The March 25th Wall Street Journal contained an article that points out yet another way in which the health care bill has nasty economic consequences.
Turns out that many of America's largest companies (i.e. largest employers) are advising their employees and their investors that they are having to cut their profit forecasts due to the added financial burdens the health care bill is now placing on them. In addition, these companies are looking at ways to try to survive these costs, whether it is lessening the health care plan coverage they currently give their employees, or increasing the out-of-pocket expenses their employees will bear, or covering fewer of their part-time workers.
Remember that promise from Obama over-and-over-and-over that "if you want to keep your plan, you can keep it, and if you want to keep your doctor, you can keep them?" Well, apparently that will often not be true, in large part because your current plan and your current doctor may not be available to you once the burden of cost of this bill hits with force.
Remember, too, that among the many shenanigans the Democrats pulled to create the illusion of being fiscally responsible, they are hitting us with the taxes and higher costs now, but most 'benefits' (such as they are) won't come for years.
It's mind-boggling how messed up this bill makes things. And Obama bet his presidency on this bill? Good luck with that.
Wednesday, March 31, 2010
Tuesday, March 30, 2010
This Bill as a Liberal/Progressive Stepping Stone - Only the Beginning
"This is perhaps the left’s most brilliant rhetorical feat – magically transforming failed corporate-statist half-measures they once championed into examples of the sorry state of the status quo and arguments for yet more statism. And you’ll see it again in about ten years, when well-meaning but dim liberals start calling federal subsidies for health-care coverage “socialism for rich insurance companies,” and argue that what we really need is a single-payer system.
This is why the right fought Obamacare tooth and nail. Not because we’re racist, or heartless, or socialist(!) We fought it because we know that statist intervention usually exacerbates the problems it is meant to fix, and worse, that it becomes the new normal, the baseline for bigger, more complex future expansions of state power. All this lets folks like my reader sleep easy, safe and sound in the knowledge that “at least we’re doing something for a change.”" - This is from an NRO Online blog post this morning. Read the rest here.
This is why the right fought Obamacare tooth and nail. Not because we’re racist, or heartless, or socialist(!) We fought it because we know that statist intervention usually exacerbates the problems it is meant to fix, and worse, that it becomes the new normal, the baseline for bigger, more complex future expansions of state power. All this lets folks like my reader sleep easy, safe and sound in the knowledge that “at least we’re doing something for a change.”" - This is from an NRO Online blog post this morning. Read the rest here.
Thursday, March 25, 2010
Educate Yourself: Topic 3 - Why the bill endangers us
With all the effort Obama and the Democrats have spent badmouthing the American medical system, you might not know the following fact: if you exclude homicides and accidents, Americans live longer on average than any other people on earth. In other words, the aspects of longevity that are affected by the quality of our healthcare system are better for Americans than for the citizens of any other nation on the planet.
Does that surprise you? I suspect it would, given the way this awful bill had been 'sold' to us. So with such a top-notch medical system we have access to, why would we we want to mess with it in ways designed to lower the quality of our system? Good question.
Let's look at how this bill will negatively affect the quality of our health care system. First of all, the bill creates a number of pressures in the system that will put the squeeze on insurers. That will translate to additional pressures on reimbursement for medical services. These pressures appear to me at this point designed to fall heavier on medical subspecialists, and perhaps somewhat less on primary care physicians. Because only a relatively small percentage of medical costs are paid to physicians for services, this will have little impact on overall health care costs.
At the same time pressures come to bear to reduce payments for services provided by physicians, there are (by reports) 30+ million people being added to the rolls of the insured who would be expected to create a big spike in the demand for medical services. There will not suddenly be additional physicians or other providers to handle this. My experiences is that physicians are busy these days. I doubt there is much "excess capacity" that could handle the extra load. Perhaps because the bill collects extra taxes for 10 years but doesn't help many people for 4 years or so (accounting games yet again), there may be a little time to try to train more providers, but there's been no talk of this and training people costs money, too.
