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2009-11-24T08:35:00.003-05:00

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The Misconception of Charity

2009-11-23T05:12:00.001-05:00

Now that the radical left has taken another step towards increasing healthcare costs, adding to our deficit and eliminating more of our liberties, individual freedoms, rights and responsibility, it might be a good time to read this from Dr. Cleveland who has a very good understanding and historical perspective.

The URL to the article: http://www.thefreemanonline.org/columns/the-immorality-of-government-mandated-health-care/

The Immorality of Government-Mandated Health CarePosted By Paul A. Cleveland

Dr. Cleveland is Professor of Economics and Finance at Birmingham-Southern College in Alabama.

As America’s politicians debate the issue of health-care reform, one element seems strangely missing from their deliberations: the question of the morality of government-mandated health insurance. Is it moral for government to institute such insurance or to force employers to provide it? The current debate assumes that it is. Discussion has centered primarily on how far coverage can be extended, with no effort to defend the morality of mandated coverage.

To examine the morality of the proposed health reform we must ask the following questions: What is the role of government and what are its moral bounds? Also, how do these bounds apply to the current health-care reform debate? If, in this examination, it is discovered that government has no proper authority to insure the availability of goods and services generally, then all health- care reform proposals seeking to establish the provision of health insurance should be rejected.

The uncritical acceptance of the proposition that a major purpose of government is to insure the provision of some goods or services is related to another popularly held proposition. That notion, either conscious or unconscious, is that government can miraculously generate resources to provide for people’s needs. But, how is that possible? Can government actually create material prosperity where none existed beforehand? Can it cause by fiat an increase in the number and kinds of products produced without harm? It should be self-evident that the answer to these questions is no. Government cannot create by mandate. It relies on its power of taxation and coercion to provide material benefits to selected citizens. In order for it to provide some benefit for an individual it must impose a cost of equal or greater value either on that individual or on someone else. Nevertheless, the mythical concept that government can provide cost-free benefits continues largely on the basis of wishful thinking and covetousness.

No Consumption Without Production

In reality there is no effortless production of anything. We can only consume that which is produced by the sweat of someone’s brow. Furthermore, our government was not primarily instituted for the purpose of production. Its primary role with respect to the economy is to punish people who use force and deceit for their own gain. History is testimony to the extent to which some individuals will inflict pain and hardship on others in order to obtain what they desire. Thus government’s primary role as an institution is to thwart this behavior by punishing the perpetrators of injustice. To that end, government uses force. Citizens are required to pay taxes to support the police function of government since society benefits from the ensuing order and peace which allow for civil relations among people.

Regrettably, this same force can be put to illegitimate ends. This occurs when the government begins to play favorites among the citizens by extending benefits to some while confiscating property or curbing the rights of others. The most obvious contemporary cases revolve around the many welfare programs established by the government. Benefits are extended to some by taxing away income from others. The costs of such benefits always exceed the costs of purchasing the benefits directly because of the bureaucratic overhead needed to administer the programs. Current health-care reform plans follow the same approach. Therefore, the question of the morality of any government provision of health care, or of mandated health insurance, can only be resolved by considering whether or not government redistribution of wealth is justified.

Do the Ends Justify the Means?

It is tempting to say that the ends aimed for are good and argue, therefore, that such government action is good. After all, what decent person would not desire to see some basic provision of food, clothing, or needed medical care provided for all those who could not pay? But to conclude that government intervention is good on this basis is to argue that the ends justify the means. The ends, in and of themselves, are not a sufficient reason for concluding that government provision of goods and services is just.

I recently had a conversation with a fellow professor about the health-care situation. My colleague expressed the common view. She argued that adequate health care is a right, “because we are human.” But such a statement begs the question: How does being human, in and of itself, generate any rights? It is clear that being human alone cannot justify any rights for humans. David Hume once noted that “the rules of morality are not the conclusions of our reason.” Therefore, if we carry Hume’s statement to its logical conclusion, we must conclude that if any human rights exist, they exist only as they have been endowed. Thus rights must be defined apart from ourselves. Ultimately they must be defined by the One who has the power of being in and of Himself, since He alone is in a position to establish such license. We are then dependent upon His proclamation of right and wrong to discern the rights of the individual. Apart from such an endowment, there are no rights! This view was expressed in the Declaration of Independence as well as many other writings and documents of the time.

Rights of Individuals

What are an individual’s rights? As expressed in the Declaration, the individual is endowed with the right to life, liberty, and pursuit of happiness. These rights allow each individual to use his talents and his property freely to the ends he personally has in mind so long as he does not violate the rights of others. In this context, people can voluntarily interact and trade with others on mutually agreeable terms to further their own interests.

The Judeo-Christian heritage substantially affirms this understanding of individual rights. The Bible requires its reader to respect the property rights of others. “Thou shall not steal,” [1] and, “Cursed is the man who moves his neighbor’s boundary stone,” [2] are its admonishments, in other places the Scriptures encourage hard work and honest dealings with others. Taken as a whole, the Bible prohibits the use of force to obtain what we wish to consume for ourselves. But this is exactly what transpires when government mandates a plan to provide health care services to everyone! As already shown, the government by definition employs force. It is a coercive institution. Thus when government begins the process of providing, or mandating the provision of, goods and services in society, it ceases to perform its primary function of thwarting and punishing wrongdoers and actually begins to participate in the very plunder that it was supposed to stop. By using force to take from one person in order to give to another, it is involved in stealing.

Why has government more and more compromised its position by engaging in legal plunder when it is clear that such action is wrong? There are two reasons. [3] The first is selfishness. People would rather have someone else pay for their consumption than work hard and purchase things for themselves. This is as true for health care as it is for any other consumable. This was demonstrated during the last presidential campaign when a man phoned a radio talk show. Bill Clinton was well ahead of George Bush in the polls and he had promised to bring about government-mandated universal health insurance. To this situation the man proclaimed, “I can’t wait ‘til Bill Clinton is elected president and gets his health-care reform through Congress. Then I won’t have to pray to God that my children don’t get sick.”

The caller had no intention of revealing his true character that day; but he did. In his proclamation we find a deeper problem. It is not that he lacks health insurance or that he cannot afford medical care. The real problem is that he does not want to pay for it himself. Rather, he wants someone else to pay, not as a matter of mercy shown to him, but as a matter of coercive force. Selfishness which leads to systematic thievery will destroy a nation. A nation can survive and prosper when there are a few thieves, but as more people leave productive endeavors to participate in government largess, production wanes and economic hardships increase. This is the inevitable outcome of all government schemes aimed at providing some benefit for some citizens at the expense of others.

The second is perhaps the most pervasive reason for the government’s drift toward promoting welfare programs in general, and for its current consideration of mandating the provision of universal health insurance. Americans have traditionally been compassionate. Generosity for those in need has been a hallmark feature of the American experience. Private charities, churches, nonprofit organizations, and the volunteerism associated with them have been a salient feature of our culture. Stated simply, the American people have a passion for helping out those in need. This spirit is the reason why most of our hospitals developed as nonprofit institutions. Yet it is this very passion which threatens to undermine the fabric of our society when charity is pursued by way of governmental mandate.

It is not hard to see how this situation can arise. At any given point in time, the available resources to meet our ends are always limited. That is, we can always imagine a better circumstance than the one we are presently in. If this is true for individuals, how much more true is it for voluntary groups seeking to do good? It is, therefore, easy to see the temptation facing people who desire to show mercy and compassion toward others: to use voluntary contributions to lobby for government action rather than devoting them directly to the cause in mind. If the efforts are successful, the organization can tap into the much larger pool of resources available in the public treasury to promote their cause. If passion for the cause blurs their vision, then they may well use government force and, as a result, inflict harm upon the neighbors they aim to help. Such is the state of American “do-goodism” in the twentieth century—coercive charity.

This movement has been greatly aided by the religious community. One cannot read the Bible for long without realizing that it calls its followers to show mercy and compassion toward others. As a result, well-meaning people have often pushed for government intervention because they see the public treasury as the only institution which has a pool of funds large enough to meet the need. However, the Bible never suggests that the government is the means through which mercy is to be shown. Actually, the evidence indicates that such action is more than inappropriate. When Satan offered to place Jesus in political control of the kingdoms of the earth, Jesus rejected the offer arguing that it was sin to have other gods above God.[4] Jesus understood that mercy and compassion are voluntary responses motivated by love and that no government is capable of forcing people to love their neighbors. He understood that any such attempts were nothing more than a false image intended to mimic the real thing.

National health-care insurance, or its mandated provision, is unjust. It is nothing more than a forced charity, which is no charity at all. In this vein we might flatter ourselves into believing that we are doing good works, but it simply is not true. True mercy is extended as a matter of voluntary choice. It is not forced. Government mandates which require some to provide for others is false philanthropy. It is fundamentally selfishness unleashed and it will thwart future prosperity. If health insurance is extended the quality of medical care will decline. The end result will be exactly the opposite of what such schemes purport to offer. Instead of provision and prosperity, pain and hardship will follow.

1. Exodus 20:15.

2. Deuteronomy 27:17.

3. Frederic Bastiat refers to these two r reasons for govern-meat involvement beyond its real purpose in his book, The Law (Irvington-on-Hudson, N.Y.: The Foundation for Economic Education, 1950).

4. See Luke 4:1-13.

Gore and the Little Girl

2009-11-20T05:17:00.000-05:00

Al Gore was seated next to a little girl on an airplane when the he turned to her and said, "Let's talk. I've heard that flights go quicker if you strike up a conversation with your fellow passenger."

The little girl, who had just opened her book, closed it slowly and said to Mr. Gore, "What would you like to talk about?"

