tag:blogger.com,1999:blog-78253569057072082072024-02-18T20:19:27.475-08:00America's Civics TeacherAgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.comBlogger36125tag:blogger.com,1999:blog-7825356905707208207.post-43564290606239388072012-03-19T09:31:00.000-07:002012-03-19T09:31:38.482-07:00Government healthcare and questions of moral behavior<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowRevisions/> <w:DoNotPrintRevisions/> <w:DoNotShowMarkup/> <w:DoNotShowComments/> <w:DoNotShowInsertionsAndDeletions/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">Who said this?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">"We go to a young girl, who’s now 18 or 16 or even younger and this is what we say, 'abandon all of your hopes, your schools will not teach you, you will not learn to read or write, you will never have a decent job, you will live in the neighborhoods of endless unemployment and poverty with drugs and violence,' but then we say to this child, 'wait, there is a way, one way, you can be somebody to someone, that will give you an apartment and furniture to fill it; we will give you a TV set, and telephone, we will give you clothing and cheap food and free medical care and some spending money besides, and in turn you only have to do one thing, that is go out there and have a baby.'”<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span></span></span></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Before I tell you who said it, let me tell you why I quoted it. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In my most previous email I mentioned that American cultural dissolution plays a critical role in our frustrations attempting to redesign U.S. healthcare. My argument is that the way people live will, to a great extent, determine how much money we will be required to provide for their medical care. In this context, I mentioned the exploding ratio of children born to single mothers, and asserted it is and will be a major contributor to runaway healthcare spending.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A reader took me to task. He argued that writing about what are “private behaviors” is futile. Government cannot impose its morals on individuals who choose to give birth outside of marriage. I counter by asserting that our massive welfare support systems incent single parentage, and directly contributes to out of control healthcare spending. By deciding to generously provide “free” healthcare we encourage the behavior that drives use of the healthcare system. Ergo, public policy is imposing a set of morals on individuals, but in this case, the moral behavior is sexual intercourse outside of marriage.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Senator Ted Kennedy, D- Mass, <span style="mso-spacerun: yes;"> </span>saw this in 1978 when he uttered the words quoted above. Kennedy, one of the most liberal members of Congress, in whose name Pres. Obama urged passage of the Affordable Care Act, knew that our welfare programs encouraged births out of wedlock. Furthermore, he acknowledged its deleterious effects on the single mother, and on society.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Take issue with me, if you will, but you take issue with reality (and I appreciate Kennedy’s support in this). Individual choices drive a good portion of healthcare spending, and this includes the choice of single parentage. Fact.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Knowing this as fact and doing something about it are two different things. Congress and our Presidents made decisions years ago that we would financially support any and all behavior. Thereby, Congress imposed a type of amorality on us which is, of course, the “new morality.” Right now, we have to deal with the consequences of this new morality.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What to do? Well, if you love the ACA and the Congress that passed it, you will love their solution. </div><div class="MsoNormal">Classifying sterilization as preventive care should excite you; this is one of ObamaCare’s solutions. So are the Independent Payment Advisory Boards (IPAB) which will decide whether to pay physicians and hospitals for various medical procedures – called rationing. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Sterilization is the ultimate contraception (but causative for HPV, STDs, and HIV). Rationing is the ultimate choice for a government that condones all behaviors. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Truly, we reap what we sow. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></div><div style="mso-element: footnote-list;"><br clear="all" /> <hr align="left" size="1" width="33%" /> <div id="ftn1" style="mso-element: footnote;"> <div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[1]</span></span></span></span></a> Ferrara, P. (2010) America’s Ticking Bankruptcy Bomb. Citing Robert Carleson in <i style="mso-bidi-font-style: normal;">Government is the Problem: Memoirs of Ronald Reagan’s Welfare Reformer.</i> Harper Collins, New York. P 150.</div></div></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-67959161122099144242012-03-08T12:35:00.000-08:002012-03-08T12:35:44.627-08:00The end of America? Healthcare is but one issue<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">In a way I felt badly for my listeners. They had to confront some very hard facts about our great country that go far beyond, but include the provision of and payment for healthcare.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The United States is in trouble – deep and serious trouble. This is what I said to the professional health insurance agents in Peoria, Illinois on March 6. Then I laid out overwhelming statistics about state and federal spending, the increase in the national debt (in dollars and as a percentage of the Gross Domestic Product), and most appallingly, the total unfunded debts and liabilities of American government. And I talked about cultural and moral decline.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Please, don’t stop reading. This is a vitally important message.</b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://www.kotlikoff.net/" target="_blank">Dr. Larry Kotlikoff</a>, a Boston University economics professor, totals the U.S. unfunded liabilities at $211 Trillion - $676,000 for every U.S. resident currently counted by the U.S. Census Bureau. These are funds that must be spent if we are to maintain the programs currently on the books. <u>But that spending will never happen because it cannot happen</u>. It cannot happen because we will be bankrupt before it can happen.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">According to Peter Ferrara, in his must-read tome, <a href="http://www.amazon.com/Americas-Ticking-Bankruptcy-Bomb-Dream/dp/0062025775" target="_blank"><i style="mso-bidi-font-style: normal;">America’s Ticking Bankruptcy Bomb</i></a>, the U.S. public debt ratio to GPS will be 107 percent by the end of 2012. It will quickly climb thereafter to a level exceeding that which is destroying Greece today. If there is no sharp change in U.S. spending, it will lead to a world economic collapse.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I know, I know, these are harsh words and hard to read; not at all uplifting. Now, however, is time for sobriety and seriousness. Frankly, <a href="http://daveracer.com/bookhim.htm" target="_blank">I wish I could give this same talk to all Americans</a>. Maybe I could do it as a webinar. It is an urgent talk, a vital talk.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But there is more.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The U.S. at its root is not about money: it’s about ideas upon which we have built a great nation of free people, an exceptional nation in every way. One of our foundational ideas is moral integrity.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“We do not have money problems,” <a href="http://www.keyesarchives.com/" target="_blank">Alan Keyes </a>often said during his 1996 presidential campaign. “We have moral problems.” The moral problems are directly related to how and why we spend money, as individuals, families, and governments. <u>How we spend money on healthcare is directly related to our moral dilemma</u>.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What I am about to write is likely to cost me some readers, because some people do not want to deal with these disturbing trends. Each of them, and far more, contributes to our cultural, moral, and financial decline.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Recently, a British bio-ethicist opined that a newborn baby should be treated the same as an unborn child – only he uses the “scientific” term, fetus. This “ethicist” believes that abortion law should apply to newborn babies – meaning parents should be free to kill the unwanted infant, just as they are able to do with babies still in the womb. Dr. Peter Singer, of Dartmouth, made the same observation years ago.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Dr. Zeke Emmanuel, former adviser to President Obama on healthcare reform and brother to Chicago Mayor Rahm Emmanuel, believes we spend too much on healthcare for certain populations. In a 2010 Lancet article, Emmanuel and his co-authors suggested that we should reduce spending for children younger than about five, and adults older than about 62. He believes we should focus healthcare spending on others, healthier people with more life expectancy. Who should decide? Under ObamaCare, the Independent Payment Advisory Board, and others of the new federal MediCrats who know better than you, or me, or pastors, priests, rabbis, and Imams. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">An 18-month old girl toddler declared one day, “I am a boy.” As a result, her parents are raising her as a boy, and intend to treat her with hormones to delay the onset of puberty. By age 17 or 18, the parents reason, the girl can choose to be a boy for life, and undergo transsexual surgery. The story is told in the context of an article about an emerging pediatric practice, whereby children are choosing to live as genders different from the one God created (oh, of course, they do not see that God has a role to play a role in these issues).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Parents of children with gender confusion hope that health insurance will pay for their children’s treatment as preventive care.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Lastly, is the latest report on children born out of wedlock – excuse the old-fashioned term. If you wish, I can just say “born to single mothers.” These statistics should set off alarms for the social cost awaiting our country, <u>none of which figure into <a href="http://www.kotlikoff.net/" target="_blank">Dr. Kotlikoff’s</a> calculations.</u></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">According to the National Institutes of Health, 29 percent of Caucasian babies are born to single moms. As bad as this sounds, 53 percent of Hispanic babies are born to single moms; the number for African-American babies soars to 73 percent. Even during slavery, as Alan Keyes points out in <a href="http://www.amazon.com/Americas-Ticking-Bankruptcy-Bomb-Dream/dp/0062025775"><i style="mso-bidi-font-style: normal;">Masters of the Dream</i></a>, only 15 percent of African-American babies were born into families without a father present. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We must integrate the underlying facts about our country’s financial and cultural demise with every decision we make about the future of U.S. healthcare. To pretend these are not relevant is to self-destruct.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The root cause and the real solution are the same: personal moral responsibility. A remnant still has it, but society in general seems to be tossing it aside. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We will keep fighting for healthcare consumerism, a reduction in wasteful healthcare spending, doctor-patient relationships, healthier bodies, and all such pursuits. But, the one pursuit that overrides all this is that of moral character, at a far higher level than is apparent today.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In 2012, we can get started on one aspect of saving America; <u>elect people of moral integrity to office</u>, and throw the others out the door.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com3tag:blogger.com,1999:blog-7825356905707208207.post-32609923440318819772012-02-29T07:55:00.000-08:002012-02-29T07:55:34.423-08:00Go ahead, Try to make a wise prediction. Can't happen.<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">Predictability. Stability. These are two critical keys to success for any family, business, or government. Neither exist in our present day politics or economy.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Who among us can predict our health care or economic future? Not one of us. All we can do is guess, and guessing is the wrong way to build anything that will last.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Good Book asks the question, “What person who is about to build a tower doesn’t first sit down and count the cost?” But how can anyone count the cost when the rules change almost daily?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A Washington Post article promoted the idea that President Obama might be open to giving states flexibility on Medicaid mandates. He might even grant states some leeway in the implementation of health benefit insurance exchanges. The test? Any flexible plans must meet the intent of the ACA? What does that mean? What flexibility? What, pray tell, is the intent of the ACA?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Secretary of Health and Human Services has been woefully lax in issuing ObamaCare rules, and now President Obama suggests the rules that are not yet rules may change – if the federal government deems that states mean to do what the Affordable Care Act requires; as if anyone can figure out exactly what that means.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We await the ruling of the Supreme Court about the ACA. Will it overturn all of it, just the mandate, or let it stand? Which is worse?</div><div class="MsoNormal"> </div><div class="MsoNormal"><span style="mso-spacerun: yes;"> </span>If it lets the ACA stand, then we face years of rules that are not rules, waivers that are not waivers, and endless political bickering. If the Court overturns the individual mandate, and lets everything else stand, we face the end of insurance companies (some would cheer this, but not stockholders). If the Court overturns everything, we face chaos.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Right now, today, someone somewhere is creating the next miracle medical device, discovering a new surgical procedure, harnessing some unknown element of creation that will revolutionize medical care. Why would anyone invest in the entrepreneur’s idea, when the investor knows that the rules will change?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Right now, today, banks and venture capitalists are pondering how to grow their money. The safest bet is not to bet on stability and predictability, because there is none. Keep the money in the vaults until America decides who and what it is. Speculate on the stock market, but avoid new ventures. For certain, keep your money far from Solyndra projects, because when the clouds carrying financial collapse produce economic thunderstorms, and America is caught up in a flood of bankruptcies, no one will worry about green energy. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Or, maybe the rules will change and none of this will happen.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The greatest damage President Obama has done to America is to leave us without any sense of stability, or ability to predict with some rational certainty, where we are headed. On the other hand, it is possible to rationally predict that we are headed for a financial disaster. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">One other prediction: The election of 2012 will determine our survival as a nation of free people. That prediction you can take to the bank.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-6055490637037949232012-02-15T14:42:00.000-08:002012-02-15T14:42:10.492-08:00Health Care Threatens Your Liberty<div dir="ltr" style="text-align: left;" trbidi="on">Take a few minutes to <a href="http://www.youtube.com/watch?v=gCUNVe6jcJ0">view this YouTube speech</a>. It's one I gave to the Association of American Physicians and Surgeons, on January 20, 2012, at a Las Vegas meeting.<br />