At the same time the system squeezes payments to physicians and overloads them with work, the government will increasingly dictate medical decisions, and will undoubtedly add more paperwork to the system (doesn't government always?). Oh, and if there are physicians still doing ok financially, most of the new taxes dictated by this bill are being placed on those making over $200,000 per year. So take another chunk out.
This isn't a pity party for docs I'm trying to spell out here...it's a reality check. Many of you are aware of the number of years of intense dedication (and the amount of debt typically) required to become a physician. People go through it for a number of reasons, but it helps knowing that for the most part you can anticipate a decent income once you've gone through the long arduous process. I do not think it's a stretch to say the effects of this bill will be deflating and demoralizing for providers of health care. There will be some who will retire early. Some will not go into medicine who might have otherwise...but more importantly I fear that the quality of our medical providers will go down. The "best and brightest" in America tend to go where there is decent income to be had. If that is no longer in medicine, many of our best and brightest will look elsewhere.
These pressures are also going to affect the quality of service given to people. How can I say this? Well, addition to creating another overworked, underpaid work force, there is the simple fact of history...can you give me an example of the federal government aggressively inserting itself to control a system or organization, and that system or organization providing better service than the private sector?
No, at the end of the day, I believe the consequences of this bill on the profession of medicine, and the quality of our health care will be damaged severely, and unless something is done to change what this bill does, it may never recover. And this (for those of you who know me) from an incurable optimist.
One more little nugget for you to digest. This bill also adds a tax on companies that innovate and create new and better medical devices and supplies. What better way to lessen the creativity that makes our medical system, for now, the best in the world.
Does that surprise you? I suspect it would, given the way this awful bill had been 'sold' to us. So with such a top-notch medical system we have access to, why would we we want to mess with it in ways designed to lower the quality of our system? Good question.
Let's look at how this bill will negatively affect the quality of our health care system. First of all, the bill creates a number of pressures in the system that will put the squeeze on insurers. That will translate to additional pressures on reimbursement for medical services. These pressures appear to me at this point designed to fall heavier on medical subspecialists, and perhaps somewhat less on primary care physicians. Because only a relatively small percentage of medical costs are paid to physicians for services, this will have little impact on overall health care costs.
At the same time pressures come to bear to reduce payments for services provided by physicians, there are (by reports) 30+ million people being added to the rolls of the insured who would be expected to create a big spike in the demand for medical services. There will not suddenly be additional physicians or other providers to handle this. My experiences is that physicians are busy these days. I doubt there is much "excess capacity" that could handle the extra load. Perhaps because the bill collects extra taxes for 10 years but doesn't help many people for 4 years or so (accounting games yet again), there may be a little time to try to train more providers, but there's been no talk of this and training people costs money, too.
At the same time the system squeezes payments to physicians and overloads them with work, the government will increasingly dictate medical decisions, and will undoubtedly add more paperwork to the system (doesn't government always?). Oh, and if there are physicians still doing ok financially, most of the new taxes dictated by this bill are being placed on those making over $200,000 per year. So take another chunk out.
This isn't a pity party for docs I'm trying to spell out here...it's a reality check. Many of you are aware of the number of years of intense dedication (and the amount of debt typically) required to become a physician. People go through it for a number of reasons, but it helps knowing that for the most part you can anticipate a decent income once you've gone through the long arduous process. I do not think it's a stretch to say the effects of this bill will be deflating and demoralizing for providers of health care. There will be some who will retire early. Some will not go into medicine who might have otherwise...but more importantly I fear that the quality of our medical providers will go down. The "best and brightest" in America tend to go where there is decent income to be had. If that is no longer in medicine, many of our best and brightest will look elsewhere.
These pressures are also going to affect the quality of service given to people. How can I say this? Well, addition to creating another overworked, underpaid work force, there is the simple fact of history...can you give me an example of the federal government aggressively inserting itself to control a system or organization, and that system or organization providing better service than the private sector?
No, at the end of the day, I believe the consequences of this bill on the profession of medicine, and the quality of our health care will be damaged severely, and unless something is done to change what this bill does, it may never recover. And this (for those of you who know me) from an incurable optimist.
