Obama: Health care law 'is here to stay' - POLITICO.com

Obama: Health care law 'is here to stay' - POLITICO.com

EXCERPTS:

"I'm running because I believe that in American no one should go bankrupt because they get sick," Obama said. To “try and move forward and make sure that every American has affordable health insurance and that the insurance companies are treating them fairly. That’s what we fought for, that’s what we're going to keep. We are moving forward.”

"We will not go back to the days when insurance companies pray on the sick," Obama said

QUESTIONS:

1.

Hospitals fight drug scarcity, fear patients harmed | Reuters

Hospitals fight drug scarcity, fear patients harmed | Reuters
 
WASHINGTON (Reuters) - At the Henry Ford Hospital in Detroit, pharmacists are using old-fashioned paper spreadsheets to track their stock of drugs in short supply - a task that takes several hours each day.
Most of the hospital's medicines - with usage estimated at $100 million a year - are tracked by automated systems that allow for quick reorders when the supply runs low. But these automated systems, designed to help the hospital avoid purchases and storage costs of unused pills and vials, do not work if it is uncertain when the next batch of drugs will come in.

A few hundred medicines make the list of drugs in short supply: anesthetics, drugs for nausea and nutrition, infection treatments and diarrhea pills. A separate list has scarce cancer drugs for leukemia or breast cancer.
"Now we have to go through the pharmacy and count those drugs on a daily basis ... to make sure we don't run out," said Ed Szandzik, director of pharmacy services at the hospital for over a decade.
The growing scarcity of sterile, injectable drugs is one of the biggest issues confronting hospitals across the country, and will be a key issue at the annual American Society of Clinical Oncology meeting in Chicago this weekend.
Health officials blame the shortages on industry consolidation that has left only a handful of generic manufacturers of these drugs, even as the number of drugs going off patent is growing. Some drugmakers have been plagued by manufacturing problems that have shut down multiple plants or production lines, while others have stopped producing a treatment when profit margins erode too far.
Some medicines have been periodically short in the past, doctors and pharmacists say, but the number of drug shortages has escalated in recent years, jumping from 56 in 2006 to 250 last year, according to U.S. Food and Drug Administration figures.
Generic drugmakers like U.S.-based Hospira Inc and Teva Pharmaceutical Industries, an Israeli company, say they are building new facilities to prevent future shortages.
But in the meantime, pharmacies around the country are counting pills, begging neighboring hospitals for extra supplies and scouring the Internet for news of additional supply disruptions.
When rumors surface of an impending shortage, some pharmacies rush to buy up more than they need, likely leading to bigger shortages, analysts and other pharmacists said.
All of this requires regular attention from hospitals to manage the crisis. At Children's National Medical Center in Washington, D.C., pharmacists and administrators meet weekly to discuss just how dire the situation is for different medicines.
"Every Wednesday before we have that (meeting), I have a bit of anxiety," said Ursula Tachie-Menson, acting chief of the hospital's pharmacy division. She spends about 30 percent of her time each week addressing shortage-related problems.
"Out of all the (21) years I have been practicing, these drug shortages have been one of the biggest challenges," she said.
EARLY WARNING SYSTEM
The FDA has been acting under an October executive order from President Barack Obama to fill in the gaps. It has had success getting an early warning from drug companies when they foresee a new shortage, allowing the agency to persuade other manufacturers to increase their production or look overseas to guarantee supply.
"I can tell you that there's not a single company I'm aware of out there that isn't talking to the FDA," said David Gaugh, head of regulatory sciences at the Generic Pharmaceutical Association, referring to the trade group's members.
The FDA said early notification has helped prevent shortages of 128 drugs in six months. It also estimates the rate of new shortages is slowing, with half the number of new scarce drugs this year compared with 2011.
There are currently about 130 drugs in short supply listed on the FDA's website.
But surveys and anecdotes keep piling up, showing doctors' efforts to find scarce drugs have not become easier. This month, a website for U.S. oncologists, MDLinx, surveyed 200 doctors and found more than 90 percent of them have experienced shortages of key cancer drugs.
CANCER, ANESTHESIA AND NUTRITION
A clinical nutrition group, the American Society for Parenteral and Enteral Nutrition (ASPEN), found that 70 percent of its 800 members who responded to an online survey, said they had seen shortages of adult injectable multi-vitamins, used for basic nutrition for patients with intestinal issues. ASPEN members responding to the survey included doctors, nurses and pharmacists.