</div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-91742277984723017912011-08-03T06:44:00.000-07:002011-08-03T06:44:36.533-07:00Private behavior has a public cost: We all will spend more<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal" style="font-family: Verdana,sans-serif;"><span style="font-size: 10pt; line-height: 115%;">Cigarette smokers have taught us that private behavior has a great public cost. Governments have no problem imputing large taxes on smokers and shaming them through tax-supported public service announcements. When it comes to smoking, we get it. But, when it comes to sex, not so much.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><span style="font-family: Verdana,sans-serif;"> </span><br />
<div class="MsoNormal" style="font-family: Verdana,sans-serif;"><span style="font-size: 10pt; line-height: 115%;">“Don’t impose your morals on me,” is the common cry of not just libertines, but all of us. The idea here is that private behavior is private and, as long as it does not affect others, people should be left to their own wills. This worked well when society expected people to exercise personal restraint. It was enough that public consensus kept people in line; few government sanctions were necessary. Healthcare reform, however, is exposing flaws in that argument as it applies today.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><span style="font-family: Verdana,sans-serif;"> </span><br />
<div class="MsoNormal" style="font-family: Verdana,sans-serif;"><span style="font-size: 10pt; line-height: 115%;">The Federal Secretary of Health and Human Services, under the authority granted by the Affordable Care Act of 2010 (ACA), recently issued eight mandates on private health insurance. The Secretary’s order means that in the future, health insurance must pay 100 percent of the cost of preventive care for these eight mandated categories. At least five of these mandates are directly related to sexual promiscuity. We will all pay the cost in higher insurance premiums.</span><br />
<br />
<span style="font-size: 10pt; line-height: 115%;">Specifically, the new Federal guidelines require that all Health Insurance policies must cover preventive care for these five behavior-oriented conditions: <span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 10pt; line-height: 115%;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></div><ul style="font-family: Verdana,sans-serif; text-align: left;"><li><span style="font-size: 10pt; line-height: 115%;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 10pt; line-height: 115%;">Human papillomavirus (HPV) DNA testing for women 30 years and older;<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></li>
<li><span style="font-size: 10pt; line-height: 115%;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 10pt; line-height: 115%;">Sexually-transmitted infection counseling;<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 10pt; line-height: 115%;"> </span></li>
<li><span style="font-size: 10pt; line-height: 115%;">Human immunodeficiency virus (HIV) screening and counseling; <span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span style="font-size: 10pt; line-height: 115%;"> </span></li>
<li><span style="font-size: 10pt; line-height: 115%;">FDA-approved contraception methods and contraceptive counseling;<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></li>
<li><span style="font-size: 10pt; line-height: 115%;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 10pt; line-height: 115%;">Domestic violence screening and counseling.</span></li>
</ul><span style="font-family: Verdana,sans-serif;"> </span><br />
<div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">Before moving on, read the list again. It is true, of course, that even the most careful, pious person or monogamous married couple could conceivably suffer from one or more of these conditions: but the incidence of such is certainly low enough not to allow a federal official to order preventive healthcare payments for medical tests related to these behaviors.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">HPV, STDs, and HIV, for the most part, are diseases resulting from promiscuous sexual behavior. American society has, for the most part, considered medicinal contraception acceptable, although tens of millions reject it on religious grounds. No one that I know of considers domestic violence acceptable behavior; about this, society continues to impose moral and legal strictures.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">Physicians are expected to withhold moral judgment while deciding whether to treat an individual. No matter the cause, a hurting or ill person needs medical attention. The man infected with HIV or AIDS should get medical care. The woman suffering from STDs or cervical cancer should get medical care. Despite potential medical, emotional, and psychological dangers, we do not withhold medicinal contraceptives from single or married women who desire to prevent pregnancy. We tolerate cohabitating partners as a price we pay to keep government out of private lives (and we celebrate it in our popular culture). These all come with a price tag, and now, the Secretary has increased it for everyone.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">You see, there really is a financial cost to all of us for not embracing the “old” morality, the morality that reserved sexual intimacy for marriage between a man and woman. We have fallen so far from this higher moral standard that today, a Federal official orders that everyone must pay more just to screen for diseases that naturally follow promiscuous behavior.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">“We cannot put enough policemen on the street if there is no policeman in the heart,” to paraphrase Alan Keyes, who has sent this on numerous occasions. Public morality flows from private morality, and a lack of it costs all of us.</span></div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-bottom: 24pt;"><span style="font-size: 10pt; line-height: 115%;">We do not want government to impose morals on us, but we should not want government to order us to pay for the results of immorality.</span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com4tag:blogger.com,1999:blog-7825356905707208207.post-23331954575353137232011-06-29T16:50:00.001-07:002011-06-29T16:50:15.922-07:00“Mandatory Life Insurance,” Cries California Congress Person<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="color: red;"></div><div class="MsoNormal" style="color: red;"><b>Perfect Match for Health Insurance Exchanges</b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">BROADMOOR, CA. June 29, 2011: “Tomorrow I plan to introduce the Affordable Life Insurance Empowerment Act in Congress,” said Arly Esperson, Congressperson from California’s 54<sup>th</sup> Congressional District. “Now that the Sixth Circuit Court of Appeals has ruled the health insurance mandate is constitutional, I think it’s time we take the next step.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Today, a three-judge federal appeals court in the Sixth District upheld the cornerstone of the Affordable Care Act of 2010. “The progressives in Congress wanted to be sure the court upheld the mandate before we started moving ahead with the rest of our agenda,” Esperson explained. Esperson spoke about the controversial ACA provision known as the individual mandate that will require every American resident to enroll in a health insurance plan by 2014.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Progressives breathed a sigh of relief over the decision, Esperson said. Esperson leads the Latte Party Caucus in Congress, a group of lawmakers who believe government needs to do more for “working people. And that’s why I am moving ahead with this new bill.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Affordable Life Insurance Empowerment Act (ALIE), Esperson explained, would require all United States’ residents to purchase a minimum of $10,000 in what Esperson called “lifetime coverage.” Ron Kelly, a spokesman for New Mexico Life Insurance clarified the term: “Esperson means whole life or cash value insurance, and it lasts a lifetime, or, well, until death.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Esperson’s bill would go farther and require everyone older than 35 to own a minimum of $250,000 in term life insurance in addition to the $10,000 whole life policy. “This will do several things for working people,” Esperson explained. “First, there will be money for burial cost. Second, it will help settle estates. And third, and just as important, the federal tax of 25 percent on the death benefit will help to reduce the national debt.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">ALIE overcomes two hurdles that might otherwise doom the bill: premium cost for low-income people, and accessibility coverage. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">First, Esperson explained that low-income people – the threshold is set at family income of less than $50,000 a year – will receive help paying their mandatory life insurance premiums. “America’s richest individuals often use life insurance to dodge paying estate taxes,” Esperson said. “We will levy a 35 percent tax on the life insurance proceeds of all plans that exceed $500,000.” In this manner, “we will make sure the rich pay their fair share.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Second, Esperson plans to fold enrollment in mandatory life insurance plans in the Health Insurance Exchanges required by the ACA. “Hey, every state must have the Exchanges, and it would be nothing for Exchange enrollers to fill out life insurance applications.” </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Under ALIE, insurance companies will have to issue life insurance to anyone, regardless of their medical condition or age. “That’s why we mandate ownership,” Esperson explained, “to eliminate cherry picking of insured people, as the life insurance companies do now.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The other ALIE key feature will help keep the premiums low for everyone, according to Esperson. “We will limit the premium rates on a three to one ratio, so that the younger people will not get stuck paying too high of premiums.” People under 33, according to ALIE, would pay one-third as much as people older than 65.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“This is the perfect adjunct to the Affordable Care Act,” Esperson said. “For the first time in our nation’s history, everyone will have health and life insurance.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">President Obama has remained silent on ALIE.</div><div class="MsoNormal"><br />
</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com7tag:blogger.com,1999:blog-7825356905707208207.post-73202466495017322642011-06-18T14:14:00.000-07:002011-06-18T14:14:34.414-07:00We elected Sue Johnson as President proving girls can govern<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVzlIYsmWXwTdDDYaoTkqlRmfmcewlqc9DkQ-CaG877GwGOo0dAqdqi-91u8pyNQYpwraOwun749qUBS02m6YrH6G2oIf1yoqOxbwnGITqfQYKQf0G6Hb9LbbDVhFjE5iO0ZiFgppqZ0kl/s1600/MicheleBachman2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVzlIYsmWXwTdDDYaoTkqlRmfmcewlqc9DkQ-CaG877GwGOo0dAqdqi-91u8pyNQYpwraOwun749qUBS02m6YrH6G2oIf1yoqOxbwnGITqfQYKQf0G6Hb9LbbDVhFjE5iO0ZiFgppqZ0kl/s1600/MicheleBachman2.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Cong. Michelle Bachmann</td></tr>
</tbody></table><div class="MsoNormal">Michelle Bachmann wants to be President of the United States. She’s a girl. I can attest to this because I have met her personally. You can take my word for it.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But can a girl win the presidency? Yes, and on this you can also take my word for it.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In 1961, Sue Johnson defeated me, Dave Racer, for the Presidency of Dr. James Phillips’ Ninth Grade Core Class. Sue served admirably. I think I became secretary of something.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Alright, running a Ninth Grade class isn’t exactly like being The Most Powerful Leader in the World. I grant you that.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But what makes a good U.S. President? It depends on the times and the challenges.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">For my money, the next president have a demonstrable record of commitment to solid principles of faith, family, thrift, limited government, and understand that we are going broke. In my family, it’s the girl that worries most about budget – and not overspending.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Okay. I am convinced that Michelle Bachmann is qualified to be President of the United States for the times in which we live. She may not be the only candidate so qualified, but she is the Real Thing.</div><div class="MsoNormal">In fact, I am willing to say it straight: If any one of the GOP boys want to be President, they should quickly adopt Bachmann’s convictions. I’m pretty sure that Mitt Romney can’t do it, and I wonder about Newt Gingrich. Ron Paul has convictions, but not for these times (he is either two centuries too late or 10 years too soon).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I see Tim Pawlenty, my governor, as an enigma. This is because I am not a pragmatist, and because I am an idealist. Pawlenty governed exceptionally well, but faced a Democrat legislature most of the time. Pawlenty also had to deal with Minnesota’s GOP “conservatives,” many<span style="mso-spacerun: yes;"> </span>of whom are to the left of a Missouri Democrat. Clearly, he can do the job, but he also knows how to cut a deal – and I’m thinking this is not the era where we need deal-cutters.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But I got off course. My purpose in this odd piece is to demonstrate that the problems we face in the United States are so ponderous that we have to throw aside the trivial arguments about race and gender, and find someone to bring about a change in course. The change, of course, is to give Barrack Obama the chance to play golf everyday – even twice daily if he wishes, and keep him away from the White House.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Don’t carp at me that Michelle Bachmann kissed George Bush, or said something silly about Paul Revere. Every politician is flawed. This is because they are human beings. Even Sue Johnson had flaws, but far fewer than mine. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">If you don’t want a girl to be president (or at least the girl named Bachmann) then lean on the boys to prove they can do it. </div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-20022969549707947232011-06-08T08:19:00.000-07:002011-06-08T08:19:04.309-07:00Resisting Federal Encroachments: Founders v. Today<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">“Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shown, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security…”</span></div><div align="right" class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; text-align: right;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">The Declaration of Independence – 1776</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">Why not read those words again before you move ahead with this blog. Do they sound extreme to you? I mean, “<i style="mso-bidi-font-style: normal;">throw off such government</i>;” that certainly sounds extreme, doesn’t it? Or does it?