One more little nugget for you to digest. This bill also adds a tax on companies that innovate and create new and better medical devices and supplies. What better way to lessen the creativity that makes our medical system, for now, the best in the world.
Wednesday, March 24, 2010
Educate Yourself: Topic 2 - The bill’s drag on the economy
With a bill this complex extending the federal government’s groping fingers around a system that is one-sixth of the U.S. economy, it would take at least a full book to even begin to assess the overall impact of this bill on jobs and the overall American economy.
That said, there are several economic effects of this bill that we can look at and get a basic understanding of.
Let’s start with the fact that since insurance companies now cannot deny coverage to individuals for pre-existing conditions (not entirely a bad thing, but the way it’s done in this bill will have some serious consequences, as we shall see), and since the federal government will now decide upon a list of things insurance companies will be required to cover, insurance companies, in order not to go bankrupt, will have to raise premiums and other direct costs to individuals they cover. The CBO estimate is 10-15% increase in costs on average. I will be surprised if it is not significantly higher than that.
Next, take the fact that the costs of this bill are approximately $1 trillion over 10 years. As we’ve noted in brief, accounting tricks and sleight-of-hand along with tax increases allowed Congress to claim that this will be more than paid for and thereby actually lessen the federal deficit by a little bit. This, to me, is a laughable claim, but there it is. Regardless, the hard costs described in the bill (the obligation being laid on us, our children, and grandchildren) is about $1 trillion.
That $1 trillion has to come from somewhere. But where? We will go into this more in another section, but for now realize that a large chunk of it will come from tax increases. Bear with me for a moment as we look at this.
The tax increase I want to focus on here is the tax on employers (businesses). Many businesses in recent years have really struggled to be able to afford health insurance for their employees. Now these costs will be [at least] 10-15% higher, and likely go up from there. These businesses then would have a choice to make. They could (a) just suck it up and pay the extra - assuming their business is making sufficient profit to cover those added costs; or (b) they could cover it but may need to cut pay or cut jobs or other cost-cutting measures to be able to afford the added costs for remaining employees; or (c) they could decide they simply can’t afford the added costs, and they can decide not to give health insurance as a benefit to their employees. The health care bill in this case would then slap a tax on companies that decide to do this. The result compared with pre-health-care-bill would be a group of individuals who used to have health insurance as a benefit from their employer who now do not - and would then have to go to either an exchange system to get their own individual plan or go to a public plan. And the business? Well they’ve just been saddled with a significant tax increase. Where does that money come from? Same options as above: from profits if the company is lucky enough to be flush with cash, or else from employee compensation, or cutting jobs, or other cost cutting measures...or if the company is able to they can increase the price of their products, and guess who pays that? Right on. Us. That wouldn’t be technically called a ‘tax’ but it’s another cost to you and I because of this whole thing in any case.
And for the individual employees in this situation, you will indeed be required to either buy a plan from the health insurance exchange or see if you qualify for a public plan...or else you can get fined and/or imprisoned if you don’t sign up for a new plan. Listen, DO NOT mess with the federal government, OK? If they say you will have health insurance, then by golly you WILL have it.
In the final analysis, although there are some potential economic positives that could come from this bill, the big elephant in the room to me is simply the $1 trillion obligation it lays on us, added on top of the $1 trillion bail out program on top of the previous $1 trillion dollar bail out program. All of these obligations must be paid in full (and with interest) at the end of the day, and ultimately the only place that can come from is from you, and me, our children, our grandchildren, and future generations.
And because government uses money inefficiently and is very poor at reigning in costs, this ties up money that would otherwise be applied to additional economic activity of working, buying, and selling. Translation? It will hinder our rate of economic growth for years to come.
Just another ‘feather in the cap’ for this awful bill.
