ObamaCare: The Good, the Bad, the Ugly, and the Ignored – Part 3

In Part 1 of this series I listed things in the house version of ObamaCare (H.R.3200) that I think are conceptually worthwhile and also some conceptually bad. Part 2 highlighted parts of H.R.3200 that are downright ugly. Part 3 adds to the downright ugly list.

The Ugly - Continued

4. Health Choices Administration: - Section 203 requires the Health Choices Administration to “specify the benefits to be made available under Exchange-participating health benefits plans”.

5. Coercion of Employers: - Section 313 requires additional payroll taxes of 8% of payroll on employers that do not provide qualified health insurance (QHBP). This tax is to be paid to the Health Choices Administration.

6. Advanced Care Planning Consultation: - Section 1233 requires “advance care planning consultations” if the patient has not had such a consultation with a health care practitioner in the past five years. “Advance care planning consultations” include

“An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such supports that are available …”

7. Patient Decision Aids: - Section 1236 establishes a demonstration project in which health care providers “shall routinely schedule Medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid … and to assist the beneficiary in thinking through how
their preferences and concerns relate to their medical care”.

Patient Decision Aid is defined as “an educational tool (such as the Internet, a video, or a pamphlet) that helps the patients (or, if appropriate, the family caregiver of the patient) understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.”

Shared Decision Making is defined as “a collaborative process between patient and clinician that engages the patient in decision making, provides patients with nformation about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.

The wording of this section seems harmless but it is mandated, the results are to be recorded and submitted to a government agency - the Health Choices Administration, and the overarching purpose is to reduce the cost of health care. This adds up to a conceptually useful tool that is likely to used as a weapon to convince, cajole, and shame Medicare patients into “taking a pill instead of having the operation” in President Obama’s words.

There’s still more ugly to report in future posts.

Links to Other Topics in the Special Report: Universal Health Care

ObamaCare: The Good, the Bad, the Ugly, and the Ignored – Part 2

In Part 1 of this series I listed things in the house version of ObamaCare (H.R.3200) that I think are worthwhile in concept if not in their implementation. I also presented elements of the proposed legislation I considered bad in concept. Part 2 highlights some things in H.R.3200 that are downright ugly.

Some have said there is no bill simply because nothing has yet been passed. In response, I point out that H.R.3200, as posted on the Internet prior to the Congress’ August recess, is the bill President Obama, Nancy Pelosi, and Harry Reid pushed to pass and sign into law BEFORE leaving Washington for the recess.

H.R.3200 may be modified after Congress returns in September, but the version dated July 14, 2009, is the version they want.

The Ugly -
1. Losing Your Current Insurance: - Section 102 allows current health insurance plans to be “grandfathered” so “you can keep your current insurance if you like it”. However, paragraph (a) (2) reads as follows:

“Limitation on Changes in Terms or Conditions – Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.”

This paragraph seems to require conversion to a “qualified” plan if anything changes in your current health insurance. If you have insurance through a private employer you are aware that health insurance coverage is renegotiated annually. So unless your employer elects to keep the current plan literally forever you will be forced into a “qualified” plan – probably as early as the year following enactment of ObamaCare (Y1).

2. Squeezing Insurance Companies: - Sections 141, 142 and 161 combined turn health insurance into a true commodity. Section 141 establishes a “Health Choices Administration”. Section 142 requires that the “Health Choices Administration create a standard benefits package that defines a “Qualified” plan or QHBP. And Section 161 establishes a limit on how profitable a health insurance company can be by requiring rebates to policy holders when profitability exceeds a predefined level. Insurance companies would effectively become “mutual insurance companies” and stock holders will need to find other investments. Capital will become a problem and a couple of years with higher than expected claims may force companies out of business.

