Red Clay Citizen

Super Sized Nanny State

Nanny-staters in LA are making Ronald McDonald public enemy #1, as this WSJ article describes.

"Jan Perry, a Los Angeles city-council member, is spearheading legislation that would ban new fast-food restaurants like McDonald's and KFC from opening in a 32-square-mile chunk of the city, including her district."

Surprised? You shouldn't be. Such measures are what naturally follow in a nation that has come to consider health care to be a "public good." If government is to provide a collective health care system, then expect government to become very concerned with your personal life, including: diet, smoking, drinking, exercise, weight, dangerous hobbies, etc., etc.

The catch-22 is that a socialized health care system is what creates the moral hazard government is trying to combat here. In other words, if government is paying for your health care needs no matter if you engage in a healthy lifestyle or if you make poor health decisions - why take care of yourself? The consequences of your poor decisions (higher medical bills) will be paid for by "society" so eat, drink and be merry - it won't cost you anything.

Let's wise up and see the writing on the wall. People's waist size and calorie intake is none of government's business, but under the single-payer type system the liberals want to impose, every aspect of your life suddenly becomes a "public good" because it is the general public that will be paying for your health care.  

This is an aspect of health care reform that lefties don't want you to know about. Their "solutions" to health care will be leveraged to excuse the most massive government intrusion into your personal life imaginable.

Beware of Health Care Councils - Update

As Max and I have commented and written about previously, Verla Insko has teamed up with some special interest groups to craft a study group to essentially recommend how to drive North Carolina further down the road to socialized medicine.

Fortunately, the bill to create a Council died, but in this year's Study Bill the North Carolina Institute of Medicine is authorized "to study issues relating to access to health care." According to the bill, the study is to research and inform the General Assembly about  providing "access to appropriate and affordable health care for all North Carolinians." That small word 'all' carries a lot of weight - implying that health care is to be viewed as a right in this study. Who is to define what is "appropriate" and "affordable" for 9 million citizens with different needs, resources, preferences etc. is not mentioned.

The good news is that this legislation merely authorizes a one-time study rather than creating an ongoing "council." The results of the study are to be released by Jan. 15, 2009, which leaves less than six months for them to develop their predictable list of government mandates and expanded Medicaid programs.

Anyone willing to bet on the number of words dedicated in their study to the negative consequences of government interference with the health care marketplace?

Beware of Healthcare "Councils"

Advocate for socialized medicine, Adam Searing, would like you to believe that his bill  (uh, I mean, Verla Insko's (D-Orange) bill) is harmless. The bill would create a health policy "Council" stacked with people who think just like Adam Searing -- by design, of course. This is a clever strategy.

Even if you got a couple of ringers on the Council to represent diverse perspectives, they'll only be able to offer muffled dissent. The General Assembly can then go about the piecemeal socialization of medicine and destruction of the healthcare system in North Carolina--and then claim everything has been thoroughly "studied" and comes from recommendations of the Council. We've seen this before. But these seemingly innocuous central planners are really a way for Adam Searing to inject his upside-down philosophy into N.C. state government. His takeover of our healthcare choices will be complete.

The M.O.: He loosens his bow-tie and sits down with Insko, plus a few special interest and activists groups (all of whom showed up at a "public meeting" that Searing, et al organized to converge on the G.A.), and they create a Trojan horse full of radical socialist activists eager to get their claws into our healthcare system and our pocketbooks. A few dissenters like me show up because they happen to keep an eye on these things. Otherwise, the public meeting is a ruse designed to create a sense among committee members that the public wants "healthcare for all," which is doublespeak for Cubacare. While I have little patience for government-caused insurance monopolies, it may be time for them to bring their considerable weight to bear before this council finds its way into the world.
-Max Borders

Healthcare: Government Raising Prices

Here's a new study on the impact of state mandates on the cost of insurance premiums.

It's one of many ways in which government is creating an army of uninsured and driving us towards socialized medicine -- a discredited system that even the FOUNDER OF CANADA's system now admits is a monster.

If Canada's system is a monster, ours is Frankenstein.

Healthcare: More Government Failure

Department of Health and Human Services Secretary Micheal Leavitt has this disturbing, yet completely unsurprising, article about the Medicare system screwing seniors out of millions - if not billions - of dollars.

"Right now the government is paying insane rental prices for medical equipment – prices far higher than it would cost to purchase the equipment outright.

For years, the Government Accountability Office and the Department of Health and Human Services's inspector general have been saying Medicare is paying too much for Durable Medical Equipment (DME). Just compare what Medicare pays to the prices of equipment for sale on the Internet.

An oxygen concentrator, for example, is a device that delivers oxygen through a tube to patients, and it costs about $600 on the open market. Medicare beneficiaries typically rent the machines. The rental period, set by statute, is up to 36 months. The monthly rental payment, also set by statute, is $198.40. So renting an oxygen concentrator for 36 months costs $7,142.

As with most items and services in Medicare Part B, beneficiaries pay 20% of the costs, and Medicare pays the remaining 80%. The government, therefore, pays $5,714 – almost 10 times the free-market price of purchasing a concentrator outright. The patient pays $1,428 – more than twice the free-market price of purchase."

So seniors and taxpayers are being soaked for billions because of this wonderful, single-payer system. Who stands to benefit? The medical equipment companies, of course. Naturally, their lobbyists are hard at work trying to ensure these out-of-whack rental rates stay in tact.

This is yet another example of what happens when government is in charge of something - the market pricing system breaks down and costs skyrocket. If today's liberals get their way and convert the US healthcare system into their cherished single-payer system, expect to see countless episodes like this. The lobbyists will be running wild in DC trying to get preferential treatment just like the medical equipment manufacturers in this case.

What we need is healthcare reform that puts the consumers back in charge, not politicians and lobbyists.

