For Better Health, Repeal Political Controls

My wife and I pay $132 per month total for high-deductible health insurance, hundreds of dollars less than we would pay for comprehensive insurance. Our goal is to never need to make an insurance claim. We pay for all of our routine medical care -- doctor visits, eye glasses, dental work, prescriptions -- out of pocket, and we like it that way.

Our medical expenses come out of our Health Savings Account (HSA), which means that it's all pre-tax money. Unfortunately for us, various enemies of HSAs have been trying to undermine them at the national level.

By paying less for high-deductible insurance, we've been able to pay off debts faster and prepare for a family, something that has been difficult given our high tax burdens.

If Colorado wants to keep and attract young working families, the legislature ought not further muck up health insurance by loading in a bunch of new expensive mandates, Nor should the legislature require such couples to further subsidize others through higher taxes and/or insurance premiums.

If the legislature wants to make health insurance more affordable for more people, it should repeal existing political controls that have driven up insurance costs and priced some people out of the market.

However, we should realize that the broader problem with health insurance is that, because of federal tax policy, most insurance is tied to one's job. Lose your job, lose your insurance. Because of the tax benefits of "paying" people with insurance coverage, such insurance is really pre-paid medical care that discourages economic provision and consumption of health care.

Our society has largely forgotten the proper purpose of insurance when it comes to health. Most people remain healthy into middle age, when risks for various diseases start to increase. Through insurance, we voluntarily pool our resources to pay for the care of the few who get unlucky. If federal policy had not driven health insurance off track, we'd buy insurance when we're young at a low rate and keep the same policy long-term, and we'd also pay for routine and expected expenses directly, which would encourage healthy competition.

All of the commonly cited problems with medicine have been caused by decades of political intervention in medicine. For details, see "Moral Health Care vs. 'Universal Health Care'," by Lin Zinser and Paul Hsieh, MD, at WeStandFirm.org.

Yet, rather than act to repeal the controls that are the cause of the problems, many of today's politicians want to impose still more controls. If they succeed, the result will be worse health care that costs even more.

Here in Colorado, the legislature has considered everything but repealing the controls that are the cause of the problems. In 2006, then-Governor Bill Owens signed into law Senate Bill 208 to create the Blue Ribbon Commission for Healthcare Reform. That commission rejected the only free-market proposal and recommended such measures as massively expanded taxes and forcing everybody to buy insurance. The Commission's recommendations basically went nowhere.

But apparently one failed commission deserves another, so State Senator Bob Hagedorn is currently pushing Bill 217. If the bill passes, later this year Governor Bill Ritter will appoint "a panel of expert advisors" to come up with a bunch of new political controls for the legislature to consider in the future.

Originally, the bill encouraged the "panel of experts" to assume that all Coloradans would be forced to purchase politician-approved health insurance. The amended bill lists that only as an option.

Forcing people to buy insurance would cause two basic problems. First, you can't force somebody to buy something they can't afford, so any such plan must accompany massive tax hikes and subsidies. Second, once politicians force you to buy something, special-interest groups will constantly fight to include their pet service as part of the forced package, whether you want it or not. The result will be continual pressure to expand the scope of the forced insurance and make it ever more costly.

Much of the bill describes the creation of politician-approved "value benefit plans" for health insurance that would be subject to a variety of restrictions and substantially subsidized through taxes.

Yet consumers and providers have the right to decide through voluntary exchange what plans constitute a value to them. We don't need a new bureaucratic commission; we need liberty.

Ari Armstrong, a guest writer for the Independence Institute, blogs at FreeColorado.com.

Labels: CO, Insurance, OpEd, States

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Mandate repeats mistakes of other states

With Senate Bill 217, which has passed the Colorado Senate and awaits House action, state lawmakers who believe that higher taxes and more spending constitute health care reform have sunk to new depths of legislative trickery.

