He’s so smart that Barack Obama didn’t even need to show him off his astounding intellect to the Senate, although they admire him so much that they’re still trying to set up a meeting, apparently just to bask in his cerebral glow.  In lieu of questioning, they should test his brain for steroids if they actually get to share a room with him. 

But I am suspicious in my thick-skulled way.  By trying to free us from the free market, Berwick embodies Obamunism better than even if Van Jones was duct-taped to Rahm Emanuel.  How could that be bad?

Yet some of us still feel the need to resist despite who we’re facing.  Like me, you don’t have an Ivy League degree, after all, and even if you do you were never president unless you are one of the George Bushes.  In that case, thank you for clicking here, Mister Presidents.

Setting aside that totally plausible scenario, my non-Bush president readers can’t compete with Obama’s résumé, even if it’s only three lines (education: Ivy; current position: prez; references: call Bill Ayers).  What would you know about making financial decisions, you non-commander-in-chief?

That is, other than everything?  Americans prove every Obama administration member wrong constantly.  Dissenters don’t even have to list specific reasons why the eternal bailout is a recession-extending, corporate behemoth-pleasing nightmare.  Simply, they do it by living their lives and buying things.  The best case against the president is made by spending while existing.

People don’t have to go to some fancy economics school to know what’s good for their personal budgets.  I for one chose a path that was worse than no college: I majored in journalism.  Yet I still know that people even as unwise as me are far better at choosing how to spend their funds than any non-Paul Ryan wonk who plies in Washington.

It’s too bad there’s no way to prove that lack of bureaucratic interdiction actually keys commercial success.  The only exception would be each voluntary purchases made throughout human history.  As an example, any American can visit any mall, supermarket, Target, bookseller, electronics retailer, restaurant, bait shop, or pretzel kiosk and buy any item desired at a voluntarily acceptable rate.  Other than that, the free market sucks.

All enjoyably worthwhile transactions are made via interaction with private sellers.  That’s true no matter one’s definition of “worthwhile.”  You may think that buying Twilight junk at Hot Topic embodies civilization’s nadir.  And you would be correct.

But that’s someone else’s decision about the value they get for their money.  The baffling spenders in question get to choose how to waste what they have even if same choices would appall and confuse people with infinitely better taste.

On the other hand, dealing with a governmentally-planned mini-economy invariably leads to misery, frustration, and comprehension of why Obama succeeds at failing.  It’s too obvious to cite the Department of Motor Vehicles as an example.  But it’s too much fun not to, either.

Wait: you mean you don’t enjoy renewing your license?  The lines, service, price, ease of transaction, and wait time for the product in question to be delivered are all familiarly dreadful.  One needn’t be reminded that the departments are not in private hands.  But it’s always worthwhile for people to keep this fact in mind, especially as the feds attempt to DMV up every industry.

Similarly, we can envision the real-world horror flick that matches Berwick’s vision of expertly-planned health care.  And we can see it, too, as long as we look north or south while standing on our tiptoes while facing certain neighbors.  Instead of seeking out the best care at a reasonable rate from doctors and hospitals who must offer excellent service in a competitive market, unfortunate residents of countries that already employ acute versions of Obamacare wait and suffer while going bankrupt for the privilege.

Worse, the antagonist is already on the loose in America.  We already have semi-socialized medicine, as the elderly or poor souls on one of the very Mediplans that Berwick now runs can attest.  Government provides simultaneously inefficient and lousy care because there’s no competition.

The fact that assigned schemers assure us that they’re better at managing real life than those they’re serving provides little consolation.  Berwick’s agency proves him completely wrong, which would make him feel embarrassed if he knew how.

Likewise, mandating emergency room care for everyone sounds noble, right until people realize they can get non-emergency care at any time for any reason.  Yeah, that’ll hold down costs.

When it comes to those who genuinely require assistance, no reasonable person claims that any hospital would turn away someone in dire need.  If they diabolically did, the free market media would rightfully shred the diabolical institution in question.

As for newsworthy words, the process of spreading ideas online works well precisely because there’s not a Cabinet official or Dot Com Czar attempting to chart the industry’s course.  People post or sell, other people read or buy, and everyone’s happy excepting the administration that hates seeing a vastly unregulated frontier succeed immensely.

You have probably noticed that the internet works.  As a matter of fact, you may be interested to know that are currently using the particular medium of information distribution in question.  That’s unless you curiously printed out a hard copy, which just means you visited the internet first.  Either way, you visited my column freely.  Nobody is blaming or accusing you of anything.  But you are choosing your own path right now.  Bless you.