</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">Throwing off the chains of oppressive government meant taking up arms to the Founders. They did not have the protection of a Constitution they had dutifully adopted, endorsed, and wished to defend. </span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">The Founders cited the primary reason for establishing government to be to “secure these [unalienable] rights,” the God-given rights to life, liberty and the pursuit of happiness (translated in the Bill of Rights and the Fourteenth Amendment to mean, the right to own property). Simply, a government that no longer defends life, liberty, and property, said the Founders, must be thrown off.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">“The individual mandate is outside Congress’ Commerce Clause power, and it cannot be otherwise authorized by an assertion of power under the Necessary and Proper Clause. It is not Constitutional,” <a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><span style="color: blue;">[i]</span></span></span></span></span></a> wrote Federal Judge Roger Vinson. (Vinson ruled on the individual mandate to purchase health insurance required by the Affordable Care Act of 2010, passed by Democrats in Congress, and signed by President Obama.) Other judges have disagreed with Vinson, and the Supreme Court will ultimately decide.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">When Congress acts in such a manner so as to attack liberty and property, as Vinson stated clearly in his <a href="http://www.freemarkethealthcare.com/"><span style="color: blue;">ruling</span></a>, what should we as citizens do? Well, if we agree that no one should be coerced by government to purchase something they may not want (in this case, health insurance), maybe we should resist? Sam Adams and the other Declaration signers would cheer us on.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">Has the time come to resist?</span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">The Declaration speaks of “a long train of abuses and usurpations” as a critical element in deciding whether to “throw off such government…” <a href="http://www.freemarkethealthcare.com/"><span style="color: blue;">Judge Vinson’s decision</span></a> looked back at how Congress has butchered, sliced, and diced the enumerated powers of the Commerce Clause; mostly since the 1930s. Vinson identified a train of ever-increasing, ever-broadening Congressional encroachments on private commerce. He quoted the Congressional Research Service and the Congressional Budget Office, both of which stated the individual mandate is an unprecedented expansion of the reach of the Commerce Clause.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">When Congress decides to tell us that we must purchase health insurance has their action crossed the line into tyranny, or is that too strong of word? Would you supply me with an alternative? And is this a one-time assertion of power, or evidence that Congress intends to continue a long train of usurpations? </span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">When you view the growth of government under the light of the Founders’ reasoning, and then under the scrutiny of history (including recent history), you see the “long train of abuses and usurpations” upon which the Founders based their claim to independence. The Founders chose to fight a hot war of rebellion as their answer, but resistance can take many other forms long before war becomes the only option. This is one of the chief blessings of our United States Constitutions.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">What methods of resistance?</span></b></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">We express resistance to tyranny at the ballot box. We elect individuals to represent our views. If our view is that Congress does not have the power to force someone to purchase health insurance, we will resist Congressional tyranny by electing a different Congress. In fact, we started that process through the 2010 election, and hopefully, will continue it in 2012. So elections are an alternative to taking up arms, as an expression of resistance – God be praised.</span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">Are there other ways to resist tyranny beyond the next election? </span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">Lawsuits, such as the one Judge Vinson ruled upon, are one way to resist. Another is to ask state and federal lawmakers that are currently serving to use every possible legal scheme of which they can conceive to resist all federal encroachments on liberty. It means asking lawmakers to scrutinize all legislation related to the Affordable Care Act of 2010, searching for any instance in which they dare to challenge the federal government by taking no action, or taking adverse action.</span></div><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">There is an ultimate form of resistance to tyranny that falls short of the Founders’ resort to arms: If millions of Americans choose <i style="mso-bidi-font-style: normal;">en masse</i> to resist laws that threaten unalienable rights to life, liberty, and property, Congress and the Courts will notice. Perhaps, if the individual mandate stands, we should incite millions of Americans to drop health insurance coverage as a form of civil disobedience; sort of like dumping tea into Boston Harbor.</span><br />
<span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt;">On the other hand, millions of Americans may remain indifferent. Today’s elected state lawmakers may choose, instead, to capitulate to Congress. If so, James Carville may prove to be right when he said recently, “…we’re going to start to see civil unrest in this country. I hate to say that, but I think it’s imminently possible.”<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_edn2" name="_ednref2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="color: blue;">[ii]</span></span></span></span></span></a></span><br />
<div style="mso-element: endnote-list;"><br clear="all" /><span style="color: blue;"><hr align="left" size="1" width="33%" /></span><div id="edn1" style="mso-element: endnote;"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Calibri", "sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">[i]</span></span></span></span></span></a><span style="font-family: Calibri;"> </span><span style="font-family: "Arial", "sans-serif"; font-size: 8pt;"><a href="http://www.freemarkethealthcare.com/"><span style="color: blue;">Case No.: 3:10-cv-91-RV/EMT - State of Florida v. United States Department of Health and Human Services</span></a></span></div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 1in; mso-layout-grid-align: none; text-indent: -0.5in;"><span style="font-family: "Arial", "sans-serif"; font-size: 8pt;">2011<span style="mso-tab-count: 1;"> </span>Federal Court, Florida District: Florida</span><span style="font-family: Courier;">. P 56.</span></div></div><div id="edn2" style="mso-element: endnote;"><div class="MsoEndnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ednref2" name="_edn2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Calibri", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">[ii]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Carville, J. (2011) “Carville: There Will be Civil Unrest—Over Economy.” Newsmax.com. June 6, 2011. </span><a href="http://www.newsmax.com/InsideCover/Carville-Obama-Clinton-civilunrest/2011/06/06/id/398990"><span style="font-family: Calibri; font-size: x-small;">http://www.newsmax.com/InsideCover/Carville-Obama-Clinton-civilunrest/2011/06/06/id/398990</span></a><span style="font-size: x-small;"><span style="font-family: Calibri;">. Retrieved June 8, 2011.</span></span></div></div></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-56394697040611936902011-06-01T07:51:00.000-07:002011-06-01T07:51:37.128-07:00Who should ration health care?<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal"></div><div class="MsoNormal">“Racer,” you may have already said, “why resort to false, emotional words like ‘ration’ when what we need is a serious discussion about health care reform?”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Easy. Rationing is an essential element of the ACA way. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Fifteen commissioners, each earning $165,000 a year, will do the rationing. They are called the Independent Payment Advisory Board, and are foundational to how ObamaCare will function.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">President Obama and the Democratic members of Congress, in passing the misnamed Affordable Care Act of 2010 (ACA), took $500 billion away from future Medicare payments. They did this knowing that more than 78 million Americans are beginning to qualify to enroll in Medicare. What happens when less money is available for more people? You choose your favorite term: I use the appropriate one: It’s called rationing.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Make no mistake about it. Rationing will happen as revenue fails to keep up with cost of care. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Medicare Revenue is directly linked to the expansion (or retraction) of the economy, except that President Obama does not believe this. Instead, he believe there is a finite amount of money, and the role of politicians is to divide it up.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The way to divide up a finite amount of money in Medicare is to ration care. The instrument to accomplish this is the Independent Payment Advisory Board (IPAB). This 15-member board, set up under the ACA, will decide what care will be allowed to be provided to Medicare enrollees, and what will be denied. Denial of care is called rationing.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It is true that there are other forms of rationing. If a person has no money, and there are not medical providers willing to care for that person, it is called rationing. But the Affordable Care Act will create more of this type of rationing, not less. Why? Because the ACA discourages individuals from becoming physicians. If there are no doctors, there is no health care – well, professional health care.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">If a person has prepaid health coverage (some call it insurance), and the insurance company or Health Maintenance Organization (HMO) is in charge of deciding who gets what coverage, that is a form of rationing. But it is far different from the way the IPAB functions. There is at least some competition among health care insurance companies to provide coverage for individuals. If there would be only one insurance company, it could dictate – yes, dictate – who will get what care, when, where, and under what conditions. This is precisely what the IPAB will be able to do, because Medicare is single payer, government-run health care – it has no competitor. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Repeat it. Tell the truth. ObamaCare, the ACA, is the process to ration health care. First, to senior citizens on Medicare, and then to the rest of society (as Exchanges give way to single payer systems, and as Accountable Care Organizations submit to the federal paymaster).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We start to fix this by repealing the IPAB. And the requirement for Exchanges. And the individual mandates. We fix it by expanding access to consumer-directed health care, Health Savings Accounts, and medical entrepreneurism. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We cannot, absolutely cannot waste our time trying to fix the ACA. It cannot be fixed. It must be rationed out of existence.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Health care decisions are the realm of patients, their families, and doctors. Communities join this process voluntarily. This is the way to pursue rational decisions about health care. </div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com3tag:blogger.com,1999:blog-7825356905707208207.post-52745299493923214252011-05-29T12:14:00.000-07:002011-05-29T12:14:22.583-07:00A Father and Daughter Deploy to Afganistan<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">What ideas are so strong that Americans fight and die for them?</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Today I stood in church next to a father and daughter, both members of the United States Army. The pastor asked them to stand and be recognized: They are both to soon deploy to Afghanistan.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Wow. <i style="mso-bidi-font-style: normal;">Why do people volunteer for military service?</i></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">He introduced another man, an ex-Marine, whose combat ribbons and medals would cover the entire breastplate of uniform. Among other things, the Marine flow #2 on the Blue Angels. The glory from flying those Blue Angel airshows pales in comparison with the Marine’s war record.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Incredible. <i style="mso-bidi-font-style: normal;">For what reason did this man risk his life time and again?</i></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I served four years in the Air Force during Vietnam, but am humbled by the service of these others.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><i style="mso-bidi-font-style: normal;">What drove me to enlist in the Air Force, knowing that Vietnam awaited, if the military so chose to send me? </i>An honest answer includes my preference not to be drafted into the Army. Yet, I had a heart full of patriotism and love for America, and wanted to do my part (I know, these are old-fashioned ideas to modernists, and maybe even sound silly).</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">A few weeks ago, I asked a close friend of mine to list three non-negotiable issues for me. I asked, “If you served in the Minnesota legislature, tell me three issues where you would draw the line.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">He responded with life – he is prolife. And the other two resembled freedom and pursuit of happiness. Good answers.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">What about you? The answers you give are the reasons we go to war, did you know that? These are the issues that make America different, and special. Life. Liberty. The Pursuit of Happiness.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Our founding fathers wrote that governments are created to protect inalienable rights, and when governments attack those rights or refuse to defend them, it is our right, and in fact, our duty to throw off “such government” and establish new forms that seem better suited to us to defend our inalienable rights. Heavy stuff, right? This is why America’s founding citizens went to war with England. And it is the same reason we fight for America today. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Now comes the tough question. Do you believe it? Do you believe that life, liberty, and the right to own property (pursuit of happiness) are willing to defend and protect, even to the point of sacrificing your life, fortune, and sacred honor? If you answer “yes,” then take some time to evaluate how you are doing so today, and how you might be doing the opposite.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I can think of one major problem that threatens our liberty: our increasing dependence on government, and more specifically, for our health care. I’ve spent the last six years studying this, and am convinced that too many of us are willing to defer to Big Government on this critical issue.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">When the federal government controls all of health care, your life, liberty, and pursuit of happiness will be in total jeopardy.