Sleepless in Midland

Hillary must be secretly hoping for an ObamaCare failure

Hillary Clinton and Barack Obama had a knock-down-drag-out fight during the Democratic primaries last year, but Mr. Obama eventually delivered a TKO. Ms. Clinton took defeat graciously and ended up as Secretary of State.

But let's not forget HillaryCare of '93 -- Ms. Clinton's own health care plan that went down in flames. Surely she must be feeling miffed as Mr. Obama is hoping to show the country that he can deliver where she couldn't. Would Hillary take it personally?  She could be feeling somewhat like the Russians do as they watch the Americans in Afghanistan and hope Americans don't succeed where Russia failed.

So far she's been relatively quiet about ObamaCare. On July 26 David Gregory asked her about it and she didn't stray too far from the party line.

When CNN asked her about ObamaCare on August 6 she harked back to the days when she was on the front lines catching heat, and she licked her wounds a little bit saying it's different now as more people realize there are fundamental problems with the existing system. She just hopes that whatever they come up with is going to be meaningful enough to make a difference.

She might never come out publicly with anything so crass as an "I told you so," but she may be secretly hoping for that opportunity. In the meantime, Page Six says she's ticked off because her appointments are taking so long, yet Obama's own selections get whisked in with seemingly no vetting whatsoever.

Finally, to the State Department's credit, that student question in the Congo which drew Ms. Clinton's sassy reply didn't get whitewashed out of the transcript, although the annoyance on display in the video seems drained from the dry print. "Wait, you want me to tell you what my husband thinks?"

Thanks, Barack Obama

One thing that both sides in the battle over ObamaCare agree on is that the current health care delivery system has some serious flaws. Both sides have come up with their solutions, and Republicans have proposed some pretty good ideas. Two, for example, are raising the amount of allowable deposits into Health Savings Accounts and allowing individuals to deduct medical insurance premiums. Those two things alone would help many people. So why haven't they been done already?

The Republicans had plenty of time in the majority to have done this. That these ideas are being proposed now seem reactionary, and we can probably accurately conclude that they would never have come up without Obama's push for health care change.

Now let me be clear, Mr. Obama's plan has some serious flaws, and the country would probably be better off if ObamaCare as we know it doesn't get passed into law. However, he has us talking about health care reform. And he has inspired some good suggestions from his opposition. So here's a begrudging "Thank You" to Mr. Obama for that.

John Mackey's health care proposals -- a Whole Foods boycott over nothing

John Mackey is an astute entrepreneur who is the brains behind a successful grocery store chain with 50,000 employees and a customer base drawn not just to fresh food but to the company's core values. However, some people mistakenly extrapolated those values to include an allegiance to President Obama's health care plan even if Mr. Mackey has a better idea.

Mr. Mackey wrote an op/ed that was published in the Wall Street Journal a couple of weeks ago, and it has inspired not only a boycott and a buycott but provided us one more example of just how divided the nation has become following the last presidential election. The dividing line seems to be between those who think Americans should be self reliant and independent and those who want a large government, high taxes and bureaucrats controlling important aspects of our lives.

An entry at Mr. Mackey's blog explains that his original op/ed had the title “Health Care Reform,” but someone at the WSJ rewrote the headline to call it “Whole Foods Alternative to Obamacare.” And that, he theorizes, is what drew the animosity from Mr. Obama's supporters.

Mr. Mackey's radical proposals are really quite simple, and those who have followed the discussion have seen them elsewhere with the possible exception of #8. But here is a short and sweet version of those ideas summarized from the original article posted at his blog:

1. Make high deductible policies more assessable and improve health savings accounts;

2. Allow taxpayers to deduct health insurance premiums;

3. Allow people to buy insurance across state lines;

4. Repeal government mandates on what insurance must cover;

5. Enact tort reform;

6. Make health care costs public;

7. Fix Medicare so that it doesn't go bankrupt; and

8. Allow tax deductions for donations to help people who aren't insured.

People are boycotting the stores for this? Proposal #8 seems especially suited to the Whole Foods boycotters. Anyone genuinely concerned about the uninsured should be able to pitch in some of their own money to help the uninsured and get a tax deduction to reward their altruism. Plus it will demonstrate that it isn't always other people's money they want to spend.