The ability to select any information you want in lieu of having Katie Couric dictate what she wants to you is the best thing that has happened to the industry since the invention of the journalist cocktail.  Naturally, a prominent liberal recently proclaimed that he wants to change what works.  Specifically, Columbia University President Lee Bollinger wants the government giving food stamps to the press.

You’d better listen: the call to quasi-nationalize the media came from the boss of Columbia, which is a school connected to Obama.  That in turn means he is more awesome than us at everything merely by association.

With that in mind, I’m all for more funding of my life’s work as a freelance journalist, especially considering said work so obviously amounts to not much.  While I should apply for a NEA grant to hold me over for now, I’m ultimately holding out for a federal columnist slot and an accompanying fat pension.

Of course, I’d still totally get to make fun of the president.  Um, right?  Why would the bureaucrats who pay my salary with money confiscated from you get to control what I say via governmental fiat?  I’ve no idea.

Federal funding for publications and broadcasts that fail to draw audiences would be rewarding failure, which would of course be an Obama administration first.  It further means we’d be effectively nationalizing an industry that most Americans think must absolutely remain private if freedom of speech is to endure.  But doing so will prove to them once and for all that central planning works.  Um, totally.  Yes!

The public will soon warm to distrusting their non-Berwickian intellects in favor of letting government pros make decisions for them.  After all, federal intervention never fails to ameliorate and improve our circumstances.  Please don’t check the unemployment rate after reading the previous sentence.

Anthony Bialy is a freelance writer and “Red Eye” Conservative in Western New York.  He blogs at http://thebuffalobean.com and tweets at http://twitter.com/AnthonyBialy.

Unlike with the Obama, we think long-term.  His nice note will not be in direct regard of his disreputable treatment of our allies or money.  Conservatives are looking past the present when they think of the president: he’s sort of totally screwed up today, and tomorrow isn’t looking fantastic, either.

But at least the misguided dunces among us provide a standard which we may avoid.  While it’s not as good as being good, our president is at least setting an archetypical bad example.  He’s doing something important, namely preventing an Obama clone from being elected for decades.  It’s unlikely we’ll come across a sugar-talking commie of his kind soon, but even a slightly less mellifluous shyster won’t stand a chance with voters.

For one, everyone is now assured that a president can’t change the world if the doesn’t know how the world works.  Obama spends his free periods guilelessly, patronizingly attempting to reform hoodlum classmates.  He’s effectively sliding up to the bad kids hanging out by the high school’s loading dock and asking for a cigarette like he’s one of the gang.

Obama thinks he can get them to come to class, not to mention that he thinks it’s his job as student council head to do so.  But his actual role is to let them rot away as loser delinquents while taking kung fu lessons so he may vanquish them in the cafeteria if they attempt to steal or flatten his juice box.  Jerks are rarely ever won over.

Anyone who sees social work as a key component of foreign policy is presently being decidedly proven wrong.  We’re nominally led by a do-gooder of a suck-up whose greatest foreign policy success is convincing Iranians to kill a woman convicted of adultery by hanging instead of heaving numerous rocks at her skull over time.  Maybe.

The pre-savior-electing chatter was that we needed a president who would smile and glad-hand our way to permanent peace.  Not quite enough voters recognized this wouldn’t work, as too many either forgot or never learned that suckers’ natural role is to get shoved.

But this administration is provoking historical comparisons: some people need to see a Neville Chamberlain-type suffer emasculation to learn what never changes.  One prompt per century is hopefully sufficient.

At least people accept that it’s preferable to have a mean president saying we have to rough up a global bully.  Nobody likes such rough talk.  But Obama’s unwillingness to stand up to anyone outside of Honduras’s democratically-elected leader or East Jerusalem’s prospective tenants means he serves as a frightfully vivid embodiment of the alternative’s consequences.  To recap, the result is that our enemies party apocalyptically while our friends tell us justifiably to sod off.  Other than that, we’re safer and beloved.

Glossy talk fails at home, too.  People are not being duped by unlimited fantastic jobs talk, at least not anymore.  And yet Obama’s present lousy poll numbers are going to look like a coffee break taken on the descent compared to how he’ll be viewed in five years. Folks will look back and wonder how we ever coped with chronic double-digit joblessness; hopefully, they’ll spot the same job-murdering traits present in future unqualified presidential applicants.

And the next clueless charlatan pining for our vote who claims we’re can’t unconsciously run a free market is going to hope we don’t remember right now.  Specifically, new Medicare and Medicaid Services boss Donald Berwick’s contempt for health care competition is as obnoxious as it is typical, especially considering the president just chickened out of letting the Senate have a go at him.