"Oh, I don't know," said Gore. "How about global warming or universal health care?" and he smiled smugly.

"OK," she said. "Those could be interesting topics. But let me ask you a question first. A horse, a cow, and a deer all eat the same stuff -- grass. Yet a deer excretes little pellets, while a cow turns out a flat patty, and a horse produces clumps of dried grass. Why do you suppose that is?"

Mr. Gore, visibly surprised by the little girl's intelligence, thought about it and said, "Hmmm, I have no idea."

To which the little girl replied, "Do you really feel qualified to discuss global warming or universal health care when you don't know shit?"

In Over his Head

2009-11-19T05:14:00.000-05:00

We certainly don't often hear commentaries like this in our Obama-run media; so let's see what the Canadian Free Press is willing to publish. And you'll note the article was published in June. It has only gotten worse since then.

Obama's White House is Falling Down

By Daniel Greenfield Thursday, June 11, 2009

In the sixth month of his presidency, Obama has turned an economic downturn into an economic disaster, taking over and trashing entire companies, and driving the nation deep into deficit spending expected to pass 10 trillion dollars.

Abroad, Obama seems to have no other mode except to continue on with his endless campaign, confusing speechmaking with diplomacy. It is natural enough that Obama, who built his entire campaign on high profile public speeches reported on by an adoring press, understands how to do nothing else but that.

Ego driven photo op appearances and clueless treatment of foreign dignitaries

While the press is still chewing over Obama's Cairo speech, this celebrity style coverage ignores the fact that Obama's endless world tour is not actually accomplishing anything. Instead his combination of ego driven photo op appearances and clueless treatment of foreign dignitaries have alienated many of America 's traditional allies. Those who aren't being quietly angry at Obama, like Brown, Merkel or Netanyahu, instead think of him as as absurdly lightweight, as Sarkozy, King Abdullah or Putin do.

While his officials carry out their dirty economic deeds, Obama responds to any and every crisis as if it were a Mickey Rooney and Judy Garland musical, with a cry of, "Let's put on a show." Thus far Obama has put on "shows" across America , Europe and the Middle East . And what the adoring media coverage neglects to cover, is that Obama's shows have solved absolutely nothing. They have served only as high profile entertainment.

Neither alienating America 's traditional allies, through a combination of arrogant bullying and ignorance, nor appeasing America 's enemies, has yielded any actual results. Nor does it seem likely to. Islamic terrorism is not going anywhere, neither are the nuclear threats from North Korea and Iran .. While Obama keeps smiling, the global situation keeps growing more grim.

At home, if Obama was elected as depression era entertainment, the charm of his smiles and his constant appearances on magazine covers appear to be wearing thin on the American public. Despite the shrill attacks on Rush Limbaugh or the Republican Enemy of the Weak-- the Democratic party of 2009, is polling a lot like the Republican party of 2008. The Democrats have suddenly become the incumbents, and the only accomplishment they can point to is lavish deficit spending, often on behalf of the very same corporations and causes they once postured against.

The European Union Parliament's swing to the right cannot be credited to Obama, though doubtlessly some European voters seeing socialist economic crisis management on display in the world's richest country decided they wanted none of it, but it is part of a general turning against federalism. And Obama's entire program is dependent on heavily entrenching federalism at the expense of individual and state's rights. Yet that is precisely his achilles heel with independent voters who are polling against more taxes and expanded government. And no amount of speeches by Obama can wish away his 18 czars or the national debt he has foisted on generation after generation of the American people.

That leaves Obama with a choice between socialism and the independent voter. And thus far he has chosen socialism.

Obama's tactic of hijacking Bush Administration era policies on the economy and the War on Terror, and exploiting them as trojan horses to promote his own agenda, have left him coping with a backlash from his own party, as well as general Republican opposition.

His Czars are meant to function as the bones in an executive infrastructure accountable to no one, but a lack of accountability isn't just another word for tyranny, but for incompetence. A functional chain of command is accountable at multiple levels if it is to function effectively. Obama's White House by contrast is in a state of over-organized chaos, the sort of organized disorganization that undisciplined egotistical leftists naturally create for themselves, complete with multiple overlapping levels of authority and no one in charge but the man at the top, who's too busy doing other things to actually be in charge.

Dennis Blair as National Intelligence, who collaborated with the Muslim genocide of Christians in East Timor , trying to muscle out the CIA to create his own intelligence network, is typical of the kind of chaos being spawned by every chief in an expanding government bureaucracy working to make sure that all the Indians answer to him. Similarly the National Security Council wrestling with the State Department, highlighted by Samantha Power getting her own specially created NSC position to butt heads with Secretary of State Hillary Clinton, illustrates the state of conflict and chaos in American foreign affairs A state of chaos so pervasive that incompetence has now become commonplace, and no one can even be found to double check the spelling of a Russian word that is meant to be the theme of American's diplomatic reconstruction with Russia , or to pick out a gift for the visiting British Prime Minister.

The death of Chrysler at the hands of Fiat and the UAW

Meanwhile on the economy, Obama exploited the ongoing bailouts, transforming them from bailouts into takeovers meant to shift the balance of power in what had been a democracy and socially engineer not only corporations, but the lives of ordinary Americans. But the public's patience with corporate bailouts is at an end, most Americans were never happy with them to begin with, and want them to end. The death of Chrysler at the hands of Fiat and the UAW might look like a victory in the union ranks, but it doesn't play too well outside Detroit . And tacking on CAFE standards that will kill the pickup truck and the SUV will badly erode Obama in the swing states, if exploited properly in 2010 and 2012. Despite the constant media barrage, orchestrated out of the White House, the public is growing disenchanted with the performance of Obama and the Democrats.

With unemployment booming and the economy dropping, the jobs aren't there and the spending is out of control.. Republicans today are polling better on ethics and the economy, than the Democrats are. That shows a trend which is likely to register in the mid-term elections in 2010, in the same way that the EU parliamentary elections served as a shock to the system.

In the opposition, Republicans are free to embrace the rhetoric of change, to champion reform and push libertarian ideas about the size and scope of government. In turn all Obama has is his celebrity fueled media spectacle world tour. A charade now serving as a parallel to the depression era entertainment that functioned as escapism in a dour time. But before long, it may be Obama that the American public will want to escape from.

A shallow, manipulative and egotistical amateur who is in over his head

Obama has tried to play Lincoln, Reagan, JFK and FDR-- but in the end he can only play himself, a shallow, manipulative and egotistical amateur who is in over his head, and trying to drag the country down with him. Obama's White House is falling down and while the flashbulbs are still glittering and the parties are going on in D.C. and around the world, Obama and the Democratic Congress may be headed for a recession of their own.

Misleading at Best

2009-11-18T05:42:00.000-05:00

The Washington Post published this article in response to the ever-increasing false and misleading claims continually perpetuated by this disastrous administration.

Robert J. Samuelson - Robert J. Samuelson on health cost control - washingtonpost.com

There is an air of absurdity to what is mistakenly called "health-care reform." Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. As we recover slowly from a devastating recession, it's widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending and curb massive future deficits. The administration estimates these at $9 trillion from 2010 to 2019. The president and all his top economic advisers proclaim the same cautionary message.

So what do they do? Just the opposite. Their far-reaching overhaul of the health-care system -- which Congress is halfway toward enacting -- would almost certainly make matters worse. It would create new, open-ended medical entitlements that threaten higher deficits and would do little to suppress surging health costs. The disconnect between what President Obama says and what he's doing is so glaring that most people could not abide it. The president, his advisers and allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.

The campaign to pass Obama's health-care plan has assumed a false, though understandable, cloak of moral superiority. It's understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise for the public good.

It's false for two reasons. First, the country has other goals -- including preventing financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans -- that "health-care reform" would jeopardize. And second, the benefits of "reform" are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today's uninsured would be modest. They already receive substantial medical care. Insurance would help some individuals enormously, but studies find that, on average, gains are moderate. Despite using more health services, people don't automatically become healthier.

The pretense of moral superiority further erodes before all the expedient deceptions used to sell Obama's health-care agenda. The president says that he won't sign legislation that adds to the deficit. One way to accomplish this is to put costs outside the legislation. So: Doctors have long complained that their Medicare reimbursements are too low; the fix for replacing the present formula would cost $210 billion over a decade, estimates the Congressional Budget Office. That cost was originally in the "health reform" legislation. Now, it's been moved to another bill but, because there's no means to pay for it (higher taxes or spending cuts), deficits would increase.
Another way to disguise the costs is to count savings that, though they exist on paper, will probably never be realized in practice. So: The House bill is credited with reductions in Medicare reimbursements for hospitals and other providers of $228 billion over a decade. But Congress has often prescribed reimbursement cuts that, under pressure from squeezed providers, it has later rescinded. Claims of "fiscal responsibility" for the health-care proposals reflect "assumptions that are totally unrealistic based on past history," says David Walker, former U.S. comptroller general and now head of the Peter G. Peterson Foundation.

Equally misleading, Obama's top economic advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group for the Peterson Foundation and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with the effect of no legislation. The studies variously estimate that the extra spending, over the next decade, would be $750 billion, $525 billion and $114 billion. The reasoning: Greater use of the health-care system by the newly insured would overwhelm cost-saving measures (bundled payments, comparative effectiveness research, tort reform), which are either weak or experimental.

Though these estimates could prove wrong, they are more plausible than the administration's self-serving claims. Its health-care plan is not "comprehensive," as Obama and the New York Times (in its news columns) assert, because it slights cost control. Obama chose to emphasize the politically appealing path of expanding benefits rather than first attending to the harder and more urgent task of controlling spending. If new spending commitments worsen some future budget or financial crisis, Obama's proposal certainly won't qualify as "reform," as the president and The Post (also in its news columns) call it. It's more like malpractice: a self-inflicted wound.

