The Non-Reform Health Care Bill

In the dark of night, appropriately, the Senate last night voted to end debate on its health care reform bill, bringing it to a floor vote. From Commentary magazine comes the following assessment of what will be voted on:

The non-reform health-care bill does, to the disgust of liberals, make insurance companies very happy. The government is coercing customers to buy the companies’ products under penalty of prosecution and fine. The non-reform health-care bill does, to the horror of seniors, slash $500B out of Medicare with no conceivable alternative other than rationing to meet its new budget. The non-reform health-care bill does, to the delight of trial lawyers, do nothing to reform the tort system or the problem of defensive medicine. And the non-reform health-care bill does, to the chagrin of deficit hawks, do nothing to bend the cost-curve or cut the deficit. (James Capretta explains: “For starters, as CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely. There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.”) Finally, the non-reform health-care bill will, to the embarrassment of good-government types, in all likelihood get passed through a combination of bribery and secrecy, with virtually no time for thoughtful consideration.

On every level it \'s a policy train wreck.

Not to mention that it pushes many of the uninsured into Medicaid, in a massive expansion of a program which is bankrupting the states, and which very few physicians can afford to take due to abysmal reimbursement rates which do not come close to covering expenses. The 22% Medicare fee cuts to physicians — one of the many accounting gimmicks thrown in to make this bill appear to be financially viable — will, if enacted, lead to a mass exodus of physicians from Medicare as well. Universal insurance coverage (which this bill does not even achieve) does not equal universal access, as we are about to discover to our horror and dismay.

I am doing my best to be sanguine about things over which I have no control, but it is difficult to watch the death of a profession and a superb health care system, to advance the partisan agenda of the power-hungry crooks and cronies who make up our current government. Revulsion is not too strong a word.

We will live to rue the day this disaster passes into law.

UPDATE: From the WSJ:

The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that “reform” has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.

***

• Health costs. From the outset, the White House’s core claim was that reform would reduce health costs for individuals and businesses, and they’re sticking to that story. “Anyone who says otherwise simply hasn’t read the bills,” Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.

The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.

These increases are solely the result of ObamaCare --above and far beyond the status quo --because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like “community rating” because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.

As for the White House’s line about cutting costs by eliminating supposed “waste,” even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. “The oft-heard promise ‘we will find out what works and what does not’ scarcely does justice to the complexity of medical practice,” the Stanford professor wrote.

• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.

This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they’ll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.

Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so “substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance” that companies like WellPoint might need to “be considered part of the federal budget.”

With so large a chunk of the economy and medical practice itself in Washington’s hands, quality will decline. Ultimately, “our capacity to innovate and develop new therapies would suffer most of all,” as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax --rising to $3 billion in 2018 --that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.

“The Senate isn’t hearing those of us who are closest to the patient and work in the system every day,” Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they’re allowed to treat. Physician Hospitals of America says that ObamaCare will “destroy over 200 of America’s best and safest hospitals.”

• Blowing up the federal fisc. Even though Medicare’s unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost “only” $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.

Yet some 98% of the total cost comes after 2014 --remind us why there must absolutely be a vote this week --and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid’s final machinations. Job creation, here we come.

Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn’t start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won’t happen but they remain in the bill to make the cost look lower. The American Medical Association’s priority was eliminating this “sustainable growth rate” but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.

The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run “exchanges” that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don’t provide insurance or work for small businesses.

As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation --whatever the mix of cash wages and benefits --very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.

For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also “a new welfare and tax system” that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into “contractors” or do more outsourcing. As more and more people flood into “free” health care, taxpayer costs will explode.

• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as “ideologues” by the White House. Those parts of the health-care industry that couldn’t be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration’s own Medicare actuaries.

Others got hush money, namely Nebraska’s Ben Nelson. Even liberal Governors have been howling for months about ObamaCare’s unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that “will be passed on to citizens through direct or indirect taxes and fees,” as he put it in a letter to his state’s junior Senator.

So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don’t have a Senator who’s the 60th vote for ObamaCare?

UPDATE 2: from Robert Samuelson, WaPo:

These fears are well-grounded. The various health-care proposals represent atrocious legislation. … So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

Samuelson argues that the uninsured will receive better care because more of them are covered. Of course, that is only true if they can actually get to see a physician who accepts their Medicaid coverage, which is already an enormous problem, and will certainly grow worse. I suspect they may actually receive better care now, uninsured, than they will covered under Medicaid.