More than a quarter were not giving their patients multi-vitamins because of the shortages, placing them at risk of severe vitamin deficiencies that can lead to issues like anemia, due to a lack of folate, or scurvy, which happens when people do not get vitamin C.
In extreme cases, a deficiency of a type of B vitamin called thiamine can lead to cardiac arrest or death.
"This is an act of daily living for people now," said Jay Mirtallo, president of the group. "How that can be acceptable, I don't understand."
When a drug is not available, doctors have to seek alternatives, which may not work as well or cost more money. Others have to ration limited supplies of a life-saving treatment to only those who need it most.
Dr. Steven Allen, a specialist in blood cancers at North Shore University Hospital in New York, recently treated a young woman who had suffered several relapses of a life-threatening cancer known as acute lymphoblastic leukemia.
Allen found a combination that involved thiotepa, an older drug his patient had not tried and could tolerate.
"When I ordered it, I was informed that there was none available, and it couldn't be obtained," said Allen, also chair of the committee on practice at the American Society of Hematology. He substituted a similar drug, but one that the woman had already taken. "We tried to make up a dose that was equivalent to thiotepa and hoped for the best. ... But I think it may have compromised her care."
On May 14, the FDA announced it would allow temporary imports of thiotepa made by Italian company Adienne Pharma & Biotech, to relieve manufacturing delays at Bedford, Ohio-based Bedford Laboratories, a unit of the private German company Boehringer Ingelheim that is the only approved manufacturer for the United States. Bedford said in April it did not know when further shipments would be available once its supplies ran out.
Imports have not helped anesthesiologists like Dr. Jason Soch, who hears about a new shortage nearly every week during his rotations at several surgical centers in Philadelphia. These are often "workhorse" drugs such as fentanyl, midazolam and propofol, used every day during surgery.
"It seems like as soon as one drug is no longer in shortage, we get an email from the hospital pharmacist that they're on their last box of another," he said.
Every disruption forces doctors to change dosing, or give new drug combinations they may not be as familiar with.
"I didn't envision this when I went to anesthesia," Soch said. "I'd figured we'd have whatever we needed."
SCRAMBLING FOR A FIX
The problem has inspired some creative solutions, like a drug shortages mobile application called RxShortages that allows medical and pharmacy staff to track new drug shortages posted on websites, including the FDA's. Mick Schroeder, a pharmacy resident who created the app, said it has been downloaded about 25,000 times.
Brooke Bernhardt, an oncology pharmacist at Texas Children's Hospital, said she checks RxShortages at least once a day.
"Unfortunately, at any point we expect a drug to go on back order," she said.
Szandzik, the pharmacy director at Henry Ford Hospital in Detroit, admits he would buy a larger quantity of drugs than usual if it became available.
"If I have to get one or two months' supply, I'll buy it, because our patients need it," he said. "Hoarding is in the eye of the beholder."
Some distributors and manufacturers prevent hoarding by allocating drugs based on historical demand. Other pharmacists say it is natural to want to buy more to ensure supply.
"Why did it ever have to get to this point in the first place?" Szandzik asked. "It takes a lot of hours, a lot of labor, a lot of luck to make sure our patients are safe. ... And I don't see it getting better for a while."
(Reporting by Anna Yukhananov; Editing by Michele Gershberg, Jackie Frank and Jan Paschal)

QUESTIONS:

1. Why you do you think there is a shortage of these drugs?
2. Did the article say anything about what has happened to the price of these drugs?
3. Based on what the article says, and doesn't say, who or what is being relied on to direct how resources in the drug sector of the economy will be used, government planners or market forces?
4. What would happen if producers of these drugs were free to charge whatever prices they wanted?

RealClearPolitics - Why U.S. Health Care Leads the Way

RealClearPolitics - Why U.S. Health Care Leads the Way

EXCERPT:

"In [the vision that prevails widely among the intelligentsia], people can draw on the available resources only to the extent that the government considers appropriate, in the light of other claims on those resources. This treats what the people have produced as if it automatically belongs to the government -- and as if politicians and bureaucrats have both the right and the wisdom to override the personal decisions that the people want to make for themselves.