More Deceptive Talk

2009-11-17T05:31:00.001-05:00

Yes our illustrious president continues to make false claims on this healthcare legislation.

On November 7th, President Obama made the following statement about the Pelosi plan. “The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality, affordable options for those who don’t; and bring down the cost of health care for families, businesses, and our government, while strengthening the financial health of Medicare.”

But once again, his claims are being challenged and disputed. This time it is by the non-partisan and independent Centers for Medicare and Medicaid Services (CMS) which is the agency in charge of running Medicare and Medicaid. They basically refute every claim he has made. The summary is as follows:

Health Care Costs Increase: “In aggregate, we estimate that for calendar years 2010 through 2019 [national health expenditures (NHE)] would increase by $289 billion, or 0.8 percent, over the updates baseline projection that was released on June 29, 2009.” In summary, Obamacare will cost more; not less

Millions Lose Existing Private Coverage: “However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchange. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their - and their employees’ - advantage to end their plans … We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 12 million.” In summary and as we have continually stated, Obamacare will cause millions of Americans to lose their existing private coverage.

Millions Pay Fines Yet Remain Uncovered: “18 million are estimated to choose not to be insured and to pay the penalty associated with the individual mandate. For the most part, these would be individuals with relatively low health care expenses for whom the individual or family insurance premium would be significantly in excess of the penalty and their anticipated health benefit value.” In summary, 18 million Americans will either face jail time or be forced to pay a new tax they will receive no benefit from.

Millions Lose Medicare Advantage: “Section 1161 of Division B of H.R. 3962 would set Medicare Advantage capitation benchmarks. We estimate that in 2014 when the MA provisions would be fully phased in, enrollment in MA plans would decreased by 64 percent (from its projected level of 13.2 million under current law to 4.7 million under the proposal).” In summary, 8.5 million seniors who currently get such services as coordinated care for chronic conditions, routine eye and hearing examinations, and preventive-care services would lose their existing private coverage.

Millions Placed on Welfare: “Of the additional 34 million who are estimated to be insured in 2019 as a result of H.R. 3962, about three-fifths (21 million) would receive Medicaid coverage due to the expansion of eligibility to those adults under 150 percent of the FPL.” In summary; more than half the people who gain health insurance will receive it through the welfare program Medicaid which is already broke in most states, has limited physicians who accept it and it will add millions of dollars to State’s expenses which will ultimately lead to more state taxes.

Seniors Access to Care Jeopardized: “H.R. 3962 would introduce permanent annual productivity adjustments to price updates for institutional providers… Over time, a sustained reduction in payment updates, based on productivity expectations that are difficult to attain, would cause Medicare payment rates to grow more slowly than and in a way that was unrelated to, the providers’ costs of furnishing services to beneficiaries. Thus, providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and might end their participation in the program (possibly jeopardizing access to care for beneficiaries).” In summary; the Medicare cuts in the House bill are so out of touch with reality that hospitals currently serving Medicare patients might be forced to stop doing so. Thus making it much more difficult for seniors to get health care.

Poor’s Access Problems Exacerbated: “In practice, supply constraints might interfere with providing the services by the additional 34 million insured persons. …providers might tend to accept more patients who have private insurance (with relatively attractive payment rates) and fewer Medicaid patients, exacerbating existing access problems for the latter group.” In summary; those 21 million people who are gaining health insurance through Medicaid are going to have a very tough time finding a doctor who will treat them. This is especially true here in Indiana.

So the questions remains; Is Obama and his staff engaging in outright lies, are they just incompetent or are they trying to deceive the public for other reasons.

The blatant contradictions between what they say and what is truthful cannot be overlooked any longer.

**see www.Heritage.org

Looking from the outside

2009-11-16T05:45:00.000-05:00

This article originally appeared in Pravda. American capitalism gone with a whimper - Pravda.Ru

It is interesting to see how some people from other countries can look at what is going on with the USA and see so clearly what is happening.

It is like families not recognizing the subtle changes with a family member when we see them every day but another relative who has not seen them everyday notices the significant change.

American Capitalism Gone With a Whimper
by Stanislav Mishin

It must be said, that like the breaking of a great dam, the American descent into Marxism is happening with breathtaking speed, against the backdrop of a passive, hapless sheeple, excuse me dear reader, I meant people.

True, the situation has been well prepared on and off for the past century, especially the past twenty years. The initial testing grounds was conducted upon our Holy Russia and a bloody test it was. But we Russians would not just roll over and give up our freedoms and our souls, no matter how much money Wall Street poured into the fists of the Marxists.

Those lessons were taken and used to properly prepare the American populace for the surrender of their freedoms and souls, to the whims of their elites and betters.

First, the population was dumbed down through a politicized and substandard education system based on pop culture, rather then the classics. Americans know more about their favorite TV dramas then the drama in DC that directly affects their lives. They care more for their "right" to choke down a McDonalds burger or a BurgerKing burger than for their constitutional rights. Then they turn around and lecture us about our rights and about our "democracy". Pride blinds the foolish.

Then their faith in God was destroyed, until their churches, all tens of thousands of different "branches and denominations" were for the most part little more then Sunday circuses and their televangelists and top protestant mega-preachers were more then happy to sell out their souls and flocks to be on the "winning" side of one pseudo-Marxist politician or another. Their flocks may complain, but when explained that they would be on the "winning" side, their flocks were ever so quick to reject Christ in hopes for earthly power. Even our Holy Orthodox churches are scandalously liberalized in America.

The final collapse has come with the election of Barack Obama. His speed in the past three months has been truly impressive. His spending and money printing has been record setting, not just in America's short history but in the world. If this keeps up for more then another year, and there is no sign that it will not, America at best will resemble the Weimar Republic and at worst Zimbabwe.

These past two weeks have been the most breathtaking of all. First came the announcement of a planned redesign of the American Byzantine tax system, by the very thieves who used it to bankroll their thefts, loses and swindles of hundreds of billions of dollars. These make our Russian oligarchs look little more then ordinary street thugs, in comparison. Yes, the Americans have beaten our own thieves in the shear volumes. Should we congratulate them?
These men, of course, are not an elected panel but made up of appointees picked from the very financial oligarchs and their henchmen who are now gorging themselves on trillions of American dollars, in one bailout after another. They are also usurping the rights, duties and powers of the American congress (parliament). Again, congress has put up little more then a whimper to their masters.

Then came Barack Obama's command that GM's (General Motors) president step down from leadership of his company. That is correct, dear reader, in the land of "pure" free markets, the American president now has the power, the self-given power, to fire CEOs and we can assume other employees of private companies, at will. Come hither, go dither, the centurion commands his minions.

So it should be no surprise, that the American president has followed this up with a "bold" move of declaring that he and another group of unelected, chosen stooges will now redesign the entire automotive industry and will even be the guarantee of automobile policies. I am sure that if given the chance, they would happily try and redesign it for the whole of the world, too. Prime Minister Putin, less then two months ago, warned Obama and UK's Blair, not to follow the path to Marxism, it only leads to disaster. Apparently, even though we suffered 70 years of this Western-sponsored horror show, we know nothing, as foolish, drunken Russians, so let our "wise" Anglo-Saxon fools find out the folly of their own pride.
Again, the American public has taken this with barely a whimper...but a "freeman" whimper.
So, should it be any surprise to discover that the Democratically controlled Congress of America is working on passing a new regulation that would give the American Treasury department the power to set "fair" maximum salaries, evaluate performance and control how private companies give out pay raises and bonuses? Senator Barney Franks, a social pervert basking in his homosexuality (of course, amongst the modern, enlightened American societal norm, as well as that of the general West, homosexuality is not only not a looked-down-upon life choice, but is often praised as a virtue) and his Marxist enlightenment, has led this effort. He stresses that this only affects companies that receive government monies, but it is retroactive and taken to a logical extreme, this would include any company or industry that has ever received a tax break or incentive.

The Russian owners of American companies and industries should look thoughtfully at this and the option of closing their facilities down and fleeing the land of the Red as fast as possible. In other words, divest while there is still value left.

The proud American will go down into his slavery with out a fight, beating his chest and proclaiming to the world, how free he really is. The world will only snicker.

The Liberal Difference

2009-11-13T05:30:00.002-05:00

If a conservative doesn't like guns, they don't buy one. If a liberal doesn't like guns, then no one should have one.

If a conservative is a vegetarian, they don't eat meat. If a liberal is, they want to ban all meat products for everyone.

If a conservative sees a foreign threat, he thinks about how to defeat his enemy. A liberal wonders how to surrender gracefully and still look good.

If a conservative is homosexual, they quietly live their life. If a liberal is homosexual, they loudly demand legislated respect.

If a black man or Hispanic is conservative, they see themselves as independently successful. Their liberal counterparts see themselves as victims in need of government protection.

If a conservative is down-and-out, he thinks about how to better his situation. A liberal wonders who is going to take care of him.

If a conservative doesn't like a talk show host, he switches channels. Liberals demand that those they don't like be shut down.

If a conservative is a non-believer, he doesn't go to church. A liberal wants any mention of God or religion silenced.

If a conservative decides he needs health care, he goes about shopping for it, or he may choose a job that provides it. A liberal demands that his neighbors pay for his.

**original source unknown

The Congress Healthcare Plan

2009-11-12T05:46:00.000-05:00

As the Elitists in congress continue to jeopardize the average Americans healthcare, let’s see what they have. The following is an op-ed that pretty much sums up the mentality of the Liberal Democrats.