My only regret is that the nearest Whole Foods Market is over 300 miles away.

Related: Bob Inglis's plan; Tom Coburn's plan; David Goldhill's plan; and Bobby Jindal's plan.

Bobby Jindal's health care plan

In a recent WSJ.com article Louisiana Governor Bobby Jindal reiterated some of the common complaints against the health care plan being pushed by President Obama and the Democrats in the House, and he provided some helpful suggestions of his own.

Many people see Mr. Obama's plan as part of a design to drive private plans out of business and push Americans into a government run program, which, Gov. Jindal opines, will result in lower quality health care. He finds humor in Democrats' claim that a massive government run program will not diminish health care quality, after all, he was in New Orleans when hurricane Katrina swept through, and he witnessed first hand how inept government can be at every level. Not so funny is that House Democrats seem willing to sacrifice quality in return for removing for-profit entities from the health care delivery process. And there's the not so small problem of how to pay for it.

However, he's optimistic. He says there is general agreement among House Republicans and Democrats that reform is needed. Once the "current over-reach by Mr. Obama and Mrs. Pelosi fails," Gov. Jindal says, a genuine bipartisan reform plan could result. And that reform plan should encompass seven principles:

1. Consumers should have more choices aided by internet transparency of prices and outcome data for tests, treatments and procedures.

2. Consumers should have a financial stake in their own health care.

3. Medical malpractice law should be reformed.

4. Insurance reform should make coverage portable, eliminate exclusion for pre-existing conditions and allow reinsurance and high-risk pools.

5. Insurance pools should be bigger so that everyone could get the lower premiums people in large organizations get.

6. Pay for outcome, not activity.

7. Tax credits for low-income working Americans to help buy insurance.

President Obama and Speaker Pelosi have given us a monster of a plan that has all but the most loyal Democratic party loyalist shaking in their boots. No plan is going to be perfect, otherwise someone somewhere would have produced it. However, some very sound ideas have come up that don't include government control of the American health care delivery system.

The debate about health care reform has exposed a real divide among Americans, and it all seems to boil down to whether a person is willing to rely on one's self or the government.

Related: Bob Inglis's plan; Tom Coburn's plan; David Goldhill's plan; and John Mackey's plan.

A simple health care solution from David Goldhill -- a consumer driven system

David Goldhill penned a wonderful article published in The Atlantic with the unfortunate title of How American Health Care Killed My Father. [Hat tip C.A. for the pointer.]  It's a pretty good summary of what's wrong with the health care system in the U.S. along with some suggestions for a solution. He's a Democrat, but his proposals are not at all similar to those being touted by leading Democrats.

He outlines how the current situation developed. Group health insurance was introduced in 1929 and was given a big boost during WWII as employers sought alternate ways to compensate employees when FDR froze wages. Then in 1954 Congress made the employers' payments for health care insurance tax deductible, and since the benefits were tax free to the employees the result was that employer funded medical insurance was the most economical means of paying for just about any medical expense. Here's Goldhill:

There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.

Medicare and Medicaid came along in 1965, and basically continued the theory that essentially everything should be covered. Health care costs have been rising in excess of inflation ever since. And with someone else paying the bills the customer has no reason to try to control costs. Furthermore, with Medicare setting the prices, doctors have to do more -- diagnostic tests, procedures, follow up appointments -- in order to get paid more.

Another Medicare caused distortion Mr. Goldhill describes is the shortage of geriatricians. It would seem that with senior citizens being the primary recipients of Medicare benefits there would be more geriatricians. However, geriatricians don't get reimbursed as much as specialists, so the unseen hand drives physicians to specialize.