If SB217 passes, the basic laws that created the failing Massachusetts health care plan could take effect in Colorado in as little as 24 months. Sponsored by Sen. Bob Hagedorn, D-Aurora, and Rep. Anne McGihon, D-Denver, the bill creates a politically appointed panel to create a set of recommendations for rules governing Colorado health care. The rules prepare the way for the panel to recommend that every individual in Colorado purchase state-defined "credible" health insurance. State tax law would "enforce the requirement."

Because even legislators know they cannot force people who have no money to buy health insurance, the panel likely will move to create a subsidy program to "assist low-income individuals and families in paying the premium costs for health insurance."

Judging from the recommendations of the Colorado Blue Ribbon Commission on Health Care Reform, this is an expensive proposition.

The commission recommended that families of four making up to $84,800 be eligible for low-income subsidies that would increase state spending by an estimated $2.3 billion. In a blow to those who peddle individual mandates as a way for the insured to save money, it estimated the subsidies would save about $777 million in spending on the uninsured.

SB217 creates a Connector program, "health marts" "through which an individual eligible for the state subsidy may select" one of the state designed "Value Benefit Plans (VBP)." The health insurance offered through VBPs would be designed by a government committee.

People who would buy "Value Benefit Plans" insurance would have to pay with their premium dollars for some odd things, like "educational materials" that show people how to use the Internet to get health information.

The Hagedorn-McGihon bill envisions prohibiting these plans from helping people to save money on health insurance premiums by paying cash for routine preventive care. It seeks to mandate preventive care and an unspecified grab-bag of wellness programs. The plans also would "encourage" insurers to use a "pay-for-performance system for reimbursing health care providers" and "evidence-based medicine."

Pay-for-performance measures may not be safe for patients.

Experts at a 2001 American Society of Transplantation conference were so concerned about the effects of forced switching from brand name to generic immunosuppressive drugs that they called for patients to be taught to inform their physicians of any switch to or among generic alternatives.

Meanwhile, the pay-for-performance program at Blue Cross Blue Shield of Michigan paid physicians $100 to switch patients from brand name drugs to generics.

SB217 contemplates the Colorado panel finding "a dedicated source of revenue" to support the new programs. But it also says the new revenues may be spent on "the premium subsidy program or other new state costs," so this dedication is a smoke screen. In practice, the new revenues will fund whatever the Legislature fancies. If the governor agrees with the expert recommendations, and he will, SB217 would require that they be submitted to the Legislature on the "third legislative day" of the 2010 session. They then would pass through the Legislature like grass through a goose. People in favor of tax and spend health care reform know that the more voters know the less they like tax and spend reform. Speedy passage limits public debate.

Speedy passage reduces the possibility that people might find out that individual mandates are failing in Massachusetts, where about 20 percent of the uninsured already have been exempted because buying insurance costs them too much. They might be reminded that insurance is not health care, especially when Massachusetts controls costs by cutting payments to doctors, creating a shortage of doctors in the program and ridiculously long waits for care.

They might also be reminded that government officials routinely understate program costs. When campaigning for the Massachusetts plan, then-Gov. Mitt Romney said it would cost $125 million. After it passed in April 2006, his administration issued bonding documents estimating costs at $276 million. As of January 2008, Massachusetts Gov. Deval Patrick was requesting $869 million to cover estimated 2009 costs. (Seven times the original estimate!)

Like Gov. Romney on costs, Colorado politicians mislead the public by saying there will be no mandates this year. In February, Sen. Hagedorn reportedly told the Rocky Mountain News, "There's no mandates coming down this session, pure and simple."

Sen. Hagedorn must have changed his mind in the last two months. He undoubtedly knows his bill contains a program that will impose a health insurance mandate in 2010.

By hiding under an expert panel subject to gubernatorial approval two years from now, he gets to have his mandate and deny it, too.

Linda Gorman is director of the Health Care Policy Center for the Independence Institute, a free-market think tank in Golden. She co-authored the minority report of Colorado's 208 Commission on Health Care Reform.