"This issue involves a difference between a world in which people can make their own decisions with their own money and a world in which decisions -- including life and death medical decisions -- are taken out of the hands of millions of people across the country and put into the hands of politicians and bureaucrats in Washington.

"One of the big claims for government-run medical systems is that they can "bring down the cost of medical care." But anyone can bring down the cost of anything by simply buying a smaller quantity or a lower quality.

One state's hospital cost solution: regulated prices

EXCERPTS:

"The new federal health law has created a flurry of hospital mergers as the industry prepares for major changes in financing and delivery of care. Some worry that the resulting behemoths will have too much price-setting power.

In one state, however, monopoly pricing won’t be a problem. The state sets the prices.

For more than 30 years, Maryland has regulated the rates hospitals can charge, while all 49 other states have relied on market mechanisms to keep prices in check. For the most part, it has worked. The urban hospitals that serve large numbers of uninsured Maryland patients are financially strong, instead of nearly bankrupt like most inner-city hospitals. And everyone — private insurers, the uninsured, and those on Medicaid and Medicare—is charged the same amount.
Maryland has the lowest price in the country for average hospital cases — a little more than $13,000, compared to a national average of $32,500. The cost of health insurance in Maryland is second lowest in the nation as a percentage of median income.

Robert Murray, who as head of Maryland’s health services cost review commission is the state's chief regulator, admits that Maryland's “macro” regulation is not perfect. But he says it has put the state in an ideal position to provide incentives for the kind of highly coordinated and efficient care the federal health law is now calling for.Already, ten of the state’s 46 hospitals have volunteered for a program in which the state sets a flat, three-year budget based on current spending levels, and hospitals have the opportunity to use cost-cutting procedures to improve their bottom lines and reap higher profits. One such procedure involves providing caseworkers for patients who are discharged from the hospital to help them plan their care after leaving so they are less likely to be readmitted for preventable reasons.

Hospitals are supportive

A regulatory approach works in Maryland partly because all stakeholders — hospitals, doctors and patients — have bought into it. Carmela Coyle, president of the Maryland Hospital Association, says the state’s hospitals strongly support the system and work closely with Murray’s 29-person regulatory staff on a daily basis. It’s “equitable and predictable,” she says, and it ensures that everyone has access to high quality hospitals. Facilities in poor areas of Baltimore, for example, do not suffer disproportionate financial burdens.

“But the system is in need of modernization,” Coyle says. The biggest problem is that Maryland’s federal charter allows it to regulate only those services provided within a hospital building or campus. As more and more doctors set up outside operations such as ambulatory surgery centers, medical imaging and diagnostic testing in smaller facilities, regulated hospitals stand to lose business to these less-expensive providers.

Len Nichols, a health policy expert at George Mason University in Virginia, agrees. Effective cost regulation eventually would have to expand to cover these services, he says. Otherwise, it stands to become gradually less relevant to the real world. Even today, hospital services account for only one-third of all health care costs.

Still, says Murray, “Maryland has bent the cost curve over the last 30 years” without micromanaging. By setting separate spending maximums for each hospital, his small staff has been able to spread the cost of uncompensated care across the state’s $14 billion hospital industry. This has ensured that every hospital maintained profitability, although at relatively low margins. In addition, the state’s Medicaid program has not suffered the same kind of spiraling cost increases other states have experienced.

Deregulatory trend

Maryland hasn’t always been a lone regulator. In the mid 1970s, Massachusetts, New York and New Jersey also set hospital prices and fees. In the decade that followed, hospital expenditures in those places declined. Earlier in the 20th century, a majority of states imposed some form of price regulation on hospitals. Since then, however, state and federal health officials have opted for letting the market regulate prices, banking on increased competition among managed care and health maintenance organizations to keep costs down.

The American Hospital Association has argued that consolidation in the industry since the 1990s created economies of scale that have generated greater investment in technology and improved safety and quality. But critics say it has also resulted in runaway price escalation.

Whether other states will emulate Maryland’s system is an open question. Any attempt to invoke cost regulation relies heavily on the people involved and the voluntary cooperation of the state’s hospitals. That is not always easy to achieve. In the end, however, Murray insists that the regulatory approach relies on a simple concept: “It’s no surprise that when people try to stick to a budget, they tend to limit their needs. Hospitals are no different."