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I cannot imagine anyone willing to fight and die for single payer health care, can you? Such a thought would shake the hearts of America’s founders, and of the millions who have fought and died for our liberty.</span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com2tag:blogger.com,1999:blog-7825356905707208207.post-1471933674074307142011-05-25T06:26:00.000-07:002011-05-25T06:26:35.229-07:00Elections that go our way have consequences - Sometimes we don’t like them<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">During the summer and fall of 2010, I traveled across Minnesota – and other states – to deliver a message to professional health insurance agents: Get involved in this election, because the next legislature will decide what kind of health insurance exchange you will have.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>A funny thing happened on the way to the election</b>. Minnesotans sent conservative Republicans to the state capital, and created a GOP majority. Not surprising, most of the new legislators are committed conservatives – and they refuse to create health insurance Exchange.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Without the votes of the freshmen legislators, the ones for whom many of us campaigned so vigorously, the Exchange went nowhere. It could resurface in a special session, or next year. But there is no indication the freshmen legislators would change their vote.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>We elected principled conservatives and they actually voted that way</b> (or in this case, withheld their vote). Elections have consequences, even when they go our way.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Consider the alternative. If we had not elected conservatives, Gov. Dayton would have signed an Exchange bill early in the session. We know what it would look like. These are some of the features of a bill passed by a liberal legislature and a liberal governor (who is on record supporting single payer):</div><div class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span>All health insurance sold in Minnesota would go through the Exchange. </div><ol style="text-align: left;"><li><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Health insurance agents would have no role in the Exchange.</li>
<li><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Health insurance agents would either go out of business or sell different lines of insurance.</li>
</ol><div class="MsoNormal">I am not making this up. I have seen the bill offered by Minnesota liberals. If you believe in a market-based health insurance system, and especially, if you believe in the health insurance agent system, you will not like what liberal legislators and a liberal governor give you.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Last summer, I risked my health and safety, driving and flying thousands of mile, to ensure the new legislatures across the country would protect a private market health insurance system. I lectured insurance agents, and tried to motivate them to engage in the process to avoid a liberal legislature and liberal governor. We won, but our win resulted in the unexpected consequence that legislators would actually do what they said they would do. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The conservative governor candidate lost by several thousand votes – a tiny fraction of the total. If he had won, everything would have been different except one thing (and about this I speculate): With Tom Emmer as governor, and a conservative GOP legislature, there would be no Exchange bill passed in Minnesota.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So if you believe that your state needs an Exchange, don’t elect principled conservative legislators because, well, they will do what they promised to do: They will oppose “ObamaCare” on every level.</div><div class="MsoNormal">This leaves you with the very risky strategy of electing a moderate or liberal legislator and governor that you will work like crazy to influence, hoping to secure a market-friendly Exchange. After that, if successful, you will have committed yourself to electing the same kind of folks for the next decade, and then work to maintain your influence.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Conclusion</b>: Elections have consequences. If you do not want to fight the Exchange, or fight “ObamaCare,” then do not elect conservatives. But, the trade-off is twofold: 1) You will work your fanny off for the rest of your carreer to influence legislators in order to protect your preferences, and 2) You will be more highly taxed, and have a more activist government than you might otherwise prefer.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I made up my mind decades ago: Three first principles - Life, Liberty, and the right to private property (pursuit of happiness). </div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-16249907722210395562011-05-13T12:27:00.001-07:002011-05-13T12:27:53.569-07:00Medicare Funds Dining<div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-size: small;"><span style="font-family: Calibri;">This short article will change how you perceive Medicare. You will realize how vital Medicare is to our economy, but you will view this in a new light. (maybe, like me, it will seem ironic and a bit troublesome.)</span></span> <div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">Walk into your favorite family restaurant. In Minnesota, I mean Perkins, but this will be true at Denny’s. Huddle House, even McDonalds. The best time is between 9:00 AM and 2 PM. Look around for people who appear to be 65 or older. </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">My bet is that “seasoned citizens” far outnumber the others. It is safe to assume that almost all of those older folks are Medicare enrollees. The fact is, without Medicare, some of them would be “pushing up grass” (to quote Rush Limbaugh).</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">Instead, there they are, some of them every day, or several times a week, eating a price-discounted breakfast or lunch, sipping on a “senior coffee,” and having a great time. At 63, I think I can say this openly: I love old people, especially when they’re having a great time.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">The idea struck me, as it will strike you now, that without Medicare and Social Security, most older Americans would have barely enough money for necessities – like home-cooked food, and shelter (and health care). </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">Think of it. Without Medicare and Social Security, many older folks might have to rely on younger people, maybe even live with them. Our society decided decades ago to ensure that grandparents remained independent from their adult children. About this, I make no value judgment, but it has created an irony, and a very expensive one that at. Every American aged 30 or younger today owes $289,000 just to pay the unfunded Medicare debt.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">You might be thinking that I have this all wrong. After all, don’t we pay Social Security and Medicare taxes on income to prepay our own cost of government retirement benefits? Well, no. The taxes we pay today pay the cost of benefits for today’s retirees. It won’t be long when two income earners will be required to pay the Social Security cost of one retiree. Today’s young people will receive Social Security and Medicare from children not yet born.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">But thanks to Medicare, since it protects older folks from financial catastrophe due to illness, there is money for a daily trip to Perkins. There is also money for Branson, time shares, golf, a winter home, Starbucks, shopping malls, travel, symphonies, and most church donations. Without Medicare, young working Perkins’ servers, paying income, Social Security, and Medicare taxes, would have no job at all. (Or, wait a minute. Maybe they would have a better job. We can’t know that.)</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">A Boston actuary calculated that each Medicare recipient will spend about $250,000 more in health benefits that they paid into the system. By my calculations that will buy 41,650 Perkins lunches at the senior discounted price of $6.00.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-size: small;"><span style="font-family: Calibri;">To add a little fun to your next trip to Huddle House, see if the older fellow at the next booth orders off the senior discount menu. Thank you President Lyndon Johnson for Medicare.</span></span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com2tag:blogger.com,1999:blog-7825356905707208207.post-57384647060916383522011-05-12T13:13:00.000-07:002011-05-13T13:25:08.504-07:00Medicare makes dining possible<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">This short article will change how you perceive Medicare. You will realize how vital Medicare is to our economy, but you will view this in a new light. (maybe, like me, it will seem ironic and a bit troublesome.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Walk into your favorite family restaurant. In Minnesota, I mean Perkins, but this will be true at Denny’s. Huddle House, even McDonalds. The best time is between 9:00 AM and 2 PM. Look around for people who appear to be 65 or older. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">My bet is that “seasoned citizens” far outnumber the others. It is safe to assume that almost all of those older folks are Medicare enrollees. The fact is, without Medicare, some of them would be “pushing up grass” (to quote Rush Limbaugh).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Instead, there they are, some of them every day, or several times a week, eating a price-discounted breakfast or lunch, sipping on a “senior coffee,” and having a great time. At 63, I think I can say this openly: I love old people, especially when they’re having a great time.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The idea struck me, as it will strike you now, that without Medicare and Social Security, most older Americans would have barely enough money for necessities – like home-cooked food, and shelter (and health care). </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Think of it. Without Medicare and Social Security, many older folks might have to rely on younger people, maybe even live with them. Our society decided decades ago to ensure that grandparents remained independent from their adult children. About this, I make no value judgment, but it has created an irony, and a very expensive one that at. Every American aged 30 or younger today owes $289,000 just to pay the unfunded Medicare debt.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">You might be thinking that I have this all wrong. After all, don’t we pay Social Security and Medicare taxes on income to prepay our own cost of government retirement benefits? Well, no. The taxes we pay today pay the cost of benefits for today’s retirees. It won’t be long when two income earners will be required to pay the Social Security cost of one retiree. Today’s young people will receive Social Security and Medicare from children not yet born.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But thanks to Medicare, since it protects older folks from financial catastrophe due to illness, there is money for a daily trip to Perkins. There is also money for Branson, time shares, golf, a winter home, Starbucks, shopping malls, travel, symphonies, and most church donations. Without Medicare, young working Perkins’ servers, paying income, Social Security, and Medicare taxes, would have no job at all. (Or, wait a minute. Maybe they would have a better job. We can’t know that.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A Boston actuary calculated that each Medicare recipient will spend about $250,000 more in health benefits that they paid into the system. By my calculations that will buy 41,650 Perkins lunches at the senior discounted price of $6.00.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">To add a little fun to your next trip to Huddle House, see if the older fellow at the next booth orders off the senior discount menu. Thank you President Lyndon Johnson for Medicare.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-55238253659972093192011-05-10T15:02:00.001-07:002011-05-10T15:02:24.879-07:00Exchanges are not the same as the Federal Employee Health Plan<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">Exchange supporters talk about the Exchange as the same model as government employees “enjoy” through the Federal Employee Health Benefit plan (FEHB). But it is not true.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The Affordable Care Act (ACA) of 2010 requires all 50 states to launch health insurance exchanges by January 1, 2014. If they do not, the federal government will do it for them. Exchanges, its supporters allege, will make health insurance more accessible for the masses. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">FEHB officials brag that government employees have hundreds of insurance options from which to choose. True enough, at least for individuals that live in multiple states at the same time. But for real humans who can only live in one place at a time, there are only a handful of choices, just like normal non-government employees.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The FEHB plan uses what is called a defined contribution model (others call it a voucher). Simply, the government gives its employees a defined per-month amount that the employee can use to purchase their health insurance. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The federal employee can apply their voucher to the purchase of the few plans available to them in the state in which they reside. If the employee chooses an option that costs more than what the government allows, the employee pays the difference. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">ACA-supporters claim that private employers and employees would relish the same opportunity afforded federal government employees in the FEHB plan.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The Massachusetts Connector, in its never-ending attempt to entice more people to enroll, modeled a program after the FEHB plan. “[Private] employers would offer employees a fixed ‘voucher’ and allow them to choose any plan or carrier [in the Connector]. This was a failure and was discontinued.”<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[i]</span></span></span></span></a></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">Why did the Connector’s private employer voucher system fail? It provides a clue as to why FEHB’s plans are different from those owned by normal, non-government employees.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">Government employers pay much more of the employee’s health insurance cost than private employers pay for their employees. The Employee Benefit Research Institute (EBRI) found in 2008 that the employee health benefits paid by governments cost <i style="mso-bidi-font-style: normal;">235 percent more</i> than those paid for by private employers. In other words, private employers insure 2.35 employees at the same cost as the government insures one.<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_edn2" name="_ednref2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[ii]</span></span></span></span></a> (Are you surprised?)</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">Perhaps just as startling are the differences in overall employee compensation. Government employees enjoy a 151 percent more generous compensation package than the private sector employees that pay the taxes to support them.