The one thing more terrifying than being responsible for your own health needs is someone who thinks they’re smarter than you doing it for you.  They have legal backing, too.

People just need to keep the lessons in mind. Apparently, some need a permanent to-do list Post-It glued to their computer monitor frame reading, “1) Buy stamps 2) Spending and bowing are two things we don’t want our president doing 3) Pick up Stan from piano lessons.”  Those suckered by Obama’s fluffy promises about making the Marshmallow Kingdom a reality may never learn that he’s actually dragging us to Black Jellybean Hell without such emphasis.

If they needed to take more drastic measures, they could write themselves a note on their palms Sarah Palin-style.  Anytime they’re tempted to think Obama can single-handedly bring about a world of cooperation, liberty from want and worry, or unlimited free Skittles can merely look at their hand and be reminded that “He’s full of it.”  It’s a way better tattoo than some dolphin or Japanese characters.

Some need that message permanently inked.  Otherwise, we’re going to encounter yet another fresh embodiment of horrid centralized planning far too soon.  Our past is streaked with them, after all: Woody Wilson, FDR, and LBJ all serve as reminders of what happens when presidents get to spend away in the name of fixing us.  Namely, we end up both broke and broken. 

That’s not even to mention the president’s most obvious foolhardy heir, namely Grinning Jimmy Carter.  Obama’s greatest accomplishment may be making America’s most notorious irrelevant dunce feel better about himself.  That’s when Carter is not threatening Israel or explaining why it was his plan all along to let Iran to keep our hostages for a bit longer.

Obama may as well have plagiarized domestic and foreign policy from the guileless grinning clown.  Man, that is such a bad ex-president from whom to crib.  Joe Biden could have finally been useful to his boss and taught Obama about proper plagiarizing.

The biggest difference between the disco and Bieber eras is that the aforementioned Iranian hooligans are much naughtier and are working to get much nastier weapons.  Yes, things have gotten worse since the Alicia Bridges era.  Also, we can at least respect Carter’s Navy service, particularly compared to Obama’s voter registration service.

Carter and Obama are otherwise identical, especially when we need examples of naively rotten lunacy.  Let’s just keep this one fresh, shall we?  It’s easy to forget everything in an instant.  I blame the iPad and Wii Sports Resort, but it’s happening regardless of the cause.

Take me: even I can only think of any random topic until the open window says someone I follow has posted a new tweet.  But I promise to try to remember the current revolting presidential situation if you do, assuming I haven’t lost my train of thought by the end of this ooh I should check Facebook to see if anyone liked that I had Burger King for dinner.

No!  I must focus.  Yet one more memory-aiding device might help.  Specifically, we should all take a digital photograph of the nice notes we’re sending Obama.  Next, print the thank you for serving as a warning about the dangers of electing an incompetently delusional egomaniac and place it somewhere prominent, perhaps next to your child’s A minus phonics test on the freezer door.

Regularly seeing a note encapsulating what we don’t like about him will help prevent Americans from ever falling for easy utopian promises again.  Like remembering your Social Security number, spouse’s birthday, or Ryan Miller’s birthday (July 17, of course), the folly of everything Obamaesque will then come to mind reflexively even after he’s back to organizing/irritating smaller communities.

Anthony Bialy is a freelance writer and “Red Eye” Conservative in Western New York.  He blogs at http://thebuffalobean.com and tweets at http://twitter.com/AnthonyBialy.

Amid all the rhetoric, the politics, and the public outcries, the truth about what really ails the American Healthcare System has been totally lost.  Whether you are a patient or a physician the problem is the same.  We, collectively, have relinquished control of the most personal service any of us ever receives or gives to a group of third parties.  It doesn’t really matter whether the third party is an insurance company or the government. Once a third party becomes involved the results are predictable and are governed by the golden rule, “who ever has the gold makes the rules.” This fundamental truth has come home to roost in our current healthcare system.

HOW DID WE GET HERE?

1- The health insurance industry was started in the 1930s in Texas as Blue Cross and Blue Shield and was designed to cover surgical care only.

2- Following World War II, employers offered “Major Medical”  insurance policies to employees as a benefit in lieu of higher wages and wrote off the cost as a business expense.

3- Physicians and hospitals recognized insurance as a means of guaranteed payment, so they helped patients by filing their claims and even accepting assignment of benefits.  Eventually, direct insurance payments became their primary source of income.

4- In 1965, under the Johnson administration, the Federal Government enacted Medicare to provide insurance for the elderly. Eventually, and for largely political reasons, Medicare was expanded to pay for doctor’s office visits, outpatient testing, and a whole variety of costs that were traditionally paid by the individual.