The Left's Latest Push to Socialize Health Care in North Carolina

There was a public hearing today regarding HB2688 - an act that would establish the "Access to Health Care Policy Council." The stated goal of this Council would be "providing access to appropriate and affordable health care on a regular basis to all North Carolinians." Translation: let's form a council to drive the effort toward socialized health care in North Carolina.

This bill is the baby of Rep. Verla Insko (D-Orange) who is an unabashed fan of socialized health care, as evidenced by her sponsorship of this bill that would add a "Constitutional amendment providing that health care is a fundamental right" (subject to voter approval).

First to speak was Eugene Barufkin from the group Health Care for All NC. Mr. Barufkin claimed in his statements that he essentially co-wrote the legislation. Let there be no doubt about the intentions behind the creation of this Council, check out the mission of Health Care for All NC.

"Health care is an essential safeguard of human life and dignity, and there is an obligation for the State to ensure that every resident is able to realize this fundamental right." (emphasis added)

In fact, much of the wording for HB2688 is taken directly from Insko's "health care for all" bill, and the Health Care For All NC's website.

During the meeting, roughly 20 or so speakers were alloted 2 minutes each to speak their mind about the bill. With about 3 exceptions, the public testimony devolved into a parade of special interests and advocacy groups begging for the implementation of a government takeover of our health care system.

Two notable exceptions to this "Marxists and rent-seekers on parade" spectacle were our friend Joe Coletti of the John Locke Foundation and our own Max Borders. Joe spoke about the dangerous assumptions implicit in the creation of such a council - specifically the fatal conceit that a group of 31 can decide for 9 million North Carolinians just what qualifies as "appropriate and affordable" health care for their families better than the people themselves.

Max warned against the lack of intellectual diversity that would be on the Council. The selection process outlined in the bill would allow for the council to be stacked with like-minded lefties hell bent on government control of your health care decisions. In a more-than likely insincere moment, Representative Insko acknowledged Max's point at the end of the meeting by claiming they will be careful to include diverse philosophies as they select the Council members.

The reality is that this Council would essentially serve as a crutch to legislators seeking to socialize our health care. Lawmakers will simply be able to deflect criticism by saying "Hey, the Health Care Policy Council recommended this, who are we to argue with these experts!"

The meeting adjourned without a vote, we will be tracking this bill's progress closely. 

"Father" of Canadian Health Care Admits its a Failure

Just yesterday, I wrote about how unpopular the British healthcare system has become. Today comes news that the man largely responsible for Canada's conversion to a single-payer health care system has admitted the system's failure:

"Back in the 1960s, (Claude) Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast."

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

As more and more nations throughout the world seek to infuse more private, market-based solutions into their government-controlled healthcare systems, for some reason lefties in this country want to make the same mistake that countries like Canada made decades ago. Let's hope voters in North Carolina and across the US wake up, or else we may be forced to confront "rationing services or injecting massive amounts of new money" into a system that even one of its pioneers admits to being a failure.

Universal Healthcare in England: Lower Approval Ratings than Bush

More and more politicians and pundits from DC to Raleigh are talking about transforming our health care system to a "universal" or "single-payer" model. They tell us our system should resemble the systems they have in place in countries like Canada and England.

This Heartland Insititute article tells us that even the people of England don't like the model they have in England.

"An April Gallup poll showed only 7 percent of British citizens were very satisfied with their health care system. Twenty-five percent of those polled said they were extremely dissatisfied with their care, and 27 percent were somewhat dissatisfied."

Why on earth would we want to emulate a system so loathed by those already subjected to it?

Health Socialism in Repose

If Adam Searing is indignant, something good must be happening in healthcare--or, at least, nothing bad is happening. Well, Adam Searing is indignant. He's angry that the N.C. Senate decided to pull extra money that was slated to expand socialized Medicine in North Carolina. Apparently, times is tight and they (the G.A.) can't find the money.

Good. Putting middle class kids on Medicaid is devastating to our ailing healthcare system. I'm sure that's the idea for Searing. For though he hides behind the apparently righteous cause of "helping children", I imagine it troubles him not-a-jot that healthcare crowdout and a worsening death-spiral in premium prices result from his policy prescriptions. After all, without destroying the insurance market, he can't hasten the coming of Cubacare.

Let me explain again for those who don't get it: Insurance is cheaper when low risk people are in the insurance risk-pool. Children are low-risk people. Putting children on Medicaid removes them from the risk pool. Prices go up. More people decide it's not worth it and go uninsured. These people are often also young. For those older, sicker people who remain, the prices goes up and up. All thanks to policies advocated by Searing. Kids' Care helps increase the number of uninsured. Nice work.

Let's all do our part to keep Adam Searing upset. People need health insurance, after all.
-Max Borders

Healthcare: The Singapore Model (Again)

The lefties made fun of me for touting the Singapore healthcare system. But people are starting to catch on, as you can see here:

The World Health Organization’s most recent full report on global health statistics says the United States spends 15.4 percent of its GDP on healthcare, while Singapore spends just 3.7 percent.

What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends.

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.”

Looks like a model to mimick as we move away from the status quo.
-Max Borders

Healthcare Reform a la John Goodman

He's nailed the trends and the fixes. Here's a sliver:

Reform Idea: So what can be done? To ameliorate all five trends and neutralize perverse incentives there should be a government commitment of $X (in this case $1,500) to every individual. Those who choose private insurance would receive a refundable tax credit to offset premium costs. For those who do not insure, $X would be sent to local safety nets in the communities where they live - to be spent on Medicaid-type programs or on free care services.

This plan (1) makes private insurance just as attractive as public insurance as far as subsidies are concerned, (2) makes a fixed financial commitment to every individual, (3) lets money follow people as they move from insured to uninsured status and vice versa, and (4) guarantees a minimum per capita funding for the safety net.

