Saturday, August 29, 2009

Health Care Follow Up

First and foremost my faithful followers, I apologize for the length of this post. I wrote with a preview about a month ago about a piece I was working on. That piece did not end up getting published by the ERLC, but will be a two part expose in the George Mason School of Law Newspaper, also known as The Docket.

I am publishing the full text of the article here first (minus footnotes) for you my loyal followers to get the first crack at it. If you would like the footnotes to get the full text articles of the quoted material, please comment and I will make sure to get them to you. Thanks for reading and hope this helps you make up your mind on health care...

The Mysteries of the Health Care Proposal Unveiled
By: Brian J Barnes, August 27, 2009

The American people and members of Congress from both parties are waging a fierce debate over health care reform. Numerous house and senate committees have trotted out proposals on how to address the perceived problems in the health care system and reaction to these proposals has been vocal and adamant. Based on news coverage from varying town hall meetings around the country it does not appear that either side is happy. Since this issue is not going to go away and Congress will be back in session shortly, your humble writer thought perhaps it was time to expose the reality behind the rhetoric on this hot button issue. In the interest of full disclosure I will tell you upfront, I am not a proponent of this brand of health care reform. This analysis will attempt to reveal some of the most disturbing aspects of the bills, but in no way covers them all. I will stake out what I believe to be to be an inevitable conclusion that the proposed health care reform is exceedingly dangerous legislation to the health and well being of most Americans and the country in general.

Rhetoric v. Reality:
The rhetoric – The government plan is more affordable: President Obama continues to claim in interviews and press conferences that health care reform will save money and make health care more affordable than our current system. If this were true, why the need to raise taxes and cut other programs and shift costs onto the states in a massive ponzi scheme?

The reality: In order to help pay for the costs of health care reform President Obama recently said in an ABC news interview, “that he would propose a reduction in the charitable tax deduction for those his administration considers wealthy.” This will drive down the amount of money people donate to charitable organizations which will further burden those relying on charity, those who are least able to help themselves. Other ideas to pay for the plan include a 3 cent tax on sugary sodas. As Senator Michael B. Enzi of Wyoming has said, “With its trillion dollar price tag, this bill is anything but affordable”.

The health care reform bill would mandate that all Americans sign up for insurance or pay a fine. Id. The same requirement would extend to businesses to either insure their employees or pay a government fine. Id.

Furthermore, due to the high cost of the legislation and the $320 million dollar deficit in funding, the bill would charge a surtax on wealthy Americans, beginning with a 1 percent levy for couples earning $350, 000 and rising to 5.4 percent on income above $1 million.

This plan is anything but affordable. It will ensure that the percent of the average American’s budget that goes towards health care actually increases either through direct expenditures on higher premiums or increased taxes or both if you are deemed significantly wealthy. Currently $84.00 out of every $100.00 spend on health care is spent by someone (en employer, insurance company, or government) other than the recipient of the care. Id. That seems like a pretty good deal for the American consumer as it currently stands. What this plan will do is create stagflation and greater unemployment as those in the higher tax brackets either will not invest to create jobs or will do so outside the United States where the tax regimes are not so oppressive.

Lastly, the plan contemplates taxing your current health benefit or removing its tax exempt status. This would mean the money your employer contributes to your insurance plan would now be taxable. It would also mean purchasing supplemental policies for dental, vision, or medical flex spending accounts would have to be done with after tax dollars, effectively making them much more expensive. A study by the Council for Affordable Health Insurance estimates that the President’s proposals could increase premiums by 75 to 95 percent. Further evidence that this plan is anything but affordable!

The rhetoric – Cutting costs: The Democrats continue to say that the proposed legislation will cut costs in the health care system. They claim that increased competition brought about by a government option, the implementation of information technology in the system, a shift to focusing on preventative care, and other reforms will lower the cost of health care.

The reality: Douglas Elmendorf, Director of the Congressional Budget Office [CBO] told the Senate Budget Committee that, “On the contrary, the legislation significantly expands the federal responsibility for health care costs”. House Republican Leader John Boehner said of the report from the CBO, “The Director of the Congressional Budget Office today confirmed that the Democrat’s government run plan will make health care more costly than ever, making clear that one of the Democrat’s chief talking points is pure fiction”. Id.

The rhetoric – The plan is Deficit Neutral: President Obama and the Democrats continue to say this bill will be deficit neutral, meaning it will not increase the national debt. President Obama’s budget director Peter Orszag stressed, “The CBO numbers are only so high because the estimates keep current Medicare reimbursements to doctors in place. If you take that off the table in terms of new policy, the House bill is deficit-neutral”. This begs the question, if the payments are off the table, where are they going?

The reality: The Senate Finance Committee members are proposing a giant ponzi scheme with the states where the states would be required to finance the entire cost (states currently pay only 43 percent of Medicaid costs) of the proposed expansion through taking on new debt by issuing bonds that the Federal government is supposed to back. This is an effort to keep the costs off the books of the Federal Government and disguised. Id. If this sounds familiar that is because you are probably remembering the Enron book cooking scandal that bankrupted the company and destroyed the pensions and lives of thousands of workers and investors. Congress is cooking the books on health care and could end up bankrupting the country if we are not watching carefully.

Congressional auditors reported that the legislation would add more than $230 billion to the federal deficit over the next 10 years. CBO Director Elmendorf, while addressing Congress, went further to state that the costs of health care are, “growing faster than inflation, wages, and the overall economy…likely impacting future deficits”.

The rhetoric – Without the government intervention health care costs will bring down the economy: Across the board Democrats and the President tell us that without government intervention the current health care problems will prolong the recession and drag down the economy.