Labels: CO, Insurance, OpEd, States

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Making Up Medicaid Cuts
Families USA Is At It Again

By Linda Gorman

If Families USA were a newspaper, it would be a supermarket tabloid carrying articles about alien abductions. Its latest campaign is a series of press releases screaming that states will lose thousands of jobs and zillions of dollars due to the Bush Administration Medicaid cuts.

Local newspapers in Colorado are repeating the Families USA press release almost verbatim.

If you are in a tax and spend health care reform haven, you may soon be seeing quotes from the Families USA director, Ron Pollack, saying things like "These cuts in federal Medicaid payments will have a ripple effect through state economies that are already struggling during this economic downturn."

In fact, as the Heritage Foundation's Nina Owcharenko explains, the Bush Administration has not proposed Medicaid budget cuts. Its FY 2009 budget proposal increases Medicaid spending by $12 to $13 billion over expected spending in FY 2008. This is in addition to FY 2005-2007 spending increases of about 10 percent. What the Bush Administration is proposing is a slightly smaller budget increase, about 7.1 percent rather than 7.4 percent. The 2009 budget numbers are available from the federal government here on page 61.

If Families USA and its fellow travelers were a real family making $50,000 a year, these budget numbers would be the equivalent of having an expected windfall of $53,700 reduced to $53,550. This small reduction in the rate of federal spending will, the people of Colorado are being told, cost Colorado "more than 3,500 jobs and an accompanying $135 million in wages," a neat trick given that Colorado is not an entity and does not earn wages.

If a newspaper in your area reproduces this nonsense, perhaps it should be politely reminded Families USA is known for approaching health care with a well defined ideological slant and for producing lousy numbers on all manner of health care issues. It might also be asked to check before reproducing Families USA press releases as news.

Labels: Medicaid, OpEd

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Flawed health-care study poses own risks

...While it is almost certainly true that, all things being equal, it is better to be insured than uninsured, a greater danger is that this deeply flawed study will stampede policy-makers into taking action that will put far more Coloradans at risk.

The Families USA study was not a traditional "double blind" experiment with a control group and a treatment group. Rather, it is a retrospective analysis, which compared the rates of people who died with insurance to those who died without insurance. Since the proportion of people without insurance seemed to be higher than those with insurance, they extrapolated likelihood to project excess deaths due to lack of insurance. But there are just too many outside variables to make such interpretations valid.

...Similarly, a study published in The New England Journal of Medicine last year found that, while far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

Of course this does not mean we should be indifferent to efforts to try to expand insurance coverage. We all want more Coloradans to be insured. However, Families USA's call for greater government control of our health-care system is a cure far worse than the disease.

One thing we know for certain is that government-run health-care systems frequently deny critical procedures to patients who need them. For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. And in Canada, more than 800,000 patients are currently on waiting lists for medical procedures. According to Canada's Supreme Court, many of these individuals suffer chronic pain and some will die awaiting the treatment they've been promised.

Even in this country, excessive government regulations on health care cost lives. A study by Christopher J. Conover with the Center for Health Policy, Law and Management in the Terry Sanford Institute of Public Policy at Duke University found that as many as 22,000 Americans die each year from the costs associated with excess regulation.

Indeed, if Families USA is truly concerned with expanding the number of Coloradans with health insurance, they might start by attacking some of those regulations that make health insurance so expensive...

Labels: Analysis, Insurance, OpEd

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Universal health care is the wrong prescription

By BRIAN SCHWARTZ
INDEPENDENCE INSTITUTE

What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" - from Hillary, Obama, to 2nd Congressional Democratic candidate Jared Polis - don't get this.

"Universal health care" is false advertising for politically controlled medicine, with government as the "single payer" monopolistic insurer. But having coverage does not guarantee getting medical care.

Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price.

To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.

The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became "medically unfit for surgery." The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died."

"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early . . . or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."

"Access to a waiting list is not access to health care," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year, a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."

And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times claims that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug."

A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." Another article says that "doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives."

Consider politically controlled health care in America: Medicaid and Medicare.

Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients. Increasing reimbursement rates won’t help much; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

ABC News says that "Medicare rules bar cancer drugs for patients," including the privately insured.

"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to health care, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.

What really matters is your chance of surviving a serious illness. The American Cancer Society claims that "U.S. patients have better survival rates than European patients for most types of cancer."

So if politically controlled medicine isn’t the solution, what is? Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically defined insurance.

The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?

Instead, we must recognize how government policies have crippled free markets.

Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single payer" it's even worse: To change insurance providers you must move to a different state or country.

Our current system also encourages thoughtless over-consumption and skyrocketing costs.

The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.

Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy.

Some Colorado legislators recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.

While "universal health care" may provide health insurance, it doesn't guarantee health care. The uninsured are not the problem, but the symptom of the real problem - government meddling in personal choices of how we care for ourselves and our families.

Brian Schwartz, an optical engineer in Boulder, is a guest author for the Independence Institute. His free-market proposal to the Blue Ribbon Commission is at WhoOwns You.org.

Labels: Canada, CO, Insurance, MA, Medicaid, Medicare, OpEd, UK

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NO INSURANCE; BREAK THE LAW

It's the grand prize of politics. Fix health care and be a rock star. Unfortunately, some things can't be fixed at the Capitol. But that's a memo state politicians refuse to read.

Both parties in the Colorado General Assembly are gleefully pushing a Senate bill they've called a bipartisan blueprint for universal health insurance, setting a goal of health care for all by 2010. Shockingly, Republicans seem as overjoyed as Democrats regarding the most overreaching and frightening bill to pass through Denver in years.

The bill, a brainchild of Sen. Bob Hagedorn, D-Aurora, is patterned after the Massachusetts health care program, signed into law by former Gov. Mitt Romney, a Republican.

Most notably, the Hagedorn plan would make it a crime for anyone in Colorado to choose against purchasing health insurance. Those who don't buy insurance would be penalized on their taxes, and subjected to other nasty sanctions of the state. It's a bit like addressing the homeless problem with a mandate that every human buy a house, or else suffer financial punishment. Imagine if there were only so many houses to go around, and every living being was required to buy one. It's a supply and demand nightmare scenario, and the health care proposal isn't much different.

In an effort to make the bill sound something less than insane, legislators will direct the Department of Health Care Policy and Financing, along with the Division of Insurance, to develop a new bare-bones health insurance package that offers something less than comprehensive coverage. That's to make us believe the program won't over-burden the health care system.

Mandatory health insurance will be a disaster, just like the program in Massachusetts. The system of Romney & Co. has resulted in higher health care costs, lower quality health care, major rationing, and a looming exodus of doctors from Massachusetts. Patients sometimes wait months to see a doctor, because everyone's entitled to consume health care now. Some residents can't find doctors accepting new patients at all, even though they're forced to pay for insurance.

The problem with health care is one of supply and demand and controls that interfere. There's more demand than supply, and that's why the price goes up. Legislators, by mandating health care coverage, will only increase demand on a system that's already unable to keep up for a variety of reasons, most of them regulatory. Hagedorn knows his bill has problems, but he feels compelled to save the day.

"The alternative to this bill is to do nothing, and I don't find that acceptable," Hagedorn said, as quoted in the Denver Post.

Mr. Hagedorn, please do nothing. It's the best thing you can do. The problems with health care have resulted from too much interference from politicians, not too little. You can't fix the system, and you'll only make it worse.

Labels: CO, Insurance, OpEd, States

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Latest health reform will backfire
By Mark Hillman

Samuel Johnson called second marriages "the triumph of hope over experience." The same might be said for the latest health-care reform bill at the state Capitol.

For more than 20 years, crusading politicians have promised to deliver better health care to more people for less money simply by saying "make it so." With rare exceptions, the resulting legislation exacerbates economic distortions, makes insurance impractically expensive, drives insurers out of the state, and creates worse problems than originally existed.