No Death Panels Needed

Over at Big Government, we get a glimpse of where ObamaCare will take us: Health Care \'s Coming Heart Attack – A Pre-Obama Care Death Panel?

I am writing of the Obama Administration \'s – regulatory decision – to go ahead with a massive cut in Medicare payments to cardiologists. I emphasize that this is a regulatory decision because it was not made by the Congress legislatively (not that that would be ok) but, instead, it was made by the massive Health and Human Services Department of the US Government. Given the limited resources of the Medicare budget, in order to increase payments to general practitioners (in an effort to attract more such doctors – a good idea), bureaucrats needed to gore somebody \'s ox and cardiologists were chosen (a horrible idea).

The decision to do so is astonishing.

Keep in mind that the very purpose of health care is to improve the health and therefore the lives of Americans. The cardiologist community has been wildly successful in that endeavor. Although heart disease remains the #1 killer of Americans, the mortality rate for heart attacks has plummeted. For instance, the post-heart attack, 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006 and the in-hospital mortality rate decreased from 14.6 percent to 10.1 percent.

Further, between 1994 and 2006, the mortality rate among women 55 and under who suffered a heart attack dropped an incredible 52.9%. For men in that same age group the drop was 33.3%. According to the author of the mortality study that determined those latter figures: “It appears that risk factors, which may be controlled through prevention efforts, are very important in driving these mortality reductions.”

Given those figures, it is hard to argue with the success of cardiologists who sit on the forefront of heart care and heart disease prevention – unless, of course, you are a government bureaucrat.

Rather than pouring more dollars into an obviously successful branch of medicine that is saving lives (the ultimate purpose of health care?), the Obama Administration is going ahead with a plan to cut nearly $1.5 billion from Medicare payment to cardiologists. Obama is doing so by such devices as literally eliminating reimbursement for certain services and/or reducing the amount they will pay for others. Case in point, cardiologists have been able to bill for an extended first visit with Medicare patients to get their history and to recommend a course of treatment. As of January 1, 2009 [2010 – ed.] – no longer.

What is being referred to here is Medicare’s decision to eliminate consultation service codes as of Jan 1 2010. These codes are almost exclusively used by specialists, and pay substantially better than standard visit codes, reflecting the higher complexity of care typically involved in specialty care. It is not just the cardiologists who are affected by this administrative change in Medicare payment — it is all specialists: oncology (cancer treatment), infectious disease, pulmonary, surgical specialties such as orthopedics, urology, ENT, neurosurgery, cardiac surgery, etc. etc. They are betting on a premise already proven false: that preventive medicine through primary care will reduce costs.

Specialty care is more expensive because specialists care for the sickest and most complex patients. When you are having your acute MI, you need a cardiologist, not a family practice physician. Specialty care is where the vast number of advances in American medicine have taken place — the advances which give us the best results in the world in cancer treatment, heart disease, and surgical advances such as laparoscopy and other minimally invasive procedures.

The inevitable outcome of these changes are that Medicare patients will have reduced access to specialists, as specialists increasingly are unable to afford taking a loss on every Medicare patient they see due to reimbursements which fall below their costs of providing care. They will by necessity reduce the number of Medicare patients specialists see, or force them to stop seeing Medicare patients altogether, resulting in longer waits to see a specialist and regional shortages of care in these areas. One does not need “death panels” to make policy changes which restrict care to the elderly and disabled; quiet bureaucracy works every bit as well, with the added advantage of plausible deniability.

Welcome to the new millennium in health care. Hope you enjoy your government-run universal health care.

Dredging Bottom at The Atlantic

Many of us have been struggling to understand the nature of our current economic meltdown. Was it greedy bankers, who made unscrupulous loans while passing the risks on to others? High-rolling hedge fund managers who resold the risky bundled securities and reaped millions? Politicians and political activists who pressured banks and lending organizations to make risky loans to minorities and low-income customers or be castigated as racists and bigots? Fannie Mae, Freddie Mac, or the FHA?

Let the confusion end: The Atlantic has hit the news stands with a breaking revelation: It’s the Christians! To wit: Did Christianity Cause the Crash?

… recently, critics have begun to argue that the prosperity gospel, echoed in churches across the country, might have played a part in the economic collapse. In 2008, in the online magazine Religion Dispatches, Jonathan Walton, a professor of religious studies at the University of California at Riverside, warned:

Narratives of how “God blessed me with my first house despite my credit” were common … Sermons declaring “It \'s your season of overflow” supplanted messages of economic sobriety and disinterested sacrifice. Yet as folks were testifying about “what God can do,” little attention was paid to a predatory subprime-mortgage industry, relaxed credit standards, or the dangers of using one \'s home equity as an ATM.