<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_edn3" name="_ednref3" style="mso-endnote-id: edn3;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[iii]</span></span></span></span></a></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The government employee premium subsidy for FEHB plans is large enough to cover most of the cost of a family health insurance policy. Private employers cannot afford to subsidize family health insurance to the same extent as the federal government does in the FEHB plan. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">In Minnesota, for instance, state taxpayers subsidize 100 percent of an employee’s health insurance cost for the basic plan, and the employee pays only 15 percent of the dependent’s premium. Total premiums for both exceed $16,000 a year – thank you taxpayers.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">Private employers may pay 50-80 percent of an employee’s premium, but many pay far less for dependent coverage. And very few small group Minnesota employers provide family coverage at $16,000 a year. Only government employers can afford such luxuries. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">An Exchange FEHB-type voucher plan could only work if it provided much less expensive coverage than Federal employees “enjoy.” Most private employers could never provide funding for the family coverage common to the FEHB plans .</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">The Massachusetts Connector has already demonstrated that a FEHB plan does not work for private employers. Soon after states or the federal government launches Exchanges, we will all understand the same fact.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: "Tahoma", "sans-serif"; font-size: 10pt; line-height: 115%;">After all, the primary purpose of the Exchange is to enroll people in tax-subsidized health insurance. The end game is to create more dependency on government. </span></div><div style="mso-element: endnote-list;"><br clear="all" /><hr align="left" size="1" width="33%" /><div id="edn1" style="mso-element: endnote;"><div class="MsoEndnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[i]</span></span></span></span></span></a><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"> A Massachusetts’ government insider, whose identity is protected, provided this insight.</span></div></div><div id="edn2" style="mso-element: endnote;"><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 26.15pt; mso-char-indent-count: -3.27; mso-layout-grid-align: none; text-indent: -26.15pt;"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ednref2" name="_edn2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[ii]</span></span></span></span></span></a><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"> Fronstin, P. (2008) “<span style="mso-bidi-font-weight: bold;">Benefit Cost Comparisons Between State and Local Governments and Private-Sector Employers.” </span>Employee Benefit Research Institute. Washington, DC. June 2008, Vol. 29, No. 6, p. 3.</span></div></div><div id="edn3" style="mso-element: endnote;"><div class="MsoEndnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ednref3" name="_edn3" style="mso-endnote-id: edn3;" title=""><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast;">[iii]</span></span></span></span></span></a><span style="font-family: "Tahoma", "sans-serif"; font-size: 8pt;"> Ibid.</span></div></div></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-53350602943206842922011-05-09T07:11:00.000-07:002011-05-09T07:11:32.651-07:00Realtors Online is not a Health Insurnace Exchange Model<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowRevisions/> <w:DoNotPrintRevisions/> <w:DoNotShowMarkup/> <w:DoNotShowComments/> <w:DoNotShowInsertionsAndDeletions/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">President Obama says health insurance exchanges work like a <a href="http://www.realtor.com/"><span style="color: black; mso-themecolor: text1;">Real Estate website</span></a>. He’s expecting you won’t think too deeply about it, because if you do, you’ll see how foolish a comparison it is.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Let’s buy a house using online tools at the current “<a href="http://www.realtor.com/"><span style="color: black; mso-themecolor: text1;">Real Estate Exchange</span></a>.” <span style="mso-spacerun: yes;"> </span>We enter data about where we want to live, how much we are willing to spend, and other desirables such as distance to schools, churches, parks, and other amenities. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Once we enter our data, the web engine spits out some options. <u>Then we call a realtor</u>. We do not point, click, and purchase the house that looks right for us. But let’s consider for a moment that President Obama designed a Home Owner Purchase Exchange (HOPE) and we did purchase homes this way.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">First, we find limited choices: maybe five models. These might range from 800 square foot starter homes (or retirement homes) to <i style="mso-bidi-font-style: normal;">extravagant </i>1,400 square foot family homes. To make sure states feel they are a part of the plan, the federal government would allow legislators to design the interior and exterior, as long as they stay within federal limits.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Our HOPE works like the Massachusetts CommonwealthConnector, the nation’s “most successful” health insurance exchange, with its seven plan choices – down from 24 at its inception. Why? Because the Connector is not capable of providing customized choices, and the people do not know there are many options beyond what the Connector offers.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Second, the primary reason we want to purchase our home on the HOPE is to receive federal mortgage payment subsidies. Why not? If an insurance exchange is like a Realtor website, then the HOPE would have mortgage subsidies (WARNING: do not share this with any member of Congress). In the HOPE, our federal government pays part of our mortgage based on our income, or lack of income. So what if we only have seven home styles from which to choose: We should be thankful that the government allows us so much freedom. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">In Massachusetts, the average health insurance premium for a non-smoker 40-year old on a family policy is $2,000 a month – more than a mortgage payment. The Connector does not reduce premiums, it just uses taxpayer money to help reduce the individual’s share of premium. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Now, here is how the real world <a href="http://www.realtor.com/"><span style="color: black; mso-themecolor: text1;">Real Estate Exchange</span></a> works as a private market health insurance exchange: Go to <a href="http://dci.buymnhealthinsurance.com/plansearch.aspx"><span style="color: black; mso-themecolor: text1;">http://dci.buymnhealthinsurance.com/plansearch.aspx</span></a> and you will find 137 health insurance choices. After you input basic data, you will want to talk with the agent about the one that best fits your situation.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">Private market health insurance exchanges already exist. If the goal of the federally imposed exchanges was simply to help people find health insurance, it has no need: The need is already being met in the private market.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">So why does the ACA require a federal/state health insurance exchange when <a href="http://dci.buymnhealthinsurance.com/plansearch.aspx"><span style="color: black; mso-themecolor: text1;">http://dci.buymnhealthinsurance.com/plansearch.aspx</span></a> already exists everywhere, all across the nation?</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">The primary purpose of the exchange is to subsidize health insurance premiums. </span></b><span style="color: black; font-family: "Verdana","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: Calibri; mso-themecolor: text1;">When the federal government achieves its goal to subsidize the health insurance premium payment of up to 60 percent of the population, it will control all of health care.</span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com3tag:blogger.com,1999:blog-7825356905707208207.post-49330559618676569762011-04-29T11:53:00.000-07:002011-05-02T08:06:30.823-07:00Gray is a real color<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal">Wide swaths of private liberty should never, ever fall to political oversight. Once politics engages, liberty, pretty much a black and white concept, becomes grayed through the political process.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>“Gray</b> or <b>grey</b> is a <a href="http://www.wordiq.com/definition/Color">color</a> seen commonly in nature. It is created by mixing <a href="http://www.wordiq.com/definition/White">white</a> and <a href="http://www.wordiq.com/definition/Black">black</a> in different proportions. Depending on the amount of light, the human eye can interpret the same object as either gray or some other color.”<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 12pt;">[1]</span></span></span></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Politics drives me crazy, in some measure because I can't rid myself of passion toward it. Otherwise, because it is an endless sea of gray coloration, and I want to be a black or white kind of guy. For those who see political theory through rose colored glasses, the truth is your vision is distorted.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Here is a great example. I see Medicare, just as ObamaCare, as unconstitutional. You might think I am irrational for thinking so: but the United States Constitution does not enumerate the power for the federal government to create a national health insurance program. If you find it, please tell me where and why you believe it to be true.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">On the other hand, Medicare is engrained in our national psyche. Trying to save it by modifying it may send Republicans to the back bench. What are we who see black and white to do about this? Would we be better off with a rigid, perfectly white view of Medicare’s nature, and then tilt at windmills trying to undo it? Or, do we try, connive, coalesce, and work incrementally to remove some of its most perverse aspects? In other words, do we shade our black and white view to become more gray in the hope of eventually restoring some semblance of constitutional balance?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">ObamaCare is patently unconstitutional, despite what the Supreme Court might eventually rule. But what if the Court only chisels away the individual mandate, and leaves the balance intact? Obama’s devotees, who also see things as black and white (I might have said red and white), argue that the mandate is required for the whole bill to work. Obama’s detractors argue that the mandate is required for the whole bill to work. This is about the only aspect of ObamaCare upon which they agree. This odd agreement could mean nothing to the Court.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Court very likely could rule the mandate to be unconstitutional, and let the balance of the bill stand. Such a ruling would protect the federal government from endless state-led lawsuits on any new federal law a state despises, and upset federal sovereignty. My bet is the Court will finesse this gray decision, and leave the country in confusion.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We who prefer black and white politics to gray politics are likely to be engaged for the next 20 years trying to adjust the shade of gray to more closely match our own perspective. We may be forced to attempt to reform health insurance exchanges, or accountable care organizations, or defang the competitive effectiveness crowd, while at the same time making it appear we are not trying to rid ourselves of them. This is highly frustrating to a black and white guy which finally gets me to the whole point of this article.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">As politics has touched health care, we have been subjected to an endless cycle of grayed policies that do nothing but pit freedom-loving people against powerful political factions and yes, the hated interest groups. If ObamaCare stands, we will have lost what little liberty remains.</div><div><br />
<hr align="left" size="1" width="33%" /><div id="ftn1"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 10pt;">[1]</span></span></span></a> http://www.wordiq.com/definition/Gray_%28color%29</div></div></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-14375740207395567292011-04-07T13:01:00.001-07:002011-04-07T13:02:15.834-07:00Cong. Ryan takes one step toward Medicare cure<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal">If we want America to survive, we have to fix Medicare (and a host of other entitlement programs).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Since Medicare’s launch in 1966, politicians have continuously tinkered with health care and methods to pay for it. Today, reasonable and honest politicians (no, that is not always an oxymoron) realize Medicare threatens our children’s financial future. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The simple fact is that each person younger than 30 years old already owes $289,000 to pay the unfunded cost of Medicare. There is no equivocation on this: Medicare is broken, and we cannot afford it as it is currently financed.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What solutions can we offer, other than government rationing of health care to Medicare enrollees? Cong. Paul Ryan got us off dead center this week by recommending what he euphemistically calls “premium support” payments for those individuals enrolling in Medicare starting in 2022. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">(Premium support is another name for tax subsidies which is another name for welfare payments, if I might be so bold. Why do I say welfare? Because Medicare enrollees today and tomorrow will receive medical services valued far beyond the dollars they contributed to the program. You can call it Medicare benefits, but I call it welfare for old folks, like me, in 2012.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Now don’t get me wrong. I commend Ryan for taking the first step. But we must do more.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Democrats’ answer to Medicare and health care’s soaring cost is to tax us more, create new government bureaucracies to launder the money, and then expand the programs. Reid, Pelosi, and Obama decided to pay for this the backs of “high” income earners and every day citizens. For “high income” earners, the Democrats increased taxes on their incomes – more income taxes and fewer dollars to invest in new businesses and jobs.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Democrats also added tens of billions in user taxes to fund Obamacare. These are taxes on consumable medicines and durable medical products, plus a tax on health insurance. These types of taxes better fit the Founding Fathers’ concept of taxation – excise taxes, user taxes, consumption taxes – but they never favored income taxes.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Fixing Medicare, in my humble opinion requires the following (although I hold my nose with anything smacking of income tax manipulation):</div><div class="MsoNormal"><br />
</div><div class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;">1.<span style="font: 7pt "Times New Roman";"> </span>Means test Medicare by requiring those with greater incomes and assets to pay a larger share of their own cost. This is not necessarily good, but it is better than having everyone regardless of income and assets pay the same. Why should Billionaire Warren Buffet qualify for the same benefit at the same price as Warren Smith, whoever that is? </div><div class="MsoListParagraphCxSpMiddle"><br />