Senate Bill 217, which the Rocky Mountain News inexplicably endorsed on April 6 ("Health-care reform for grown-ups"), seems to be a desperate attempt to "do something" without a game plan. What it does best is to create case studies in irony, hubris and cognitive dissonance.

At times, the bill's sponsors sound frenetic in their urgency, as when they propose to declare in state law: "Colorado cannot wait to address the current problems related to the delivery of affordable health care!" (Conspicuously absent exclamation point added.) Other provisions of the bill do not convey the same urgency. For example, the governor is instructed to appoint "a panel of experts" - yes, another blue-ribbon commission - to help craft a reform plan that could lead to substantive legislation not this year, or next year, but in 2010.

Elsewhere, it appears that the bill's sponsors never recognized that many of their objectives are irreconcilable. In calling for health insurance companies to design "value benefit plans" to provide a low-cost insurance alternative, the bill says that the state "shall not specify benefits or other details" of those plans. Just two paragraphs later, however, the bill stipulates a dozen mandated benefits or other details that value benefit plans must include.

Essentially, insurers are prohibited from proposing anything that's remotely innovative. They are commanded not to "interfere with the existing small-group market" but are locked into the same rating criteria that has devastated that market for most of the last decade.

Colorado's small-group market is verging on a "death spiral" - the point at which it is so overpriced and overregulated that anyone who is healthy enough to obtain insurance elsewhere has fled, leaving a pool that is disproportionately sick, aging and expensive.

Since 1998 when 536,367 people were insured through employers of 50 or less, the small-group market has suffered a mass exodus, largely due to well-intended but economically unreasonable price-fixing schemes imposed by the legislature.

By 2005 the state's population had grown by 16 percent, but the small-group market withered by 33 percent, covering just 358,264 insured lives.

If insanity is "doing the same thing over and over but expecting different results," then legislators need to own up to their own psychosis. Lowering health-care costs isn't as simple as passing a law demanding more for less.

If it were, Colorado wouldn't have the seventh-highest insurance premiums in the nation.

Legislators should permanently loosen the rating handcuffs, forcing insurers to compete for business, and repeal the mandates that have driven costs through the roof. Absent the courage to do that, they could at least allow insurers to propose choices that are popular and less expensive in other states.

SB 217 does change the existing health-care market in one dramatic respect, by signaling to insurance companies that state government is ready to force its incorrigible citizens to buy health insurance, even if it's unaffordable.

The bill calls for "a requirement that all Coloradans obtain health insurance either individually or through their employer" and provides for enforcement "though the state tax laws."

Rather than allow insurers to offer new choices or allow consumers to obtain coverage across state lines where Colorado's draconian regulations aren't strangling the market, legislators prefer to penalize taxpayers for the audacity of refusing to buy insurance that costs too much.

Even California Democrats recently figured out that it's wrong to tell working families to buy something they cannot afford just because government says so, joining Republicans to kill a heavy-handed mandate proposed by Gov. Arnold Schwarzenegger.

Economist Thomas Sowell has said, "The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics." Unfortunately, Colorado politicians seem determined to again disregard sound economics and stick consumers with the cost of their political promises.

Mark Hillman (markhillman. com) served as majority leader of the Colorado Senate.

Labels: CO, Insurance, OpEd

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The budget: An "immoral document"

A "moral document." This is what Colorado House Democrats called their budget ("State budget clears House,: March 27), which expands government-run children's health insurance. This moral grandstanding is typical of the anointed, who support expanding Medicaid and the State Children's Health Insurance Program (SCHIP) — and it’s nonsense. There's no compassion or virtue in spending other people's money taken by force.

If a thug forces you to donate to charity, does that make either you or the thug virtuous or compassionate? What if this charity unfairly competes with voluntary charities, fosters dependency of recipients, encourages people to stop buying private insurance, and is run by a government that makes insurance expensive in the first place? All of these apply to Medicaid and SCHIP, which are government-run charities.

Advocating for government-run charities doesn't make one compassionate, as there's no compassion in forcing others to comply with another's notion of virtue. Unlike voluntary charities, not "donating" to a government charity through taxes lands you in prison.