3. Insurance for Illegal Aliens: - Section 301 theoretically precludes illegal aliens from getting taxpayer-paid public option health insurance. It does not preclude them from buying public option health insurance that will almost certainly be subsidized for all. It will also be entirely moot if President Obama and the Democrat Congress are able to push through their desired “comprehensive immigration reform”. Once passed the illegals would be illegal no more and hence eligible for taxpayer-paid public option health insurance after all.

There’s plenty more ugly to report in future posts.

Links to Other Topics in the Special Report: Universal Health Care

ObamaCare: The Good, the Bad, the Ugly, and the Ignored – Part 1

Most people acknowledge that reform of our health insurance system is needed but they do not agree on the nature and scope of reform.

The version of President Obama’s health care bill now before the House of Representative is H.R.3200 titled “America's Affordable Health Choices Act of 2009”. It is, of course, very controversial. The link in the previous sentence will take you to an on-line copy of the 1,017 page bill with hyperlinks to each section. You can also download the entire bill in PDF format. Be warned, it is very difficult reading. Representative John Conyers spoke the truth when he said he would need two days with two lawyers to interpret what the bill means.

Representative Conyers used that as an excuse for why he hasn’t read the bill. But, the fact that Congressmen are willing to vote for and pass a piece of legislation they not only have not read but are unable to understand is sufficient reason to show them the door. If the Congress that writes and votes for a bill cannot understand its own work – who can – who will? The logical implication is that the courts will decide what the bill means since no one else knows.

Still, many people have now read the bill and interpreted what is in it - and what is not - as best they can. Below, I have summarized the most important findings – the good, the bad, the ugly, and the ignored.


The Good
Availability and Renewability: Section 112 requires insurers to make insurance available and renewable except for non-payment of premiums and Section 111 prohibits exclusion of coverage for pre-existing conditions.
Covering those Who Cannot Afford Insurance: Section 242 provides coverage for people who are not eligible for Medicaid but earn less than 400% of the official poverty level.
Covering Pre-existing Conditions when Switching Insurance: Section 111 prohibits exclusion of coverage for pre-existing conditions.

The Bad
Higher Federal Deficits: The Congressional Budget Office estimates that the bill will add $1.6 trillion to the Federal debt burden over the next ten years.
Higher Payroll Taxes: Sections 312 and 313 require all employers with payrolls exceeding $250,000 per year to contribute to the health insurance of their employees directly or indirectly through a sliding scale of additional payroll taxes. This means that employers that do not currently provide health insurance for their employees will be forced to do so one way or the other. Marginally profitable businesses will go out of business or layoff workers because of this increased expense.
Citizen Coercion – Section 401 imposes an income tax penalty of 2.5% of adjusted gross income upon anyone who is not covered by a qualified health insurance plan. This penalty will be enforced by the Internal Revenue Service.

The Ugly and The Ignored still to come.

Links to Other Topics in the Special Report: Universal Health Care

Death by Rationing

The various health care bills before Congress this summer, if enacted, will kill your mother. Regardless of what President Obama, Nancy Pelosi, Harry Reid, or the other Democrat leaders say, their legislation will ration health care.

Consider:

• They say there are 47 million uninsured Americans. If true, and if they are all covered by the new universal health care program then 47 million people will soon consume much more health care than they consume now. Demand for health care nationally should increase by more than 20% but the number of doctors, nurses, clinics, and hospital beds will remain roughly constant.
  
• The program makes no secret of its intention to squeeze doctor’s pay in the name of efficiency and eliminating abuse. But if a job pays less then less people want the job. Less pay will result in fewer doctors.
  
  These situations will produce higher demand for a shrinking supply of service. Normally, prices would go up but, under universal heath care, prices will be controlled. This will produce lines of people waiting for service; like the lines at gas pumps when the price of gas was controlled in 1973; like the lines at controlled price Soviet food stores when a rumor circulated that the store had fresh fruit.
  
  It will result in months-long waits for certain tests and treatments; kind of like the waits in Canada and the United Kingdom under their current universal health care administrations.
  