In 2004, Walton was researching a book about black televangelists. “I would hear consistent testimonies about how ‘once I was renting and now God let me own my own home,’ or ‘I was afraid of the loan officer, but God directed him to ignore my bad credit and blessed me with my first home,’” he says. “This trope was so common in these churches that I just became immune to it. Only later did I connect it to this disaster.”

Whew! That was easy! Who knew? But is it really that simple? What are the facts on which this startling conclusion is based?

…Kate Bowler found that most new prosperity-gospel churches were built along the Sun Belt, particularly in California, Florida, and Arizona --all areas that were hard-hit by the mortgage crisis.

Makes sense: these were rapidly growing areas of the country; with rapid growth and cheap credit, lots of homes were getting sold. And lots of new churches and churchgoers would be expected. So, these Sun Belt areas grew quickly, had a lot of new churches (some of which were the “prosperity” variety) and ended up with a lot of foreclosures. But surely there has to be more evidence than that…

Nationally, the prosperity gospel has spread exponentially among African American and Latino congregations. This is also the other distinct pattern of foreclosures. “Hyper-segregated” urban communities were the worst off, says Halperin. Reliable data on foreclosures by race are not publicly available, but mortgages are tracked by both race and loan type, and subprime loans have tended to correspond to foreclosures. During the boom, roughly 40 percent of all loans going to Latinos nationwide were subprime loans; Latinos and African Americans were 28 percent and 37 percent more likely, respectively, to receive a higher-rate subprime loan than whites.

So, a lot of foreclosures occurred in the Hispanic and black communities — and the prosperity gospel was increasingly popular among these groups as well. Pretty damning, I’d have to say. Pretty much nails it down, don’t ya think?

Or not.

Seriously, there’s really not much more to the “evidence” in this article than that. Sure, they mention that some of the banks were marketing to prosperity Gospel churches, and some pastors were a bit cozy with the banks as well, and seemed to be encouraging debt. But really, that’s about it. Perhaps some numbers would be nice: how many of these churches’ members actually ended up foreclosed or financially destitute? What percentage of foreclosed homes were purchased by these church members? If you’re going to make the claim that the prosperity churches are a major factor in the housing meltdown, wouldn’t some hard facts and numbers be, you know, reasonable to provide?

Oh, and here’s a little mental exercise for you: imagine their cover blaring forth: “Did African-Americans and Hispanics Cause the Crisis?”

Sigh. From a once-great magazine to garbage journalism, chasing Newsweek to the bottom of the literary barrel. What drivel. This is their cover story? Jeez.

Where to begin? The prosperity Gospel churches and their televangelists have always been favorite targets of the mainstream media and pundits who want to get a handle on “Christians” and what they think. They are easy targets because they have such high media visibility, and their preachers often have an ostentatious lifestyle which almost begs the accusation of greed and hypocrisy. And sometimes, as happened with Jim and Tammy Baker and Jimmy Swaggert, they hit paydirt.

What seems to go unnoticed is the the “health and wealth” churches, although culturally highly visible, are very much a fringe movement in Christianity, bordering on cultic at times, and are regarded by most mainstream evangelical and Catholic theologians and scholars as being heterodox at best, if not outright heretical — the antithesis of the core Christian doctrines about concern for the poor, the spiritual benefits of suffering, the dangers and bondage of debt, excessive materialism, and an unhealthy focus on wealth. They are widely ridiculed and little respected among most Christians in my experience, and I suspect their stated numbers of followers is inflated more than Obama’s “jobs created or saved” stats.

True, there will always be an appeal for a message that promises you wealth in the now and joy in the hereafter, and so it is no surprise that their congregations are often large. But neither is the teaching of these prosperity preachers solely devoted to wealth acquisition; there is a strong emphasis by most on morally upright living, self-discipline and spiritual development, and they often have ministries to the divorced, victims of domestic abuse, the homeless, and drug and alcohol recovery. Not everyone in the pew on Sunday is looking to cash in on God.

No, the real motivation behind this article has nothing at all to do with any serious attempt at understanding the housing crisis and its causes; it is a gratuitous slap at conservative Christians, and the nefarious politicians and preachers who supposedly exploit them:

Few of Sarah Palin \'s religious compatriots were shocked by her messy family life, because they \'ve grown used to the paradoxes; some of the most socially conservative evangelical churches also have extremely high rates of teenage pregnancies, out-of-wedlock births, and divorce.

