Time to Pursue Conservative Health Care Reform
Since the Supreme Court's infamous 4-1-4 ruling on the Affordable Care Act in June, nearly two dozen states have grappled with whether or not to comply with the first of many forthcoming deadlines found in the rules written (and still being written) by the functionally unconstitutional entity known as the Department of Health and Human Services (DHHS).
November 16th is the deadline, and a flurry of letters are finding their way to Kathleen Sebelius' desk this afternoon telling her they will not comply with the requirement to set up an exchange. The great debate has been over the enticement written into the law:
- Either states create the exchanges, and the Feds will not only pay for the administrative costs but also the cost increases of expanding Medicare and Medicaid, or...
- The Federal government will set one up for them and not give states the authority to direct their exchanges.
The false choice was tantalizing for many governors and state legislators, but tens of thousands of organized Constitutionalists stared their governments in the eye and told them to act like the soveriegn states they are. The Federal government never intended to NOT direct states and their exchanges, they merely wanted to entice states into giving up their Constitutional functions and legal rights to implement a federally-mandated atrocity. It was a destruction of the dual-federalist roles of state and federal functions while disgused as a "states' rights" issue, pitting Conservative against Conservative for several months. Thankfully, nearly half of all states have opted out of the first step in Obamacare's tentacle-growing implementation.
So, from Jan Brewer (R-AZ) to Rick Scott (R-FL) and Scott Walker (R-WI) to Rick Perry (R-TX), governors nationwide are taking the political gamble of forcing the Feds to not only implement the illegal healthcare exchanges, but also bear the cost of them. Thanks to a small, but significant silver-lining in the June SCOTUS ruling, the Feds are not allowed to alter Medicare/aid funding as any kind of penalty or compensatory difference for not complying. So the Federal government is on the hook for the entire bill, which will force voters to truly grapple with the consequences of unconstitutional, progressive policies. It also protects the thinning veil between state and federal roles. It's very simple: managing the health care industry is not found among the enumerated powers of Article One, and is therefore not a legitimate constitutional function of the Federal government.
Health care is expensive.
Insurance policies, by default keep growing. Costs are out of control, administration is mind-numbingly complex and abuse of a once-charitable industry is making it more difficult for everyone to access good health care. That is the status quo. But it was not always that way.
Beginning in the late 60's and early 70's with HMO's, Medicare and then Medicaid, the Federal government and multiple states began creating an incestuous web of regulations to make it more accessible to the poor and indigent. Their plan sounded reasonable: provide for the poorest and oldest among us for a small tax, and have states provide the administration of it. The states would pay for half, and the feds would match it. Nevermind that any kind of program is an end-run around the Constitution, which forbids the federal government from being involved in the industry at all.
Because of increased costs, more people began needing insurance, even for preventive care. Add to this the cost of outragous malpractice claims, general lawsuit abuse, employer regulations and 50 ever-changing state standards for health care. Every special interest in the nation has lobbied for various mandates and protections in a market that used to be free and open. As the market changed, so did the choices. Now, our options are between health insurance plans, not services or quality. Creating a third-payer system in an market that is most secretive in how it charges for services is illegal in most other industries, but not in health care. In fact, we end up blaming the insurance companies or providers for lack of expected care, because we no longer HAVE to hold ourselves responsible for the lineup of services invading our bodies with every visit. We simply show up to a provider the insurance company chooses, hand them a card and walk out. (two or more hours later)
THE CURRENT SYSTEM IS NOT A FREE MARKET
The current system is not a case of the free market failing the little guy and favoring the wealthy. Right now:
You cannot choose one medication over another, even beforehand, on the basis of cost;
You cannot choose one hospital over another based on the quality of management and nursing support;
You cannot choose your doctor based on hourly rate or volume of patients;
You cannot choose what procedures you want or need based on how much they cost from one hospital or doctor to the next.
This is insane.
Health care costs have become so convoluted, they have disappeared into the thousands of pages of paperwork related to one person's health. And the regulations for the industry have become so onerous that more than 50 cents of every dollar goes to the administrative or base hospital charges, rather than into the skilled care itself. Only 1/4 even goes to the doctors, who themselves spend between 20-40% of their fees on legal protection, and only 2-5% ends up in the hands of the insurance companies underwriting your care.
Read that again: only 2-5% of your health care costs are profit in the hands of the insurance companies. They are not the boogeymen.
Doctors are finding the cost of their education rising to $250,000 or more, just to find they can only take home $100-200,000 a year for 12 years of education and 100 hr work-weeks. They are not the bad guys.