Compulsory donations to government charities are unfair to voluntary charities. Every dollar the state extorts from taxpayers for SCHIP or Medicaid is one less dollar for a voluntary charity.

Forced giving is also disrespectful and intolerant. By forcing us to fund causes others think are important, it thwarts our freedom of expression and ability to support causes we judge to be worthwhile.

Unlike government charities, voluntary charities have strong incentives to be effective. Since they compete with other charities for donations, they must convince potential donors that their cause is worthwhile. Government charities need not persuade.

We know the cost of not "donating": prison.

If each Colorado adult funded Medicaid and SCHIP equally, we’d each pay almost $1000 per year. If you had $1000 to donate to a medical charity, which would you choose? Would you choose SCHIP, or a voluntary charity like Rocky Mountain Youth Clinics, which provides primary care to infants, kids, and teens?

Might SCHIP or Medicaid deserve your donations? Downloading Cato Institute studies "Sinking SCHIP" and "Medicaid's Unseen Costs" could provide guidance. SCHIP covers non-needy families: more than half of eligible children already have private insurance. The National Bureau of Economic Research reports that "For every 100 children who are enrolled in public insurance, 60 children lose private insurance."

Both Medicaid and SCHIP ensnare recipients in a low-wage trap: aversion to seeking higher-paying jobs for fear of losing "benefits." This keeps people on their backs and dependent on government, instead of being independent and self-sufficient. As "entitlement" programs, they send adults the message that they are entitled to have children — even if they cannot afford to raise them.

Too bad you have no choice; it's your hard-earned income after all. But government could provide such choice — by allowing its programs to compete more fairly with voluntary charities. One method is a dollar-for-dollar tax credit for donations to non-government charities that assist families with the medical and insurance expenses.

Taxpayers who prefer Medicaid and SCHIP to non-government charities can continue to fund them. The threat of lost tax revenue would give Medicaid and SCHIP strong incentive to effectively and efficiently assist families in need and foster their independence.

Empowering taxpayers to choose allows for true compassion, which is absent when we are forced to give. Taxpayers could compare non-profits with tools like Charity Navigator and GuideStar.org. GuideStar envisions "an increasingly efficient nonprofit marketplace where donors seek out and compare charities, monitor their performances, and give with greater confidence; nonprofit organizations pursue more effective operating practices, embrace greater accountability, and enjoy lower fund-raising costs; and society benefits from a more efficient, generous and well-targeted allocation of resources to the nonprofit sector."

So drop the "you're a bad person for opposing government charity" rhetoric and rise to this challenge: If Medicaid and SCHIP are so good, why not let them compete fairly with other charities, and let individual taxpayers decide for themselves?

Brian T. Schwartz, Ph.D., submitted the free-market proposal to the Blue Ribbon Commission on Healthcare Reform.

Labels: CO, Medicaid, OpEd

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Battered, not broken
Health system doesn't need more government

As was expected after Sen. John McCain locked up the Republican presidential nomination, media attention has shifted to the Democrats. Recent coverage has focused on whether Florida and Michigan would have new Democratic primaries, Sen. Barack Obama's troubles with his racist minister and the release of Sen. Hillary Clinton's White House papers. It's difficult to remember back to the days of the debates, when commentators would spend hours examining every little difference in the candidates' health care plans. Those plans might not be the lead story in the paper every day, but it's important voters don't forget they're out there.

Both Democratic candidates insist our health care system is broken and a little tinkering around the edges isn't going to bring about the necessary changes. Not surprising, each has a plan to revamp major portions of the U.S. system in an effort ensure every American has health care.

Neither candidate is proposing a National Health Service similar to what England has. That's good, because that system might make health care available to all in theory, but the reality is much different. All Britons are covered by the system, but getting in to see the doctor can mean waiting in line - for weeks. And rationing care is common, according to a Cato Institute policy analysis.