Take Medicare and insurance out of the picture, and prices go down. Lasik surgery is the poster child for market driven medical care prices. Medicare and insurance doesn't typically cover it, so prices are transparent and relatively cheap.

A consumer driven care system is Mr. Goldhills proposed solution. It's not an original idea, but he sets it out concisely. Get rid of private insurance, Medicare and Medicaid, and replace it with a single program of mandatory catastrophic insurance based on a single national pool with premiums based solely on age. Non-catastrophic medical expenses would be paid for by individuals out of a revamped Health Savings Account which every American would be required to maintain.

The government would supplement or pay the premiums for low income Americans. Abolish Medicare and suddenly there's money available to do something like that.

Mr. Goldhill makes a strong case for how bad the current system is and provides many arguments in favor of his solution. What you see here is a brief summary. Read the whole thing to appreciate the magnitude of the problem and the logic of this simple proposal.

Related: Bob Inglis's plan; Tom Coburn's plan; Bobby Jindal's plan and John Mackey's plan.

Sen. Coburn's "Patient Choice Act of 2009" -- an alternate health care plan

ObamaCare is on the ropes, and no one can say at this time whether the Democrats in the House and Senate will ship it to the President without Republican support. If so, Republicans might be handed a gift that will keep on giving. Or perhaps as Mark Steyn predicts, every issue in future elections would be about the level of government service as Americans become less self reliant and voters want more and more from the government.

Most agree that the current medical care distribution system is flawed. And there is fierce opposition to ObamaCare's "Public Option," i.e., government run medical service. However, there are alternatives to ObamaCare on the table. The other day we discussed Bob Inglis's plan. Link. The topic today is the "Patient Choice Act of 2009," a plan introduced last May by four Republicans -- Senators Tom Coburn, M.D. (R-OK) and Richard Burr (R-NC) and Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA.

The key component of the plan would be state insurance exchanges which would allow consumers to shop for and compare insurance plans. And the key word is "optional." Participation by states would be optional. Participation by insurance companies would be optional, and participation by customers would be optional.

In states which choose to participate, no customer could be excluded because of age, health or pre-existing conditions. "Plans participating in the exchange must offer at least the same minimum health benefits made available to Members of Congress," according to the summary PDF.

The exchanges must have a mechanism to avoid excessive premiums. And to protect uninsurable individuals, the exchanges would have to include independent risk adjustment, pools or reinsurance.

To help the customers pay the premiums the tax code would be changed to redirect the tax benefit from the employer to the customer as well as give a tax credit to the customer which could only be used for insurance premiums or medical expenses. Any excess could be rolled over at the end of the year. And the HSA contribution limits would be raised.

Go to Senator Coburn's Health Care Reform page for links to the bill, FAQs, a short summary, a long summary, a section by section summary, and just about anything one would want to know about it.

Aside: After having read through enough PDFs to make my eyes cross, I wonder how many Americans might be tempted to simply say "to hell with it," and go along with the ObamaCare government run program rather than have to read and choose from among several insurance policies. Well, there's a selling point for Dr. Coburn's proposal. States which put in place a smart exchange program will make the choice as easy as selecting a cell phone carrier.

Hey, it just might work.

Related: Bob Inglis's plan; David Goldhill's plan; Bobby Jindal's plan and John Mackey's plan.

The perfect healthcare plan -- is there such a thing?

The perfect health care plan doesn't exist, otherwise we would see it either in the U.S. or somewhere else. Every plan has at least one major flaw. And the flaw of the moment in ObamaCare is the "public option," i.e., government run medical services.

RasmussenReports.com tells us this about a poll of likely voters as of 8/19/09:

57% oppose ObamaCare w/o public option;
34% support ObamaCare w/o public option;
42% supported ObamaCare last week before public option was in the news.

That tells us within +/- 3 percentage points that ObamaCare, as we know it, is headed for the dumpster. And there is so much hostility in the air you can feel it. The atmosphere is like that of an un-airconditioned divorce court packed with angry couples eager to acknowledge the other person's fault but not their own. Who started it? Does it matter anymore?