There is no single scapegoat, and there is no simple solution. But one at a time, each must be addressed, and with some sacrifice all-around. The concept of law has been so widely perverted by competing interests that doctors' associations are pitted against advocacy groups, and insurance companies battle with regulatory commissions. This doesn't help any of them, and any temporary band-aid is soon negated by a compensation for it elsewhere. We have real problems in health care, but it must be resolved with free-market-centered reforms.
THE SOLUTIONS ARE OUT THERE, BUT SPECIAL INTERESTS WANT A QUICK FIX
John Mackey is the co-founder and CEO of Whole Foods, a national grocery chain that specializes in organic, unprocessed foods and natural remedies. It is an immensely successful venture, with 340 stores worldwide and 73,000 full-time employees, all of which qualify for a custom health care plan the company has devised. In 2009, amidst the health care reform battle, Mackey wrote an op-ed in the Wall Street Journal that compiled the most important and understandable reform principles needed in health care, and presented them as an alternative. The current law take almost none of them into account, and simply changes who pays for it rather that moving the industry toward a real free market.
These solutions are not the be all-end all of reform, but they are the most fundamental change we could advocate that would take our current system and move it closer to one that is cheaper, more accessible, freer and more flexible to changing patient needs and scientific discoveries.
• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.
Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.
• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.
Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.
• Repeal all state laws which prevent insurance companies from competing across state lines.
We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable. This can still be accomplished at the federal level, with respect to the Constitution, because it is enforcing TRUE interstate commerce. Laws within the states would still apply to native providers and insurers, but the public would be allowed to carry their plans purchased elsewhere.
• Repeal government mandates regarding what insurance companies must cover.
These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
These costs are passed back to us through much higher prices for health care.
• Make costs transparent so that consumers understand what health-care treatments cost.
How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?
• Enact Medicare reform.
We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.
• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
John Mackey further explains his perspective here, on the John Stossel show. (See video attached to this blog)
FULL-COURT PRESS, WIN THE MESSAGE-WAR
The Conservative movement needs to rescue the Right from itself. We have for too long not been willing to fight the war, and hone our message to attract the masses to real reforms. The left has thrived with emotional rhetoric, but these reforms are real changes that give real choices to real people. The public wants these freedoms, and they want cheaper health care.
Some physicians are already trying new models for their own reform-minded practices, but they frequently run into obstacles, legally and commercially. If government has any role in the free market at all, it is to "make regular" the exchange of goods in a market, rather than "regulate" it through "management." Direct Primary Care is one of many options doctors are trying, which allows them to have a practice they can enjoy, and really makes a difference.
Then there are administrative relationships that need to be reformed. Point of service, emergency, home health care and end of life services will continue to drive health care costs like nothing else, and something must be done that allows private enterprise to spread those costs across their business platforms. Currently, the opaque nature of the health care industry appears to be the largest factor in driving costs, but there are many elements that need reform. Compliance is more important than competitiveness and with Obamacare, quantity will become more important than quality.
We need to make sure real changes are pursued that honor both individual lives and their liberties, without stealing from the rich to pay for a system that will still be too expensive unless we're willing to do what it takes to make it cheaper, like anything else we buy.
And that's a message we can sell to the folks next door.
Lyle Ruble
8:25 am on Sunday, November 18, 2012
@Willing...I question many of the figures that you are presenting. But a more important question to consider, if healthcare is something that we all have to use, why has it been allowed to function like a for profit business, where turning a profit is the motive for providing services. Healthcare is operating as a monopoly and it is time to go to a national healthcare services and get out the business of making money off of people's misery. National healthcare would eliminate all the issues you are addressing.
Ed Willing
9:22 am on Sunday, November 18, 2012
Question away. Not a very good rebuttal. "I question...." Lol I have links.... Knock yourself out.
And no, your question is NOT more important, because it is flawed. Health care is not tantamount to a utility. We do not all use it, it is a market of services that we access upon need or desire. And right now, there is very little "free market" in the industry. It is so heavily managed, regulated, restricted and hidden from public scrutiny and access that it drives up costs. The only thing you said that is partially right is e monopoly comment... It's not a monopoly, there's 1,400 insurance companies in the US, hundreds of hospital groups, hundreds of thousands of doctors and thousands of universities for research.... But the costs, management and manner of payment functions like socialized medicine already. Which is, A MONOPOLY.
National healthcare would make the problems I'm addressing worse, Lyle. You criticize a monopoly while advocating one.
Btw, did you watch the video? If you remove profit from the process, the motive for true innovation disappears. It's a fundamental trait of socialism vs. free market, and it's the only element of the free market that has a sliver remaining in the system we have. You will never win on that point, because your ideas have been failing for 100 years.