</div><div class="MsoListParagraphCxSpMiddle"><b>If the idea of requiring individuals to spend down their personal assets for their own health care is repugnant to you, if it makes more sense for children yet unborn to pay these costs, then I will change my position on the death tax: If you want to stash your mattress with cash and use my grandson’s piggy bank to pay for your health care, then let’s take 50% of your estate in taxes when you die.</b></div><div class="MsoListParagraphCxSpMiddle"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -0.25in;">2.<span style="font: 7pt "Times New Roman";"> </span>As Cong. Ryan’s bill would do, let Medicare pay a flat amount to the health plan of your choice for coverage. If you want a rich plan, go ahead, but use your own money to pay the difference. If you want a stripped down plan, by all means, do so. You choose, not the government. However, being able to afford the coverage you want might mean tapping your own funds and that is why I added the next step.</div><div class="MsoListParagraphCxSpMiddle"><br />
</div><div class="MsoListParagraphCxSpLast" style="text-indent: -0.25in;">3.<span style="font: 7pt "Times New Roman";"> </span>Expand the use of Health Savings Accounts (HSAs). HSAs provide a safe haven for your hard earned income, and allow you to accumulate money in a non-taxable savings account. This money can be used to pay all manner of health care related expenses. </div><div class="MsoNormal"><br />
</div><div class="MsoListParagraph" style="text-indent: -0.25in;">4.<span style="font: 7pt "Times New Roman";"> </span>Allow doctors to “balance bill” their patients. This means that doctors would be allowed to charge you a real price for medical services instead of the reduced price the government allows them under Medicare today. Balance billing is currently illegal, and partly explains why nearly 30 percent of doctors will no longer see Medicare patients.</div><div class="MsoNormal"><br />
</div><div class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;">5.<span style="font: 7pt "Times New Roman";"> </span>Here is the toughest change. Extend the age of qualification to enroll. Start it now. Perhaps 67 for my age group, and then move it to 71 over the next 10 years. Then index it in relationship to life expectancy.</div><div class="MsoListParagraphCxSpLast"><br />
</div><div class="MsoNormal">Medicare has become a pox on us. Of course, I understand it has provided health care to tens of millions of people. I get it. But it also opened the door to endless meddling by politicians and as a result, when compounded by other Great Society programs, today our nation faces financial ruin.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Let’s find the courage as a people to face the fact: Medicare, Medicaid, federal government solutions, threaten our liberty. Let’s get on with this first step toward sanity.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com4tag:blogger.com,1999:blog-7825356905707208207.post-19708053440278136632011-03-31T18:15:00.001-07:002011-03-31T18:15:44.838-07:00Q: Where do you get the best price for an MRI?<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowRevisions/> <w:DoNotPrintRevisions/> <w:DoNotShowMarkup/> <w:DoNotShowComments/> <w:DoNotShowInsertionsAndDeletions/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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How can you find the best price for an MRI (and why would you care)? I should have gone to <a href="http://www.medibid.com/">Medibid.com</a>, but didn’t. “My bad,” as the kids say. <div class="MsoNormal"><br />
</div><div class="MsoNormal">My wife tore her meniscus during 2009. By the spring of 2010, the pain had finally became too great. We though she needed surgery. Since we have a Health Savings Account (HSA), though, we wanted to make sure an expensive surgery made sense.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We headed to <a href="http://summitortho.com/">Summit Orthopedics</a> to see Dr. Jack Drogt.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Drogt suggested first to treat her with a cortisone shot, rather than recommending an MRI and surgery. That made sense. The shot, at $180, could knock the pain down and surgery – at thousands of dollars – could be unnecessary. (He never said it, but I suspect this is a practice guideline for all but the most obvious surgical situations.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Weeks later we returned with the sorry report: The knee hurt, and perhaps even more. Drogt prescribed an MRI with a consultation thereafter.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Can you tell me the price of an MRI (no fair looking at an Explanation of Benefits – once you have that, it’s too late to worry about price)? Have you ever asked? If you did, would anyone tell you? Do you care about the price? You do if you have an HSA and want to hang onto your money.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In Minnesota, the law requires doctors, hospitals, and insurance companies to tell you ahead of time the price of a medical service, product, procedure, medicine, and so forth. The law (Sec. 62J.81) calls this price quote a “good faith estimate;” like going to the auto repair shop to get new brakes. Auto mechanics are used to giving you an estimate – doctors not so much, but this transparency idea is a new thing.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I called three MRI service providers. One quoted $1,050. A second, $980. These two clinics were free-standing, non-hospital based. I knew better than to call the hospital for a quote, because I had made that mistake in 2008. The third option, an MRI machine dragged around in a 40’ trailer, gave an $750 estimate, but I felt wary of their service. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I also knew about <a href="http://www.smartchoicemri.com/">Smart Choice</a>, an MRI clinic in Milwaukee. Smart Choice promises a $600 price for all MRIs, regardless of what kind of scan the doctor prescribe. I had to decide whether it was worth it for me to drive five hours to save the money, and therefore, chose not to do so.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We chose the $980 option – and wasted $600. I could have checked <a href="http://www.medibid.com/">Medibid.com</a>, and received the MRI for less than $400 at a clinic just a few miles away.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://www.medibid.com/">Medibid.com</a>, founded by my good friend and Canadian expatriate Ralph Weber, allows a person to input a request for bid for a variety of medical procedures, including MRIs. You should check out <a href="http://www.medibid.com/">Medibid.com</a> right now (no, this is not a commercial and I do not get paid for it – I just believe in what they are doing).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Dr. Drogt performed the surgery, and my wife received therapy at his clinic. We spent several thousand dollars, but her knee seems “fixed.” </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Drogt is a first-class orthopedic surgeon, but guess what? If I would have gone to <a href="http://www.medibid.com/">Medibid.com</a>, I could probably have found an equally first-class surgeon in a nearby community to do the surgery and saved hundreds or thousands of dollars. (Now I remember!)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I tell you about <a href="http://www.medibid.com/">Medibid.com</a> because it is an example of how the marketplace can answer the health care pricing problem. It is not “the” answer, it is “an” answer. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What we must guard against is a government bent on destroying the <a href="http://www.medibid.com/">Medibid.com</a> types of <span> </span>innovation or the two people working day and night in a garage somewhere to create the next miracle medical device. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What I fear, and fear is the right word, is an Independent Payment Advisory Board deciding that even though <a href="http://www.medibid.com/">Medibid.com</a> is a fabulous idea, it does not fit their payment model and therefore, must be shut down. Or, it must be shut down because Ralph Weber is an outspoken critic of government-run health care.</div><div class="MsoNormal"><br />
</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com0tag:blogger.com,1999:blog-7825356905707208207.post-36084368865251521502011-03-26T13:44:00.000-07:002011-03-26T13:44:43.442-07:00Board to Death and The Coming Revolution<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal"><span style="font-size: small;"><span style="font-family: "Tahoma","sans-serif";">No, I did not get the headline wrong. Using independent boards to strip us of our freedom appears to be the <i>modus operandi</i> of the Obama administration.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span style="font-family: "Tahoma","sans-serif";">Since my focus has been on health care reform for the past six years, I have not kept up with the broad range of constitutional concerns to which we all should pay attention. My sense, however, has been that the Obama administration is busily, and often quietly, carving out a series of administrative cabals that threaten to choke off liberty: You have heard of the czars? </span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span style="font-family: "Tahoma","sans-serif";">Czars run this or that project, and many do not answer to Congress nor to voters – only to the person that appointed them: President Barack Obama.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span style="font-family: "Tahoma","sans-serif";">Each czarist fiefdom seizes on one or another project “in the public interest” with the clear intent of controlling the organic behavior of private industry, or that of private individuals. Simply stated, your personal liberty is being eroded by a group of nearly-silent streams of incremental bureaucratic overreach. You know you feel uncomfortable, but not quite able to decide if it is something about which to fuss or fume.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span style="font-family: "Tahoma","sans-serif";">Perhaps this will help bring some focus: Stories about two of new federal ruling boards intersected on my digital desk this week, causing me to finally put pen to paper (or keyboard to software).</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;"><span style="font-size: small;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Tahoma","sans-serif";">The Consumer Financial Protection Bureau</span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -0.25in;"><span style="font-size: small;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Tahoma","sans-serif";">The Independent Payment Advisory Board (IPAB)</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Taken by themselves, these two command structures are reason enough to recall the President – but darn it, the Founders never gave us that option, except at election time. </span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Elizabeth Warren runs the Consumer Financial Protection Bureau cabal right out of the White House. Despite Congress and the law, knowing the Senate would never approve of her appointment, Pres. Obama let her set up shop without bothering with the constitutional nuisance of actually getting the U.S. Senate to approve her appointment.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Warren and her Czarist Bureau, with a projected budget of more than $500 million, answers to no one, except on paper (written with disappearing ink). She is already badgering banks to shake them down to refinance home mortgages. Warren believes mortgage holders should cough up $20 billion, sometime before the 2012 election, to write off mortgage principle for thankful debtors – called voters.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">“But,” you protest, “One of the primary obligations of government is to <i>enforce</i> legal contracts.” Czar Warren, however, threatens to use government police power to cajole unwilling contract-holders – mortgage lenders – into giving up their legal rights.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Next is the 15-member Independent Payment Advisory Board (IPAB) created by the Democrats with the “Affordable Care Act of 2010.” We will someday come to call this the Absolute Coercion Act.</span></span></div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">The IPAB will execute a financial stranglehold on how, how much, when, and what for doctors, hospitals, and health care providers are paid. Never mind the individual medical needs. Never mind the financial aspects of providing medical services. The 15 Czars in the new command-and-control health care system will decide what is good for us, and how much professionals should be paid to favor us with it. Is there anyone on the planet that can call this liberty? Yet, it gets worse.</span></span></div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Although the Absolute Coercion Act of 2010 (see above) requires the President to win Senate consent for the 15 IPAB Czars, that does not mean it will happen. The Congressional Research Service explains: </span></span></div><div class="MsoNormal" style="margin-left: 0.5in;"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">“There is no constitutional or statutory qualification on the President’s ‘Power to fill up all Vacancies ....’ Because the President’s recess appointment authority is unqualified, it appears that he could fill member positions on the IPAB by recess appointment during any period when he could otherwise make such appointments.”<a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">[1]</span></span></span></a></span></span></div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Silly idea, apparently, requiring presidents to get the approval of elected U.S. Senators for the appointment of people that will hold the power of the federal purse in their hands.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">Knit these two boards together (the IPAB and the CFPB). Political appointees of the current president, without the approval any single elected official or a single citizen vote, will hold power over lending, shelter, life, and death. But more worrisome: These are but two of the many federal fiefdoms fostered by this president.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">The Declaration of Independence makes it clear: Government serves by the consent of the governed. Government is established for the singular purpose of protecting the unalienable rights of the governed. Among these unalienable rights are protecting human life, securing individual liberty, and providing maximum latitude for the individual decisions we make about pursuing our own happiness. </span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">The Obama Czars are a direct assault on unalienable rights, a clear violation of the purpose of government, and war against government by consent of the governed.</span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: small;"><span lang="EN" style="color: black; font-family: "Tahoma","sans-serif";">The Declaration also states clearly that once government has thrown aside the rights of citizens to consent to their government, citizens have the right and duty to throw off that government, and create new forms that will protect rights. We still cling to the hope of correcting this at the next election. Pray that we will do so, because if we do not throw out the Czars in 2012, what follows after will make the American Civil War look like an afternoon skirmish.</span></span><span style="font-family: "Tahoma","sans-serif"; font-size: 10pt;"></span></div><div><br />
