Gray is a real color

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.

“Gray or grey is a color seen commonly in nature. It is created by mixing white and black in different proportions. Depending on the amount of light, the human eye can interpret the same object as either gray or some other color.”[1]

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.

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.

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?

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.

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.

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.

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.

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[1] http://www.wordiq.com/definition/Gray_%28color%29

Cong. Ryan takes one step toward Medicare cure

If we want America to survive, we have to fix Medicare (and a host of other entitlement programs).

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.

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.

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.

(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.)

Now don’t get me wrong. I commend Ryan for taking the first step. But we must do more.

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.

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.

Fixing Medicare, in my humble opinion requires the following (although I hold my nose with anything smacking of income tax manipulation):

1.      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?

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.

2.      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.

3.      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.

4.      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.

5.      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.

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.

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.

Q: Where do you get the best price for an MRI?

 How can you find the best price for an MRI (and why would you care)? I should have gone to Medibid.com, but didn’t. “My bad,” as the kids say.

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.

We headed to Summit Orthopedics to see Dr. Jack Drogt.

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.)

Weeks later we returned with the sorry report: The knee hurt, and perhaps even more. Drogt prescribed an MRI with a consultation thereafter.

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.

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.

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.

I also knew about Smart Choice, 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.

We chose the $980 option – and wasted $600. I could have checked Medibid.com, and received the MRI for less than $400 at a clinic just a few miles away.

Medibid.com, 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 Medibid.com right now (no, this is not a commercial and I do not get paid for it – I just believe in what they are doing).

Dr. Drogt performed the surgery, and my wife received therapy at his clinic. We spent several thousand dollars, but her knee seems “fixed.”

Drogt is a first-class orthopedic surgeon, but guess what? If I would have gone to Medibid.com, 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!)

I tell you about Medibid.com 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.

What we must guard against is a government bent on destroying the Medibid.com types of  innovation or the two people working day and night in a garage somewhere to create the next miracle medical device.

What I fear, and fear is the right word, is an Independent Payment Advisory Board deciding that even though Medibid.com 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.

Board to Death and The Coming Revolution

No, I did not get the headline wrong. Using independent boards to strip us of our freedom appears to be the modus operandi of the Obama administration.

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?

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.

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.

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).

·         The Consumer Financial Protection Bureau

·         The Independent Payment Advisory Board (IPAB)

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.

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.

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.

“But,” you protest, “One of the primary obligations of government is to enforce legal contracts.” Czar Warren, however, threatens to use government police power to cajole unwilling contract-holders – mortgage lenders – into giving up their legal rights.

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.

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.

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:

“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.”[1]

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.

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.

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.

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.

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.

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[1] 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.

$289,000 or maybe $812,000

I am going to suggest we are not good men [people]. “A good man leaves an inheritance to his children’s children… Proverbs 13:22A.

 

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.

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.

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.

Oh, did I mention, this is only the Medicare debt, and does not account for Social Security shortfalls, or the Obama deficits.

A farmer that eats his seed corn dies. A nation that consumes its children’s inheritance dies, and deserves to do so.

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):

1)      Delay enrollment for Baby Boomers. I am 63. I will wait – 70 sounds like a good starting point. And then index it.

2)      Means test it.

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 free services during Medicare enrollment. That is a welfare program.

3)      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.

4)      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.

5)      (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.)

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.