Now read John's five megatrends. They'll be similar to ones I've enumerated here. Remember, that direct subsidy of healthcare will remove some if not all of the distortions of the current system.
-Max Borders

Healthcare: Another Lesson in Government Failure

This WSJ article describes what anyone with a lick of common sense could have predicted. Massachusetts's "Romneycare" plan is already coming in wildly over budget, and government run "free" healthcare is simply unaffordable.

"One lesson here is that while pledging "universal" coverage is easy, the harder problem is paying for it. This year's appropriation for Commonwealth Care was $472 million, but officials have asked for an add-on that will bring it to $625 million. For 2009, Governor Deval Patrick requested $869 million but has already conceded that even that huge figure is too low. Over the coming decade, the expected overruns float in as much as $4 billion over budget."

Never to be discouraged by actual fact and results, our two leading Democratic presidential contenders are clinging to their ideological faith of government being the solution to, well, everything.

"Barack Obama and Hillary Clinton are both proposing versions of RomneyCare on a national scale, with similar promises that covering everyone under a government plan will reduce costs. Mr. Obama at least argues that more people would be covered were insurance more affordable. But his solution is Massachusetts on steroids – make insurance less expensive for policyholders by transferring the extra costs onto the government. Mrs. Clinton likes that but also wants the individual mandate, despite the mediocre results so far."

Voters in North Carolina should take note as our lawmakers move incrementally to shift more and more of our population onto government health care programs (i.e. Medicaid, NC Health Choice, Kids Care).

Pro-life and Family Legislation

Here is a rundown of the pro-life and family legislation introduced during the 2007-2008 session:

ABORTION/REPRODUCTIVE ISSUES

H 1782 Ultrasound Before An Abortion
H 419 State Health Plan/No Abortion Coverage
H 1552 WRTK-Woman's Right to Know
S 481 Notarized Consent for Minor's Abortion
H 420 Abortion-Parental Consent Notarized
S 480 No Abortion Coverage/State Health Plan
H 155 Conscience Protection/Health Care Providers
S 897 Choose Life Special Registration Plate
H 1774 Born Alive Infant Protection Act
S 968 Born Alive Infant Protection Act

FETAL HOMICIDE
H 263 Unborn Victims of Violence
S 295 Fetal Murder

SEXUAL/EMOTIONAL EDUCATION
H 879 Modify School Health Education Program
S 664 Social-Emotional Curriculum in Public Schools

MARRIAGE
H 493 Defense of Marriage
S 1608 Defense of Marriage
S 13 Defense of Marriage

HOMOSEXUALITY
H 1366 School Violence Prevention Act

VACCINES
S 1018 Vaccine Requirements/School Entry
S 710 Immunization Changes-AB

See, also, our recap from last session.

And, if we missed anything, please let us know.

Searing on Easley's Healthcare Budget

Adam Searing likes most of the Governor's healthcare budget. (Should we be surprised?) Some of his comments on the budget, however, reveal weaknesses in his overall position on government-distorted healthcare:

First, he lauds Easley's further attempts to expand medicaid:

The Governor does budget for anticipated growth in NC Health Choice, finding an additional $10 million to help enroll another 10,000 or so kids. [blah, blah...] This is doubly important as tough economic times increase, causing many families to lose the insurance coverage they have through their jobs.

Funny, Adam Searing isn't worried about people losing their jobs in this healthcare video, where he explicitly opposes $2500/$5000 (person/family) refundible tax credits so people can get health insurance (using the old rebuttal-by-dishonesty technique, as I point out here.). Hello. If you lose your job, you don't lose your health insurance when you get it on the individual market. (Searing also doesn't seem to be too concerned about the 50-60% of eligible children (read: poor) not yet enrolled in Medicaid. What about them?)


Do I smell partisanship? Or is it simply a profound lack of concern for families who lose their insurance when they lose their jobs. Either way, it suggests that Searing is complicit in the left's grand strategy to choke healthcare markets beyond recognition and keep people trapped in job-based insurance via an unfair subsidy. (Why would they do this? They want us to cry 'uncle' so they can foist single-payer on us.)

Oh, and here's the funniest bit. He doesn't like Easley's cigarette tax suggestion:

Biggest misstep – increasing the cigarette tax by 20 cents. Give me a break. We've only known since dinosaurs roamed the land where the Legislative Office Building now sits that any rise in the price of a pack of smokes of less than 10% has no effect whatsoever on getting people to quit. Otherwise, it's just a tax on smokers, God bless them, and has no beneficial health effects. Here's a novel suggestion – raise the cigarette tax by $1. Then put the several hundred million you generate into first guaranteeing an affordable health plan with sliding scale premiums for every child in NC, eliminating the provider fee cut above, and a tax rebate targeted at people who've just lost their jobs. We stop thousands of kids from starting to smoke and we generate more money besides.

Whoa. I don't know what smells funniest in that passage--the inherent paternalism, the audacity of the a $1tax, or the economic backwardness behind his revenue predictions for such a big tax. Anyway, I love it when the left attempts to be anything but emotional and linear. The arguments unravel themselves.
-Max Borders

Healthcare: Poor or Middle Class?

Weird lead-in from the WSJ:

WASHINGTON -- The Bush administration appears to be softening a policy that states have complained hindered their efforts to expand health-care coverage for poor children under a popular state-federal insurance program.

In a letter sent to states Wednesday, the administration says it will give states more flexibility to prove that they have enrolled 95% of poor children from eligible families -- a condition, laid out in an August directive, for using federal funds to expand coverage under the State Children's Health Insurance Program.