Rules Eased for Some Health Plans - WSJ.com

EXCERPTS:

"WASHINGTON—Amid pressure from employers, the Obama administration on Monday loosened rules for bare-bones health-insurance policies. It marks one of the administration's biggest steps to peel back regulations that big business found onerous under the health- care overhaul.
McDonald's Corp. had warned regulators it might have to drop its health-insurance plans for 30,000 hourly workers unless it got an exemption for these policies, which have low premiums but also limit payments for medical costs.
The administration's move underscores how businesses, after complaining loudly about the overhaul in the run-up to passage, are now winning a handful of modifications.
The change was part of sweeping new rules rolled out by the government Monday that will force insurers to spend a high portion of their premium revenue on medical care.
Consumers will reap some benefits. Insurers that don't meet the new standards will be forced to issue rebate checks, which the administration estimated could affect nearly nine million Americans, for a total payout of up to $1.4 billion.
The rules, codifying language in the health law, say insurers will be required to spend between 80% for smaller carriers and 85% for larger carriers of their revenue on medical care, a calculation known as a medical-loss ratio. That limits how much they put toward salaries, profit and other nonmedical costs.
Providers of "mini-med" policies, like McDonalds, which caps benefits at a low level, had objected that they would have trouble meeting those levels, in part because they have high administrative costs.
About 1.4 million Americans are covered under mini-med plans. They're typically offered by low-wage employers, who have high employee turnover and end up paying out little money in medical claims....
Democrats said eliminating plans with such limited coverage was the reason they passed the law in the first place.
But Obama administration officials said they were determined not to prompt any employers to drop their plans because of the law. "No one's going to lose their coverage," said Jay Angoff, a director at the Department of Health and Human Services.
***
"Starting in 2014, many low wage workers will shift to getting coverage inside new insurance exchanges, because that's where they can tap tax credits to offset their costs. Stricter rules for the minimum benefits that employers can offer are expected to displace the plans altogether.

McDonald's, 29 other firms get health care coverage waivers - USATODAY.com

EXCERPTS:

"Nearly a million workers won't get a consumer protection in the U.S. health reform law meant to cap insurance costs because the government exempted their employers.

Thirty companies and organizations, including McDonald's (MCD) and Jack in the Box (JACK), won't be required to raise the minimum annual benefit included in low-cost health plans, which are often used to cover part-time or low-wage employees.

The Department of Health and Human Services, which provided a list of exemptions, said it granted waivers in late September so workers with such plans wouldn't lose coverage from employers who might choose instead to drop health insurance altogether.

Without waivers, companies would have had to provide a minimum of $750,000 in coverage next year, increasing to $1.25 million in 2012, $2 million in 2013 and unlimited in 2014.

"The big political issue here is the president promised no one would lose the coverage they've got," says Robert Laszewski, chief executive officer of consulting company Health Policy and Strategy Associates. "Here we are a month before the election, and these companies represent 1 million people who would lose the coverage they've got."

COMMENT:

Note that the health reform law that almost caused these workers to lose their health insurance was not repealed. These 30 companies have been granted a waiver, but other employers are still required to comply. Someone who works for an employer in a similar situation, but who isn't able to persuade the government to grant them an waiver, has a problem.

Congress Can't Repeal Economics by John Stossel on Creators.com - A Syndicate Of Talent

EXCERPTS:

"It's raining! I don't like it! Why hasn't Congress passed the Good Weather Act and the Everybody Happy Act?

Sound dumb?

Why is it any dumber than a law called the Patient Protection and Affordable Care Act, which promised to cover more for less money?

When Obamacare was debated, we free-market advocates insisted that no matter what the president promised, the laws of economics cannot be repealed. Our opponents in effect answered, "Yes, we can."

Well, Obamacare has barely started taking effect, and the evidence is already rolling in. I hate to say we told them so, but ... we told them so. The laws of economics have struck back.

Health insurers Wellpoint, Cigna, Aetna, Humana and CoventryOne will stop writing policies for all children. Why? Because Obamacare requires that they insure already sick children for the same price as well children.

