Incoherent health care

Charles Krauthammer is not against coming up with health insurance for those who do not have it, but he points out that the current bills are utterly incoherent, making a system that is already inefficient even more so:

The United States has the best health care in the world — but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

— You'll find mandates with financial penalties — the amounts picked out of a hat.

— You'll find insurance companies (which live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third — numbers picked out of a hat.

— You'll find sliding scales for health-insurance subsidies — percentages picked out of a hat — that will radically raise marginal income tax rates for middle-class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

Then do health care the right way — one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

He goes on to recommend malpractice reform (which the current bills do not address, out of respect for trial lawyers, one of the Democrats’ biggest sources of donations, even though fear of malpractice suits causes doctors to run countless unnecessary and expensive extra tests); then allowing insurance companies to compete across state lines (which the current bills do not address, even though this would cut insurance premiums); then taxing benefits to raise money to help the uninsured (which I’m not sold on).

But still. . .His point is that this bill is a bloated monster that won’t accomplish what it claims to. A better solution would be to take one reform at a time with the goal of making health care less expensive and less complicated.

The young picking up the tab for their parents

Economics columnist Robert J. Samuelson finds another quirk in the Health Care bill. Already, our system of entitlements is forcing the young to subsidize the old, what with Social Security imbalances.

Now comes the House-passed health-care "reform" bill that, amazingly, would extract more subsidies from the young. It mandates that health insurance premiums for older Americans be no more than twice the level of that for younger Americans. That's much less than the actual health spending gap between young and old. Spending for those age 60 to 64 is four to five times greater than those 18 to 24. So, the young would overpay for insurance that — under the House bill — people must buy: Twenty- and thirtysomethings would subsidize premiums for fifty-and sixtysomethings. (Those 65 and over receive Medicare.)

Dictating how much something is allowed to cost is always disastrous, since market mechanisms work whether one wants them to or not. (When I was in Estonia under the Soviet Union, the communist government kindly mandated that bread be sold for a price that was less than what it cost to produce it, which meant that bread was reasonably priced but that there was no bread in the shops!) For the bill to presume to set these kinds of prices–as well as others, such as not allowing insurance companies to charge extra for pre-existing conditions–is a dire sign.

But now to force young adults just starting out–who already have a hard time making it, thanks to housing prices and the rest of our high cost of living–seems especially unfair. This is not a matter of the young helping out the venerable old. Retirees are under Medicare. This is paying for their parents, who are at a stage where they make far more than their 20-something kids.

Spiritual healing in the health care bill?

Christian Science practitioners are trying to get spiritual healing to be paid for in the Health Care Reform bill:

The calls come in at all hours: patients reporting broken bones, violent coughs, deep depression.

Prue Lewis listens as they explain their symptoms. Then Lewis — a thin, frail-looking woman from Columbia Heights — simply says, "I'll go to work right away." She hangs up, organizes her thoughts and begins treating her clients' ailments the best way she knows how: She prays.

This is health care in the world of Christian Science, where the sick eschew conventional medicine and turn to God for healing. Christian Scientists call it "spiritual health care," and it is a practice they are battling to insert into the health-care legislation being hammered out in Congress.

Leaders of the Church of Christ, Scientist, are pushing a proposal that would help patients pay someone like Lewis for prayer by having insurers reimburse the $20 to $40 cost.

The provision was stripped from the bill the House passed this month, and church leaders are trying to get it inserted into the Senate version. And the church has powerful allies there, including Sens. John F. Kerry (D-Mass.), who represents the state where the church is based, and Orrin G. Hatch (R-Utah), who said the provision would "ensure that health-care reform law does not discriminate against any religion."

What do you think of that? Would you be OK with acupuncture? macrobiotics? “natural healing” techniques? (I don’t know if the bill would cover those treatments or not. Does anyone know? Do most insurance companies? Do any insurance companies cover “alternative medicine”?)

The Louisiana Purchase

The Health Care Reform Bill passed a key procedural vote in the Senate, shutting down the possibility of a filibuster, when Democratic leaders promised a moderate Democratic holdout $300 million for her state in return for her vote. Here is how the Washington Post describes this and other shenanigans:

Staffers on Capitol Hill were calling it the Louisiana Purchase.

On the eve of Saturday's showdown in the Senate over health-care reform, Democratic leaders still hadn't secured the support of Sen. Mary Landrieu (D-La.), one of the 60 votes needed to keep the legislation alive. The wavering lawmaker was offered a sweetener: at least $100 million in extra federal money for her home state.

And so it came to pass that Landrieu walked onto the Senate floor midafternoon Saturday to announce her aye vote — and to trumpet the financial "fix" she had arranged for Louisiana. "I am not going to be defensive," she declared. "And it's not a $100 million fix. It's a $300 million fix."

It was an awkward moment (not least because her figure is 20 times the original Louisiana Purchase price). But it was fairly representative of a Senate debate that seems to be scripted in the Southern Gothic style. The plot was gripping — the bill survived Saturday's procedural test without a single vote to spare — and it brought out the rank partisanship, the self-absorption and all the other pathologies of modern politics.