Isn't the whole idea that states are trying to expand eligibility to children who are NOT-so-poor, i.e. middle class children? Wasn't the Bush administration's rule that states must cover 95% of poor children before attempting to cover middle class children? The above WSJ snippet seems either accidentally circular or purposefully misleading. And you'd think a counter-argument might be "poor is subjective." But considering the kinds of eligibility expansions they are considering here in N.C. (Kids' Care), my family will probably qualify if we have another baby! Funny, I don't consider myself poor.
-Max Borders

Healthcare: Doctors are Uniting for Reform

In this Open Letter, physicians are calling for reform that puts patients back at the center of the healthcare system (a system currently corrupted by bureaucrats, insurers, and care-providers).
-Max Borders

Understanding Healthcare & How to Reform It

Americans find it difficult to understand why healtcare costs are going up, limiting access, and driving up the number of uninsured. In this two-part video, we explain why in pretty simple terms.
Part One


Part Two

-Max Borders

HSAs in N.C.: 128,143 Strong...and Growing

Progressives refer to health savings accounts (HSAs) plus high-deductible plans (HDHPs) as "crazy."

But according to a the most recent figures on the number of people in North Carolina, our state has 128,143 crazy people who have chosen these plans. And the numbers are growing rapidly. Here are some highlights from the national numbers:

• There were 35 percent more HSAs in January, 2008 than 12 months prior. This continues a blistering growth curve highlighting the popularity of HSAs.
• In the small group market, there were 70 percent more HSAs over that time period.
• The average annual premium for a single person age 30-54 was $2,278 ($189/month).
• Among small group plans, the average lifetime maximum benefit was $3.9 million.
  o  A full third of small group HSAs had unlimited lifetime benefits.
• HSAs are most popular in Minnesota, Louisiana, and, oddly enough, the District of Columbia. HSAs have the most growth potential in states you’d expect: New York, Massachusetts, New Jersey, and Hawaii.

Up with HSAs. (HT: Jameson Taylor)
-Max Borders

Healthcare: Making Prices More Transparent

Check out this release:

"Chicago, IL, April 30, 2008 - OutofPocket.com, a technology startup dedicated to promoting health care transparency and competition, announced today the launch of its new search engine.  The search engine enables consumers to look up prices and comparison shop for health care services by searching for price data across different websites. OutofPocket.com launched an earlier version of their website in July 2007 which provided consumers with a platform to collaborate and expose the true prices of routine health care services.  With the addition of the new search engine, the enhanced website collects health care price data from multiple sources including provider price lists, consumer contributed content, claims data from businesses, Government CMS Medicare data, websites that publish health care prices (hospitals, diagnostic testing facilities, clinics, labs, physician practices), and price transparency tools on public websites.

"Consumers need to know the true price upfront before purchasing health care services.  After researching the basic price transparency tools that are available today from providers, health plans, vendor tools and state initiatives, it was obvious that the industry lacks a robust search tool that summarizes price data across different sources," said Mona Lori, founder of OutofPocket.com.  Using collaboration to bring price transparency to health care, OutofPocket.com emerges as a leader in exposing true prices for routine health care services using intelligent search technologies.

Health care costs continue to rise each year.  Consumers are paying more of their own health care costs in the form of higher premiums, deductibles, co-pays, and out-of-pocket expenses for health care.   Increasingly, businesses and individuals, in an effort to control health care costs, are adopting consumer driven health plans.  These plans have proven effective in controlling costs; however, in order for these plans to be successful, consumers need access to meaningful tools to help them make informed decisions before purchasing health care services."
-Max Borders

Healthcare: Rebutting Adam Searing's "Rebuttal"

Adam Searing wants to deny people greater choices and more affordability. He wants to continue the favorable tax treatment of employer-based insurance, which essentially locks people into getting insurance through their employer. But if you lose your job, you also lose your insurance and the tax benefit that comes with it. Does Adam care? It's difficult to say. But he seems more interested in preserving the status quo, perhaps because he believes that this is the track that will get us to socialized medicine... And he's right about that.

But let me tell you what he's wrong (i.e. FALSE) about:

First, giving refundible tax credits is neither "radical" nor "dangerous". Tax credits allow people like waitresses, young people, the unemployed and the underemployed to get health insurance as easily (read: affordably, equitably) as someone who gets their insurance through work. It's that simple. When I was an adjunct professor teaching philosophy and making $20K a year, I had to buy health insurance on the individual market. And yet someone making $45K at a swanky office got subsidized to buy his health insurance by as much as $2000 a year. That's fundamentally unfair. But you don't have simply to believe me, ask the professors over at Duke University about this perverse, inequitable system.

Second, Mr. Searing tries to argue that the way one would pay for this system is to take the tax benefit away from employer-based insurance. This is simply FALSE. Notice how people in the background of his video keep laughing? It's because the claims he makes are laughable. All a refundable tax credit does is give you the same benefit whether you buy your healthcare on the individual market or at work--it doesn't matter which. People who would get their healthcare through work would enjoy the same benefit as they did before. So Searing is being, well, dishonest to claim otherwise. Perhaps it's desperation. Because tax credits would go a long way to reforming the healthcare market that he and his counterparts on the left have been busily trying to tear down, distort and ruin.

Finally, that means his '150 million people would be in danger of losing their health benefits' is just wrong. Mr. Searing would like for wealthier, gainfully employed people to continue to be subsidized while poorer, underemployed must fend for themselves? This suggests to me that he does not care so much about those people - including the uninsured and unemployed - who need affordable coverage, which tax subsidies would rescue. One should be very suspicious of his motives, then, as he generally claims to want to help cover the uninsured, which tax credits would most assuredly do. In fact, one would be crazy not to take $2500 for health insurance and not spend it! Carrots are preferable to Searing's sticks.

But in short, he offers NO EVIDENCE whatsoever that people with pre-existing conditions would be harmed by this. Indeed, if you have such a condition and lose your job, your healthcare is currently not portable. Under a system in which more people (not all, perhaps) get their insurance on the (more competive and thus less expensive) individual market, those people would have less chance of losing their coverage (expensive COBRA notwithstanding) no matter what happens with their job. And they'd get tax help to boot.