Tuesday, March 23, 2010
Educate Yourself: Topic 1 - the new Advisory Board
What you will hear from Democrats trying to “sell you” on what they already did:
The “Medicare Advisory Board” is established by this bill to ‘directly control payments for Medicare benefits’ to help lower medical costs for people in this program. This is a perfect example of how government works when it is trying to control costs. It should be a good thing that they are “independent” from the functioning of Congress (once the members are approved by Congress, that is), because Congress is terrible at controlling costs. However, by definition they will be looking at “the good of the whole” and making the overall Medicare budget work better. What they won’t do because they can’t, is look out for each individual patient, nor will they pay much attention to the effect on health care providers and organizations. Thus it turns into either ‘hard’ or ‘soft’ direct rationing of health care by committee.
Here’s an example to make it more understandable: a few months back, you may recall that the government-funded group called “U.S. Preventive Services Task Force” (USPSTF) reviewed the data they have available about mammograms - their cost, risk vs. benefit analysis, etc. They recommended against women getting mammograms in their 40’s, primarily because it was not found to be cost effective. Women and women’s groups around the country were immediately up in arms about this. The head of the Center for Disease Control quickly called a press conference to assure us all that ‘hey, it’s ok everyone because this is just a recommendation from this group - it will not change your insurance coverage and mammograms are still covered like before - so just talk to your doctor about what’s right for you to do.’
Very nice. This sort of worked because the USPSTF does not have real power to change coverage or reimbursement for the tests it evaluates. The new Medicare Advisory Board, however, would indeed have such power. So the next time the USPSTF says something is unnecessary or not cost effective, that can and will become in fact what you are allowed to get. Medicare already plays this game with any number of tests and services or treatments - if it has deemed that only certain groups at certain ages can get text X, then that’s just the way it is. You’re 49 years and 9 months old and want to get your screening colonoscopy? Sorry, but if you do get it, you either get the bill sent to you personally or the doctor and facility that did it are forced to ‘eat’ the cost themselves. Now you’re 50? OK, now it’s covered.
Does private insurance do things like this? Yes and no. They do set up ‘rules of coverage’ and we have to deal with those. However, it is usually more like a negotiation...depending on how strict an insurance company wants to be with a particular test or treatment, it may be an easy or difficult negotiation, but if the doctor and patient both feel some test or treatment is important and needed, we can push and give reasons and get those approved in most cases. When we work with Medicare, however, it’s just a done deal, and although I’m sure in theory there exists some way to appeal, I’ve not seen it work that way in practice.
So point one from this bill is the creation of a committee that will determine what tests and treatments you can and can’t get. Theoretically this will apply initially only to government funded plans, but I guarantee it will become the ‘de facto’ standard across the board for private plans as well the way the system will now be structured.
SO, welcome to one example of new government rationing of your health care options!
Monday, March 22, 2010
The War to Repeal Starts TODAY
The gauntlet has been thrown down by Democrats hell-bent on extending control of government over our lives, apparently untroubled by the costs that will add more debt to our already overburdened nation.
A bill that was passed only in the most sickening manner with sleight of hand, bribes, raw political threats, and secrecy? Never mind that! Passed with accounting trickery that would make Enron blush? It's all for your own good - you just don't understand that yet! A bill sold as a deficit-reducer that will add over a trillion dollars to our federal spending and half-a-trillion of that added to our national debt? Hey, it'll all work out, never fear! A bill that doesn't even address most of the fundamental issues creating pressures and problems in our health care system? We'll fix that later, trust Congress to do the right thing! A bill that increases taxes on businesses and individuals, imposes penalties if you don't make specific decisions the government deems best, and will increase health care costs to those of us with jobs and health insurance? Hey, don't be selfish - it's for the good of all! A bill that will add significant burdens to a health care system and providers already very busy while reducing payments for services provided? Never fear, somehow the system will handle it with no decrease in quality of care and service - not sure how, but again just trust us!
This bill is a disaster in so many ways one hardly knows where to start but let's try beginning with this: the federal government has just thrust itself into yet another area of your life. Your personal choices and options will now be limited and controlled by the federal government. Does that inspire confidence in you? You think the feds and Congress can do this right? Can you think of a single solitary large scale service-oriented system at which government has done well? Especially at the federal level? And this bill puts Congress in the drivers seat for a much larger, more complex system than it HAS EVER ATTEMPTED BEFORE.