<hr align="left" size="1" width="33%" /><div id="ftn1"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=7825356905707208207#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 10pt;">[1]</span></span></span></a> Staff. (2011). Independent Payment Advisory Board Membership: The President’s Recess Appointment and Removal Authorities. Memorandum. Congressional Research Service. March 18, 2011. Washington, D.C.</div></div></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-72683134974055918182011-03-08T19:33:00.000-08:002011-03-08T19:33:57.113-08:00$289,000 or maybe $812,000<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowRevisions/> <w:DoNotPrintRevisions/> <w:DoNotShowMarkup/> <w:DoNotShowComments/> <w:DoNotShowInsertionsAndDeletions/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">The two numbers that title this missive relate to the unfunded Medicare (just Medicare) debt we are leaving for our children, children’s children, and even their children. It is immoral. </div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">According to the U.S. Census Bureau, about 128 million Americans are 30 or younger. These are the ones that will be paying the unfunded Medicare debt. The debt, depending on whose numbers one uses, and the assumptions you accept, ranges from $37 Trillion to as much as $104 Trillion. </div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">We are leaving our progeny with somewhere between $289,000 and $812,000 (or more) each to pay for our profligate health care spending. Some people blame the 78 million Baby Boomers for this (I am one, and Medicare eligible in 2012). I blame politicians for being gutless.</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">Oh, did I mention, this is <i>only</i> the Medicare debt, and does not account for Social Security shortfalls, or the Obama deficits.</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">A farmer that eats his seed corn dies. A nation that consumes its children’s inheritance dies, and deserves to do so.</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">As a 63-year old father and grandfather about to become Medicare-eligible, I suggest four immediate changes to Medicare coverage (if those already on Medicare refuse to participate, so be it – nothing stops us from embracing change):</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="font-family: Verdana,sans-serif; margin-left: 0.75in; text-indent: -0.25in;"><span><span>1)<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Delay enrollment for Baby Boomers. I am 63. I will wait – 70 sounds like a good starting point. And then index it.</div><div class="MsoListParagraphCxSpLast" style="font-family: Verdana,sans-serif; margin-left: 0.75in; text-indent: -0.25in;"><span><span>2)<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Means test it. </div><div class="MsoNormal" style="font-family: Verdana,sans-serif; margin-left: 1in;">Medicare is a welfare program. There, I said it. Welfare. The average Medicare enrollee today has paid in less than $40,000 over a 40 year work life, and will receive more than $250,000 in <u>free</u> services during Medicare enrollment. That is a welfare program. </div><div class="MsoListParagraphCxSpFirst" style="font-family: Verdana,sans-serif; margin-left: 0.75in; text-indent: -0.25in;"><span><span>3)<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Allow doctors and hospital to “balance bill.” This means, let medical providers charge a fair rate, instead of the underfunding they receive today. Without doing this, Baby Boomers will seldom find a doctor willing to serve them.</div><div class="MsoListParagraphCxSpMiddle" style="font-family: Verdana,sans-serif; margin-left: 0.75in; text-indent: -0.25in;"><span><span>4)<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Change Medicare to a defined contribution program. Instead of paying for benefits, no matter what they are, provide a fixed amount each month to be used to purchase health coverage. The Medicare enrollee will have to make up any difference in cost (yes Matilda, we can make some arrangements for low-income welfare recipients, but it’s the middle-class and wealthy Medicare welfare recipients that need to start paying their own way.</div><div class="MsoListParagraphCxSpLast" style="font-family: Verdana,sans-serif; margin-left: 0.75in; text-indent: -0.25in;"><span><span>5)<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>(Yes, I know I said four, but this one is profound enough to make you think. Maybe it’s time we came face-to-face with the reality that we do not have the right to live forever, when it means we steal from our great-grandchildren.)</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Verdana,sans-serif;">Let’s have a robust discussion about this. How many of you could care less about what we leave for our children’s children? Okay, you three move further to the left. The rest of us want to fix this problem.</div><span style="font-family: Verdana,sans-serif;"> </span></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com4tag:blogger.com,1999:blog-7825356905707208207.post-60278049817934413542011-02-11T17:40:00.000-08:002011-02-12T13:21:46.899-08:00Federal health care reform - Does it promote an evil practice?<div dir="ltr" style="text-align: left;" trbidi="on"><b>Despite the fact that I have written 25 books, a thesis, and hundreds of papers, apparently, I am a failure at writing this kind of information. Why? Because already, a number of you who have contacted me about this piece have missed the whole point. So I am going to beg you, please, please, read the whole story. Do not make any judgment until you read it all. Then write down the point: The point is that the federal law declares that what doctors are taught and what they believe, even what the law says is illegal, is suddenly okay because it is practiced in a government-approved mega-corporation. Now, if you cannot get that out of this article, please <a href="mailto:dgracer@comcast.net">write me immediately</a> so I know that I am compelled to go take a "Blog Composition 101" course.</b><br />
<b> </b><br />
<div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">What I am about to say uses a make believe doctor to tell a story. As you will hear shortly, what he does is immoral, unethical, illegal, and even evil. But almost no doctors do these things. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">I am going to illustrate how the Affordable Care Act of 2010 throws ethics overboard to replace them with institutional behavior that would land a corporate leader in prison.</span><br />
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxbBp5oulpJexcyU1thmIxveiRGvO0fy12RQGRJYIVvQ2LGoDtHBlTFdGcyBo-3GfesD-qDhmaigYcBD0V1kQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;"><br />
</span></div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"></div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">For purposes of this story, we’ll call your doctor Smith. How would you respond if Dr. Smith looked you in the eye and said: “You need an MRI for your sore finger, and I want you to use my clinic, the Smith Radiology Clinic across the hall.” Unless you own a piece of Smith Radiology, you would probably be incensed, not that the doctor owns another medical practice, but that he seemed to be forcing you to use his facility.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Let’s try another. “That really is a nasty rash you have there,” Dr. Smith says, “and I want you to go to Dr. Jones, the dermatologist, to have her look at it.” He fails to mention that Dr. Jones sends him $25 every time he does this. If you knew that Dr. Smith got a kick back (called fee splitting) from Dr. Jones, you would certainly find two new doctors.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">And one more. “You appear to have hurt your right arm and left foot,” Dr. Smith says after examining you. “Let’s look at your arm today, then I want you to come back tomorrow so I can examine your foot.” He winks and adds, “That way I can charge two office call fees. But don’t worry, your insurance covers the cost.” That would be the last straw. Good bye Dr. Smith.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Dr. Smith, in this scenario, is motivated to do as many procedures as possible to wrestle away health insurance money, or your own. This is a nasty idea, and despite what Big Government planners want you to believe, the practice is limited to a tiny percentage of doctors.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">If you discovered that Dr. Smith did self-referrals, fee-splitting, and manipulated the system to get more than one office fee, you would report him to President Obama, the FBI, and worse yet, Nancy Pelosi. What an outrage this would be.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">This behavior is also illegal in most states, and unethical, immoral, and evil in all…until, well, until Congress passed the new health care law. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">An Affordable Care Organization, called an ACO, is one of three lynchpins of the new law (the other two are insurance exchanges and the inevitable reduction in the number of health insurance companies). Here is how the ACO works:</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Medicare, and eventually all medical payers, pays a flat fee to the ACO to pay for your medical services. You have access to all the doctors and other medical providers under contract or employed by your ACO.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">If Dr. Smith is employed by or under contract to the ACO, he makes more money by providing fewer medical procedures. The fewer procedures Dr. Smith does, the more money retained by his ACO, and ergo, his bonus is greater. This is really the same thing Dr. Smith used to do when we called it evil, but it is in reverse. Before, more medical care and more money. In the ACO, less medical care and more money.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Rather than fee split with a doctor friend, however, Dr. Smith now does his fee splitting with the ACO, and the federal government blesses him for it. When Dr. Smith sends you to a dermatologist or radiologist under contract with his ACO, he receives a gold medal for sticking to the plan, and incidentally, the ACO gets paid. It is true that Dr. Smith would probably examine both your arm and leg the same day, but he would do it as quickly as possible. Or, more likely, the ACO will have Nurse Practitioner Johnson or Physician’s Assistant Peterson see you – they cost the ACO less, and leave more on the table for Dr. Smith.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Studies show that when doctors work under contract where they earn a salary their productivity falls – often as much as 50 percent. In the new ACO, Dr. Smith can work less, make more, and still be able to self-refer and fee split, plus get back door fees from his ACO peers. What a deal.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">The federal reformers tell you the ACO is a better way to deliver health care than a fee-for-service plan: It is true if your doctor is immoral, evil, and unethical, like an ACO. The purpose of the ACO is to consolidate services in a closed system to cut cost. While it may be true it would be effective helping people with chronic illness get more coordinated care, it does so using the very reimbursement arrangements it labels illegal or immoral when done by individual doctors. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">ACOs that rely on self-referral and fee splitting, which they do, should be judged by the same standard you use on Dr. Smith. But if you complain to President Obama, he will “call you out,” and Nancy Pelosi will whine and shake her finger at you.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Verdana","sans-serif"; font-size: 11pt;">Over time, I plan to share the 50,000 foot picture of the ultimate intent of ACOs, Exchanges, and massive consolidation of care and insurance. Just stay well, please!</span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-30304369032198106002011-02-05T10:52:00.000-08:002011-02-08T18:14:07.216-08:00Judge calls out Congress as constitutionally stupid<div dir="ltr" style="text-align: left;" trbidi="on"><br />
Politicians should avoid tempting the constitution, because principled judges can make them look stupid.<br />
<div class="MsoNormal"><br />
</div><div class="MsoNormal">Federal Judge Roger Vinson recently overturned the new federal health care law. He did this because the mandate that would force everyone to sign up for health insurance is unconstitutional. Note that I said it is unconstitutional. Not too long from now, we will learn if the Supreme Court also understands the constitution.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Almost two years ago I offered to be the lead plaintiff opposing the individual mandate. Thank goodness, 20 state attorneys general did this on our behalf.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I teach the constitution. My high school students can read it and pretty much understand it. They read it in plain language, and in the context of the Founding Fathers who wrote it. But more importantly, they learn that it is a document of enumerated powers, not of unlimited powers.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">If the Democrats that passed the new health care law knew this truth, that the United States constitution tells the federal government what it can and to some extent, what it cannot do, they would never have passed the individual mandate. If Congress stuck to the spirit and letter of the constitution, they could have avoided having this judge make them look constitutionally stupid.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">For years, of course, the federal courts have also ignored the constitution, and wrote their own modern ideas into their decisions. We now know, clearly, that when men choose to make up laws as they go along, without regard to rules, we end up with confusion. Confusion may be good for lawyers, who earn their living off it, but it is bad for citizens.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">That is why I am so astonished when several members of a Minnesota State Senate committee recently said, “We deal with health policy. We don’t deal with constitutional issues. That’s not our job.” I hate to say it, but it is true. The Senators that said this were all Democrats, and so were all of those that voted for the unconstitutional federal health care law.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Even more astonishing, however, were the comments of Hennepin County Board Chair, Mike Opat. Yes, he, too, is a Democrat. When asked specifically if the constitution was important to the county board’s decisions, Opat said, “I believe the constitution is irrelevant to what we do at the county. We are reactive.” Well, how about reacting in concert with the law, Mr. Opat? And State Senators, and Federal Congress members? </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This thumbing of the nose at the constitution by legislators and other government policymakers is exactly why Judge Vinson’s ruling is so important. If our policymakers are free to create any and every kind of scheme they devise, without regard to the rules under which we the people have ordered them to live, then we do not have a government – we have an oligarchy, aristocracy, or worse, a dictatorship of the chosen ones.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So paradoxically, one of the blessings of the unconstitutional federal health care law is that we finally, might actually get to talk about the rule of law again. We might get to teach lawmakers and citizens alike that We the People are in charge, not them, and we will enforce the constitution.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-962780869504835392011-01-31T08:35:00.000-08:002011-01-31T08:35:46.795-08:00Do we spend too much or does it cost too much?<div dir="ltr" style="text-align: left;" trbidi="on"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:DoNotShowRevisions/> <w:DoNotPrintRevisions/> <w:DoNotShowMarkup/> <w:DoNotShowComments/> <w:DoNotShowInsertionsAndDeletions/> <w:DoNotShowPropertyChanges/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal" style="color: #990000;"><b><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">We can’t even ask the right questions.