Those with serious conditions and those with diseases that are costly to treat are often shunted aside because of a lack of resources. The Cato analysis cites a London Observer report that said many colon cancer patients (almost 20 percent) who were considered treatable when diagnosed were forced to wait so long for treatment that by the time it was available, their cancer had progressed to the point it was incurable. Efficient, popular hospitals are forced by the government to institute mandatory waits of up to four months so they are not swamped with patients and run out of resources too soon. Democratic candidates aren't pushing such a plan, but activists such as Michael Moore like to trumpet the British program.

What the candidates are proposing, however, is more government intrusion and control of our health care system than what we have now.

The Cato report examined health care systems around the world that have more government involvement than ours, many of which are held up as examples of what our system could be. Cato found that in nearly all cases, after many years of government mandates and control, nations are loosening the reins and allowing more types of market-based policies to address the shortfalls of their health delivery systems.

This, of course, is lost on those in this country who wish to use government to force medical providers to care for everyone. Supporters of such action often cite World Health Organization statistics that rank the United States' health system far down the list of nations. They then use these statistics to argue for more government involvement in health care because, they say, the free market has failed to provide care for everyone. A Cato briefing paper says that's not surprising.

"To use the existing WHO rankings to justify more government involvement in health care is to engage in circular reasoning because the rankings are designed in a manner that favors greater government involvement," it said in the February paper. WHO rankings include variables outside the purview of a nation's health system, so the rankings can't be taken at face value.

When high-ranking officials in foreign governments need serious medical attention, they come to the United States. Doctors from around the world come here to have access to the best medical equipment available. That's because, in spite of the problems our system does have, it's still one of the best available. Pushing it toward more government involvement won't improve the situation. What we need is less government, not more.

Labels: OpEd

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"Universal" Health Care Kills

What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" — from Hillary, Obama, to Colorado congressional candidate Jared Polis — don't get this.

"Universal health care" is false advertising for politically-controlled medicine, with government as the "single-payer" monopolistic insurer. But having coverage does not guarantee getting medical care.

Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price. To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.

The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became "medically unfit for surgery." The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died."

This week the Globe and Mail reported that:

Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.

She sought treatment in the United States, as do Canadians in need of intensive care and emergency cardiac care.

"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early... or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."

"Access to a waiting list is not access to healthcare," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."

And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times reports that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug." A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." "Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives," reports another article.

Consider politically-controlled health care in America: Medicaid and Medicare. Doctors are five times more likely to refuse seeing new Medicaid patients than privately-insured patients. Increasing reimbursement rates won't help much; more than two-thirds of doctors reported being overwhelmed by Medicaid’s billing requirements, paperwork, and delays in payment.

ABC News reports that "Medicare rules bar cancer drugs for patients," including the privately-insured. As the population ages and Medicare costs continue to increase, Medicare may further restrict patients and doctors.

"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to healthcare, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.

What really matters is your chance of surviving a serious illness. The American Cancer Society reported that "U.S. patients have better survival rates than European patients for most types of cancer."

So if politically-controlled medicine isn't the solution, what is?

Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically-defined insurance.

The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?

Instead, we must recognize how government policies have crippled free markets.

Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single-payer" it's even worse: to change insurance providers you must move to a different state or country.

Our current system also encourages thoughtless over-consumption and skyrocketing costs. The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.

Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. Sponsors of Colorado House Bill 08-1327 recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.

So remember, the uninsured aren't the problem, but a symptom of political meddling in our most important personal choices.

Labels: Canada, CO, Countries, MA, OpEd, States, UK

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The coming debate over health care

No matter who wins the Democratic presidential nomination, that candidate will have a significantly different prescription for the nation's health-care system than Sen. John McCain, the Republican nominee. Which is a good thing, since that means the country is in for a debate involving real substance.

Both parties agree that "the health system needs major repairs," reports Kevin Sack in a recent analysis of the candidates' proposals by The New York Times. As Sack noted, the Democrats are more interested in universal coverage, while the Republicans focus on cost containment.