An article in WSJ.com tells about how Rep. Bob Inglis, R-South Carolina, is catching heat from his constituents. He opposes ObamaCare, they are fine with that.  But his compromise plan would require some government involvement, and there's where he parts from his constituents. But take a look at it, he has some good ideas. Here's a link to the summary PDF. Basically, the four principles are these:

1. Spread the big risks and own the little risks. Each of us pays for our own little expenses. And insurance would do what they do best -- cover the big expenses. Make a huge pool and reduce premiums for people who don't smoke and aren't overweight.

2. Do health care, not sick care. Give everyone a thousand bucks for a wellness account which could be used for physical exams, tests, health counseling, fitness programs, etc., to try to keep everyone as healthy as possible.

3. Everyone is covered. Universal coverage with everyone required to have it. Attach it to the individual, not the employer. Eliminate any denial for pre-existing conditions, and allow the risks and costs to be assessed with a community rating.

4. Everyone pays in. A person pays based on how much he/she can afford.

No plan is going to be perfect, but this one is so simple it just might work.

Related: Tom Coburn's plan; David Goldhill's plan, Bobby Jindal's plan and John Mackey's plan

Conaway town hall 8/10/09

It was standing room only at the Midland Memorial Hospital room in which District 11 Representative Mike Conaway held his town hall meeting this afternoon. The room was packed, and the crowd filled the outer room, too, flowing into the hall.

So, here's a report from the hall. It sounded very quiet. There was no yelling. No one got beaten up. And if there were any swastikas they were extremely well hidden.

But seeing all the concerned young faces in hospital garb makes an observer wonder how many voters around the country might at this very moment be trying to shake off a hangover from the intoxication of the campaign of '08 in which a charismatic charmer cast a hypnotic spell creating a dreamy illusion which, on sober reflection, could not be real.

Rep. Conaway's town hall meetings

District 11's representative, Mike Conaway, has scheduled some town hall meetings. The following is from his website:

8/10: 3:30-5:00 pm: Meet with hospital staff, faculty, physicians, and patients at Midland Memorial Hospital - OPEN TO THE PUBLIC!

8/11: 8:30 am: Meet with doctors, nurses, hospital personnel, and the general public at Odessa Regional Medical Center in Odessa (East Campus Auditorium, 515 N. Adams) - OPEN TO THE PUBLIC!

The "Open to the public" looks almost like an afterthought since the target groups were already listed. Furthermore, the Reporter-Telegram says space is limited at the one in Odessa, and people wanting to attend need to RSVP. It's noteworthy that they know in advance that the space won't accommodate everyone, but I guess a "town hall" meeting is anything a politician wants it to be.

That aside, these could be interesting meetings. There are plenty of people within the target groups -- faculty, physicians, nurses, hospital personnel, and patients -- who may want to minimize government involvement on one hand but maximize government payouts on the other.

Some TV pundits were ridiculing a town hall attendee somewhere who said, "Keep the government out of Medicare." They yucked it up over what they thought was an ignorant rube not knowing that Medicare was a government run program. But they weren't absorbing his meaning. What he most likely wanted was to keep the current administration out of Medicare. Big difference.

It's going to be tough to satisfy everyone. And our representatives have a hard job. But a rush to sign an unread and misunderstood Obamacare plan seems unwise.

After Obamacare all future elections to be about level of government services -- Mark Steyn

Mark Steyn, having lived in Britain, Canada and the U.S., is one of those few who has experienced health care delivery in all of those countries. He doesn't like the direction the U.S. is going, and he is a very harsh critic of President Obama's plan to reform the health care industry.

Some people will benefit from Mr. Obama's plan, should it ever become implemented, and some people will suffer under it. The trick for any serious health care reformer is to come up with a plan that will benefit the most people without a radical disruption for the others. Mr. Obama will probably sign any legislation the House and Senate agree to put before him, and we don't know right now what form the eventual bill will take.