</span></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Maybe it’s the writer in me, but it drives me nutty when smart, educated, informed people say we have to cut health care cost, when that’s not what they mean. What I believe they mean, taken from the context in which this phrase is usually used, is that we spend too much on health care (and I believe that assertion is hard to defend). </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">The evidence of what I say? Listen to the discussion. “We spent $2.5 trillion on health care, 16 percent of our GDP. We have to cut the cost of health care.” So, do we spend too much or does it cost too much? Furthermore, is health care spending a good thing or a bad thing?</span></div><div class="separator" style="clear: both; text-align: right;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dwSgWtIF8vOISRMO4qgVd_td2F-2Sm2PipYBGqvnVmTJnOOBPvm9KVymX4-THONRZFu7HhdYV2UM5bBzpNH' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><div class="MsoNormal" style="text-align: right;"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Cost. Every purchase we make reflects built in cost. Cost includes labor, materials, administration, marketing, and various other overhead expenses. The cost of a pacemaker, for instance, includes research, development, marketing, the buildings in which all this is done, taxes, snow plowing (lately, all across the country), administration and a whole lot more. You get the idea.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Price. Every purchase carries a price. Price is different from cost. Price usually reflects cost plus some degree of margin. If the total cost of making a pacemaker is $15,000, and the manufacturer wants a 10 percent return on investment (before taxes), the price will be $16,670.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Spending. When all purchases are combined we can arrive at a spending level. Spending includes cost and price, plus use or the quantity of purchases made. My insurance buys me a pacemaker. Nine others in my town also receive pacemakers (thanks to their health insurance or government health plan). Our health care payers just spent $167,000 on the pacemakers (plus at least that much for the doctors, surgeons, scanners, MRIs, X-rays, blood test, hospital room, surgical center, etc.). </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Every facet of the health care industry reflects cost and selling price. Spending reflects purchase quantity.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">The definitional difference is critical to our health care redesign debate. Because spending, quite frankly, is directly related to rationing. Someone is going to ration health care because someone has determined that we spend too much in the aggregate, or we spend too much on a certain type of procedure.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">The best way to control cost, on the other hand, is through competition. When Smart Choice of Milwaukee figured out how to do all MRI’s for $600, it should have resulted in other MRI providers finding a way to reduce their cost if they want to stay in business. Unfortunately, the third party payer system seems to prefer to pay a higher price and real cost competition falls aside. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Yet, at $600 each, we cannot say whether health care spending would fall just because the price is less – because Smart Choice found a way to reduce cost. Spending could very well double as more people turn to less expensive MRIs in place of less effective but cheaper X-rays. Such is the nature of health care <i>spending</i>.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Ask your health care guru, Congressman, or state legislator this question: Do you intend to reduce health care spending? Or do you intend to reduce the cost of health care?</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">There is something Congress and legislators can do to reduce cost, and they ought to do it quickly. The cost of business regulation in the United States during 2009, according to <i>The Wall Street Journal</i>, was $1.75 trillion dollars or 14 percent of GDP. What if a miracle occurred, and elected officials decided to reduce the <i>imposed cost of doing business</i> that result from over-regulation? These regulatory costs are included in every increment of health care cost.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">If the government-imposed regulatory cost were reduced, the price of health care services would fall, thanks to competition. This is a winning strategy, but it does not address the other question: How much do we and should we spend on health care?</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 11pt;">Stay tuned.</span></div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-6628009276838601072011-01-25T16:47:00.000-08:002011-01-25T16:59:07.098-08:00Congress actually is doing something constitutional<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div class="MsoNormal">Republicans in the U.S. house want to cut federal spending back to the 2008 level. That’s a good start.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Consider the irony of this, however. The cuts they are proposing now, in 2011, are not for 2012’s budget. They for the current budget. </div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: left;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxM5M0VhbfwENGe4ni6u3bo5A-YxPBtORoT6o55GpHYvIusgaaZluWawwtQyKvfhv5Po7MxSPMMna0icdYTMQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>The Constitution is quite clear about what Congress is supposed to do – somewhat less clear, thanks to the Supreme Court and some very aggressive politicians, about what it cannot and should not do. One of the very clear tasks is this: appropriate money.<br />
<div class="MsoNormal"><br />
</div><div class="MsoNormal">All bills that spend money must originate in the House, so says the Constitution. The Senate cannot create bills to appropriate money, although they certainly can, and so, amend them – billions in earmarks each year. The President cannot write a bill to spend money – all he can do is find creative ways to spend what Congress allows.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The point is that it is a primary responsibility of Congress to figure out appropriate, constitutional ways to spend money. That is why Congress passes a federal budget every year except, well, last year.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Instead of passing budget, which is their constitutional obligation, Congress bailed out big business, wrote a federal takeover of health care, grabbed more power over banks, started the process of dictating rules and regulations, and a plethora of other constitionally questionable actions. Is it any wonder that voters threw out the old rascals and elected new ones?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The new House, however, actually seems to want to listen to and obey the Constitution. They had the gall to actually read it aloud on the House floor – can you imagine? Now, the House actually wants to write a budget, and properly appropriate money. Will wonders ever cease?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Imagine the incredible freedom we could all enjoy if Congress and the President focused on what is constitutional, instead of the continuous increase in federal power over us. Imagine. Well, like our founding fathers imagined. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Given a chance to do it right, maybe the GOP will usher in a new day in a America, a shining city on a hill. But let’s be clear about this: it will only happen if We the People continue to lead and insist on it.</div></div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1tag:blogger.com,1999:blog-7825356905707208207.post-67791886675986349672011-01-18T17:43:00.000-08:002011-01-18T17:43:53.692-08:00Accountable Care Organizations: Accountable how, to whom, and how does that work again?Take a look at the two pictures included in this article.<br />
<div class="separator" style="clear: both; text-align: center;"></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv-_9qZLGUDvwuKriJ8q_3gSuGqmpXF6U2fJYEvYNypR_Ou9j45lJ2UpoQyVIS3X9ssi3KQIp7UODThkjfp0rrsLMDbeX_vCcLgtKboFeiAGDim5DrlaW0v4x3G8ukU35tMyuPtQ6H1mb9/s1600/hcsys+%25282%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="154" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv-_9qZLGUDvwuKriJ8q_3gSuGqmpXF6U2fJYEvYNypR_Ou9j45lJ2UpoQyVIS3X9ssi3KQIp7UODThkjfp0rrsLMDbeX_vCcLgtKboFeiAGDim5DrlaW0v4x3G8ukU35tMyuPtQ6H1mb9/s200/hcsys+%25282%2529.jpg" width="200" /></a></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The first one is a picture of our health care system – many disconnected or sort of connected pieces that work in a relatively chaotic manner to deliver care. This system is very hard to manage and by nature, is beset by some level of inefficiency. It is also, however, extremely dynamic and able to quickly add new technology, practice concepts, treatments, medicines, and evermore refined medical delivery.</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkeSPNI6X2IVZ87zXmG5JHMwSHpXr6x9Yf9yW6nRiJHLomxNJMx0IVVRf9AJ0QoPdkQVSj4bjZ5DQ_NBv0bXLxoVv0u5j2qKjzlQ3oK5A_A1gFeqZ0N_ee-__fTR7hVBITxgldi7_OdVcy/s1600/acasys+%25282%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="136" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkeSPNI6X2IVZ87zXmG5JHMwSHpXr6x9Yf9yW6nRiJHLomxNJMx0IVVRf9AJ0QoPdkQVSj4bjZ5DQ_NBv0bXLxoVv0u5j2qKjzlQ3oK5A_A1gFeqZ0N_ee-__fTR7hVBITxgldi7_OdVcy/s200/acasys+%25282%2529.jpg" width="200" /></a></div><div class="MsoNormal">The second picture is how the Affordable Care Act wishes our health care system could look – an organized, coherent, manageable monolith. This is kind of system that can more easily be managed from the top down, like the Army, a football team, or a single payer health care system. (Actually, the analogy falls apart with single payer; it’s just a way of saying that is what single payer adherents believe to be true.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The Affordable Care Act of 2010 (ACA), the new federal health care law, in trying to create this coordinated, efficient, top-down health system model, points toward three large organizational structures to accomplish its goal: The Health Benefit Insurance Exchanges (one in each state), consolidation of health insurance companies (the eventual result), and Accountable Care Organizations (ACOs). Here I want to briefly address the ACOs, and will leave the others to another time.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://medinnovationblog.blogspot.com/">Dr. Richard Reece</a>, who has been writing about health care reform efforts for nearly 50 years, calls ACOs, “Another attempt to herd doctors into large organizations.” Other of my MD-friends call them “HMOs on steroids.” Or, “super-sized HMOs.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The simple definition of an Accountable Care Organization is this: a broad system of doctors in a wide variety of practice types, along with hospitals, clinics, and other health care service providers. ACOs will deliver services under contract with the Centers for Medicare and Medicaid Services (CMS). ACOs will also contract with private insurance companies. CMS believes by bundling care into these super-sized HMOs, it will be able to accomplish several purposes, the most important of which is to reduce the cost of health care.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The “Accountable” part of the ACO is designed to use manufacturing quality control concepts to evaluate the performance of a doctor or hospital. If the doctor follows the prescribed guidelines (i.e., is accountable), the doctor will be rewarded with a bonus. If the doctor fails to follow the guidelines (never mind the uncooperative patient that refuses to obey the medical cookbook), the doctor receives no bonus – and might be paying to keep his or her job.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It’s essential to understand that the ACO on its own is not designed to reduce the use of health care, nor will it reduce overall spending. Its purpose is to reduce the unit cost of care. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Using the ACO to reduce the cost of care is something like thinking that if we could eliminate small bakeries and have all pastries made and distributed from one source that our donuts would cost less. We will probably buy as many donuts or even more, but each one would save us a nickel.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I believe that the purpose of the ACO is to make it more possible for the federal government to manage the health care of everyone who receives care from an ACO. And who might that be? Well eventually, you, me, and everyone.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>What’s a doctor to do?</b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Right now, doctors all across the country are trying to decide what to do about these ACOs. Do they sell their practices and go to work for the hospital or mega-medical system that sits at the center of the ACO? Do they try to continue in private practice, or in small, independent group practice? A cash only practice might work, unless you are a cardiac surgeon.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">More regularly now, the march is toward selling a private clinic or practice to join the ACO, as if it is a matter of fate. Many doctors believe it is a way to escape from the underpayments he or she receives whenever a Medicare or Medicaid patient enters their clinic. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">(For the non-doctors reading this column, understand that more than 75 percent of doctors report that Medicare’s payments for their services barely meet the hard cost of providing the service, or in fact, the doctor loses money every time he or she sees a Medicare patient. But even at that, Medicaid is far worse. Doctors report receiving as little as 28 cents on the dollar for each Medicaid patient. Therefore, many doctors are refusing to see anymore Medicare and Medicaid patients.)</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">When the doctor contracts with the new ACO, he or she may have walked into a trap, and it might be one from which extracting oneself is nearly impossible. Here is why: Hospitals cannot turn away Medicare or Medicaid patients. When the doctor joins the ACO in concert with a hospital (and an ACO cannot exist without a hospital), the doctor has by default agreed to accept Medicare and Medicaid payments for service. So what was inadequate before is just as inadequate in the ACO, except the doctor has no recourse, other than to quit the ACO.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The others that join ACOs – nurse practitioners, physician assistants, perhaps pharmacies, medical device resellers, etc. – to flee the Medicare and Medicaid reimbursement system will find themselves at the financial mercy of the ACO. The ACO, in turn, will be subject to the reimbursements it can win from the remaining, huge, private health insurance companies and the granddaddy of them all, CMS.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This is all driven, in my humble, yet studied opinion, by the belief that large organizations are more manageable and efficient than are small organizations. More so, that solving the health care “crisis” means that the federal government must be in charge. Here is the greatest worry about all this. The federal government wants Accountable Care Organizations so government planners can hold someone accountable. But, who holds the government planners accountable?</div><div class="MsoNormal"><br />
</div>AgainstTheGrainhttp://www.blogger.com/profile/00041848513378887042noreply@blogger.com1