  People will die waiting for treatment.
  
  Consider:
• The bills would establish a “Federal Health Board” empowered to approve procedures & medications based on their cost and typical effectiveness. Health care providers would be prohibited from administering disapproved treatments. Your doctor, your mother’s doctor, would not be allowed to prescribe the treatment he believes is necessary or best in your mother’s individual case. He would be constrained to prescribe only the treatments allowed by the “Federal Health Board”.
• It is said that 90% of health care expenses are incurred in the last 6 months of life. That could be understood to mean 90% of the cost of your personal medical care under today’s circumstances is, on average, expended in the last six months of your life.
  
• The program diverts $200 billion net from Medicare to help fund the currently uninsured. Proponents say the cuts will extend the life of the Medicare “trust fund” by five years.
  
• Elderly people will be required by the program to undergo periodic “End of Life Counseling” encouraging death (hospice or assisted suicide) instead of treatment.
  
• Proponents of “universal health care” describe calculating a value of expected remaining quality life - for use in treatment approval decisions for elderly or terminal patients.
  
  These thoughts imply a predilection toward estimating the remaining life of the patient if effective treatment is administered; when the estimate is six months or less then treatment would be cut off. As President Obama put it, “you might be better off just taking a pain pill”.
  
  Depending on exactly how the calculation of a “value of expected remaining quality life” works, that six month cut off time for treatment could be much longer. After all, once they chop off the last six months of your mother’s life they will quickly find that 90% of the remaining health care costs are incurred in the last six months of your mother’s new and shorter life. And so they will be tempted to chop off another six months, and another, and another?
  
  Health care cost can indeed be controlled. Demand can be brought back in balance with supply.
  
  All that is needed is death by rationing.

Links to Other Topics in the Special Report: Universal Health Care

Any of Us Would be Angry

President Obama said in his 7/22/2009 press conference that “any of us would be angry” if, like his friend Henry Gates, the police knocked on our door investigating a “break-in in progress” at our home.

In the event, Mr. Gates apparently did break into his own home and was seen doing so by a neighbor who called the police. Mr. Gates became belligerent when the police officer asked for identification. He was arrested for “disorderly conduct” and the charges were later dropped.

One aspect of the incident that’s received little attention is the President’s assertion that “anyone would be angry”.

If I broke into my own house, and I have, I most assuredly would NOT be angry if the police came to investigate a reported break-in.

I would be careful to make certain that the police knew who I was and that I was not a threat. I would be thankful that my neighbor noticed the “break-in” and that the police responded to the report. I would feel just a bit more confident in the competence and reliability of my local police department.

It seems to me that only someone with a huge chip on his shoulder would get angry in this situation. Perhaps that describes both Mr. Gates and President Obama.

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47 Million Uninsured

President Obama says 47 million Americans lack health insurance. One breakdown of that number is:

• 9.5 million people are illegal aliens


• 8.3 million uninsured people earn between $50,000 and $74,999 per year and choose not to purchase insurance


• 8.7 million uninsured people earn over $75,000 a year and choose not to purchase insurance


• 6 million are estimated to be eligible for Medicaid but have not signed up


• That leaves 14 million "at risk" Americans lacking health insurance

There is a significant debate going on about these numbers; their accuracy and their implications. One aspect of the numbers that's being overlooked is that coverage of illegal aliens will absolutely encourage the number of illegal aliens to grow.

Already pregnant Mexican women cross the border solely for the purpose of giving birth in the United States and guaranteeing their off-spring United States citizenship.

Legally paying for all the health care for illegal aliens will surely encourage many to cross the border just to go to the doctor or get a prescription. It will encourage still more to cross into the United States to live permanently.

Even if you think illegal immigration is a good thing, and I do not, you can't possibly believe that paying for the health care of an ever-growing number of illegal aliens will reduce overall health-care costs.