Adam Searing may have his heart in the right place on healthcare. But his head is totally in the wrong place. His hostility to tax credits reveals a genuine fear that his project to socialized medicine will fail if government stops privileging people with jobs. But if he really wants to help people, he'll join groups on the left who actually see the value in such a simple and elegant proposal.
-Max Borders 

Healthcare: CAHI Roundup of Presidential Health Plans

Check it out. You be the judge.
-Max Borders

Don't Worry, Its Just Government Money

We often hear stories about the abuses of the Medicaid system and we call them "horror" stories.  Monday's News & Observer/Charlotte Observer has a real horror story about a criminal conspiracy masquerading as a dental practice in Charlotte.  The details are chilling.  A 5 year old little girl was strapped into a chair and had "mini" root canals done on 14 teeth with steel crowns  added in one session.  (Ever seen Sir Lawrence Olivier as the Nazi dentist in "Marathon Man?")

  The article states that the child's mother took her to the clinic to just have her teeth cleaned.  What ended up happening was a multi-hour torture session on Antavia Digsby. 

Where to begin?  There is just so much wrong with this story.

• Children only have 20 teeth to begin with, so this person (pretending to be a dentist) got all but 6 of them.
• The staff refused to let the mother see the child during the "procedure." (Screams?, What screams?)
• The so called Dentist noted in the file that the child was "very uncooperative."  (I'm sure.)
• The name of the practice is a dead give away: "Medicaid Dental Center" (Now known as Smile Starters)
• The owners have just agreed to pay a $10 Million settlement to avoid  going to court  for over charging Medicaid.

The Dental Board has documented other children as young as 4 years old  having teeth pulled out and mini root canals while some children had 16 and 17 teeth canaled and crowned at this "Little Shop of Horrors".  If they have the ability to pay a  settlement of $10 Million, how much  have they billed in the past?  All of this happened nearly 5 years ago.  How long have these crooks been defrauding the guv'ment (i.e. you and me)?

When dental & medical con men get wind of big money in Medicaid and Medicare, look out.  John Dillinger never got his hands on $10 Million.  Maybe he would have been better off becoming a dentist.  Let's hope the tooth fairy is good to Antavia and her mother in court.

When the government pays, fraud is inevitable.  Hopefully, these con-dentists can use their alleged talents at a federal penitentiary near you.

So What's Wrong with Singapore's Healthcare System?

Not much apparently.

Our friends over at NC Policy Watch took a cute lil swipe at me because I suggested we emulate Singapore's healthcare system in terms of...
a) subsidizing the poor to get private health insurance and,
b) expanding the use of health savings accounts (HSAs).

Why would the left make fun? Because the only way to argue with the truth is to deride it.

But Singapore is doing something right: see here, here and here. Oh, and here if you buy the WHO's methodology -- they put Singapore at #6. Singapore spends less than 5% of GDP on healthcare compared to 16% in the US.
-Max Borders

Healthcare: HSAs & Preventive Care - As Promised

For those of you who may have caught WRAL's Headline Saturday where I talked about our ailing healthcare system, I promised you studies that indicate increased likelihood that folks with HSAs would get preventive care. Here they are:

1. On the incentives/providers side, there's this study from AHIP.
2. In this study, use of preventive care increased over traditional HMOs and PPOs! (And no, Cigna has no incentive to bias the study in favor of the consumer driven option. Quite the contrary.)

To the latter study: are people with HSAs less likely to procrastinate on getting care with HSAs, HDHPs?

"No," says the Georgia Public Policy Institute (GPPI) referring to a Cigna study: "regardless of the type of insurance policies, Americans tend to procrastinate in going to the doctor. A comparison of HSA-eligible plans to others shows HSA enrollees are no more likely to forego care:

-Did Not Go To Doctor: 18% of HSAs; 18% of other plan types
-Delayed Treatment:  17% of HSAs; 17% of other plan types
-Delayed Prescription:  15% of HSAs; 15% of other plan types"

Folks like my counterpart on the show, Adam Searing, would have you believe that HSAs and HDHPs are "crazy". Maybe my family and I are crazy, but we like our consumer driven plan and we don't need busybodies to make our healthcare choices for us, or to obscure the facts about the benefits of such plans--plans we have enjoyed.

(Note: In a sickening turn of events, Democrats have begun trying to dismantle efforts to have more health freedom.)
-Max Borders

TV Alert

Those of you in the Raleigh area not going to the CLC, make sure you tune into WRAL's Headline Saturday at 7pm tomorrow evening to see Civitas' own Max Borders debating the left's Adam Searing on health care.

Should be a can't miss event.

Ouch: More Universal Healthcare Failures

Half the population in Britain going without dentistry in the last couple of years. People pulling out their own teeth. Yikes!
-Max Borders

Healthcare Lessons from Massachussetts

This Washington Times article should serve as warning to those in North Carolina's General Assembly with designs on implementing any shade of "universal" or "mandatory" health insurance coverage.

"RomneyCare has done exceedingly little to correct American health care's excess costs compared to other advanced economies. Its cost has surged above initial estimates and shows few signs of abating. Overall medical costs continue to skyrocket in ways that threaten competitiveness, social services, pensions and more. If relatively wealthy and medically advanced Massachusetts faces significant difficulties, how much worse will it be in less favorably positioned states?"

So, massive government intrusion into the health care marketplace doesn't contain costs, and creates provider shortages and long wait times? That's something us 'market fundamentalists' have been warning against for years - maybe someday politicians and liberals will accept this economic reality.

Similarly, a concept that the left intentionally tries to confuse the public with is equating access to health insurance with access to care. Evidence from Mass. tells us otherwise:

"It is nearly two years since then-Gov. Mitt Romney signed this experiment into law. Today, a greater number of state residents are now covered: About 340,000 of the 600,000 uninsured in 2007 are covered, which is a significant gain. But the dramatic rise in health care demand has not been met with a co-equal rise in supply of physicians. This has fueled a rise in costs, a resort to nurse practitioners and other non-M.D.s; it has made waits for appointments longer and resulted in other unwanted effects. The surge in demand has stretched the state's corps of primary-care physicians. This in turn may be pushing more new doctors into specialty medicine. Routine preventive care is likely to remain elusive for most people.