That sounds compassionate, but — in case Obamacare fanatics haven't noticed — sick children need more medical care. Insurance is about risk, and already sick children are 100 percent certain to be sick when their coverage begins. So if the government mandates that insurance companies cover sick children at the lower well-children price, insurers will quit the market rather than sandbag their shareholders. This is not callousness — it's fiduciary responsibility. Insurance companies are not charities. So, thanks to the compassionate Congress and president, parents of sick children will be saved from expensive insurance — by being unable to obtain any insurance! That's how government compassion works.

In 2014, the same rule will kick in for adults. You now know what to expect.

Not everyone agrees with Adam Smith

Donald Berwick, current head of the administrative agency which oversees Medicare and Medicaid, is an example.

Who Decides on Health Care Value? - WSJ.com

EXCERPTS:

"What would you think if bureaucrats confiscated your iPhone because they decided it didn't provide enough value? State regulators may help the federal government do just that to the health-care benefits of millions of Americans.

The most important element in implementing ObamaCare will be the requirement for health insurers to meet what is called a medical loss ratio. This requires health-insurance plans to split the dollars they receive from insurance premiums into two buckets.

Depending on the type of insurance coverage, 80% to 85% of premiums must be spent on either medical services or "activities that improve health care quality." This bucket includes everything from doctor visits, hospital stays and surgery to prescription drugs and medical equipment. It also includes programs to help patients cope with chronic diseases and reminders to take prescribed medications. The remaining 15% to 20% of premiums falls into a smaller bucket of "administrative" expenses like overhead, marketing, profits, compensation and agent commissions.

Regulators will soon decide which specific activities fall into which bucket. Forcing a wide range of services and benefits into the smaller administrative bucket puts them in direct competition with other critical aspects of a health insurer's business, as health plans will be compelled to cut back on those activities labeled "administrative" to meet new federal requirements. Plans will be forced to choose between priorities that benefit patients—such as preventing health-care fraud and reducing unnecessary services—and other priorities like creating new technological innovations or upgrading equipment....

Obama Warns Insurers on Rates - WSJ.com

EXCERPTS:

"President Barack Obama told health-insurance executives they should keep a lid on big rate increases, but the executives said some rises were unavoidable because the new health law requires them to offer better benefits.

Mr. Obama met with them the same day he touted new regulations released Tuesday, in line with the law's provisions, that lift limits on insurance coverage and prevent insurers from denying care to consumers.

***
In remarks afterward, the president ... said insurers should justify rate increases and shouldn't use the law to drive up rates in an "unreasonable" way, citing a proposed 39% rate increase by WellPoint's California subsidiary.


Insurance company executives, speaking after the meeting, said they couldn't be expected to improve customers' benefit packages as required by the law without charging more.
Ron Williams, chief executive of Aetna, cited the law's rule that insurers allow children to stay on their parents' plan until age 26. That rule "does increase costs, and that cost is going to show up in the premium increases," he said.


***
Starting next year, insurers must use at least 85% of premiums to pay for medical care for patients when they are selling to large employers, and 80% when they are selling to individuals and small employers. The remainder of premiums can go to administrative costs and profit.
Ms. Praeger said she was concerned some insurers will pull out of certain markets because they can't meet the requirement. An administration official said Health and Human Services Secretary Kathleen Sebelius indicated the law allows her to modify the regulations on a case-by-case basis if they would disrupt the market.

The new regulations released Tuesday cover four parts of the bill that take effect starting Sept. 23 or later. They prevent insurers from placing lifetime caps on insurance coverage and restrict the value of annual limits to no lower than $750,000 a year, with a gradual increase to $2 million a year by 2012. The law says insurers must accept children with pre-existing health conditions.

***
Mr. Obama called the rules a "patients' bill of rights," evoking Congress's failed attempt almost a decade ago to pass legislation ensuring basic medical rights and a fairer insurance appeals process. He criticized Republicans who want to repeal the law, citing four stories of Americans who were harmed by insurers.

"Anybody who favors repeal is welcome to come talk to these people and tell them why we should go back to the status quo prior to us signing this bill," he told an audience that included congressional Democrats and the insurance executives.