Well, maybe if your name is Obama, you might believe that - or say you believe that. But one no else could.

Links to Other Topics in the Special Report: Universal Health Care

Cap & Trade (Carbon Tax) – Part 2 – The US Goes It Alone

In the 100 years from 1900 thru 1999 the average temperature of the Earth reportedly increased by 1.0 degree Fahrenheit.

Recently, the G8 would not agree to set carbon limits or time-tables. They did, however, agree to try to limit global warming to 3.7 degrees Fahrenheit. That’s 370 years worth of warming at the 20th Century rate of increase.

Some will retort that the 21st Century rate of warming will be higher, so far though, the 21st Century rate is negative – we’ve experienced global cooling since 1998.

China and India will have nothing to do with capping carbon emissions. Developed countries embraced the Kyoto Treaty early and then failed to keep it. They never met any of its targets or timetables though they spent a lot of money trying. It’s just too expensive and too anti-growth.

Spain has lost 2.2 jobs for every “green” job created by building wind turbines. Plus, every one of those “green” wind turbine jobs cost the Spanish government $1.4 million in subsidies.

Enron’s Key Lay, since indicted and deceased, was a strong, 1990’s, proponent of “cap and trade”. He said it could "do more to promote Enron's business than almost any other regulatory initiative.”

In addition, to being a potential bonanza for the next Enron, “cap and trade” is expected to cost as many as 2.3 million American jobs by raising the cost of doing business and pushing even more manufacturing overseas.

All this to achieve a miniscule 0.07 degrees Celsius supposed reduction in the Earth’s temperature by 2050, an amount too small to verify.

Economic Stimulus: Part 6 – Unintended Consequences

Where I live roads are being repaved early; years before they need to be. We received some “stimulus” money and we’re spending it.

Eventually, these roads would actually need repair. So, in a sense, the money is not being wasted. It’s just being spent early. Of course, value is lost because repaving early wastes the remaining value of the previous paving; it becomes a sunk cost. I’m sure VDOT knows what the sunk cost is.

Beyond the sunk costs there are now traffic jams where there were none before the repaving started. Now, I don’t know any of the details or costs of these projects. I’m just thinking and wondering so I’ll just make up some numbers to play with – let’s say 50 people are employed who wouldn’t be employed if not for the “stimulus” financed repaving projects. I think that estimate is ridiculously high, but I’m going with it just for the mental exercise.

So, if 50 people are employed for a year at $40,000 per year in total wages – again I’m just making up these numbers – then $2,000,000 in direct wages would be added to the local economy (plus the cost of material which would be spread out over the state economy and perhaps further).

$40,000 per person per year in wages equates to $19 per straight time hour (I’m rounding all of these numbers to the nearest whole dollar). If repaving related traffic jams reduce a person’s daily productivity by 10 minutes and the people in the traffic jams also earn $19 per hour then the value of the lost 10 minutes is $3.

If one person loses $3 per day in productivity and the repaving related traffic jams occur 250 days out of the year then the $2,000,000 in direct wages would be countered by the lost productivity of 2,496 people at 10 minutes each per day. It’s not a big stretch to believe that this could happen. Even if my fictional example overstates the effect by twice it still suggests that half of the direct wage portion of the “stimulus” might be totally ineffective. In fact, considering that people losing productivity in traffic jams are probably engaged in work that others are actually willing to pay for without the “stimulus” their $19 is probably more valuable to the real economy than the $19 earned by the paving workers.

Now, suppose someone is injured in a repaving related auto accident. One could coldly calculate that the cost of repairing the damaged vehicles adds to consumption, but more likely it just redirects consumption to the repairs from some other part of the economy. If someone is injured, however, their productivity could be impaired for weeks or months, or even the rest of their lives.