I am aware that “horse trading” is how things get done in the Senate, but Sen. Landrieu is so brazen about it–bragging about the money she got on the Senate floor–that this strike me as particularly shameful. I wonder if that $300 million will be calculated into the costs of this bill. At any rate, if we get a new health care system, whether for good or for bad, we can look back years later and thank Sen. Landrieu and the Democratic leadership for this Louisiana purchase.

Health care reform will increase deficits AND costs

Robert J. Samuelson is an economics columnist who has never struck me as particularly conservative. But he delivers a pretty devastating critique of the current schemes for health care reform. He makes the point that the goals of health care reform are contradictory and that there is nothing in these bills that will do what the administration says must be done, namely, lower the nation’s health care costs. On the contrary, these schemes will mean that even more of our GNP will go for health care. Furthermore, he accuses the current administration of out-and-out deception:

[The] far-reaching overhaul of the health-care system — which Congress is halfway toward enacting — would almost certainly make matters worse. It would create new, open-ended medical entitlements that threaten higher deficits and would do little to suppress surging health costs. The disconnect between what President Obama says and what he's doing is so glaring that most people could not abide it. The president, his advisers and allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.

The campaign to pass Obama's health-care plan has assumed a false, though understandable, cloak of moral superiority. It's understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise for the public good.

It's false for two reasons. First, the country has other goals — including preventing financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans — that "health-care reform" would jeopardize. And second, the benefits of "reform" are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today's uninsured would be modest. They already receive substantial medical care. Insurance would help some individuals enormously, but studies find that, on average, gains are moderate. Despite using more health services, people don't automatically become healthier. . . .

Obama's top economic advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group for the Peterson Foundation and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with the effect of no legislation. The studies variously estimate that the extra spending, over the next decade, would be $750 billion, $525 billion and $114 billion. The reasoning: Greater use of the health-care system by the newly insured would overwhelm cost-saving measures (bundled payments, comparative effectiveness research, tort reform), which are either weak or experimental.

Samuelson goes on and on in this vein. Can anyone answer his objections?

Abortion funding ban may stand in Health Care Reform bill

Columnist E.J. Dionne is a liberal Democrat and a Catholic. He says that the ban on abortion funding in both the public and the private insurance companies that was added to the health care reform bill may stand, and if it does, it would be worth it:

For some years, Democrats have denounced parodies that cast their party as utterly closed to the views of those who oppose abortion. Last weekend, Democrats proved conclusively that they are, indeed, a big tent — and many in the ranks are furious.

From the outraged comments of the abortion-rights movement, you'd think that Rep. Bart Stupak's amendment to the House version of the health-care bill would all but overturn Roe v. Wade.

No, it wouldn't. The Michigan Democrat's measure — passed 240 to 194, with 64 Democrats voting yes — would prohibit abortion coverage in the public option and bar any federal subsidies for plans that included abortion purchased on the new insurance exchanges.

Stupak argues that the federal government has stayed out of the business of financing abortion since passage of the Hyde Amendment in 1976 and that none of the policies available on the Federal Employees Health Benefits Program covers elective abortion. The structures that reform would create, he says, should carry the same restrictions, which do not apply in cases involving rape or incest or when a mother's life is in danger.

Supporters of abortion rights counter that, at the very least, individuals who pay part of the cost of their policies should be allowed to choose abortion coverage.

Whatever else is true, Stupak's amendment is unlikely to have a significant effect on the availability of abortion. And most abortions are not paid for through health insurance. The Guttmacher Institute, for example, reported that only 13 percent of abortions in 2001 were directly billed by providers to insurance companies — although the institute has cautioned that the proportion of women whose abortions were covered by insurance could be higher because the figure did not include those "who obtain reimbursement from their insurance company themselves." . . . .

But a key group of Democrats who supported the rest of the House bill (roughly 10 by the best count I have been able to get) was still not satisfied, partly because the Roman Catholic bishops were not satisfied. These Democrats turned out to be essential on a bill that ultimately passed by five votes.

Last Friday night, Stupak put forward a final compromise to House Speaker Nancy Pelosi that would have prohibited abortion coverage in the public plan but would have allowed an annual vote on the abortion ban for the private plans. Pro-choice Democrats rejected this, and the stronger version of Stupak's proposal then passed.

What happens now? Democratic supporters of abortion rights need to accept that their House majority depends on a large cadre of antiabortion colleagues. They can denounce that reality or they can learn to live with it. . . .

And if the Senate forces a change in the Stupak language, one obvious approach would involve a ban on abortion in the public plan — if such an option survives — and the application of Ellsworth's rules to the private policies sold in the insurance exchange. The alternative would be Stupak's original compromise offer to Pelosi. There are not many other options.

The truth is that even with the Stupak restrictions, health-care reform would leave millions of Americans far better off than they are now — including millions of women. This skirmish over abortion cannot be allowed to destroy the opportunity to extend coverage to 35 million Americans. Killing health-care reform would be bad for choice — and very bad for the right to life.

So he says. At any rate, it’s time to give the small, hard-pressed, marginalized pro-life Democrats some credit.