As the New York Times reported this weekend, merely scheduling a physical can mean more than a year's wait in some parts of Western Massachusetts. The primary-care physician shortage identified by the Massachusetts Medical Society last year continues."

And lastly, this comment provides further evidence supporting the old axiom "government intervention begets more intervention":

"State lawmakers are currently proposing medical-school loan-forgiveness plans to draw primary-care physicians where they are needed, among other measures."

The state creates a behemoth health care bureaucracy which of course costs more than projected and creates unintended consequences possibly worse than the situation they intended to 'fix,' so naturally the politicians believe that even more government planning and spending will 'fix' the new problems that they created trying to 'fix' the first problem. How many times have we seen this scenario play out before, and when will the public push back against this vicious cycle?

The Market Provides - Despite, not Because

Despite the heavy hand of government blocking the invisible hand at so many turns, the market provides. Check out this new effort by WalMart. It's time to move forward with more quasi-physicians, like nurse practitioners, who can offer basic services without an MD. They cost less and are great for sinus infections, rashes, etc. etc. (HT: Jameson Taylor)
-Max Borders

Healthcare Reform: More than Price Transparency

In response to my piece on price transparency in the N&O, Wally Dawson writes:

Max Borders asserted in his March 6 Point of View article "When consumers are driving health care" that the lack of cost transparency in our health-care system is a problem. While I agree, that issue is not driving America's health-care cost bus. True cost drivers are insurance claims, advances in technologies, a vast number of uninsured and the practice of defensive medicine -- issues over which health savings accounts (HSAs) have little influence.

Moreover, cost shouldn't be the only factor consumers consider when making health-care decisions. If you needed a cardiac catheterization, would you visit the cheapest cardiologist or the more-expensive cardiologist who performed thousands of procedures with few complications? Cost transparency works only when patients also have access to reliable quality-of-care data, which aren't readily available.

Many HSAs reward patients who use health care sparingly. They need to financially reward patients who use health care wisely by paying for efforts that create healthier people less prone to disease.

I support consumer-driven health care, and I agree that HSAs represent the next frontier in medical insurance. But for HSAs to work, America's health-care system needs a bigger fix than a doctor simply posting the cost of a standard office visit on his front door.

Wally is right to say that a lack price transparency isn't the only problem in a host of pathologies. That's why I wrote this article, this one, and this one, too.




-Max Borders

Healthcare: The Asheville Project

Something good besides Thomas Wolff comes out of Asheville:

A gold standard in health policy is finding ways to improve care, save money, and enlist patients in better managing their chronic conditions. And we have new evidence of the success of a program that is doing just that.

The Asheville Project began several years ago, enlisting local pharmacists to monitor and help manage the health of diabetes patients and coach them about using their medicines properly. In exchange for these regular visits, patients' co-payments are waived for their diabetes medicines.

The results have been impressive: Patients' health improved dramatically, and their employer -- the City of Asheville, North Carolina -- saved money. Direct medical costs fell up to $1,872 per patient per year, absences from sick time decreased, and productivity increased by up to $18,000 a year. The Asheville Project was expanded to help patients manage other chronic illnesses as well.

Healthcare: Portability is the Key

So the unions have finally figured out that the government-created system of employer-based insurance has a fatal flaw:

"Approximately three-fourths of American workers are concerned with losing their health insurance if they change jobs, according to a survey released by the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO)."

How do you increase portability? Level the tax code to include equal tax treatment for individual plans that aren't tied to employment. This would effectively get companies out of the insurance business if people sought out individual policies. But so what? This WWII model has got to go (hey, ho.)
-Max Borders

Healthcare: Out of State Insurance

Here is a solid paper on breaking down the barriers to competition in the insurance market by letting people purchase insurance (particularly health) in other states. This is one of the BIG things we can do to remedy our ailing healthcare system.
-Max Borders

Healthcare: 3 Problems, 3 Fixes

Three problems:

>The federal tax treatment of health care subsi­dizes employer-sponsored insurance (ESI), but not health insurance policies purchased by indi­viduals and families in the non-group market.

>In many states [read: N.C.], the state policies and regulations that shape and direct health insurance markets do not facilitate the purchase of affordable health plans or allow for the portability of health plans.

>The large public programs, including Medicaid and the State Children's Health Insurance Pro­gram (SCHIP), are not designed to enable indi­viduals and families to move easily from public assistance to private health insurance. In other words, getting off public assistance is difficult, regardless of the person's desire to do so.

Three Fixes:

>Congress should change federal tax law to provide direct tax relief to individuals and families for the purchase of health insurance coverage. This would enable them to own their coverage and take it with them from job to job. Portability of coverage is the chief remedy for the instability of the existing health insur­ance markets.

>Until Congress makes these changes, state policymakers should redesign state health insurance markets to promote personal own­ership of health plans, enabling individuals and families to keep coverage regardless of employ­ment changes.

>State and federal policymakers should reform public health programs, notably Medicaid and SCHIP, guaranteeing enrollees a reliable, predict­able funding stream for health care while design­ing assistance so that they can use it to buy private coverage, thus facilitating a seamless transition into private coverage. The right wel­fare policy would enable individuals to move off welfare and into the private economy.

Check out the whole report.
-Max Borders

Healthcare: Saturday Irony

While U.S. progressives are trying to give us Canadian-style healthcare, Canadians are trying to move away from their Soviet-style rationing model by proposing a modicum of cost-containment measures and limited access to private care. Check out this Fraser Institute report.
-Max Borders

Healthcare: Mandates Redux

Here is some more fodder on mandates -- from 2002. It's only gotten worse in 6 years, by the way.