Congress Keeps Gold-Plated Health Care... For Themselves

by Jillian Bandes

Personal doctors on call 24/7. Coverage that knows no caps. No exemptions for pre-existing conditions.

Those are the sorts of benefits members of Congress currently enjoy on the taxpayer’s dime, and the kinds of benefits Americans on a government-run public health care plan will never see if Obamacare passes.

“One thing is certain: Congress will exempt itself from whatever lousy health care system it forces on us little people,” said Michael Cannon, director of health policy studies at the Cato Institute. “Congress will get better insurance than you do because politicians always get a better deal under government-run health care.”

While it’s not news that Congressional health insurance plans are posh, CBS News recently uncovered the details of plans – right as the details of the Baucus health care bill are being hashed out.

Members of Congress can choose from five different plans, and have access to both the VIP Bethesda Naval Hospital and a reserved spot Ward 72 at Walter Reed Army Medical Center, an elite division usually reserved for military members. Their everyday medical concerns can be taken care of at a doctors office located inside of Congress.

Their premiums are the same as those of insurance plans with half the benefits, and the plans last a lifetime; not until Medicare kicks in do ex-Members or loose their Congressional health benefits. Congress has repeatedly voted down any provision that would switch their insurance plans to the lower-grade public option if Obamacare goes through.

Helen Evans, the director of Nurses for Reform, a campaign for more consumer-led, sustainable healthcare systems in Britain, said that this sort of elite care for the bureaucracy – and low-brow care for the plebes – is the same thing that happens in the government-run British health care system.

“Independent academic research has shown that on average the professional and managerial types obtain 40% more resource per illness episode than lower down the social spectrum” in Britain, she said.

Evans is certain that the exact same thing would happen in the U.S. if Obamacare was installed.
“The National Health Service, is famous for being a highly politicised bureaucracy that whilst it legitimises itself on the basis of equality favours the powerful, articulate and well connected,” she said. Nurses for Reform is unsurprised that American politicians are pushing for government-run health care “while of course attempting to secretly perpetuate their own elitist system funded by ordinary taxpayers.”

At least one U.S. Congressman is speaking out.

"If we pass a law that says a public option will be made available, I think people like myself should get out of this plan and go into the public option," Sen. Lindsey Graham, (R-S.C.), told CBS.

The Real Costs

2009-11-11T05:30:00.000-05:00

Dick Morris succinctly describes some of the costs to the American people with the Baucus bill that is being proposed. Dick Morris and Eileen McGann : How Much Obamacare Costs the Average Family - Townhall.com

My question to those for this reform is this;

If you cannot afford health insurance now or cannot afford it for your employees, how in the world are you going to come up with the money when it is mandated?

Whether or not you now have health insurance, Obama’s health care bill will cost you dearly.
If you don’t have insurance, you will be required to buy it. The legislation specifies how much you will have to pay for the coverage before any subsidy kicks in. All during the campaign, Obama kept speaking about affordable coverage. Now it appears that his definition of “affordable” might be a bit elastic.

If your household income is $66,000 a year, slightly above the national average, Obama’s health care bill will require you to spend 12 percent of your income -- about $8,000 a year or almost $700 a month -- to buy health insurance before you get any federal subsidy.

Even those making less will have to reach deep into their meager resources to satisfy Obama’s statutory requirement. Families scraping by on only $44,0000 a year will have to pay 7 percent of their income (about $3,000) on insurance. Even those making just $33,000 will have to ante up 4.5 percent of their income (about $1,500) for health insurance. The required payments reach so far down the scale that those who are living at the federal poverty level of $22,000 will have to shell out 2 percent of their totally inadequate incomes ($440) for insurance.

That Obama is charging premiums to those living at or on the border of poverty is absolutely incredible! And this from a candidate who pledged that he would not tax the middle class!
If you have insurance, you will get hit by his proposed 40 percent tax on insurance premiums.
When the tax -- and the legislation -- takes effect in 2013, all families making about $120,000 or more in combined household income (14 percent of all families or one in seven) will have to pay the tax.

By the next year, 2014, the tax will hit every family making more than $100,000 (about 18 percent of all families or one in six).

By 2019, 10 years hence, the tax will reach down to affect every family making more than $75,000 a year (31 percent of families or one in three).

The tax will take 40 percent of all premiums above $21,000.

So if you don’t have insurance, you will be socked with a mandate to buy coverage and pay a hefty proportion of your income to do it; and if you have insurance, you will be hit with an excise tax on the coverage.

(In theory, it is the insurance companies that have to pay the tax, but the Senate Finance Committee “assumes” that they will pass the tax along to their policyholders).

These costs make a mockery of Obama’s oft-repeated pledge to avoid any tax increase that would impact those making under $250,000 a year. He finances about half of his health care plan on the backs of the elderly by cutting Medicare and inducing scarcity and the other half by premium taxes and insurance purchasing mandates on the middle and lower middle class.

More Democratic Meddling

2009-11-10T05:40:00.000-05:00

We can never say the Democrats don’t seize every available opportunity to sock it to the business owners.

In this article, we see that some Democrats want to force employers to pay for sick days for employees if they are off with the H1N1 virus or other diseases.

Proposed law would require pay for sick workers Health Reuters

The emergency law would cover pandemic H1N1 flu or any other infectious disease, said California Representative George Miller, a Democrat who chairs the House Education and Labor Committee and who introduced the bill.

Well let’s think about this. What is an infectious disease? We have things like strep throat, pink eye, gonorrhea and Chlamydia, most diarrheal illnesses and virtually thousands of others that would fall into this category.

Are employers now supposed to pay employees for all of these illnesses?

When are these intrusive government mandates going to end?

No Apologies

2009-11-09T05:32:00.000-05:00

In varying places around Europe lie thousands of Americans who made the ultimate sacrifice for their country.

They are buried, row upon row, under simple white crosses or Stars of David in cemeteries in Belgium, England, France, Luxembourg, Italy and the Netherlands.

They died far from home in battles and operations known as Belleau Wood, the Somme, the Meuse-Argonne Offensive in World War I, or D-Day, Anzio and the Battle of the Bulge in World War II.

As the living memories of these battles fade, these cemeteries are what’s left to remind us of their sacrifice.

More than 100,000 soldiers, sailors, airmen and Marines are buried in these cemeteries, looked after by the American Battle Monument Commission.

It is frustrating and disheartening to hear our President and the Democratic leadership apologize for the role Americans have played in shaping history.

Here is a list of our European arrogance in alphabetical order:

1. The American Cemetery at Maine-marine, France. A total of 2289 of our military dead.

2. The American Cemetery at Ardennes, Belgium. A total of 5329 of our dead.

3. The American Cemetery at Brittany, France. A total of 4410 of our military dead. Excuse us.

4. Brookwood, England American Cemetery. A total of 468 of our dead.

5. Cambridge, England. 3812 of our military dead.

6. Epinal, France American Cemetery. A total of 5525 of our Military dead.

7. Flanders Field, Belgium. A total of 368 of our military.

8. Florence, Italy. A total of 4402 of our military dead.

9. Henri-Chapelle, Belgium. A total of 7992 of our military dead.

10. Lorraine, France. A total of 10,489 of our military dead.

11. Luxembourg, Luxembourg. A total of 5076 of our military dead.

12. Meuse-Argonne. A total of 14246 of our military dead..

13. Netherlands, Netherlands. A total of 8301 of our military dead..

14. Normandy, France. A total of 9387 of our military dead.

15. Oise-Aisne, France.. A total of 6012 of our military dead.

16. Rhone, France. A total of 861 of our military dead.

17. Sicily, Italy. A total of 7861 of our military dead.

18. Somme, France. A total of 1844 of our military dead.

19. St. Mihiel, France. A total of 4153 of our military dead.

20. Suresnes, France. A total of 1541 of our military dead.

We should apologize to no one. What we should do is remind those of our sacrifice and don't confuse arrogance with leadership.

The count is 104,366 dead.

Disappointment cannot begin to describe the feelings when we watch an American elected leader apologize to Europe and the Middle East that our country is "arrogant"!

We really should ask this question: How many French, Dutch, Italians, Belgians and Brits are buried on our soil, defending us against our enemies?

AMERICANS DON'T ASK FOR PRAISE ... BUT WE HAVE ABSOULUTELY NO NEED TO APOLOGIZE!!

The Obama Tablet

2009-11-06T05:46:00.001-05:00

Here is the newest prescription the radical left wing and "The One" will be mandating that we all take.

I for one won't be prescribing it!!

Reasons for Hope

2009-11-05T05:35:00.000-05:00

Tuesday’s election certainly gives many conservatives hope that the radical left agenda will not be shoved down our throats without a fight.

Conservatives took two Governor’s races in New Jersey and Virginia by substantial margins. GOP sweep: Big governor victories in Virginia, NJ - Yahoo! News

Conservatives also defeated gay marriage in the very liberal state of Maine
Dejection fills ballroom after gay marriage vote - Yahoo! News

This will hopefully send a very clear message to moderates that pushing through this horrible and radical healthcare takeover will not set well with the voters.

We’ll continue to pray for an even better showing for the 2010 midterm elections.

Even “The One” couldn’t bring home the election for Corzine.

What a great way to head into the weekend.

Lessons from the past

2009-11-04T05:35:00.001-05:00

By Colonel David Crockett; Compiled by Edward S. Ellis

One day in the House of Representatives, a bill was taken up appropriating money for the benefit of a widow of a distinguished naval officer. Several beautiful speeches had been made in its support. The Speaker was just about to put the question when Crockett arose:

“Mr. Speaker–I have as much respect for the memory of the deceased, and as much sympathy for the sufferings of the living, if suffering there be, as any man in this House, but we must not permit our respect for the dead or our sympathy for a part of the living to lead us into an act of injustice to the balance of the living. I will not go into an argument to prove that Congress has no power to appropriate this money as an act of charity. Every member upon this floor knows it.