The challenge before us could hardly be more daunting, as it has perhaps no comparison in our history. What we must do is mount such a massive effort between now and November that we will overwhelm the Democrats. It must be the most unmistakable message that it cannot be missed even by the thick-headed mainstream media. It must let everyone in Washington know that we expect them to REPEAL this bill and give us back the freedom they took. There are other ways to resolve problems in our health care system without destroying what is the best health care system in the world.
What I'm asking of each of you is this:
(1) make sure you are registered to vote where you live.
(2) find a few reliable internet sites that will allow you to keep in touch with and support this effort in your area and across the nation.
(3) look for opportunities to talk to other about this. E-mail discussions, blogs, letters to editors, calls to talk radio shows and politicians, talking to and educating your family and friends - we need to create a groundswell that builds over a full 8 month period. Our lives are busy and people's attention spans are short but we must find a way to do this. If there is one moment in history we need to rise up with stamina and determination and never give up, it's now. This is our Revolutionary War. The patriots of 1776 had a long, hard slog to fight the British for 7 years...they never gave up. That's our inspiration for the next 8 months. We cannot get discouraged, cannot tire, cannot weaken. In fact, we must get stronger every month that passes.
Please keep in touch and let's make this thing happen. We are Americans, and we will NOT tolerate being dictated to by the elites, ruined and warped with power, in Washington.
A bill that was passed only in the most sickening manner with sleight of hand, bribes, raw political threats, and secrecy? Never mind that! Passed with accounting trickery that would make Enron blush? It's all for your own good - you just don't understand that yet! A bill sold as a deficit-reducer that will add over a trillion dollars to our federal spending and half-a-trillion of that added to our national debt? Hey, it'll all work out, never fear! A bill that doesn't even address most of the fundamental issues creating pressures and problems in our health care system? We'll fix that later, trust Congress to do the right thing! A bill that increases taxes on businesses and individuals, imposes penalties if you don't make specific decisions the government deems best, and will increase health care costs to those of us with jobs and health insurance? Hey, don't be selfish - it's for the good of all! A bill that will add significant burdens to a health care system and providers already very busy while reducing payments for services provided? Never fear, somehow the system will handle it with no decrease in quality of care and service - not sure how, but again just trust us!
This bill is a disaster in so many ways one hardly knows where to start but let's try beginning with this: the federal government has just thrust itself into yet another area of your life. Your personal choices and options will now be limited and controlled by the federal government. Does that inspire confidence in you? You think the feds and Congress can do this right? Can you think of a single solitary large scale service-oriented system at which government has done well? Especially at the federal level? And this bill puts Congress in the drivers seat for a much larger, more complex system than it HAS EVER ATTEMPTED BEFORE.
The challenge before us could hardly be more daunting, as it has perhaps no comparison in our history. What we must do is mount such a massive effort between now and November that we will overwhelm the Democrats. It must be the most unmistakable message that it cannot be missed even by the thick-headed mainstream media. It must let everyone in Washington know that we expect them to REPEAL this bill and give us back the freedom they took. There are other ways to resolve problems in our health care system without destroying what is the best health care system in the world.
What I'm asking of each of you is this:
(1) make sure you are registered to vote where you live.
(2) find a few reliable internet sites that will allow you to keep in touch with and support this effort in your area and across the nation.
(3) look for opportunities to talk to other about this. E-mail discussions, blogs, letters to editors, calls to talk radio shows and politicians, talking to and educating your family and friends - we need to create a groundswell that builds over a full 8 month period. Our lives are busy and people's attention spans are short but we must find a way to do this. If there is one moment in history we need to rise up with stamina and determination and never give up, it's now. This is our Revolutionary War. The patriots of 1776 had a long, hard slog to fight the British for 7 years...they never gave up. That's our inspiration for the next 8 months. We cannot get discouraged, cannot tire, cannot weaken. In fact, we must get stronger every month that passes.
Please keep in touch and let's make this thing happen. We are Americans, and we will NOT tolerate being dictated to by the elites, ruined and warped with power, in Washington.
Subscribe to:
Posts (Atom)