Some choice bits your progressive friends won't like:

A study prepared by the actuarial firm Milliman and Robertson for the National Center for Policy Analysis assessed the costs of the 12 most common state-imposed mandates. The analysis found that these mandates could increase the cost of family health insurance by as much as 30 percent. The firm's analysts also found that certain individual mandates, such as well child care, involve relatively small increased cost, adding as little as $35 a year to the price of a basic family health insurance policy. [Emphasis mine.]

30% for just 12 mandates!? I'm waiting for the response that actuaries Milliman and Robertson are in the pay of big oil.

A report by professors Frank A. Sloan and Christopher J. Conover of Duke University found that, "...the higher the number of coverage requirements placed on plans, the higher the probability that an individual was uninsured, and the lower the probability of people having any private coverage, including group coverage. The probability that an adult was uninsured rose significantly with each mandate present." The study found that 20 to 25 percent of the number of uninsured was due to the presence of state mandates.

Oh, those right-wing insurance lobbyists at Duke.

In a comprehensive review of state regulation of health insurance conducted for the U.S. Congress, the General Accounting Office (GAO) found that insurance costs are consistently higher in states that impose a large number of mandates on insurers. The report noted that while consumers receive some targeted advantages, findings show there is no question that state insurance regulations "add costs to insured health plans."

Citing recent studies, GAO researchers found that while mandates invariably boost the overall cost of insurance claims, the amount of increase differs among states. In Maryland, for example, mandated benefits accounted for 22 percent of claims costs, while in Virginia they represented 12 percent of costs and in Iowa 5 percent. The GAO concluded that, "In general, such cost estimates are higher in states with more mandated benefits and in states that mandate more costly benefits."

It seems that at least the GAO report focuses on cost of claims, not insurance premiums. Interesting. I'll wait for our "progressive" friends to explain that one away. And, by the way, I explained this phenomenon in past arguments, but the progressives couldn't grasp it. Seems - yet again - their linear thinking is an impediment to understand healthcare holistically.

Oh, and even the left-wing Urban Institute expressed concern over mandates:

The Urban Institute also pointed to the link between state-imposed mandates and a rising uninsured population... "While most firms may not drop coverage because such a mandate is enacted, the mandate may contribute to higher premiums over time, and these higher premiums lead some people to drop their employer-sponsored or individual coverage."

(Big HT: Brian Balfour)
-Max Borders

Healthcare: You Call This Analysis?

Here's another example of rhetoric sans analysis -- and note the timbre of partisanship:

The Republican plans often read like talking point lists from a conservative backwards-thinking tank:  “tort reform,” “mandates,” “high-deductible health plans,” and, of course, “tax credits galore.”  Memo to conservatives – people want a choice of affordable, comprehensive health plans and they don’t want a smokescreen of bad ideas instead of that goal. 

Scare quotes let you know that he doesn't feel like thinking or talking about the relative merits of ideas. But even a brief discussion of Searings' scarequoted phrases reveals there is much more depth than he'd like you to believe. And "people want" let's you know that he doesn't care about costs or the means, he just cares about people getting what they want -- you know, like healthcare grows on trees.

Mandates -- Items government forces you to purchase in your healthplan which drive up costs - or as Searing puts it, starts "jacking up rates".

High-deductible Health Plans -- Affordable plans that people can get to control healthcare costs, but require us pay for more out-of-pocket expenses. Very often HDHPs are coupled with a health savings account (HSA), which allows you save for out-of-pocket expenses in a tax-protected account you get to keep. A great option for young people who usually only need out-of-pocket healthcare. The catastrophic portion is there when they need it (and any high deductible is covered by the HSA). If you had a $30,000 knee surgury, would a $3000 deductible be all that objectionable? Sadly, Searing likes the cost-shifting of the current system, which tends to benefit the upper middle class. I prefer consumer-driven healthcare, which is why I bought such a plan for my family.

Tax credits -- This is how you help all people - working poor and middle class - get access to healthcare. Indeed, North Carolina spends more than $20,000 per working family on health and human services -- most of which is Medicaid (HT - Brian Balfour). Just think how much you could do with that money if you just subsidized the poor to get their own healthcare with tax credits (which they prefer over government healthcare). Tax credits would also allow people to address the unequal tax treatment which favors employer-based insurance -- a problem that Searing doesn't care one iota about, apparently.

Does Adam Searing hate good ideas? Yep, if they're not embraced by his chosen party and/or if they don't let bureaucrats run your life, he does.
-Max Borders

(Update: Oops, oh and tort reform is a means to keep outrageous malpractice award sums from driving up the cost of malpractice insurance (which is passed onto you). Sure, negligent doctors should have to pay for their mistakes. But the citizens of North Carolina shouldn't have to pay for greedy lawyers who're suing to keep themselves in Mercedes, or for juries who think they can put a value on human life by adding zeroes to award sums. The system is perverse.)

Healthcare: the Big Problems

Here's a good summary of the major pathologies in our healthcare system. The author thinks:

The projection that health care spending will reach nearly 20 percent of gross domestic product (GDP) within the next ten years confirms what every leading health care economist is saying: health care spending is out of control, and the time for action is now. But these are not signs that the health care market has failed.

Nope. Again, the problem is government. Three major issues this author cites are:

a) One key problem lies in the federal tax code – specifically, the federal tax exclusion for employer-provided coverage. It is this policy that causes most Americans to rely on their employers for health coverage. But small businesses frequently cannot afford group insurance for their employees, and large companies have tended to restrict the choices of employee coverage on the false premise that such restrictions would restrain cost growth.

b) Another major distortion in the market is the huge amount of spending the government pumps into Medicare and Medicaid. As the projections show, about half of the $2.4 trillion we spend on all health care nationally comes from taxpayer dollars. And when government pours that much money into any sector, prices go up. The cost of private insurance is also affected, since these programs create benchmarks for private plans.

c) And... One of the big problems in health care is that prices are opaque. In the Milwaukee area you can pay $100,000 for a bypass operation at one hospital, and just $48,000 for the same procedure at another hospital. But most patients – and sometimes even the doctors – don’t know this.