We have the right, as individuals, to give away as much of our own money as we please in charity; but as members of Congress we have no right so to appropriate a dollar of the public money. Some eloquent appeals have been made to us upon the ground that it is a debt due the deceased. Mr. Speaker, the deceased lived long after the close of the war; he was in office to the day of his death, and I have never heard that the government was in arrears to him.

Every man in this House knows it is not a debt. We cannot, without the grossest corruption, appropriate this money as the payment of a debt. We have not the semblance of authority to appropriate it as a charity. Mr. Speaker, I have said we have the right to give as much money of our own as we please. I am the poorest man on this floor. I cannot vote for this bill, but I will give one week’s pay to the object, and if every member of Congress will do the same, it will amount to more than the bill asks.”

He took his seat. Nobody replied. The bill was put upon its passage, and, instead of passing unanimously, as was generally supposed, and as, no doubt, it would, but for that speech, it received but few votes, and, of course, was lost.

Later, when asked by a friend why he had opposed the appropriation, Crockett gave this explanation:

“Several years ago I was one evening standing on the steps of the Capitol with some other members of Congress, when our attention was attracted by a great light over in Georgetown . It was evidently a large fire. We jumped into a hack and drove over as fast as we could. In spite of all that could be done, many houses were burned and many families made homeless, and, besides, some of them had lost all but the clothes they had on. The weather was very cold, and when I saw so many women and children suffering, I felt that something ought to be done for them. The next morning a bill was introduced appropriating $20,000 for their relief. We put aside all other business and rushed it through as soon as it could be done.

“The next summer, when it began to be time to think about the election, I concluded I would take a scout around among the boys of my district. I had no opposition there, but, as the election was some time off, I did not know what might turn up. When riding one day in a part of my district in which I was more of a stranger than any other, I saw a man in a field plowing and coming toward the road. I gauged my gait so that we should meet as he came to the fence. As he came up, I spoke to the man. He replied politely, but, as I thought, rather coldly.

“I began: ‘Well, friend, I am one of those unfortunate beings called candidates, and–’
“‘Yes, I know you; you are Colonel Crockett, I have seen you once before, and voted for you the last time you were elected. I suppose you are out electioneering now, but you had better not waste your time or mine. I shall not vote for you again.’

“This was a sockdolager . . . I begged him to tell me what was the matter.

“‘Well, Colonel, it is hardly worth-while to waste time or words upon it. I do not see how it can be mended, but you gave a vote last winter which shows that either you have not capacity to understand the Constitution, or that you are wanting in the honesty and firmness to be guided by it. In either case you are not the man to represent me. But I beg your pardon for expressing it in that way. I did not intend to avail myself of the privilege of the constituent to speak plainly to a candidate for the purpose of insulting or wounding you. I intend by it only to say that your understanding of the Constitution is very different from mine; and I will say to you what, but for my rudeness, I should not have said, that I believe you to be honest. . . . But an understanding of the Constitution different from mine I cannot overlook, because the Constitution, to be worth anything, must be held sacred, and rigidly observed in all its provisions. The man who wields power and misinterprets it is the more dangerous the more honest he is.’

“‘I admit the truth of all you say, but there must be some mistake about it, for I do not remember that I gave any vote last winter upon any constitutional question.’

“‘No, Colonel, there’s no mistake. Though I live here in the backwoods and seldom go from home, I take the papers from Washington and read very carefully all the proceedings of Congress. My papers say that last winter you voted for a bill to appropriate $20,000 to some sufferers by a fire in Georgetown . Is that true?’

“‘Well, my friend; I may as well own up. You have got me there. But certainly nobody will complain that a great and rich country like ours should give the insignificant sum of $20,000 to relieve its suffering women and children, particularly with a full and overflowing Treasury, and I am sure, if you had been there, you would have done just as I did.’

“‘It is not the amount, Colonel, that I complain of; it is the principle. In the first place, the government ought to have in the Treasury no more than enough for its legitimate purposes. But that has nothing to do with the question. The power of collecting and disbursing money at pleasure is the most dangerous power that can be intrusted to man, particularly under our system of collecting revenue by a tariff, which reaches every man in the country, no matter how poor he may be, and the poorer he is the more he pays in proportion to his means. What is worse, it presses upon him without his knowledge where the weight centers, for there is not a man in the United States who can ever guess how much he pays to the government. So you see, that while you are contributing to relieve one, you are drawing it from thousands who are even worse off than he. If you had the right to give anything, the amount was simply a matter of discretion with you, and you had as much right to give $20,000,000 as $20,000. If you have the right to give to one, you have the right to give to all; and, as the Constitution neither defines charity nor stipulates the amount, you are at liberty to give to any and everything which you may believe, or profess to believe, is a charity, and to any amount you may think proper. You will very easily perceive what a wide door this would open for fraud and corruption and favoritism, on the one hand, and for robbing the people on the other. No, Colonel, Congress has no right to give charity. Individual members may give as much of their own money as they please, but they have no right to touch a dollar of the public money for that purpose. If twice as many houses had been burned in this county as in Georgetown , neither you nor any other member of Congress would have thought of appropriating a dollar for our relief. There are about two hundred and forty members of Congress. If they had shown their sympathy for the sufferers by contributing each one week’s pay, it would have made over $13,000. There are plenty of wealthy men in and around Washington who could have given $20,000 without depriving themselves of even a luxury of life. The congressmen chose to keep their own money, which, if reports be true, some of them spend not very creditably; and the people about Washington , no doubt, applauded you for relieving them from the necessity of giving by giving what was not yours to give. The people have delegated to Congress, by the Constitution, the power to do certain things. To do these, it is authorized to collect and pay moneys, and for nothing else. Everything beyond this is usurpation, and a violation of the Constitution.

“‘So you see, Colonel, you have violated the Constitution in what I consider a vital point. It is a precedent fraught with danger to the country, for when Congress once begins to stretch its power beyond the limits of the Constitution, there is no limit to it, and no security for the people. I have no doubt you acted honestly, but that does not make it any better, except as far as you are personally concerned, and you see that I cannot vote for you.’

“I tell you I felt streaked. I saw if I should have opposition, and this man should go to talking, he would set others to talking, and in that district I was a gone fawn-skin. I could not answer him, and the fact is, I was so fully convinced that he was right, I did not want to. But I must satisfy him, and I said to him:

“‘Well, my friend, you hit the nail upon the head when you said I had not sense enough to understand the Constitution. I intended to be guided by it, and thought I had studied it fully. I have heard many speeches in Congress about the powers of Congress, but what you have said here at your plow has got more hard, sound sense in it than all the fine speeches I ever heard. If I had ever taken the view of it that you have, I would have put my head into the fire before I would have given that vote; and if you will forgive me and vote for me again, if I ever vote for another unconstitutional law I wish I may be shot.’

“He laughingly replied: ‘Yes, Colonel, you have sworn to that once before, but I will trust you again upon one condition. You say that you are convinced that your vote was wrong. Your acknowledgment of it will do more good than beating you for it. If, as you go around the district, you will tell people about this vote, and that you are satisfied it was wrong, I will not only vote for you, but will do what I can to keep down opposition, and, perhaps, I may exert some little influence in that way.’

“‘If I don’t,’ said I, ‘I wish I may be shot; and to convince you that I am in earnest in what I say I will come back this way in a week or ten days, and if you will get up a gathering of the people, I will make a speech to them. Get up a barbecue, and I will pay for it.’

“‘No, Colonel, we are not rich people in this section, but we have plenty of provisions to contribute for a barbecue, and some to spare for those who have none. The push of crops will be over in a few days, and we can then afford a day for a barbecue. This is Thursday; I will see to getting it up on Saturday week. Come to my house on Friday, and we will go together, and I promise you a very respectable crowd to see and hear you.’

“‘Well, I will be here. But one thing more before I say good-by. I must know your name.’

“‘My name is Bunce.’

“‘Not Horatio Bunce?’

“‘Yes.’

“‘Well, Mr. Bunce, I never saw you before, though you say you have seen me, but I know you very well. I am glad I have met you, and very proud that I may hope to have you for my friend.’
“It was one of the luckiest hits of my life that I met him. He mingled but little with the public, but was widely known for his remarkable intelligence and incorruptible integrity, and for a heart brimful and running over with kindness and benevolence, which showed themselves not only in words but in acts. He was the oracle of the whole country around him, and his fame had extended far beyond the circle of his immediate acquaintance. Though I had never met him before, I had heard much of him, and but for this meeting it is very likely I should have had opposition, and had been beaten. One thing is very certain, no man could now stand up in that district under such a vote.

“At the appointed time I was at his house, having told our conversation to every crowd I had met, and to every man I stayed all night with, and I found that it gave the people an interest and a confidence in me stronger than I had every seen manifested before.

“Though I was considerably fatigued when I reached his house, and, under ordinary circumstances, should have gone early to bed, I kept him up until midnight, talking about the principles and affairs of government, and got more real, true knowledge of them than I had got all my life before.

“I have known and seen much of him since, for I respect him–no, that is not the word–I reverence and love him more than any living man, and I go to see him two or three times every year; and I will tell you, sir, if every one who professes to be a Christian lived and acted and enjoyed it as he does, the religion of Christ would take the world by storm.

“But to return to my story. The next morning we went to the barbecue, and, to my surprise, found about a thousand men there. I met a good many whom I had not known before, and they and my friend introduced me around until I had got pretty well acquainted–at least, they all knew me.