5- The number of people covered by Medicare has increased with the growing population of those over 65 as well as the inclusion of many other individuals and specific treatments, like renal dialysis, not initially part of the program.  More recently, under the Bush administration, and even in the face of looming financial insolvency, Medicare was expanded to include prescription drugs (Part D).  But, Congress failed to increase funding to pay for them.

6- Insured patients were charged higher rates for most services to make up for lower rates paid by Medicare.  This “hidden tax” was levied indirectly on those with health insurance to compensate for Medicare underpayment.

7- The American Hospital Association developed a very powerful lobby that successfully negotiated guaranteed annual increases in Medicare Part A, but physicians, under Medicare Part B, had no such deal, so their payments have progressively declined for 20 years.

8- Premiums for private health insurance continued to increase prompting corporate buyers to seek ways to control their costs. Shortly after taking over as Chairman of Chrysler in the late 1970’s, Lee Iaocca went on television with an ad declaring that the cost of healthcare in his automobiles exceeded the cost of steel, and ignited a national movement toward what became known as Managed Care.

9- Under managed care the insurance carrier became a healthcare broker by contracting with both employers and “providers” (formerly known as physicians).  Managed care plans offered members (formerly known as patients) low co-pays and the promise of comprehensive coverage for all healthcare services.  Doctors and hospitals participated in these plans as contracted preferred providers, ensuring them a continued flow of patients.

10- Physicians were initially offered reasonable fees, but part of every contract contains a clause prohibiting balance billing of the patient for anything beyond than their co-pay.  This effectively employed the physician and controlled the terms of that employment.

11- Reimbursement rates for various services are determined unilaterally by the insurance company and over time have progressively decreased using the Medicare rates as an index.

12- Hospitals successfully merged into larger regional and national healthcare systems, forcing insurance companies to negotiate with them directly, but physicians have been prevented from banding together because of antitrust laws.  Individual doctors have had only two alternatives; sign the contract and work for the insurance company, or don’t, and risk having no patients.

13- The managed care system offers no incentives to either the patient or the physician to control utilization, thus the cost of healthcare has continued to rise.

14- To maintain profitability, insurance companies have gradually raised both premiums to employers and deductibles and co-pays for patients, while decreasing payments to physicians.

15- The rising threat of medical liability suits has further increases utilization, a practice known as defensive medicine.

The government and private insurers have both creating a system that  has addicted American physicians and their patients.  One based on their hunger for profit and the other for political power.

THE RESULT – BOTH PATIENT AND PHYSICIAN ARE UNHAPPY

Many physicians no longer provide personal care as their services have become a commodity.  By contract they work for the third party payer, not the patient.  Patients are unhappy with what they perceive as impersonal service, but by contract they have comparatively little financial exposure.  To be fair, not all physicians practice as insurance employees, but ALL are under pressure to do so or risk financial insolvency.  The practice of medicine has become a business with declining roles for both the physician and the patients despite their obvious vested interests.

Today we have the most expensive healthcare in the world.  This argument is often used to justify a total government take over, (i.e.) the single payer system. In such a system the government becomes responsible for everyone’s care.  This “one size fits all” solution cannot be responsive to the individual circumstances of 300 million Americans, and will serve to further erode the last vestiges of personal service.  Single payer systems around the world must eventually deny care when the committed public resources are insufficient to cover the costs.  In most instances this is not a direct denial of care.  The “payer” indirectly discourages various costly treatments by lowering reimbursement to a point where they become financially impractical to provide them.  This process also discourages new technologies and innovations and eventually quality and access to even basic care.  There is little incentive for research and development, and bright young people are discouraged from choosing a difficult career only to become a government employee.  The ultimate manpower crunch leads to physicians being replaced by nurse practitioners, and aides replacing nurses.  This is a huge problem in Britain and Canada and there is already a critical shortage of primary care physicians and even certain specialists here in the United States, directly related to poor reimbursement.

THE SOLUTION: TURN BACK THE CLOCK

1- Return to a strong patient-physician relationship through mutual respect and responsibility.

2- Recognize that our problems center around our collective dependence on impersonal third parties that have no real role in healthcare other than financial or political.

3- Encourage individual responsibility through tax incentives or government vouchers to purchase their own personal and completely portable catastrophic, or major medical insurance policy to cover major expenses like hospital bills for major illnesses or surgery.

4- Encourage individual responsibility through tax incentives or government vouchers to establish their own medical savings account through which they can pay for most of the lower cost aspects of their care, including most physician services

5- Encourage physicians to eliminate contractual relationships with third party payers and instead offer their services directly to patients in exchange for reasonable payment by the recipient of those services.  Only through this “free market” system will the costs go down and quality be rewarded.

