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The States’ Failed Experiments: The major provisions of ObamaCare have already been tried. And they don’t look good
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Like participants in a
national science fair, state governments have tested variants on
most of the major health care reforms Congress is considering. The
results include dramatically higher premiums in the individual
market, spiraling public costs, and reduced access to care. -
Despite these state-level failures, President Barack Obama and
congressional Democrats are pushing a slate of similar reforms.
Unlike most high school science fair participants, they seem
unaware that the point of doing experiments is to identify what
actually works. Instead, they’ve identified what doesn’t—and
decided to do it again.
Did Progressives Even Know What Was In the Health Care Reform Bill?
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And as lefty
opposition to the bill has intensified, something incredibly
frustrating has happened: progressive criticism has come to mirror
the criticism that's come from market-oriented skeptics. -
What does this mean? I see two possibilities: The most likely is
that progressives are latching on to these criticisms because
they're now so angry that they're ready to do anything to kill the
bill — including admit what they had to have known all along, which
is that these criticisms actually have a lot of merit.The second, while less likely, is more disturbing: Many
progressives who backed this bill throughout the year had no idea
what was in it. They hated Republicans, heard endless
public-option hosannas from their leaders, and believed they'd
found a way to start the move toward single payer.
Obama shadow boxes with 'enemies' of health plan
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Who were these "well-financed forces" and profiting "opponents of ... reform"?
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The Pharmaceutical Researchers and Manufacturers of America, the largest industry lobbying group in the country, is shelling out $12 million for pro-"reform" ads this summer and fall. Obama has bragged that "even the pharmaceutical industry" is on board.
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Legislative Reality vs. Political Reality: How Democrats game the Congressional Budget Office
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But after the August recess, scores for the various reform
proposals improved markedly. Not only were they cheaper,
requiring less total spending, they were judged by the CBO to
result in net reductions to the deficit. What happened? -
In large part, the answer is that Democrats became more skilled
at manipulating the CBO's scoring process. Indeed, they have
become so skilled at getting what they want out of the CBO that
the office has taken to including strongly worded warnings that
the various bills' real costs may not actually match their
estimates.
Progressives vs. Democracy: The health care debate reveals a nasty tendency within liberal politics
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Their increasingly shrill reaction to the debate has revealed a
disturbing strain of American political thought that cannot
comprehend how anyone could disagree with a big-government
solution to health care without being evil, stupid, insane, or
all three. -
“I will not stand by while the special interests use the same old
tactics to keep things exactly the way they are,” the president
said in a September speech to Congress. “If you misrepresent
what’s in the plan, we will call you out.” Call you out, yes, but
not by name— an understandable strategy, considering that all the
major corporate interests within the health care industry have
been busy negotiating with (and lending support to) the White
House and Congress. - 4 more annotations...
When Asked Where the Constitution Authorizes Congress to Order Americans To Buy Health Insurance, Pelosi Says: 'Are You Serious?'
I think the lesson here is that even written constitutions are not much of an obstacle to governments doing whatever they want.
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Pelosi then shook her head before taking a question from another reporter. Her press spokesman, Nadeam Elshami, then told CNSNews.com that asking the speaker of the House where the Constitution authorized Congress to mandated that individual Americans buy health insurance as not a "serious question."
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Elshami responded by sending CNSNews.com a Sept. 16 press release from the Speaker’s office entitled, “Health Insurance Reform, Daily Mythbuster: ‘Constitutionality of Health Insurance Reform.’” The press release states that Congress has “broad power to regulate activities that have an effect on interstate commerce. Congress has used this authority to regulate many aspects of American life, from labor relations to education to health care to agricultural production.”
Public option: Treatment worse than the disease
Jeffrey Miron strikes at the root of the arguments for government involvement in health insurance. Being poor sucks. Some people, <em>by accident of birth</em>, have higher costs of living or lower income than other people. Hardcore egalitarian statists believe the government should compensate the unfortunate at the expense of the fortunate, but they should recognize that not everyone agrees with their notion of fairness, and that their approach would degrade everyone's standards of living.
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Government should not subsidize health insurance -- for the uninsured, the poor, the elderly or anyone else -- or regulate health insurance markets.
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Subsidizing health insurance means that patients and doctors are insulated from the costs of health care, so they utilize too much -- often in the form of unnecessary tests or medical procedures whose value hasn't been proven. This excess demand, along with technological progress, means rapidly growing deficits, so governments limit reimbursements to health providers or ration care. This kills innovation and creates its own inequities. The taxes necessary to fund subsidies are a drag on economic growth.
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Public plan mirage
Robert Samuelson might also have mentioned that Medicare is insolvent in the face of retiring Baby Boomers.
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The public plan's low costs would be artificial. Its main advantage would be the congressionally mandated requirement that hospitals and doctors be reimbursed at rates at or near Medicare's.
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But health costs wouldn't subside; hospitals and doctors would offset the public plan's artificially low reimbursements by raising fees to private insurers, as already occurs with Medicare.