“In due time notice was given that I would speak to them. They gathered up around a stand that had been erected. I opened my speech by saying:

“‘Fellow-citizens–I present myself before you today feeling like a new man. My eyes have lately been opened to truths which ignorance or prejudice, or both, had heretofore hidden from my view. I feel that I can today offer you the ability to render you more valuable service than I have ever been able to render before. I am here today more for the purpose of acknowledging my error than to seek your votes. That I should make this acknowledgment is due to myself as well as to you. Whether you will vote for me is a matter for your consideration only.’

“I went on to tell them about the fire and my vote for the appropriation and then told them why I was satisfied it was wrong. I closed by saying:

“‘And now, fellow-citizens, it remains only for me to tell you that the most of the speech you have listened to with so much interest was simply a repetition of the arguments by which your neighbor, Mr. Bunce, convinced me of my error.

“‘It is the best speech I ever made in my life, but he is entitled to the credit for it. And now I hope he is satisfied with his convert and that he will get up here and tell you so.’

“He came upon the stand and said:

“‘Fellow-citizens–It affords me great pleasure to comply with the request of Colonel Crockett. I have always considered him a thoroughly honest man, and I am satisfied that he will faithfully perform all that he has promised you today.’

“He went down, and there went up from that crowd such a shout for Davy Crockett as his name never called forth before.

“I am not much given to tears, but I was taken with a choking then and felt some big drops rolling down my cheeks. And I tell you now that the remembrance of those few words spoken by such a man, and the honest, hearty shout they produced, is worth more to me than all the honors I have received and all the reputation I have ever made, or ever shall make, as a member of Congress.

“Now, sir,” concluded Crockett, “you know why I made that speech yesterday.

“There is one thing now to which I will call your attention. You remember that I proposed to give a week’s pay. There are in that House many very wealthy men–men who think nothing of spending a week’s pay, or a dozen of them, for a dinner or a wine party when they have something to accomplish by it. Some of those same men made beautiful speeches upon the great debt of gratitude which the country owed the deceased–a debt which could not be paid by money–and the insignificance and worthlessness of money, particularly so insignificant a sum as $10,000, when weighted against the honor of the nation. Yet not one of them responded to my proposition. Money with them is nothing but trash when it is to come out of the people. But it is the one great thing for which most of them are striving, and many of them sacrifice honor, integrity, and justice to obtain it.”

Holders of political office are but reflections of the dominant leadership–good or bad–among the electorate.

Horatio Bunce is a striking example of responsible citizenship. Were his kind to multiply, we would see many new faces in public office; or, as in the case of Davy Crockett, a new Crockett.

For either the new faces or the new Crocketts, we must look to the Horatio in ourselves!

**This and other articles can be found at Not Yours To Give Foundation for Economic Education

The Underlying Meaning

2009-11-03T05:43:00.000-05:00

Last week, when many moderates were condemning Harry Reid’s statements about there was going to be a public option in the Senate bill, Sen. Bill Nelson, D-Fla made the following statement;

“Intense days and nights lie ahead. Senators who don't like the bill will find themselves the focus of a "prayer session”. They will pray that the retribution of God doesn't come down on them."

The real underlying question in his remark is was he referring to Obama and his wrath. We have seen the strong arm tactics already used on others who disagree and many democrats are very leery of crossing “The One”.

Small Business Meeting Economics 101

2009-11-02T05:13:00.000-05:00

This was forwarded to me by email.

Here is a transcript of remarks made by Leo Carrington (who doesn’t exist) to a mandatory meeting of all employees of Carrington Automotive Enterprises, Inc. (which doesn’t exist either) on August 17th, 2009 at the Royal Payne Hotel (a purely imaginary place) in Norfolk, Virginia (which does, in fact, exist).

Although it is purely fictional, the basic economics and principles are solid and realistic.

Subject: The Employee Meeting

I would like to start by thanking you for attending this meeting, though it's not like you had much of a choice.. After all, attendance was mandatory. I'm also glad many of you accepted my invitation to your family members to be here as well. I have a few remarks to make to all of you, and then we'll retire to the ballroom for a great lunch and some employee awards.

I felt that this meeting was important enough to close all 12 of our tire and automotive shops today so that you could be here. To reassure you, everybody is being paid for the day --- except me. Since our stores are closed we're making no money. That economic loss is mine to sustain.
Carrington Automotive has 157 full time employees and around 30 additional part-timers. All of you are here. I thank you for that.

When you walked into this auditorium you were handed a rather thick 78-page document. Many of you have already taken a peek. You were probably surprised to see that it's my personal tax return for 2008. Those of you who are adept at reading these tax returns will see that last year my taxable income was $534,000.00. Now I'm sure this seems rather high to many of you. So ...
let's talk about this tax return.

Carrington Automotive Enterprises is what we call a Sub-S - a Subchapter S corporation. The name comes from a particular part of our tax code. Sub-S status means that the income from all 12 of our stores is reported on my personal tax return. Businesses that report their income on the owner's personal tax return are referred to as "small businesses." So, you see now that this $534,000 is really the total taxable income - the total combined profit from all 12 of our stores.

That works out to an average of a bit over $44,000 per store.

Why did I feel it important for you to see my actual 2008 tax return? Well, there's a lot of rhetoric being thrown around today about taxes, small businesses and rich people. To the people in charge in Washington right now I'm a wealthy American making over a half-million dollars a year. Most Americans would agree: I'm just another rich guy; after all ... I had over a half-million in income last year, right? In this room we know that the reality is that I'm a small business owner who runs 12 retail establishments and employs 187 people. Now here's something that shouldn't surprise you, but it will: Just under 100 percent ... make that 99.7 percent of all employers in this country are small businesses, just like ours.

Every one of these businesses reports their income on a personal income tax return. You need to understand that small businesses like ours are responsible for about 80 percent of all private sector jobs in this country, and about 70 percent of all jobs that have been created over the past year.

You also need to know that when you hear some politician talking about rich people who earn over $200,000 or $500,000 a year, they're talking about the people who create the jobs.

The people who are now running the show in Washington have been talking for months about raising taxes on wealthy Americans. I already know that in two years my federal income taxes are going to go up by about 4.5 percent. That happens when Obama and the Democrats allow the Bush tax cuts to expire. When my taxes climb by 4.5 percent the Democrats will be on television saying that this really isn't a tax increase. They'll explain that the Bush tax cuts have expired .. nothing more. Here at Carrington we'll know that almost 5% has been taken right off of our bottom line. And that means it will be coming off your bottom line.

Numbers are boring, I know ... but let's talk a bit more about that $534,000. That's the money that was left last year from company revenues after I paid all of the salaries and expenses of running this business. Now I could have kept every penny of that for myself, but that would have left us with nothing to grow our business, to attract new customers and to hire new employees. You're aware that we've been talking about opening new stores in Virginia Beach and Newport News . To do that I will have to buy or lease property, construct a building and purchase inventory. I also have to hire additional people to work in those stores. These people wouldn't immediately be earning their pay. So, where do you think the money for all of this comes from? Right out of our profits .. right out of that $534,000. I need to advertise to bring customers in, especially in these tough times. Where do you think that money comes from? Oh sure, I can count it as an expense when I file my next income tax return .. but for right now that comes from either current revenues or last year's profits. Revenues right now aren't all that hot ... so do the math. A good effective advertising campaign might cost us more than $300,000.

Is this all starting to come together for you now?

Right now the Democrats are pushing a nationalized health care plan that, depending on who's doing the talking, will add anywhere from another two percent to an additional 4.6 percent to my taxes. If I add a few more stores, which I would like to do, and if the economy improves, my taxable income ... our business income ... could go over one million dollars! If that happens the Democrats have yet another tax waiting, another five percent plus! I've really lost track of all of the new government programs the Democrats and President Obama are proposing that they claim they will be able to finance with new taxes on what they call "wealthy Americans."

And while we're talking about health care, let me explain something else to you. I understand that possibly your biggest complaint with our company is that we don't provide you with health insurance. That is because as your employer I believe that it is my responsibility to provide you with a safe workplace and a fair wage and to do all that I can to preserve and grow this company that provides us all with income. I no more have a responsibility to provide you with health insurance than I do with life, auto or homeowner's insurance. As you know, I have periodically invited agents for health insurance companies here to provide you with information on private health insurance plans.

The Democrats are proposing to levy yet another tax against Carrington in the amount of 8 percent of my payroll as a penalty for not providing you with health insurance. You should know that if they do this I will be reducing every person's salary or hourly wage by that same 8 percent. This will not be done to put any more money in my pocket. It will be done to make sure that I don't suffer financially from the Democrat's efforts to place our healthcare under the control of the federal government. It is your health, not mine. It is your healthcare, not mine. These are your expenses, not mine. If you think I'm wrong about all this, I would sure love to hear your reasoning.

Try to understand what I'm telling you here. Those people that Obama and the Democrats call "wealthy Americans" are, in very large part, America 's small business owners. I'm one of them. You have the evidence, and surely you don't think that the owner of a bunch of tire stores is anything special.

That $534,000 figure on my income tax return puts me squarely in Democrat crosshairs when it comes to tax increases.

Let's be clear about this ... crystal clear. Any federal tax increase on me is going to cost you money, not me. Any new taxes on Carrington Automotive will be new taxes that you, or the people I don't hire to staff the new stores I won't be building, will be paying. Do you understand what I'm telling you? You've heard about things rolling downhill, right? Fine ...
then you need to know that taxes, like that other stuff, roll downhill. Now you and I may understand that you are not among those that the Democrats call "wealthy Americans," but when this "tax the rich" thing comes down you are going to be standing at the bottom of the mud slide, if you get my drift. That's life in the big city, my friends ... where elections have consequences.