6- Physicians will be free to offer charity care for those who simply cannot pay, a fundamental principle that is part of our basic compassionate character.

7- Hospital charges are far and away the largest component of the cost of any major illness and these charges should continue to be billed by the institution to the insurance company directly.  But hospitals must be subject to open market competition through the elimination of preferential tax exempt status for some but not others.

8- Patients who choose to pay for all their own healthcare out of their own pocket should have the opportunity to negotiate directly with both their physician and the hospital.  Currently, cash paying patients are penalized; typically paying much higher fees than contracted insurance payers.

The bottom-line is that the core of healthcare has traditionally been the physician-patient relationship and we need to return to THAT system.  Third parties have inappropriately become brokers of our sacred relationship and now the government threatens to take over. To ensure quality and personal care, the patient-physician relationship needs to be fostered by any new system, not destroyed by it.  The logical answer has eluded us.  Ultimately, both patients and physicians must accept their individual responsibilities or risk the loss of their respective freedoms.  By returning to that concept we will ensure that American healthcare will remain the envy of the world.

Jenny Erikson recently interviewed Dr. Sewell for The Smart Girl Report. Click here to listen, or download on itunes (episode 22).

With the public option seemingly off the table, Harry Reid and Senate Democrats had to look for another idea to sway votes for the healthcare bill. Their latest offering? Expand Medicare to allow a buy in for those between the ages of 55 and 64. This Medicare option now appears to be off the table, but what’s next?

While Democrats touted the Medicare expansion as an alternative to public option, in reality it accomplished the same thing as the public option: it paved the road to single-payer healthcare. By expanding Medicare to cover more Americans, raising the income qualifications for Medicaid and continuing to expand SCHIP (State Childrens’ Health Insurance Program) you have a ever growing number of Americans dependent on these entitlement programs.

Fortunately, Medicare expansion didn’t have the votes. This weak attempt at an alternative to the public option didn’t provide the 60 votes Harry Reid needs to pass this bill. Over the weekend Senator Lieberman confirmed that he would not support the Medicare expansion as an alternative to the public option.

At this point, one wonders what the point is of continuing with the current bill. Even if the Senate bill passes without a public option and without Medicare expansion, you still have to reconcile the House and Senate bills. You likely loose the vote of those Democrats that hoped for the public option. You also lose the Democrats that are truly opposed to abortion funding as the Senate bill does include federal funding for abortion services. Do you pick up any Republicans? Not if they are reading the latest polling numbers showing ever growing opposition to the bill.

As Democrats cling to the hope of eventual single-payer healthcare and try to save their bill, their desperation is showing. It’s time to scrap the current bill in its entirely and go back to the drawing board.

Say you work in an office, and your cool boss decides that placing a box full of money in the break room would be a great way to inspire productivity. While everyone has access to it, he announces one stipulation, namely that each person is only allowed to take a dollar per day. He puts one thousand singles in the receptacle, which should be enough to last a month for a staff of 50.

Of course, the cash will all be gone by lunchtime, as a few wayward souls will ignore the single provision. Some may drain it even if there’s a reminder summarizing the guidelines written upon a Post-it note stuck to the container. The ingenuous manager will thus have learned what everyone should know, namely that the actuality frequently won’t match what the rules proclaim will be the outcome. Human nature influences the course of every plan ever concocted. President Obama should bear this guideline in mind before he follows up his last speech about why his astounding health care plan is only opposed by deceitful hate-mongers who are racist (probably).

For example, the words “death panel” don’t appear anywhere in the Bronx phone book-sized health care bill. And they don’t have to: an unpleasant set of circumstances can come into being even if the precise term describing them isn’t written down.

In this case, bureaucrats equipped with a limited budget to provide care for everyone could end up denying treatment to the elderly. They’ll issue the justification that it’s a waste of finite resources to treat Mildred and Cornelius when Madison and Connor need treatments and have so many years in front of them. It’s almost feasible that there could be a panel effectively making life or death decisions.

Plus, those who think government can cure all of life’s problems have trouble accepting that users will abuse the system. Even many of those who aren’t as cynical recognize that we’ll either go beyond bust giving everyone all the care they want or shave a fraction off the inconceivable cost by limiting what’s doled out. On the plus side, it’s amusing that Obama’s reference to the theoretical panels during his joint session lecture means he obviously can’t stop thinking about Sarah Palin.