The reality: The statement above may be true. Without changes and improvements the system is facing very significant challenges. Recession and the aging baby boomer generation (who will consume increasing amounts of health care resources) will only compound those challenges. However, the solution the Democrats and President Obama propose is a nuclear option. Their proposal would not be a slow death of the health care system and the economy, but rather a preemptive strike. The US Chamber of Commerce in a letter to the Ways and Means Committee wrote, “The tax increase would be devastating to small businesses, which have led America out of the last seven recessions and create two out of every three jobs during a recovery.” Moreover, they claim that the legislation as proposed would, “override long-standing tax treaties, damage U.S. relationships with major trading partners, and could prompt retaliation by foreign governments against U.S. companies operating abroad, further aggravating already jittery financial markets”. Id. This is a complete repeat of history. As you may recall at the outset of the Great Depression one of the aggravating factors that drove the world economies into a tailspin was retaliatory escalating import and export tariffs and excise taxes.

To increase taxes at a time when the economy is sinking is simply unheard of. The Heritage Foundation has said, “Not a single economic school of thought advocates raising taxes during a recession or threatening to do so in its aftermath. To call for a tax increase during the largest recession in 70 years is downright reckless”.

The rhetoric – The government plan will improve quality of care: President Obama says, “Government will make health care cheaper and better”.

The reality: According to Sally Pipes of the Pacific Research Institute, “To reduce costs they will have to ration – deny – care”. Id. Rationing the health care you can receive is certainly not improving the quality of care. Moving to a system of evidence based medicine, which the Senate bill includes, will not improve the care. A system of rationed care or evidence based medicine will actually lead to denial of remedies to the American consumer. The only difference between the current system and the government plan will be who tells the consumer No, that treatment is not covered. This plan replaces the insurance company employee who denies your claim with a government bureaucrat that denies your claim.

The reality is that the current American system which is partly profit driven allows for the reduction of waste and costs in pursuit of profit and provides the world with advances in medicine that ease pain and save lives. Id. The logical end point of the path that Congress is moving us down is rationed care and long waiting lists, essentially Medicaid for everyone. Even if implementation of a public health insurance option does not occur, rationing will be likely under the health care bill. Private insurers will face mandates to provide the essential benefits package and to cut costs. This will create a situation where extreme rationing is inevitable. The government would decide who should live or die. Americans must ask themselves if there is a price tag that can be put on human life. America’s founding document, The Declaration of Independence, says, “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”. When we start rationing off life-saving treatment through the use of evidence based medicine and limiting it to those deemed more valuable to society, we undercut those ideals.

No Rhetoric? There are other parts of the bill that have no rhetoric to accompany them because the proponents of reform are being careful not to bring them up. A sampling of some unnerving topics:

SEC. 2233. PUBLIC HEALTH TRAINING CENTERS
(a) GRANTS.—The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall award grants to, or enter into contracts with, eligible entities to provide training to graduate medical residents in preventive medicine specialties.

The Bill empowers government to take over medical education through, building, running, developing, or licensing these Public Health Training Centers.

SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN.
PURPOSE —The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.

The House bill gives access for the government to come into your home and inspect it to determine if it is a suitable environment for children and ascertain if you are a fit parent. They do this by establishing the Home Visitation Program for families with young kids & families expecting kids. If this program becomes non-voluntary, and it very easily could, it would certainly sound very much like George Orwell’s 1984, Big Brother would no longer just be a bad summer television show.

Abortion is not explicitly defined as an essential benefit in Sec. 122 of HR 3200. However, the terminology there is vague enough to allow for abortion. For example, abortion could be included under “preventive services.” During a pre-recess hearing, Senator Barbara Mikulski put in an amendment in the Senate bill to cover “preventative services”. At that point, Senator Hatch questioned her to find out what “preventative services” entailed. He further asked her to clarify that they would not include abortion. When pressed further, Mikulski eliminated any uncertainty. Hatch asked her a final question. “Madame Chairman, would you be willing to put some language in that says, ‘Not including abortion services’?” Mikulski concluded saying, “So, no, I would not be willing to do that at this time.”

The Republicans have made four attempts to block the abortion funding with amendments of their own, but Democrat majorities have voted all four measures down.

The Democrats plan seems to be intentionally vague in many respects and grants incredible powers to the Department of Health and Human Services to determine what language means and what plans would be required to cover. An advisory panel appointed by a pro-abortion president is certainly going to come to the conclusion that abortion be included in the benefits package. Even if they did not, courts are likely to interpret this new law in conjunction with Roe v. Wade and mandate abortion funding from the bench. Making abortion an essential benefit in public health care would mean United States taxpayers would fund abortions regardless of their personal convictions on the issue.

The Bottom Line:

The bottom line is that the House Health Care Bill, H.R. 3200, is 1018 pages in length. The magnitude of the bill along with the numerous citations to other legislation makes it nearly impossible to figure out what everything in the bill actually means. The above items are only a smattering of the numerous changes and problems that the currently proposed legislation has to offer the American people. The analysis is what the reform could potentially mean. The simple fact is that if passed, no one can say for certain how badly this will play out in practice. Pragmatically, I can only say that there is an almost absolute certainty that this legislation will lead to diminished health care for most Americans. This bill will lead to less choice in health care for most Americans. This bill will lead to higher taxes and premiums for American business and citizens. And, this bill will lead to unprecedented government intrusion into every level and aspect of society, from business, to education, to homes and families. This bill is a blatant affront to the American ideals of personal choice, capitalism, and to individual liberty.

If health care reform goes through we will see drastic changes to the quality of life for all Americans.

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