Lyle Ruble
9:41 am on Sunday, November 18, 2012
@Willing...Where is our current choice. If you look at the results of the National Health Care found it most of the other industrialized nations; they have better outcomes, better access, longer life times, etc. while spending half or less than what we are paying per capita. Why should going into healthcare be a means to become part of the 1%? It doesn't in the nations with National Health Care. As far as innovation, the U.S. system doesn't have the corner on innovation and many of the products and procedures we now enjoy have come from everywhere.
Lyle Ruble
9:43 am on Sunday, November 18, 2012
@Willing....Your comments about constitutionality is moot. Where did you get your law degree and how long have you been practicing constitutional law? Last time I checked, the US Supreme Court is the only body capable of ruling on the constitution.
Adam Wienieski
9:55 am on Sunday, November 18, 2012
Lyle, surely you're not suggesting we've had a free market in healthcare at any time for the last 50 years. The point of the article is we should try it.
National health care creates more deadly problems:
"MONTREAL — Surgery wait times for deadly ovarian, cervical and breast cancers in Quebec are three times longer than government benchmarks, leading some desperate patients to shop around for an operating room.
But that’s a waste of time, doctors say, since the problem is spread across Quebec hospitals. And doctors are refusing to accept new patients quickly because they can’t treat them, health advocates say.
A leading Montreal gynecologist said that these days, she cannot look her patients in the eye because the wait times are so shocking. Lack of resources, including nursing staff and budget compressions, are driving a backlog of surgeries while operating rooms stand empty. The latest figures from the provincial government show that over a span of nearly 11 months, 7,780 patients in the Montreal area waited six months or longer for day surgeries, while another 2,957 waited for six months or longer for operations that required hospitalization."
http://www.montrealgazette.com/health/crisis%20Quebec%20women/7537213/story.html
Ed Willing
10:14 am on Sunday, November 18, 2012
Leave it to Lyle to bring up the one percent Ina discussion on health care.
Hey Lyle, news flash.... Doctors and researchers are the most brilliant people on the planet, and spend a quarter of a million and 12 years getting their education. They deserve to be 1%'ers.... And yet, you're wrong.... Most of them aren't.
Save the MoveOn.org rhetoric for a less-serious discussion. You've done nothing to dispel my facts other than say you "question" them.
Or, the 8 points of reform Mackey proposed...
Jeff Gramins
11:01 am on Sunday, November 18, 2012
Lyle, you say you don't want healthcare to operate as a monopoly and that it should be nationalized. You do realize that the US federal government is the largest monopoly in the world, right? On top of that, it has a power no privately-owned monopoly has ever had - the power to compel us to give it money whether we want to or not.
As far as it's constitutionality is concerned, the beauty of the Constitution is that it is written plainly so that any normal person can pretty much understand it. Where we get in trouble is when "educated" people start seeing meanings that do not exist. The simple fact that it compels every citizen to purchase a product makes it unconstitutional. That is not one of the 18 enumerated powers of the federal government.
The argument of "everyone else has it" is about as weak an argument as you can get. When wealthy Canadians get sick, where do they go? The US. How about Brits? Again, the US. Why? We have (had) a private healthcare system driven by a profit motive. That profit motive drives innovation. Otherwise, why spend years and millions of dollars inventing a new drug, treatment or device if you are not going to gain some recompence for your efforts and investment. Good feeling don't pay the bills, Lyle, especially in Obama's economy.
Ed Willing
10:54 am on Sunday, November 18, 2012
The future of American health care under the Affordable Care Act
Nothing "affordable" or "caring" about it.
http://healthreform.kff.org/subsidycalculator.aspx?source=QL
Ed Willing
10:58 am on Sunday, November 18, 2012
I love how formulaic this is. And imagine how much money is will cost.
I'm so sick of formulas. I shudder to think of what this will do to innovation, research, access and choice to providers.... It's a nightmare
Gabriel Larrabee
11:20 am on Sunday, November 18, 2012
Our good friend Lyle Is off on a couple of points and doesn't take into consideration a number of things when presenting his argument. Even if Healthcare was a necessity that all must use why can it not function as a profitable venture? After all, are you not offering services that may or may not be needed at an agreed upon price? Would you as a doctor provide your skill sets for free after having worked and paid to procure those same skill sets? Should others benefit for free off of your gained knowledge because it is the "fair" thing to do? Your statement that healthcare is acting as a monopoly is based off of what evidence? With over 1,000 different insurance companies nation wide, one could not say without ignorance that there is a healthcare monopoly. That being said, it has been government regulation and laws limiting healthcare competition that have done more to hamper any attempt at competition. A good example being that an individual cannot purchase health insurance out of state.