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FACT CHECK: Health insurer profits not so fat
Of course, established health insurers do enjoy some protection from competition, thanks mostly to state governments.
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Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo? Answer: They're all more profitable than the health insurance industry.
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Ledgers tell a different reality. Health insurance profit margins typically run about 6 percent, give or take a point or two. That's anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones.
Health Care’s Muddled Incentives
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This article will summarize empirical observations that I consider important in looking at the U.S. healthcare system. First, I look at international comparisons. Next, I look at the implications of studies that compare health care in different regions within the United States.
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What I believe is most distinctive about the U.S. healthcare system is that it combines fee-for-service compensation for healthcare providers with fairly unlimited access to medical services. This means that supply is limited neither by rationing nor by absence of compensation nor by any fixed government budget. Notwithstanding considerable regulation of medical practice, the supply of health care is relatively unsocialized.
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The Lesson of State Health-Care Reforms
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Like participants in a national science fair, state governments have tested variants on most of the major components of the health-care reform plans currently being considered in Congress. The results have been dramatically increased premiums in the individual market, spiraling public health-care costs, and reduced access to care. In other words: The reforms have failed.
In Letter, Health Insurers Back Regulations in Exchange for Individual Mandate
Health insurance companies are all in favor of the left's reform proposals, provided there is no public option and all Americans are forced to buy their products (the "individual mandate"). More evidence that big businesses are not enemies of big government.
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The health plan community is united in support of comprehensive health care reform that ensures all Americans have high-quality, affordable health care.
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Creating a new government-run plan would thwart the ability of the health care sector to implement meaningful delivery system reforms, exacerbate the cost-shift from public programs to consumers and employers in the private market, and destabilize the employer-based system.
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Coverage Story: Does the cost of uncompensated care justify forcing people to buy health insurance?
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the true annual cost per family is more like $200, with uncompensated care accounting for "less than one percent of private health insurance costs."
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What about the young and healthy (or middle-aged and wealthy) person who decides insurance is not worth his money but pays all his medical expenses out of his own pocket? His choice does not impose costs on anyone, but under Obama's plan he would still be punished for it.
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The Consumer Is Not the Customer : Both parties promise to preserve one of the health care system's central problems.
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Three-fifths of Americans, the share with employer-provided health insurance, are in the same situation: Since someone else buys insurance for them, using money they would otherwise receive as wages, they are in no position to shop around and typically do not even know the true cost of their coverage. This disconnect between payment and consumption is one of the central problems with the current health care system, contributing to rapidly escalating costs, insecurity, and the general lack of choice and competition. Yet both Democrats and Republicans insist upon preserving it.
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In addition to enhancing competition and controlling costs, cutting the link between employment and health insurance would relieve the insecurity that many Americans feel about going without coverage when they lose or leave their jobs. Obama is right that it would be "a radical shift"—radical in the sense that it goes to the root of the current health care mess.
ObamaCare: Status Quo on Steroids
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World War II was a bonanza for the industry, especially Blue Cross Blue Shield. Government economic controls prohibited firms from attracting or keeping workers with higher wages. So someone hit on the idea of supplementing wages with noncash compensation, specifically, health insurance. The government said okay and the rest is history. Employee insurance was untaxed, creating a bias toward employer-provided health plans.
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Under the old-style indemnity plans (which individuals shopped and bought for themselves), contracting a catastrophic disease triggered a fixed insurance payment — to the policyholder – according to an agreed-on predetermined schedule. The money was hers. If she could find services that cost less than the insurance payment, she pocketed the difference. Of course, this provided an incentive to be cost-conscious in buying medical care. Homeowners’ and other types of insurance still works like this.
In contrast, under the Blue Cross Blue Shield model pushed by government — which began not as insurance but as a prepayment plan for doctors and hospitals — the policyholder never sees a dime. Treatment simply sets in motion a process in which the insurance company sends a check to a hospital, lab, or doctor. No treatment, no payment. The individual has no reason to shop around (there can be great variation in prices), or to question whether a test or procedure is necessary, or to even ask what anything costs.
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Obama's Health Care Plan: Put Up And Shut Up
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If there was anything bipartisan about the speech it was that he embraced every bad big-government idea from both sides. If he prevails, the American public won't get "choice and competition" as he proclaimed, but a one-size-fits-all government-prescribed health care plan that it dare not refuse and dare not challenge.
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Obama would encourage unlimited health care consumption by patients while eliminating the last vestige of price consciousness. But the reason America is facing unsustainable health care cost increases is precisely because its third-party system of insurance doesn't encourage prudent consumption by patients.
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Forcing insurance companies to cover preexisting conditions is immoral
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Obama undermines his call
for honest debate when he proposes to force insurance companies to administer a covert welfare program and calls it "insurance
reform." -
Obama's plan to force insurance companies to cover people with preexisting conditions combined with his
plan to force everyone to buy health insurance whether he or she wants it or not would impose an implicit tax on all policyholders
in the form of insurance premiums that are higher than they would have been without the program. (Some would have opted out
of insurance and paid nothing.) The rich would not be the only ones taxed, no matter what Obama says.
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