There has been severe criticism of the plans currently under consideration, and Mr. Steyn sees a consequence that deserves some notice -- a change in the direction of all future elections. Here's a direct quote:

It alters the equation. If you provide government health care, then suddenly all the elections, they’re not thought about war and foreign policy, or even big economic questions. They’re suddenly fought about government services, and the level of government services, and that’s all they’re about, because once you get government health care, the citizens’ dependency on government as provider is so fundamentally changed that in effect, every election is fought on left wing terms.

(Source: This was from a podcast of the Hugh Hewitt show, a transcript of which can be found here. Listen to the podcast by going here and scrolling down to May 7, Episode 167.)

While most of us thought "hope" and "change" were merely focus group tested campaigning devices, there were those who argued that Mr. Obama hoped to change the U.S. from a country full of people proud of their individuality and brimming with initiative to a country full of government dependents. Mr. Obama rode into office on the backlash of an economic downturn and a dislike for his predecessor. And it's questionable whether those voters who were swept off their feet by him really expected the monumental transformation he is proposing. The U.S. is being tested right now, and we will eventually see whether Mr. Steyn's prediction is correct.

Obamacare in France

President Obama and supporters of his health care plan are pushing like crazy to get the thing passed into law. Meanwhile, most of us out here in flyover country, the people who may benefit or suffer from it but who will definitely pay for it, are wishing they would slow down a bit so we can study the whole thing some more.

It would be nice if supporters could point to a similar system somewhere in the world where it has been tried and actually works. There are people around who will attempt to tell us how great the government run programs are in Britain and Canada -- for example see previously, How bad could the Canadian healthcare system really be? However, there is certainly no shortage of complaints about those systems, and we have to conclude that no system is perfect.

Same with France. HealthcareEconomist.com says, "France has the highest level of satisfaction with their health care among all European countries." However, it didn't take Le Parisien long to find some dissatisfaction. In particular, they found doctors who won't accept patients who are under the government plan. Excerpt (translation from Google translate.):

The two-tier medicine is a reality. Victims, patients receiving universal health coverage (CMU), reserved for people earning less than € 621 per month. They have more and more difficult to seek treatment outside of hospitals. Proof: The test that we conducted among physicians Paris and its suburbs.

Thirty practitioners contacted, eight or 25% refused to grant us an appointment when it was as a patient benefiting from the CMU.

So we have an example of doctors not making enough money treating patients under the government plan, so even though the law says they have to treat them, they don't. C'est la vie.

The Obamacare plan presumably will require people to buy insurance either from a private insurer or the government. And while some of the opponents say the government may squeeze out the private insurer, it's possible the opposite could happen if the government doesn't pay doctors enough. The practical effect would be to put all those people currently without insurance right back where they started.

How bad could the Canadian healthcare system really be?

The health care issue in the U.S. certainly has blood pressures rising. However, regardless of the side one takes, most will agree that there are some aspects of the distribution system that could be better.

One doesn't need to look far for complaints about the long waits for medical attention in Canada, the one problem that seems to get the most play in the debate whenever a comparison is made with the Canadian system.

That's nothing new to those of us living out in the U.S. boonies. Long waits for a doctor's appointment are routine. And once in the front door, there is usually another long wait to actually see a doc. Maybe a Canadian style system in the U.S. would mean even longer waits. But let's see what a Canadian has to say about it.

DenverPost.com has an article titled Debunking Canadian Health Care Myths by Rhonda Hackett in which she attempted to bust some myths about the Canadian health care system. This excerpt addresses the long waits:

Myth: There are long waits for care, which compromise access to care. There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

President Obama has bitten off a big chunk to chew on, and he hasn't so far provided much reason to place any great confidence in his ability to solve problems. But maybe somehow, someway he will get lucky and a better health care distribution system might result from all of this. In the meantime those of us in flyover country will be patiently enduring the long wait under the present system for our doctors' appointments.

For an argument in favor of the status quo see 10 Surprising Facts about American Health Care.