You know our economy is very weak right now. I've pledged to get us through this without layoffs or cuts in your wages and benefits. It's too bad the politicians can't get us through this without attacking our profits. To insure our survival I have to take a substantial portion of that $534,000 and set it aside for unexpected expenses and a worsening economy. Trouble is, the government is eyeing that money too ... and they have the guns. If they want it, they can take it.
I don't want to make this too long. There's a great lunch waiting for us all. But you need to understand what's happening here. I've worked hard for 23 years to create this business. There were many years where I couldn't take a penny in income because every dollar was being dedicated to expanding the business. There were tough times when it took every dollar of revenues to replenish our inventory and cover your paychecks. During those times I earned nothing. If you want to see those tax returns, just let me know.

OK ... I know I'm repeating myself here. I don't hire stupid people, and you are probably getting it now. So let me just ramble for a few more minutes.Most Americans don't realize that when the Democrats talk about raising taxes on people making more than $250 thousand a year, they're talking about raising taxes on small businesses. The U.S. Treasury Department says that six out of every ten individuals in this country with incomes of more than $280,000 are actually small business owners. About one-half of the income in this country that would be subject to these increased taxes is from small businesses like ours. Depending on how many of these wonderful new taxes the Democrats manage to pass, this company could see its tax burden increase by as much as $60,000. Perhaps more.

I know a lot of you voted for President Obama. A lot of you voted for Democrats across the board. Whether you voted out of support for some specific policies, or because you liked his slogans, you need to learn one very valuable lesson from this election. Elections have consequences. You might have thought it would be cool to have a president who looks like you; or a president who is young, has a buff body, and speaks eloquently when there's a teleprompter in the neighborhood. Maybe you liked his promises to tax the rich. Maybe you believed his promise not to raise taxes on people earning less than a certain amount. Maybe you actually bought into his promise to cut taxes on millions of Americans who actually don't pay income taxes in the first place. Whatever the reason .. your vote had consequences; and here they are..
Bottom line? I'm not taking this hit alone. As soon as the Democrats manage to get their tax increases on the books, I'm going to take steps to make sure that my family isn't affected. When you own the business, that is what you're allowed to do. I built this business over a period of 23 years, and I'm not going to see my family suffer because we have a president and a congress who think that wealth is distributed rather than earned. Any additional taxes, of whatever description, that President Obama and the Democrats inflict on this business will come straight out of any funds I have set aside for expansion or pay and benefit increases. Any plans I might have had to hire additional employees for new stores will be put aside. Any plans for raises for the people I now have working for me will be shelved.

Year-end bonuses might well be eliminated. That may sound rough, but that's the reality.
You're going to continue to hear a lot of anti-wealth rhetoric out there from the media and from the left. You can chose to believe what you wish, but when it comes to Carrington Automotive you will know the truth. The books are open to any of you at any time. I have nothing to hide. I would hope that other small business owners out there would hold meetings like this one, but I know it won't happen that often. One of the lessons to be learned here is that taxes ... all taxes ... and all regulatory costs that are placed on businesses anywhere in this country, will eventually be passed right on down to individuals; individuals such as yourself. This hasn't been about admonishing anyone and it hasn't been about issuing threats. This is part of the education you should have received in the government schools, but didn't. Class is now dismissed.

Happy Halloween

2009-10-30T05:30:00.000-04:00

You have been officially mooned for Halloween.

Stay safe and have fun.

Why Malpractice Not Part of the Bill

2009-10-29T05:45:00.000-04:00

The Obamacare bill HR 3200 that has been passed out of committee contains 1018 pages of increased taxes, increased government mandates, increased oversight, restrictions on physicians, hospitals, patients, insurance companies, and employers and not a single mention anywhere of tort reform.

Any meaningful healthcare reform has to address this in some fashion as our legal system does contribute to the problem.

If we want to emulate European systems, than why is tort reform not part of the change.

Here is an excerpt from Medical Economics about malpractice in other countries. There should be some changes in our system if the democrats really want reform.

Malpractice: Do other countries hold the key? - - Medical Economics Practice Management

Are doctors better served by judges than juries?

The United States is one of the few countries where a jury routinely decides whether a doctor committed malpractice. The norm elsewhere is for a judge to try malpractice claims and other civil litigation, says David Bernstein, a professor at the George Mason University School of Law in Arlington, VA. That's true in Germany, the UK, and most Commonwealth nations. In Canada, every province except Quebec gives warring parties the jury option. However juries heard only 4 percent of cases going to trial in 2002, according to the Canadian Medical Protective Association, which provides malpractice coverage for 95 percent of the nation's physicians.

Bernstein and others argue that judges usually render better decisions than juries because their education and experience enable them to understand complex cases, arrive at sound conclusions, and resist purely emotional arguments. "Plaintiffs' lawyers want ignorant juries that they can manipulate," Bernstein says.

Unlike juries, judges must put their decisions in writing—another plus. "It forces them to be more methodical and logical," says anesthesiologist John Hickey, CEO of the Medical Protection Society, which provides malpractice coverage to physicians in the UK and dozens of other countries. Written decisions also give plaintiffs and defendants a clearer basis for appeal, and clearer precedents for other courts as well as for the medical profession.

However, not everybody believes that juries can't be trusted. Social psychologist Neil Vidmar, who teaches at the Duke University School of Law in Durham, NC, points to studies showing that outside medical experts tend to agree with jury decisions, and that judges tend to agree with juries in all manner of civil litigation. "Most malpractice cases aren't rocket science," notes Vidmar, author of Medical Malpractice and the American Jury: Confronting the Myths about Incompetence, Deep Pockets, and Outrageous Damage Awards (University of Michigan Press, 1995). "They usually boil down to a communication breakdown or some organizational matter."
And some proponents of trial-by-judge temper their support. "I've heard the 'dumb jury' argument, but our experience hasn't proven that to be the case," says FP John Gray, CEO of the CMPA in Canada. Likewise, John Hickey in the UK says court decisions didn't tilt noticeably in favor of physicians after Ireland switched to nonjury civil trials several decades ago.

Proponents of trial-by-judge in the United States face a huge obstacle. The Seventh Amendment in the Bill of Rights—and most state constitutions—guarantees the right to a jury trial in civil suits involving more than $20. "I don't think a constitutional amendment to eliminate civil jury trials would have a chance," says Kenneth Suggs, secretary of the Association of Trial Lawyers of America, which represents the plaintiffs' bar. "Thomas Jefferson thought this was one of the most important rights that citizens had."

It would be possible for US judges to wield more power—even without a constitutional amendment, says Bernstein. They could grant more pretrial summary judgments in cases where one side can't prove the facts are contestable. And state legislatures, he says, could authorize judges to award damages if the plaintiff wins, bumping the jury aside.

Court-appointed experts: nothing but the truth

Expert witnesses are often called "hired guns" because they're seen as weapons for plaintiff and defendant alike in the adversarial setting of the courtroom. Juries may view their testimony as partisan, and therefore not entirely credible.

But what if a truly neutral expert witness added his two cents' worth? Wouldn't that contribute to a fair verdict? Germany thinks so. Its judges routinely pick their own expert witnesses in malpractice cases, although plaintiffs and defendants can hire experts as well. "This prerogative gives a judge a more unbiased view," says gynecologist Bernhard Gibis, director of quality for the National Association of Statutory Health Insurance Physicians, which represents 142,000 German physicians who treat patients in the government health insurance system.

Having judges appoint experts isn't an alien concept in the United States. "It's permitted under the Federal Rules of Evidence, and many states have copied the federal rules," says Ken Suggs. "However, court-appointed experts are the exception rather than the rule in this country.

Courts generally can't afford them."

Even if taxpayers did pony up more money for court-appointed experts, their value shouldn't be overestimated. "Even a supposedly neutral witness will have biases," says Vidmar.

Clamping down on attorneys' fees

An attorney who charges a contingency fee is taking a gamble. He'll collect nothing if his client loses. But if his client receives court-awarded damages or a settlement, the attorney receives a pre-determined share—usually 30 to 40 percent.

Germany prohibits attorneys from taking civil cases on contingency. True, German lawyers can charge more for cases involving larger sums of money, but only according to a government fee schedule. And the fee schedule isn't generous by American standards. A lawyer handling a case valued at $600,000 and actually tried before a judge would normally collect only about $7,500.
The UK bans percentage-based contingency fees, but in the 1990s, it introduced what's called a conditional fee. As in the United States, the plaintiff pays his lawyer only if he wins. However, the lawyer can collect no more than double what he would normally charge—not a formula for a million-dollar payday.

Critics of US contingency fees say they divert too much money away from injured patients. They also steer lawyers away from solid cases involving low damages and toward speculative suits worth millions. "An attorney has an incentive to take on a lot of cases with a high dollar value, but a low probability of success," says law professor David Bernstein. "If he files enough of them, he's bound to win one and strike it rich."

To Neil Vidmar, though, contingency fees are a necessary evil, because most patients can't afford to pursue a malpractice claim on their own. And since contingency-fee attorneys must invest tens if not hundreds of thousands of dollars in a lawsuit, he says, lawyers choose only those cases with the best chances of winning. "Contingency fees improve the quality of cases filed," adds Ken Suggs. "You don't have a motive to file a frivolous case."

Tort reform pending in Congress would put contingency fees on a sliding scale to minimize the attorney's cut, but if Canada's experience is any indication, this measure may not amount to much. Canada's provinces have gradually embraced contingency fees over the years, with the last holdout, Ontario, coming on board in 2002. "In our view, it's made no difference," says the CMPA's John Gray. "We don't see a lot of nonmeritorious claims being pursued regardless of how the attorneys are paid."