QUESTIONS:

1. When the government requires insurance companies to provide additional services how does this affect the company's costs?
2. If the insurance company's costs increase but it is not allowed to increase the price charged for its product, what consequences will result?
3. If the services included in an insurance policy, and the price that can be charged for the policy, are decided by someone in government, rather than by competition between insurance companies, do you think this change will benefit or hurt the average person? Defend your answer using economic concepts.

Doctors Chafe As Medicare Cuts Loom - WSJ.com

EXCERPTS:

"For more than two decades, internist Lee Antles has treated Medicare patients at his practice in Olympia, Wash. Last month, he started turning them away.

What pushed him over the edge was Congress's failure to end the looming threat—which no one expects to be carried through—of a 21% payment cut for doctors who participate in the seniors' insurance program. Last year, he and his wife, Margie, who manages the office, took home $55,000 before taxes.

Dr. Antles is considering quitting medicine and moving to Chicago, so his wife can return to a sales job that pays at least twice that much. "It just causes me such angst," he said. "It leaves 1,000 Medicare patients. Where do they go?"

The Senate could vote as soon as Wednesday to end debate on a bill to delay the cuts. But lawmakers are considering postponing them just through the year's end. A House bill that passed last month would delay the cuts through the end of 2011.

Repeated short-term fixes of the problem in recent years have left doctors frustrated and some, like Dr. Antles, are refusing to take new Medicare patients....

A "Duty to Die"? - Thomas Sowell

EXCERPTS:

"One of the many fashionable notions that have caught on among some of the intelligentsia is that old people have "a duty to die," rather than become a burden to others.... Already the government-run medical system in Britain is restricting what medications or treatments it will authorize for the elderly. Moreover, it seems almost certain that similar attempts to contain runaway costs will lead to similar policies when American medical care is taken over by the government.

Make no mistake about it, letting old people die is a lot cheaper than spending the kind of money required to keep them alive and well. If a government-run medical system is going to save any serious amount of money, it is almost certain to do so by sacrificing the elderly.

Health-Insurance Agents Can Expect Reduced Commissions - WSJ.com

EXCERPTS:

"Among the first to feel the effects of the nation's health-care system overhaul are insurance salespeople, whose commissions for selling policies are themselves getting overhauled.

The new law requires that insurers use at least 80% of the premiums to pay for medical care for patients rather than administrative costs and profit-taking. But many companies that sell health insurance to individuals and small businesses maintain a lower "medical loss ratio" because they use more of the premium to cover administrative expenses, including sales commissions.

The commissions typically run between 4% and 6% of a policy's premium, but can be as high as 30% for the first year.

A recent Senate report found that companies targeting the market for individual policies paid only 74% of their premiums for medical expenses in 2009, while firms that target large employers generally met the law's required ratio.

Healthcare and "Progressivism" - WSJ.com

"American Enterprise Institute senior fellow Christopher DeMuth, on the AEI Enterprise Blog:

Progressives believe that the natural course of history is the emergence of secular rationality as the true way to think about problems and of state power as the effective way to organize society along rational lines. If that is your worldview, then such things as revealed religion, cultural tradition, and the marketplace (whose outcomes are spontaneous, not rationalized) are vestiges of our primitive past, sure to be displaced by the spreading application of human reason. When liberal politicians describe themselves as 'progressives,' that is not just because 'liberal' has acquired unpopular connotations but because progressive is the more accurate word for their core beliefs....

The grip of progressivism is probably the best explanation for the Democratic Party's astonishing campaign to nationalize the U.S. healthcare sector by all means necessary. To attempt to enact a radical and unpopular program in a bill that includes many corrupt provisions, on a party-line vote and through a procedural trick (if the 'Slaughter solution' is employed) that seems clearly unconstitutional, appears quite mad and self-defeating to the outsider. But it is not mad ... to those who think it is ... historically inevitable that the government must administer medical care. In this view, the political actor is simply holding history's coat while it does its work. Political untidiness, even the loss of an election, are transitory considerations. The progressive mindset also explains, as more than populist demagoguery, the contempt that the proponents of ObamaCare exhibit for doctors and pharmaceutical and insurance companies—for they are the practitioners of a benighted form of health care that is about to be swept away by a new and higher form."

A Point of No Return? - Thomas Sowell

EXCERPT:

"With the passage of the legislation allowing the federal government to take control of the medical care system of the United States, a major turning point has been reached in the dismantling of the values and institutions of America.