Lyle Ruble
3:33 pm on Sunday, November 18, 2012
@Mr. Larrabee...No one is asking any healthcare professional to provide their services for free. However, why have the medical profession been allowed to be self regulating? There is a significant shortage of physicians, yet new medical schools have not been built and additional students allowed in to increase the numbers. Therefore, the demand far exceeds the supply. This is not accidental. You have many people who pursue professions that require as much or more education and training, but they are not guaranteed the income that physicians are. Also, why is it that healthcare continues to inflate each year and the rest of the economy is either stable or stagnating. Why should they be able to raise prices at will to equal a $2.6 trillion per annum.
Just because there are so many private insurance companies doesn't mean they are not acting as a monopoly or trust. They all participate in price fixing and there is little or no competition.
Jay Sykes
4:43 pm on Sunday, November 18, 2012
How do you answer(solve) Lyle's valid concern about medicine being self regulated and it's apparent stranglehold on medical school and the number of doctors entering the workforce?
Gabriel Larrabee
5:05 pm on Sunday, November 18, 2012
While no one is asking, that is the intended concequence of socialized healthcare. Although no for free but wages being regulated by the government. England is a classic example. You want to see the future of the Affordable Health Care Act, look to them. As far a worker demand, That is a responsibility left up to the private sector, which is where true job creation comes from. Rise in demand necessitates rise in production, ergo new schools and jobs. You can look to a number of reasons as to why there may be a shortage of jobs in this field. A lot of people are tending to shy away from these particular positions in large part because of legalities and governmental interference. In short, the future of the doctors field isn't looking to bright. And so what if other people pursue professions that require more education and training.
Gabriel Larrabee
5:05 pm on Sunday, November 18, 2012
You choose what field you do into based on what you like and what you are looking for in pay. That's just how life works. No one says you have to go into a field where the money is less. Income is not supposed to be garunteed. It is a mutual agreement between the one providing the services and the one paying for them. And that is not why healthcare costs continue to inflate each year:
http://www.cato.org/pubs/pas/pa211.html
http://usconservatives.about.com/od/conservativepolitics101/i/HealthCareReform.htm
It is in fact a number of things. Each one needs to be addressed in order to make health care more affordable for people.
Insurance companies are not acting as a monopoly or trust. What they are doing is trying to survive as a business. It is a universal goal shared by any company that wants to survive and stay in business.
Ed Willing
10:03 pm on Sunday, November 18, 2012
Gabe, your arguments are very well constituted.
It's a wonder that Lyle doesn't try to address the Constitutional question here. Of either federalism, or enumerated powers.
Perhaps because he knows its a losing argument.
Hey Lyle, you want socialized medicine? Pass a Constitutional Amendment. Till then, leave my health, my money and my son's future alone.
Gabriel Larrabee
11:32 am on Sunday, November 18, 2012
And Lyle, where is your evidence that suggests that "other industrialized nations; they have better outcomes, better access, longer life times, etc. while spending half or less than what we are paying per capita"? It is always good to cite sources when making claims of evidence. And how did you come to the conclusion that the U.S. system hasn't led and held the corner in the innovation of products and procedures? Here are some articles that say otherwise:
http://www.industryweek.com/regulations/can-us-hold-its-lead-medical-technology-innovation
http://news.heartland.org/newspaper-article/2010/01/05/us-lead-medical-innovation-under-threat-reform-bills
And this from the Washington Post:
http://views.washingtonpost.com/healthcarerx/panelists/2009/06/right-brennan.html
And this from the New York Time:
http://www.nytimes.com/2006/10/05/business/05scene.html?_r=0
Lyle Ruble
3:57 pm on Sunday, November 18, 2012
@Mr. Larrabee...I wrote a blog piece on this earlier this year and international organizations are the source. As far as innovation is concerned, that does come from around the world. The American pharmaceutical companies develop product and then sell it at negotiated prices around the world, but we get the honor of paying for the research and marketing costs at higher non negotiated prices. Before so many hospitals and clinics became for profit institutions, pricing was slower to rise. With the increase of for profit institutions they have not increased competitiveness and prices continue to rise.
Gabriel Larrabee
5:17 pm on Sunday, November 18, 2012
Be more specific please. "international organizations" isn't good enough. Cited sources would be nice. What makes you believe hospitals were not for profit? Even nurses, doctors, and the like were paid for services rendered. As well as mortgages and utilities paid for the hospitals themselves. They did just work for free. As for the pharma companies, greed is universal. No matter where you go you will find it. And government is no different. With the government picking winners and losers, lack of real competition, and price gouging, the result will always be exorbitant costs. Problem with this is the government is in bed the pharma biz. So what then do you do about a corrupt government making dealings with a corrupt pharma? Have fun with that one. Lol. Good business and good government must rely on honesty, integrity, and trust. All three are lacking by both.