Those may be the points of emphasis, but McCain wants expanded access, too, while Barack Obama and Hillary Clinton claim they can rein in health-care costs. One thing we've learned from state-based experiments in universal coverage: It's not cheap. In Massachusetts, taxpayer subsidies for its two-year-old program of mandated coverage will rise from $158 million in 2007 to $600 million this year and $870 million in 2009. Lawmakers are now scrambling to impose new cost controls. On the menu: lower payments to doctors, hospitals and drug companies.

Meantime, a similar plan proposed in California died in January when the independent Legislative Analyst projected the program would cost at least $4 billion more in its first five years than proponents first suggested.

By contrast, McCain's agenda would primarily expand choices for consumers. Among other things, he would allow Americans to purchase health coverage from a licensed insurer in any state; individuals could shop nationwide for an appropriate policy and compare prices. He would also allow membership organizations (like AARP) or other non-employers to sell group policies.

Most dramatically, he would end the tax deduction that employers receive for providing health insurance; instead, individuals would receive tax credits they could use to either purchase policies or invest in Health Savings Accounts. They would no longer depend on their employers for medical coverage.

Taken in combination, these proposals would give individuals more control of their health-care options..

Until the next president takes office, states would be well-advised to steer clear of comprehensive reform. But they can act on the margins. Indeed, we're encouraged to see several consumer-friendly initiatives in this year's legislature. House Bill 1061, with bipartisan sponsors, has passed both houses and would allow advanced practice nurses (who have specialized certification, such as in clinical practice or anesthesia), to provide a broader range of care - more like physicians.

Next, House Bill 1311 would establish two new, bare-bones insurance plans for any employer that does not offer its workers medical insurance. The proposal died in committee, but the lead sponsor, Rep. Spencer Swalm, R-Centennial, told us that House Speaker Andrew Romanoff has expressed interest in reviving it.

Finally, House Bill 1327, from Rep. Cory Gardner, R-Yuma, would allow Coloradans to purchase insurance from out-of-state providers if a group of states set up a market for such policies. McCain's plan does not have to be law for this bill to take effect.

HB 1327, scheduled for a committee vote on Monday, offers another example of an incremental reform at the state level that could expand choices and contain costs. We encourage more efforts along these lines.

Labels: CO, Free Market, Insurance, OpEd

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Children with health insurance, studies have shown, are less likely than uninsured kids to end up in emergency rooms, more likely to get key vaccinations, and less likely to be absent from school.

None of five studies Human cited after the fact support her article's statement about what "studies have shown" regarding the effects of insurance on emergency room use, vaccinations and school absences. Indeed four of the five studies she cited do not even address those topics. ...One study cited by Human was relevant, and it directly contradicted her article's claim.

...So Human's pronouncement in her Post article - "Children with health insurance, studies have shown, are less likely than uninsured kids to end up in emergency rooms" - turns out to be not entirely accurate. A large body of research contradicts her claim, and that research is in the very studies which Human pointed to when she was challenged to support her claims.

...In the last two years, the phrase "studies have shown" has appeared in staff-written pieces 31 times in the Rocky Mountain News, and 36 times in the Post. About half the time the phrase is used in a direct quote, or in another way which tells the reader the source of the information. For example, "According to professor Roy Hinkley, studies have shown that minnows . . . "

But the other half of the time, the dailies used "studies have shown" with no source. The unattributed locution was especially common in Post editorials, and in health and nutrition coverage in both papers.

The phrase ill-serves readers who want to learn more about a subject, but who are left in the dark about where to look. The phrase can be used to falsely declare scholarly consensus about a subject. And the phrase can be a crutch for a writer who feels "sure" about a supposed fact, but who doesn't want to take the time to verify it.

Labels: Analysis, Insurance, OpEd

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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.

Labels: OpEd

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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.

Labels: Insurance, OpEd

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Labels: 208, CO, Insurance, OpEd

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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.

Labels: 208, CO, OpEd

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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.

Labels: 208, CO, Insurance, OpEd

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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.

Labels: Free Market, OpEd

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