They just can’t help themselves, can they? What does Sarah Palin have to do with the housing crisis? And precisely what are these “extremely high rates of teenage pregnancies”, etc., etc.? Facts and hard numbers don’t matter when your proffering a political and religious hit piece. Or this:

There is the kind of hope that President Obama talks about, and that Clinton did before him --steady, uplifting, assured. And there is [Pastor] Garay \'s kind of hope, which perhaps for many people better reflects the reality of their lives. Garay \'s is a faith that, for all its seeming confidence, hints at desperation, at circumstances gone so far wrong that they can only be made right by a sudden, unexpected jackpot

The real “desperation” comes not from sincere-if-misguided congregants of some prosperity gospel churches, but rather from a dying journalism industry, which having lost all objectivity and the respect of their readers, have become naught but petulant, pathetic harpies hoping to score a journalistic jackpot at the expense of religious conservatives.

It’s not working, fellas — nobody’s listening to you or reading you anymore.

Perhaps the money we gullible Christians save by canceling our subscriptions to your sad rag can go towards a bigger home someday.

Speaking Truth to Power

From Hewitt:

Bishop Thomas Tobin opens a can of whoop-ass on Congressman Patrick Kennedy, on his “I’m pro-choice and a good Catholic, too” shtick:

“The fact that I disagree with the hierarchy on some issues does not make me any less of a Catholic.” Well, in fact, Congressman, in a way it does. …

There \'s lots of canonical and theological verbiage there, Congressman, but what it means is that if you don \'t accept the teachings of the Church your communion with the Church is flawed, or in your own words, makes you “less of a Catholic.”

But let \'s get down to a more practical question; let \'s approach it this way: What does it mean, really, to be a Catholic? After all, being a Catholic has to mean something, right?

Well, in simple terms … being a Catholic means that you \'re part of a faith community that possesses a clearly defined authority and doctrine, obligations and expectations. It means that you believe and accept the teachings of the Church, especially on essential matters of faith and morals; that you belong to a local Catholic community, a parish; that you attend Mass on Sundays and receive the sacraments regularly; that you support the Church, personally, publicly, spiritually and financially.

Congressman, I \'m not sure whether or not you fulfill the basic requirements of being a Catholic, so let me ask: Do you accept the teachings of the Church on essential matters of faith and morals, including our stance on abortion? Do you belong to a local Catholic community, a parish? Do you attend Mass on Sundays and receive the sacraments regularly? Do you support the Church, personally, publicly, spiritually and financially?

In your letter you say that you “embrace your faith.” Terrific. But if you don \'t fulfill the basic requirements of membership, what is it exactly that makes you a Catholic? Your baptism as an infant? Your family ties? Your cultural heritage?

Bravo. Look, if you’re pro-choice, fine. But spare us the hypocrisy of claiming to be a “faithful Catholic” and pro-abortion at the same time. That dog won’t hunt, and it’s long past time our vaunted political leadership got called on it.

Health Care on Life Support

From the Wall Street Journal, on the passage this weekend of health care legislation in the House:
 

The bill is instead a breathtaking display of illiberal ambition, intended to make the middle class more dependent on government through the umbilical cord of “universal health care.” It creates a vast new entitlement, financed by European levels of taxation on business and individuals. The 20% corner of Medicare open to private competition is slashed, while fiscally strapped states are saddled with new Medicaid burdens. The insurance industry will have to vet every policy with Washington, which will regulate who it must cover, what it can offer, and how much it can charge.

We have little sympathy for the insurers, or for that matter most of the other medical providers who signed on to this process only to claim now to be appalled by the result. The insurance lobby --led by Aetna CEO Ron Williams --made the Faustian bet that it could trade new regulations for more new subsidized customers who would face a tax penalty if they didn’t buy their insurance. The Pelosi bill includes the regulation but guts the tax penalty because it’s unpopular. Insurers will thus have to cover more sick people with fewer dollars, as healthy folk opt out of coverage until they are sick…

Unless the Senate has an epiphany of common sense, Americans will be paying the bills for this willful exercise for generations to come.

Historic moment: you are witnessing the demolition of America’s health care system, and the crippling of its economy for generations to come. When the public wakes up from their slumber to discover what “universal coverage” looks like in the flesh, it will be far too late to undo the disaster.

Best make an appointment to see your doctor now — you may not have many opportunities left…