While it’s a matter of opinion, it’s certainly not lying to claim that Obamacare will create unpleasantly unintended consequences. Can the same be said of the other side? Although the charge of deliberate untruthfulness was famously applied to the president recently, he may not be fibbing outright. Still, he at best enjoys a fishy relationship with the truth.

Most obviously, it’s remarkable that the number of uninsured Americans dipped so rapidly. The amount magically decreased to 30 million in Obama’s last speech from the 47 million count that was routinely, and of course incorrectly, previously thrown around as the accurate number.

Where did 17 million of our friends go? They disappeared thanks to precise vocabulary: by using the word “citizens,” lawyer Obama removed the naughty people who snuck over our borders from the count. Now, he just has to stop including those who are eligible for Medicaid but don’t receive it, people between jobs, and young and/or well-off people who choose to not spend money on insurance, and he’d finally have an accurate tally.

The same president who thinks IRS-style health care is our wisest course of action may really also believe that there will be an efficient mechanism for checking citizenships of emergency room patrons. Congress did attempt to modify the bill following Obama’s thoroughly inconsequential speech so that those who shouldn’t be here will be prevented from getting medical attention. But there’s zero hope that any enforcement mechanism will be effective. How will the same government that can’t keep out illegal aliens in the first place stop them from getting health care?

Paying for health services of those who sneak in isn’t the only concern. More distressingly, abortion might go from a procedure we’re forced to tolerate to one we’re forced to finance. People brave and patient enough to read the bill have concluded that it would allow for funding insurance plans that cover abortion (http://blog.heritage.org/2009/08/13/townhall-downfall-rep-zoe-lofgren-d-ca-admits-obamacare-will-fund-abortions/).

The alleged compromise is that only individual subsidies will be used to pay for abortions. Obama condemns Wall Street across the board when a handful of rogue corporations shift around money to hide losses; meanwhile, he’s claiming that you shouldn’t worry, as your particular money won’t fund the grisly termination of life out of convenience. That shouldn’t assuage consciences.

Overall, our oh so progressive leader still hasn’t explained how this will be the first government plan in the history of the universe to run a profit. But it just may be that he’s genuinely confused. This might not be a matter of the president lying, as that would mean he was deliberately pretending he thought Washington can heal the sick. No: he really believes that Obamacare will save costs while offering better service to absolutely everyone except illegal immigrants. Frighteningly, that’s worse than willfully distorting reality.

The president may not believe he’s deceiving us even as he’s deceiving us. He needs to, but never will, realize that there’s a difference between him saying something will happen and it occurring here in reality. It’s ultimately Chris Matthews’s fault for never shutting up about the mellifluous nature of every word that the president reads off a screen. Of course, Obama doesn’t have to believe all the praise he hears; still, there’s so much thrown at him that it was likely inevitable that would eventually absorb it all.

The result, namely a delusional president who didn’t realize some of us were teasing when we addressed him as the messiah, means there’s a chance he’s not actually insincere. Deep down, this could be Obama when he’s honest. Yes, that’s troubling. But he’s also making himself easy to counter: just transcribe his comments, add a notation reading, “He really means this,” and show to others. As a result, his attempt to import Canada’s take on well-being will defeat itself. It may or may not be better than the semi-olden days of a decade ago when President Clinton spoke and everyone knew he was full of it.

By: Richard G. Fessler, MD, PhD

Are the administrative costs of single-payer health care systems less than current private insurance system in the United States?

One claim made by advocates of single-payer health care systems is that private insurance is less “efficient” because of high administrative costs incurred by having “multiple” insurance companies, and the costs of competitive marketing, satellite services, and the need to make a profit! For example, Woolhandler et al have reported that the administrative cost of health care in the US accounts for 31% of health care dollars, but only 16% in Canada.1 The Congressional Research Service estimates the cost of administrative overhead at 2% of total program costs for Medicare, 9.5% for private insurance, and 11.9% for HMOs.2 However, such estimates are misleading.

First, one has to ask which services are considered “administrative” and which are “patient care?” Often these services are categorized differently in single-payer systems and private insurance, resulting in “apples to oranges” comparisons.3

Second, the cost “efficiency” of a system is influenced by more than just overhead and administrative costs. Benefit (such as length of time waiting for health care delivery, variety of options, freedom of choice in health care, and access to advanced technologies) must also be considered.

Third, governments can shift cost to physicians and taxpayers in a manner, which private insurers cannot. For example, the American Medical Association reported that physicians spend an average of 23% of their patient care time on administrative functions for Medicare claims.4 (Beyond the “up-front” cost here, consider the additional savings if each physician could see 23 % more patients!)