If two people suffered permanent loss of their productivity through injury or death and each effectively lost 25 productive years the $2,000,000 in direct “stimulus” wages would be counterbalanced; again assuming $40,000 per year in productive value per person injured; Not counting the possibility that a permanently injured worker could find himself on public assistance for the rest of his life. And not counting the possibility that his children may be unable to go to college, or to the college of their choice.

Like I said before, all of these numbers are made up. But I wonder if the value of the sunk cost of repaving early, plus the value of productivity lost in repaving related traffic, plus the productivity lost because of any repaving related auto accidents is really less than the “stimulus” money being spent; borrowed money that must be repaid by taxing our productivity

Links to Other Topics in the Special Report: Economic Stimulus

Pat Ryan Coleman

Wednesday we buried a dear friend. She was our miracle lady.

Twelve years ago or more she was dying with advanced diabetes and total kidney failure. She was on dialysis and her husband was engaged in adultery. Her situation seemed hopeless, but Pat Ryan Coleman was not hopeless. She was a woman of strong Christian faith and a powerful spirit.

I didn’t know her then. It was several years later after a kidney and pancreas transplant; after a messy divorce; and after a divorce recovery program that brought a special group of people together, that I first met Pat.

I was at a singles dance for the first time in twenty-five years and I was alone. I sat at an empty table in the front right corner of the room next to the D.J. watching the dancers on the floor. I didn’t know how to dance and it worried me. But my confidence increased as I watched. Most of the people on the floor didn’t know how to dance either. So, figuring that no one would notice I started working my way counter-clockwise around the room inviting women I didn’t know to dance with me. It was a bit scary, especially at first, but after the fourth or fifth dance I felt better. No one had laughed at me after all.

I continued working my way around the room inviting women to dance if they made eye contact with me. I danced with many but didn’t dance with anyone twice.

Near the front left corner of the room, directly opposite from where I’d started, I made eye contact with a pretty blond. As I approached her she smiled big and warm and agreed to dance with me.

We talked on the dance floor, of course, and she told me she was there with a group. She was friendly and warm and her name was Pat Coleman. I don’t know what got into me. It was totally out of character, but I asked Pat if I could join her group at their table. She was un-offended by my request and readily led me back to her table. She introduced me to her friends – all women that night. I soon learned that a number of single men were members of the group but they were not present.

I talked and dance with the three of them at the table. Off and on throughout the conversation Pat and her friends talked about “their leader,” Linda. The ladies said Linda organized and motivated them. I was curious about Linda and looked forward to meeting her.

I met Linda briefly that night but then she was immediately whisked back onto the dance floor.

There is a great deal more to this story than can be told. I was adopted into the group and it remains close after more than ten years and the deaths of two charter members. Linda became my wife and the love of my life.

Others, men and women, were later adopted into the group; some have paired off and married. One man adopted into the group became Pat’s special friend. Pat and Billy blessed each other’s lives for four years. We were happy for them.

My life was blessed by Pat Coleman and her smile. Pat is gone now. She and Roger are relocating our group to a new and better place. We’ll all eventually join them and see Pat smile again. In the meantime, we’ll periodically stop by Pat’s gravesite to let her know what’s going on with the group and to reassure her that we continue to care for her love, Billy.

Sarah Palin: Preparing for Battle

Did they hear the same speech I did?

Talking heads are abuzz over Sarah Palin’s resignation as Governor of Alaska effective at the end of July. They buzz that she is burned out; that she is quitting politics; that she is withdrawing from public life because of attacks from the socialist press and comics. Some buzz that her resignation may be the jumping off point for a 2012 Presidential campaign.

She and her family have been under attack alright. But I think she is unbelievably misunderstood. This woman is a fighter, a hunter, a life member of the NRA, a commercial fisherman, a committed Christian, and the mother of a special needs child. She battled her way to the Governor’s office and she might have dragged the unpopular John McCain across the finish line last year if the economy had not collapsed.

She is a lioness. Her children and her values and her integrity are under attack. What does a lioness do when her cubs are attacked?