Even the massive transfer of crucial decisions from millions of doctors and patients to Washington bureaucrats and advisory panels-- as momentous as that is-- does not measure the full impact of this largely unread and certainly unscrutinized legislation.

If the current legislation does not entail the transmission of all our individual medical records to Washington, it will take only an administrative regulation or, at most, an Executive Order of the President, to do that.

With politicians now having not only access to our most confidential records, and having the power of granting or withholding medical care needed to sustain ourselves or our loved ones, how many people will be bold enough to criticize our public servants, who will in fact have become our public masters?"

The Health-Care Wars Are Only Beginning - WSJ.com

EXCERPT:

"America will be in a constant health-care war if ObamaCare is enacted. Passage wouldn't end the health-care debate. Rather, it would perpetuate ObamaCare as the dominant issue for decades to come, reshape politics, create an annual funding crisis in Congress, and generate a spate of angry lawsuits. Yet few in Washington seem aware of what lies ahead."

The core irrationality of American health care - WSJ

EXCERPT:

The core irrationality "in American health care, something that economists have spent decades begging the political class to fix. Namely: "Because most consumers of health care are largely insulated from directly paying for the services they use, health care is generally perceived as an unlimited free good. . . . Wants and needs become insatiable when care is believed to be free."

"Mr. Battistella begins with the original sin of modern American health care: the government's World War II-era decision that gave businesses tax incentives to sponsor insurance for their workers but that did not extend the same dispensation to individuals. Since third parties were paying most of the bills—employers at first and eventually, with the creation of Medicare in 1965, the government as well— no one had any reason to be assiduous about controlling the cost of care. Patients always seemed to be spending someone else's money.

Alice in Medical Care: Part IV - Thomas Sowell

EXCERPT:

"The loss of one doctor-- even a very good doctor-- may not seem very important in the grand scheme of heady medical care "reform" and glittering phrases about "universal health care." But making the medical profession more of a hassle for doctors risks losing more doctors, while increasing the demand for treatment.

Alice in Health Care: Part III - Thomas Sowell

EXCERPT:

"If medical insurance simply covered risks-- which is what insurance is all about-- that would be far less expensive than covering completely predictable things like annual checkups. Far more people could afford medical insurance, thereby reducing the ranks of the uninsured.

But all the political incentives are for politicians to create mandates forcing insurance companies to cover an ever increasing range of treatments, and thereby forcing those who buy insurance to pay ever higher premiums to cover the costs of these mandates.

That way, politicians can play Santa Claus and make insurance companies play Scrooge. It is great political theater. Politicians who are pushing for a government-controlled medical care system say that it will "keep insurance companies honest." The very idea of politicians keeping other people honest ought to tell us what a farce this is. But if we keep buying it, they will keep selling it.

One of the ways of reducing the costs of medical insurance would be to pass federal legislation putting an end to state regulation of insurance companies. That would instantly eliminate thousands of state mandates, which force insurance to cover everything from wigs to marriage counseling, depending on which special interests are influential in which states.

It would also promote nationwide competition among insurance companies-- and competition keeps prices down better than politicians will. Moreover, competition can bring down the costs behind the prices, in part by forcing less efficient insurance companies out of business.

How Should Medicare Pay Doctors? : NPR

You really should listen to this whole interview. You get the feeling they were starting a program without first figuring out how it would really work, and how it would change incentives and behavior. They planned to get it started, then worry about the details. Sound familiar?

EXCERPT:

"CHANA JOFFE-WALT: In 1965, Joe Califano had to answer a question. He didn't know it was such a big question, or a question that would change the course of health care in American for the next five decades. It just seemed simple: How should the government pay doctors?

DAVID KESTENBAUM: Califano was President Lyndon Johnson's adviser for domestic affairs. And the government was about to get into the health insurance business in a huge way - about to launch the largest health insurance plan we've ever had: Medicare. But the idea made doctors nervous, so LBJ, Califano and lawmakers made what seemed like a small concession. The government told doctors: We will pay you for every procedure you do. How much will we pay you? Whatever you think is right.

JOFFE-WALT: Califano shakes his head describing that call now. But he says, look, the government needed doctors to participate. If doctors didn't accept Medicare, wouldn't see patients covered by Medicare, the whole thing would fail."