on Terror
Obama: Obamacare / …um…I guess he’ll be defined by his dealings with Egypt?

On this spectrum…do we see anything that is an unquestionable good thing?

Reagan’s destruction of Russia (granted…this was on the back of other presidents and following a course first laid out by Truman)…his successful negotiation of the international waters…should be considered a fantastic victory. Clinton’s reform of the budget was also a great victory by modern standards. I’m not just singling out GOP leaders here…I think Clinton’s economic policy was well informed…I actually think that, on the whole, he did a very good job listening to the GOP controlled House Appropriations and Senate Appropriations committees and putting sensible measures in place to fix the budget. It got broken again later, but for a short time…he did something really well.

Are there any unquestioned failures on that list?

Well, whether you think OIF was justified or not, I think we can all agree that Bush Jr. was a diplomatic failure…that he couldn’t convince the western governments of the threat posed by dictators who kill hundreds of thousands of their own people speaks to his poor communication skill. And what’s worse…that he began OIF with a tremendous public support that vanished a year later because the war was run so poorly speaks to his failure as a strategist and his failure to convince his own people that this war was just.

I would also declare Carter’s economic policies an unquestioned failure. The energy crisis was almost entirely his fault with his idiotic price controls. His high tax rates whipped Americans into a sense of frustration and hopelessness that only Reagan could break. Well…that and the 1980 US Olympic Hockey Team.

And I think we can generally agree that Bush Sr. was a LOUSY economist, unlike Reagan.

And then we come to Obamacare…the bill sponsored by a man so vain and egotistical that it had to carry his name. The bill that may be about to be declared unconstitutional by the Supreme Court…it’ll be a close vote (and that, by itself, is a bad sign…LOL). The bill that has already been voted down by a new Congress. The bill that currently has an approval rating of 28%. OUCH!

It’s too early to declare it an UNQUESTIONED failure…but it will be quite a statement if Obama’s first term is marked only by a bill that turns out to be as big a failure as it currently appears. And an even bigger statement if that bill continues to bear his name into history. Some would call that the very definition of failure as a leader and as a man. Maybe they should change that annoying Google link between George W. Bush and failure.

On Being Catholic & Politically Conservative

Sub Spike not-so-subtly requested over email that I comment on the following WaPo editorial (and because he is my father, I shall oblige him):

Catholic Republicans’ political beliefs, challenged by their faith
by Michael Gerson

The Catholic tradition asserts the necessity of limited government. The establishment of justice and acts of compassion should be done at the lowest, most human levels of society, instead of by distant, centralized bureaus – a perspective fully consistent with the designs of America’s founders. But gaps in the justice and compassion of a society require government intervention to secure the common good, which is not common until it includes the poor, the immigrant, the sick, the disabled, the unborn. Catholic teaching elevates the primary importance of families, charities and strong communities – while rejecting the simplistic notion that such institutions render government unnecessary. In determining the proper balance between civil society and government, there is much room for political debate. But the search for that balance is a source of sanity in our political life, involving the rejection of both collectivist and libertarian utopias.

So how will Catholic Republicans respond to these arguments? The U.S. Conference of Catholic Bishops, after all, has no canonical standing, just a moral authority that has been recently diminished by scandal.

But there will probably come a point when red lines get crossed and Catholic and other religious leaders declare: Contempt for immigrants, even illegal immigrants, is not a moral option. Or, cutting AIDS and malaria funding violates pro-life principles. Or, health-care repeal without a serious alternative is not responsible.

At that moment, one hopes, the faith of politicians has sunk deeper than the skin – and that they will be less nasty than they otherwise would have been.

Gerson is basically right about Catholic teaching. That’s why you will never see me espouse the kind of radical libertarianism which declares that government is good for nothing but mustering a police force. I don’t object to the existence of a basic social safety net.

Where Gerson goes wrong, I think, is in his assumptions about the Tea Party movement. There are hardcore libertarians and militia members who attend Tea Party rallies, but I think most Tea Partiers are just like me. They’re not opposed to government full stop. They are opposed to the bloated and wasteful government supported by Obama and his coterie of followers in the Congress.

The paragraph I highlighted above reveals Gerson’s incorrect interpretation of the Tea Party movement most distinctly. When he declares, for example, that contempt for illegal immigrants is not a moral option, he simultaneously implies that we Tea Partiers are guilty of such contempt. In my case at least, the exact opposite is the case. I believe we should curb illegal immigration not because I hate Latin Americans, but because I care for them.

Allow me to expand upon my last statement: Because our immigration laws have been imperfectly enforced – and because we have backed away from assimilating new-comers – we have now within the United States a virtually permanent underclass of unskilled laborers. Because these laborers live off the grid, they are extremely vulnerable to exploitation — and more often than not, this wretched status is passed down to these laborers’ children. I have personally worked with Hispanic adults who failed to get even an elementary education even though they were born and raised in the U.S.. That is how stratified our society has become.

Amnesty advocates claim that simply declaring these laborers legal residents after the fact will correct this pervasive injustice, but amnesty does nothing to bring such people into the true mainstream — and it certainly doesn’t ameliorate the dangers of the illegal entry itself. (“Oh, yes. We can get you over the border — if you agree to work as a sex slave.”) If, on the other hand, we insist that people have their documents in order before they cross our border, there is, in my conservative opinion, a far greater chance that we can protect them from abuse.

Thus, to summarize: I believe we should enforce our immigration laws because their lack of enforcement has resulted in more social injustice, not less.

Gerson is also wrong to imply that we conservatives wish to repeal Obamacare without proposing any “serious alternatives”. At the same time Congressional Republicans decided to vote for repeal, they also put together a committee whose very mission is to come up with alternatives. Just because you personally don’t consider free market solutions to be “serious” doesn’t mean they aren’t, Mr. Gerson. Be careful not to present your opinion as an objective fact.

In general, I’ve experienced very little substantive conflict between my political beliefs and my Catholic beliefs. I am perhaps a bit more hawkish than our current or previous pope, but the Catholic principle of subsidiarity and the Church’s consistently fierce denunciations of both Communism and secular humanism make me quite confident that I am sitting in the right political camp. What I find most challenging as a conservative Catholic is keeping a Christian tone. Because I am, shall we say, a young woman of passion (heh), I find the nastiness of our political discourse to be a constant source of temptation. My first urge is always to punch back when I feel I’ve been wronged; Jesus’ admonition to turn the other cheek is, for me, a very difficult thing to put into practice — particularly on the faceless medium that is the Internet.