Gabriel Larrabee
11:47 am on Sunday, November 18, 2012
With regards to your comments on constitutional law and the claim that only the supreme court can rule on the constitution and all that it entails, what gives one individual the right to judge another's ability to legitimately interpret the constitution and related said articles? One doesn't have to be a constitutional scholar nor a supreme court justice to have adequate working knowledge of our country's founding documents. To imply otherwise would suggest a belief that some people should not be able to because they don't have an official degree or title behind their name. The constitution and its related articles were not meant for limited eyes only and for understanding by the the elite few. Bad debating man, just plain bad debating. And if memory serves me correctly, the chief Justice usurped his authority by stepping on congressional legislative powers when he changed the legal argument of the case. Congress called it a penalty, not a tax. But Roberts called it a tax. Roberts isn't allowed to change the definition. He is supposed to address the case as is. Those powers are delegated specifically to congress. Not the judicial branch. It isn't up to the supreme court to change words and definitions of our laws. Only to interpret them.
Lyle Ruble
4:11 pm on Sunday, November 18, 2012
@Mr.....Our judicial system has given the right to the U.S. Supreme Court to determine . It began with the first Chief Justice John Marshall and has continued since. When considering cases it is not only the founding documents that must be considered, but case law and all previous decisions. For the lay person to argue constitutional matters is only opinion and carries no weight and opinions are like anuses, everyone has one. Only those educated in such matters have the learned opinions and the rest of us must second guess.
I don't know how many people I have encountered who define themselves as constitutionalists and claim they have the knowledge of original intent. What I have found with these people is they view the founding documents as immutable, which is the furthest thing from the truth. to assume immutability is to deny that society has changed and the needs for expanded interpretations.
Gabriel Larrabee
5:40 pm on Sunday, November 18, 2012
The judicial system is required to interpret law, not change how a bill was worded, or change the argument of a case. And while it may only be the average "lay person", as long as their "opinion" falls in line with with what the constitution say, it doesn't matter if they have a title or not. It doesn't take a genius, a guy with a title or Phd, to understand. The constitution isn't some mystical document who's meaning is only afforded to the "well educated". That opinion is a bit inclusive. And the Constitution is immutable. What would make you think otherwise? Sorry, but natural truths do not change with society. Do you somehow think to judge or gauge the thoughts of those who wrote it? It was meant to be a permanent fixture. A beacon or cornerstone upon which all else was done. People of your thought is exactly the reason why this is so. How would a society be if they could change their founding principles on a whim or by one party control? That is after all why we have the ability to add amendments. That way it would take a large majority to add to or alter such an important founding document. And contrary to what you might think, even supreme court justices are capable of making bad judgments or in a good number of cases, biased judgments. Which makes them no better than the "common man".
Gabriel Larrabee
11:55 am on Sunday, November 18, 2012
And one thing that Lyle doesn't take into account regarding the "better" outcomes of other industrialized nations is other key data regarding long term population statistics over a one hundred year period, dietary habits, health habits, genetics, and other needed information necessary for determining an individual nations population health outcomes and their likely causes.
Lyle Ruble
4:20 pm on Sunday, November 18, 2012
@Mr. Larrabee....One of the primary reasons for improved health in developed nations is the implementation of public health infrastructures including clean water supplies and sewage systems. However, your claims about differences are true to an extent, but if you compare people of white European descent, then the Europeans still have better outcomes.
Ed Willing
9:48 pm on Sunday, November 18, 2012
And we're all much happier over here..... ;)
Jay Sykes
3:18 pm on Sunday, November 18, 2012
The Whole foods CEO, John Mackey, wrote his article following John Hurd CEO of Safeway explaining their employee healthcare experiences/fixes:
http://online.wsj.com/article/SB124476804026308603.html
Brian Dey
12:08 pm on Monday, November 19, 2012
Is it just me or has anyone else noticed that when Lyle is confronted with producing evidence of his claims, he goes MIA? On this and other posts, I have noticed that he will converse only so long until being confronted with producing evidence. Then it goes silent. Just saying...
Mr. Willing, this is spot on. We here all the time of compromise from the left, yet some of the items you listed, which Republican leaders clearly articulated prior to the passage of the ACA, were never discussed. Why? TORT reform would have negative impacts on trial lawyers which tend to support the current administration. Reforming the tax code would hit CPA's hard who again support this administration. And again, there are many more examples of protectionism of the administration for key constituent professions.