Finally, the true cost of government run health care delivery is often hidden in complex bureaucratic reporting and tracking systems. Government initiated auditing expenses of health care services, for example, are not included as “health care cost”, but as part of the budget of other public agencies. Similarly, the cost of collecting taxes or lobbying for additional funding are not included in the cost of government run health care overhead expenses, whereas collecting premiums and marketing are included in the overhead of private insurers.

The bottom line, however, is that a “public” insurer and a “private” insurer ultimately perform the same services. There are costs associated with both them, which must be equally accounted for. Concealing them in bureaucratic pigeon-holes, although expedient when one wants to applaud government sponsored single-payer systems, does not magically make them go away.

In a report estimating the true cost of public programs, including hidden costs such as taxes, Mark Litow found that Medicare and Medicaid spent 26.9 cents as overhead for every dollar of benefit paid, compared to 16.2 cents spent by private insurers.5 Thus, he reported that government run programs had 66% more overhead cost than private insurers per dollar of care delivered (see figure).

Implicit among the single-payer advocates is the belief that a system in which one organization pays all the bills, is inherently better than one in which multiple organizations compete against each other. One way to analyze whether this is true or not, is to examine the cost to individuals using the only “single-payer” model available in the United States, Medicare, compared to the cost to individuals with private insurance. Most patients with Medicare find that many services (such as drugs, rehabilitation, and preventative medicine) are not covered by their policies, thus leaving them at risk for potentially thousands of dollars of out of pocket expense. To cover this potentially catastrophic risk, a high percentage of Medicare patients also pay for supplemental private insurance. On the average, Medicare recipients pay $5,000 more per year “out of pocket” on their health care, than non-Medicare patients.6 These results revealed by Mark Litow coupled with the increased out of pocket expenses paid by Medicare recipients argue strongly, therefore, that Government run, single-payer health care are MORE expensive, not less expensive, than private insurance.

1 Woolhandler, S., Campbell, T., Himmelstein, D.U., “Costs of Health Care Administration in the United States and Canada”, New England Journal of Medicine, 349:768-775, 2003.

2 “Administrative Costs: Medicare Compared to Private Insurance and HMOs, 1993”, figure 3.29, table 3.29, prepared by the Congressional Research Service, “Medicare and Health Care Chartbook”, Ways and Means Committee, U.S. House of Representatives.

3 Goodman, John C., Musgrave, Gerald L., Herrick, Devon M., Lives at Risk, Rowman and Littlefield Publishers, Inc, New York, 2004, pp 106.

4 American Medical Association Center for Health Policy Research, “The Administrative Burden of Health Insurance on Physicians”, SMS Report 3, no.2, 1989.

5 Litow, Mark, “Rhetoric vs Realtiy: Comparing Public and Private Health Care Administrative Costs”, The Technical Committee of the Council Committee for Affordable Health Insurance (CAHI), March, 1994.

6 U.S. Department of Health and Human Services, Medicare and Medicaid Statistical Supplement, 1999,” Health Care Financial Review, Publication No. 03417, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services, November 1999, figure 19, p.37.

For additional information about the financial viability of the Medicare program, please visit: http://www.healthandsharing.com/18/healthblogdetail

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by Kimberly Moore

It’s an interesting question and one that isn’t easily answered. I don’t know anyone who would see someone suffering and not want them to seek medical help. After careful consideration, I believe to force upon our country a universal health care plan is immoral.

There have been many figures announcing how many people in the U.S. are currently uninsured or underinsured. 46 million people seems to be the most common number as those uninsured. What we need to remember is this number is slightly elevated. According to “Liberty and Tyranny” by Mark Levin, 9.5 million were not citizens, 17 million lived in households with incomes over $50,000 a year, and 18 million were between the ages of 18-34 and were in good health or chose not to purchase it. So, if these numbers are correct, that would leave 1.5 million people without health insurance that are American citizens who couldn’t afford it. But there is a solution to help many of those without health insurance.

In 1965, the Medicaid bill was passed when President Johnson was in office. Medicaid fell under the Social Security Act and currently Medicaid is the largest state expenditure. For those citizens who are unable to purchase health care insurance due to low income, they have the option to get the medical care needed. Children can be eligible for Medicaid, even if the parent is not. Lawfully admitted immigrants may also be eligible for Medicaid.