Now, progressives say they are only concerned about resolving problems that will mean 100% coverage for all Americans. They don't care how they get there. But short of sticking the government jackboot into people's necks, there is a way you can asymptotically approach universal coverage: refundable tax credits. Carrots are better than sticks. (We can already see the unraveling of the Massachusett's plan, which has most of the elements of Hilarycare 2.0.)
-Max Borders

Economic Illiterates for Universal Health Care

Complete ignorance of economics and markets in general is the only explanation for those that continue to insist on "universal" or "single-payer" health care. Sheldon Richman explains why in this outstanding article.

"Case in point: How would one see through the flimflam served up as health-care policy without a working knowledge of economic principles? When politicians promise "universal and affordable" medical care and insurance, how else are we to know that those promises can't be kept. Indeed, attempting to keep them would gravely damage our medical care (even more), our prosperity, our liberty."

Richman describes how an insurance market (and therefore the health care industry as a whole) simply can not function properly in the context of, say, Hillary Clinton's vision of health care.

"Clinton declares, "I want to stop the health-insurance companies from discriminating against people because they're sick."

One doesn't know whether to laugh or cry at a statement like that. Is it ignorance, stupidity, or demagoguery?"

The article explains why such a mentality would inevitably lead to price controls, which of course everywhere and always leads to rationing and shortages. How refreshing would it be to find just one politician who could articulate why it is in fact the countless ways in which government interferes with the marketplace that is primarily responsible for escalating health care costs? Don't hold your breath.

"In fact, the politicians love those interventions. So they promise to lower medical costs through direct controls. Even a modest familiarity with how markets work reveals that this would make things worse. Is it too late for Americans to see through the con game?"

Here in North Carolina, we have our own resident useful idiot who has bought the "con game" hook, line and sinker.

Healthcare: Talking Points and Elevator Pitches

I came back from our Civitas luncheon yesterday, upset because the panelists largely ignored the bulk of the healthcare results of the DecisionMaker Poll, which I thought were far more important than all the speculating D.G. Martin and Tom Fetzer did on McCain, Clinton, Obama and the mobocratic winds of presidental politics.

Apparently someone felt the same way I did when Fetzer remarked that healthcare is just too "complicated" an issue to get any traction in the election -- despite the fact that affordability in healthcare is the #1 concern among NC voters:

GOP political consultant Tom Fetzer at the Civitas Institute poll luncheon today said health care is too complicated to be a deciding issue in elections. It can't be summarized in 30 seconds.

Let's try 10 seconds:

---

No employer, insurance company, or government bureaucrat knows better than you about your family's health needs. You should have the right to purchase health care and health insurance as you see fit, without governmental restrictions or penalties.

---

I'm open to suggestions to strengthen the pitch.

I wouldn't change a thing.

If I was stumping, I might only add some preliminary rhetorical questions -- making the elevator pitch the punchline:

1) Why don't you have the right to buy less expensive insurance in other states?
2) Why do employers get a tax deduction to buy employees insurance, but you get no tax deduction to buy your own insurance?
3) Why are North Carolinians forced to pay for 47 coverage items like drug abuse treatment and providers like chiropractors -- when they could choose which items they need and pay less?
4) Why don't we know much of what anything costs in this state if we wanted to buy healthcare out-of-pocket?
5) Why are we paying to put more and more people on Medicaid, when we could offer subsidies to buy health insurance at a much lower cost to taxpayers.
6) Why isn't N.C. doing anything about malpractice awards, which drive up costs for everyone?
7) Why does the party in power in this state want our healthcare decisions to be controlled by government?
8) Why does the party in power in this state have no interest in making the health insurance market more competitive, and thus less expensive?
9) Why does NC punish the individual and group markets with costly, burdensome regulations, when that's only about 40 percent of the insurance market?
10) Why is the state trying to put middle class kids on Medicaid, when parents can afford insurance, and when doing so only drives up insurance costs for everyone else?

OK, OK. Maybe I'm proving Fetzer's point to a degree by offering this laundry list of grievances. It does get complicated. But Coletti's point is simple: the healthcare "market", such as it is, is messed up because government has turned it into an expensive, complicated Rube Goldberg machine that has nothing to do with consumer choice and everything to do with bureaucratic, employer, special interest and insurance company control. Government must get out of the way to empower the consumer again. That is your right.
-Max Borders

Healthcare: Consumer-Driven Revolution

Check out this Baltimore Sun interview with Greg Scandlen, whom I've met personally and is doing great work to reform healthcare. Here's an excerpt:

Q: In general, can the system best be reformed by changes at the federal level or the state level?

A: We are working on reforming the system independent of any state or federal action. There is already plenty of money in the system; it just isn't allocated properly because the wrong people control the money.

Every penny spent on health care comes from us as citizens. It is simply passed through to insurance companies in the form of premiums, employers in the form of lost wages and government in the form of taxes.

We were willing to let them control our money because we thought they would do a good job of managing it. But they haven't. They have all created a system that is bureaucratic, inefficient, inconvenient, of questionable quality and way too expensive. It is time to take our money back and control it directly. When that happens, health care will become as responsive, efficient, convenient and affordable as the rest of the economy.

This is the conversation we need to be having right now. And yet the public is largely ignorant on this issue. (Read the whole interview.)
-Max Borders

Herzlinger Interview: Two Cheers

Harvard Biz-school's Regina Herzlinger is one of the architects of the consumer-driven healthcare revolution. And she gets it mostly right in this interview:

Well, essentially the problem is that you and I have taken part of our salaries and given them to our employers to use in buying health insurance on our behalf. There is no way they could buy our clothes or our homes or anything else as well as we can -- and they don't do a very good job of buying health insurance, either. The only reason we've done that is because they can use our salaries pre-tax to buy health insurance ... The