Below are some direct quotes from the transcript of her resignation announcement.

“… it may be tempting and more comfortable to just keep your head down, plod along, and appease those who demand: “Sit down and shut up”, but that’s the worthless, easy path; that’s a quitter’s way out. And a problem in our country today is apathy. It would be apathetic to just hunker down and “go with the flow…”

“… only dead fish “go with the flow.”

“And there is such a need to BUILD up and FIGHT for our state and our country. I choose to FIGHT for it! And I’ll work hard for others who still believe in free enterprise and smaller government; strong national security for our country and support for our troops; energy independence; and for those who will protect freedom and equality and LIFE… I’ll work for and campaign for those PROUD to be American, and those who are INSPIRED by our ideals and won’t deride them.
I WILL support others who seek to serve, in or out of office, for the RIGHT reasons, and I don’t care what party they’re in or no party at all. Inside Alaska – or Outside Alaska.”

“My choice is to take a stand and effect change…”

“…we know we can effect positive change outside government at this moment in time, on another scale, and actually make a difference for our priorities – and so we will, for Alaskans and for Americans.”

“In fact, this decision comes after much consideration, and finally polling the most important people in my life - my children (where the count was unanimous… well, in response to asking: “Want me to make a positive difference and fight for ALL our children’s future from OUTSIDE the Governor’s office?” It was four “yes’s” and one “hell yeah!” The “hell yeah” sealed it…”

“I think much of it had to do with the kids seeing their baby brother Trig mocked by some pretty mean-spirited adults recently…”

“…we can ALL learn from our selfless Troops… they’re bold, they don’t give up, they take a stand and know that LIFE is short so they choose to NOT waste time. They choose to be productive and to serve something greater than SELF…”

“…we NEED hardworking, average Americans fighting for what’s right! And I will support you because we need YOU and YOU can effect change, and I can too on the outside.”

“We need those who will respect our Constitution where government’s supposed to serve from the BOTTOM UP, not move toward this TOP DOWN big government take-over… but rather, will be protectors of individual rights…”

“We are not retreating. We are advancing in another direction.”

Her kids said “yes” and “hell yeah!” This is a frontier family with guts, motivation, and determination. They may be course. They may not be polished speakers. They are unlikely to receive invitations to Manhattan cocktail parties – they’re even less likely to go if invited. But, they’re bold, they don’t give up, they take a stand and know that life is short so they choose to not waste time. They choose to be productive and to serve something greater than self.

Sarah Palin may or may not run for high public office in the future, but I expect Sarah to soon become one of the most effective opponents of Barack Hussein Obama and Nancy Pelosi. I expect her to attack like the lioness she is; defending her children, her state, and her country.

She told us that 80% of her time and that of her staff has lately been consumed defending against frivolous ethics charges plus $2,000,000 of public money and $500,000 of her own money. She has, then, been doing her job as Governor in only 20% of her time. She rightly said that Alaska is not being served properly under these conditions and, since it costs nothing to make frivolous ethics charges, Alaska can expect this situation to continue.

She wants Alaska to be properly served so she’s turning the Governor’s office over to another while she focuses. In the parlance of the old sail-powered navy, she is clearing the decks, she is preparing for battle. Sarah Palin without the responsibility, and the distraction, of running the state of Alaska, will be seen and heard quite a lot more in the coming months. I think we’ll see her on talk television, hear her on talk radio, see her at book signings, and during the 2010 Congressional campaign I think we’ll see her stumping for conservatives across the country.

Will Sarah Palin run for President in 2012? I don’t know and I don’t think she knows either. Running for President is not the point. She will go on offense. She will be a powerful voice for conservatism. And, unless others join with her on the field of battle, she may become the leader by default.

To paraphrase Japanese Admiral Yamamoto shortly after he orchestrated the 1941 attack on Pearl Harbor - socialists will soon fear they have awakened a sleeping lioness – the smart ones already do.

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