The moral issue is not if America has universal health care but rather it becomes a moral issue when asked how a decision is made under the universal health care regarding who lives and who dies. Oregon has a state-run health care program for those who live under the poverty line. According to ABC News, Barbara Wagner had lung cancer, which had been in remission, but returned. In order to live, her doctor prescribed medication that cost $4,000 per month. The state-run insurance program refused to pay for the medication but offered to pay for assisted suicide. So, basically, they are telling Ms. Wagner, we won’t pay to help you live, but we will pay to help you die. What kind of message is that sending to the rest of the U.S.? Unfortunately, I see this as a common problem if the universal health care plan is passed. At the request of her doctor, Ms. Wagner was able to receive her medicine free of charge.

There are concerns with the medical professionals staying employed in the medical industry or searching other employment should the universal health care plan be enacted. With the cap of bonuses that the White House is placing on the automobile industry executives, there will certainly be a cap on salaries of physicians and medical specialists. With government-run health care in the U.S., frustrations being felt by doctors to meet the demands of the government may force early retirement of physicians and encourage future students of the medical field to seek employment in other professions. Not only would we have a shortage of doctors, there will be an increase in patients and the quality of the health care will decrease while the wait time to see a doctor for diagnosis of a potential life-threatening ailment could be months away.

The Republicans have planned to unveil the Patients Choice Act on May 20, 2009. This is an alternative to what the Democrats are proposing. Rather than depending on the federal government to determine our health decisions, the Patients Choice Act will provide a tax credit of $2290 for an individual or $5710 for families each year to help those without insurance and use the tax credits to purchase insurance through a private insurance company. This is budget-neutral compared to the $2 trillion already considered for spending on universal health care. Also, the Patients Choice Act will help get people off of Medicaid because of the tax credit and the ability to choose their own doctor.

Until a final decision is made, think about this: the United States already has a universal health care plan. It is Medicaid and Medicare. For all others, it seems to be a choice. If health insurance is not offered by an employer, there are insurance plans available. Like car insurance, the best advice is to compare prices and benefits and choose which you can afford based upon your income. Do you really want to leave your life or death in the hands of the federal government? I certainly do not.

By: Laura Adelmann

Is there something about our culture that makes an ever growing number of Americans feel that they should be getting everything they want, with no real effort on their part? What happened to the values of working hard and saving, starter homes and delayed gratification? It seems they’ve disappeared from the landscape and it’s a trend that should concern us all.

Once upon a time, actions had consequences. If you didn’t have the money to buy a house, you didn’t buy a house. Then along came your friendly neighborhood government and made lenders give you money because everyone should be able to buy a house, no matter their financial situation. Fannie and Freddie loaned with abandon. People put no money down, took out variable rate mortgages and the loan defaults began. Everyone now has to pay for that pandering error in judgment with lower housing values and harder to get credit.

Social Security is another program that leads to government dependence. It was created at a time when the life expectancy was much shorter and it was a safety net, not a retirement plan. It has now become for many their only retirement plan. Why save for your golden years when you can spend now and the government will provide you a paycheck when the time comes.

And, don’t forget welfare or Temporary Assistance to Needy Families as it’s more politely called. People used to take care of each other in hard times. We relied on family and church if things were dire. Then along came welfare and people learned that the more children you had the more money you received. Clinton tried to end that downward spiral by reforming the system, but the truth of the matter is that many life-long welfare recipients moved to Social Security in the form of means tested Social Security Insurance benefits (SSI.) They are deemed disabled, and there is little monitoring of their continued eligibility. Others spend their time and energy trying to find new ways to stay on benefits rather than using the assistance as a step up to independence. Welfare creates very few success stories. The cost of this program continues to expand, with no end in sight and no new reforms in the wings.

Finally, since it seems we haven’t learned that entitlements drain the life out of both their recipients and the economy, we have our President eager to dabble in healthcare reform. Rather than consider the example of Medicare, a program that grows more and more expensive each year, the President appears to subscribe to the idea that a government run option will reduce healthcare spending. He has already expanded SCHIP, the health insurance program for children whose parents earn too much to qualify for Medicaid. He will likely offer a government insurance option. Soon, to cut costs, rationing would start and again those entitled to this “free” insurance would suffer. Soon, so would the rest of us in the form of higher taxes and fewer and fewer private options until we are all in the same boat, our lives subject to what the government tells our doctor is appropriate treatment.

Social Security, welfare, misguided housing reforms have all trained people to look to the government for what they should provide for themselves. As our country’s entitlement programs grow ever larger and Obama seeks to add yet another large bureaucratic monstrosity in the form of healthcare reform, we must remember that entitlements depend on taxpayers to fund them. But what Congress and the President fail to realize is that the more they hand out to people, the fewer people will be out there working and paying the taxes that fund their “voter outreach.” Entitlements will become unsustainable. It’s better to pull the plug now, while the patient still has a chance on his own.