The loser-pay rule: a judicial speed bump?

One gripe about American justice is that even if you triumph over a plaintiff, you (or your insurer) still have to shell out big bucks to defense attorneys. In Germany, the UK, and other Commonwealth countries, the loser pays the winner's legal bill.

"This rule would dampen our fervor for speculative suits," says law professor David Bernstein. "And it would discourage plaintiffs from trying to wear out the other side with excessive discovery."

Opponents of the loser-pay rule, of course, challenge the assumption that doctors are beset by a tidal wave of flimsy lawsuits. Ken Suggs says the loser-pay rule would discourage plaintiffs with legitimate claims. However, there's a way to make the rule less risky for plaintiffs. In the UK and Germany, they can buy special insurance that will cover what they'll owe a defendant if their suit fails.

Alaska is the only state that observes the loser-pay rule in some form. Florida tried it out with malpractice litigation during the early 1980s, but dropped the rule after doctors there were disappointed with the results. They found that while their costs went up when they lost a case, they often couldn't collect from insolvent plaintiffs when they won. So much for deterrence.
Florida's experience mirrors that of Canada, where the loser-pay rule is on the books. "We seldom attempt to collect costs from plaintiffs when we win," says John Gray. "Frequently, the families who sue aren't well off to begin with, and they're attempting to care for someone who is severely injured."

The no-fault approach: End the blame game

Several countries, Sweden and New Zealand among them, have a no-fault system of evaluating and paying medical malpractice claims, similar to the way car accidents and workplace injuries are handled. If someone is injured by medical treatment and meets certain criteria, the government cuts a check.

The word "no-fault" is a bit misleading, though. In Sweden, an injury must be deemed "avoidable" to merit compensation. In New Zealand, about 10 to 15 percent of compensated injuries are each year classified as medical errors. The rest are "mishaps," or very bad outcomes. The physician didn't make a mistake, but the bad outcome is severe enough and rare enough to warrant compensation (there are criteria for severity and rarity). But whether an injury is considered avoidable, the result of error, or just bum luck, the no-fault approach spares physicians the ordeal of litigation.

Meanwhile, injured patients reap significant benefits. The streamlined nature of no-fault translates into speedy decisions and payments within months. In contrast, plaintiffs in a malpractice suit might have to wait years for their money. In addition, the ease of no-fault systems encourages small claims that might otherwise be shunned by plaintiffs' attorneys. That's an important consideration to legal experts who say that contrary to conventional wisdom, the US tort system doesn't do enough for victims of malpractice. Only one in eight actually files a claim and only one in 15 receives any money, according to a landmark study of hospital patients in New York published by Harvard University researchers in 1990.

A mandatory no-fault system for medical malpractice in the United States probably would meet tremendous resistance from trial lawyers who'd see it as an infringement on the public's right to file suit and their ability to earn a living. Some scholars question whether it would adequately deter medical negligence, given that nobody's taking the rap for mistakes. And it's not clear whether the United States could afford no-fault.

However, a 1997 study published in Law & Contemporary Problems suggests that a no-fault system in the US is within our economic reach. The study concluded that no-fault could compensate two to three times more victims than the court system, while costing the same or less than what doctors and hospitals pay in malpractice premiums. The researchers came to this conclusion by hypothetically applying the Swedish avoidability test to Colorado and Utah patients injured by medical care in 1992.

Affordability, though, is a real-life issue for New Zealand's no-fault system. Outlays for patients injured by medical errors and mishaps rose 82 percent from 1997-'98 to 2001-'02. The cost per claim has been rising dramatically, and the system piles on new claims even while it continues to pay on old ones. Some New Zealanders are so concerned about the level of spending that they've proposed having physicians reimburse the government for what it pays injured patients.
New Zealand's situation doesn't surprise health care economist Patricia Danzon, a professor at The Wharton School of the University of Pennsylvania. "I don't think there's an advantage in moving away from a fault-based system," she says. "It's hard to define a compensable injury if you eliminate the idea of error. You don't want to pay for all bad outcomes, but where do you draw the line? The cost can go through the roof."

Overseas physicians pay high premiums, too

Even if the US wanted to imitate other countries in their approaches to medical malpractice, there are a number of caveats to be considered first. For one thing, cultural differences can make it hard to transplant features of foreign legal systems into ours. It's said that Germans respect authority more than Americans do. So while Germans may be content with judges issuing verdicts, Americans may not.

Plus, any success that other countries have in avoiding an American-style malpractice crisis can't be solely attributed to their legal systems. Germany, the UK, and Canada have various forms of universal medical coverage that tend to reduce damages doled out by courts, says social psychologist Neil Vidmar. "A big proportion of awards are for past and future medical care, and in these countries, these costs are paid by the state."

As it is, the malpractice blues are a worldwide phenomenon, infecting countries that US doctors would consider models for tort reform. Australia has a legal system like that in the UK, for example, but it's been experiencing a malpractice meltdown similar to ours—skyrocketing premiums, bankruptcy for the nation's main carrier (now on government life support), and cries for tort reform from doctors. United Medical Protection, the distressed carrier, has attributed its woes to a downturn in investment income and higher reinsurance costs following Sept. 11 as well as increased litigation and higher court awards.

Lawsuits also are on the rise in Germany, says gynecologist Gerhard Gibis. "People are less likely to view the doctor as a superman who always does the right thing," he says. Gerhard Bester, a plaintiff's attorney in Munich, says a newfound willingness of doctors to testify about each other's mistakes has also contributed to the surge in litigation.

What concerns malpractice carriers in the UK and Canada isn't so much an increase in malpractice claims as an increase in their monetary value. The average award or settlement for Canada's primary malpractice carrier rose 38 percent from 1997 to 2001, despite an inflation-indexed cap on noneconomic damages now set at close to $290,000 (in Canadian dollars). The average payment per claim for the UK's Medical Protection Society rose by 48 percent in roughly that same period.

Bigger payouts are cited as one reason high-risk specialists in both countries have been jolted by sharp hikes in malpractice coverage. The MPS upped its rates 18 percent for ob/gyns and 17 percent for neurosurgeons in 2003, although many nonsurgical specialists such as pediatricians saw theirs drop 10 percent. CMPA rates in Ontario, Canada's most populous province, rose 10 percent for orthopedic surgeons, neurosurgeons, and heart surgeons in 2003. Ontario internists and FPs who don't perform hospital procedures also got hit hard with rate increases of 24 percent and 19 percent, respectively.

Canadian doctors are largely insulated from malpractice sticker shock because provincial governments foot much or most of the bill, says John Gray. "The rate for an ob/gyn in Ontario is $75,000, but the government pays about $70,000 of that." You'd think Canadian doctors would be more content than their US peers, but Gray reports that some ob/gyns in Ontario are leaving practice, while neurosurgeons no longer perform

Obama Rhetoric

2009-10-28T05:34:00.000-04:00

In a recent article at the Hudson institute and from the American Spectator, we once again see how Obama and the Liberals continually exaggerate and use inflammatory rhetoric to promote their radical healthcare agenda.

In his weekly radio address June 6, the President claimed "skyrocketing costs" were making it impossible for families to afford health care. Secretary of Health and Human Services Kathleen Sebelius was right on message, warning a women’s group about the same "skyrocketing costs." Senators Edward Kennedy and Max Baucus, chairmen of two committees drafting proposals, warned that soaring health spending threatens the stability of American families and the economy.

These doomsday scenarios are untrue. Health care spending is increasing at more moderate rates than in previous decades. Spending increased 10.5 percent in 1970, 13 percent in 1980, and consistently less than 7 percent in each of the last five years, reaching a low of 6.1 percent a year ago (see chart 1).

The rest of the article Hudson Institute > Downgrading American Medical Care describes how this radical agenda will downgrade the wonderful healthcare we currently enjoy.

There are problems with the delivery of healthcare and it can be improved, but Obamacare is not the answer or the reasonable approach we should be taking!

Personal Responsiblity

2009-10-27T05:41:00.001-04:00

Thomas Sowell points to the real problem of our society and the progressive liberal mindset that prevents the solution. I’ve stated it many times on this and other blogs that personal responsibility is the key to solving most problems.

The bigger question is; What is Governments role? I’d like to hear some of the thoughts on what people really think the Government should be doing in our everyday lives.

The Great Escape by Thomas Sowell on National Review Online

Much harm results when we run from personal responsibility.

Many of the issues of our times are hard to understand without understanding the vision of the world that they are part of. Whether the particular issue is education, economics, or medical care, the preferred explanation tends to be an external explanation — that is, something outside the control of the individuals directly involved.

Education is usually discussed in terms of the money spent on it, the teaching methods used, class sizes, or the way the whole system is organized. Students are discussed largely as passive recipients of good or bad education.

But education is not something that can be given to anybody. It is something that students either acquire or fail to acquire. Personal responsibility may be ignored or downplayed in this “non-judgmental” age, but it remains a major factor nevertheless.

After many students go through a dozen years in the public schools, at a total cost of $100,000 or more per student — and emerge semi-literate and with little understanding of the society in which they live, much less the larger world and its history — most discussions of what is wrong leave out the fact that many such students may have chosen to use school as a place to fool around, act up, organize gangs, or even peddle drugs.

The great escape of our times is escape from personal responsibility for the consequences of one’s own behavior. Differences in infant-mortality rates provoke pious editorials on a need for more prenatal care to be provided by the government for those unable to afford it. In other words, the explanation is automatically assumed to be external to the mothers involved and the solution is assumed to be something that “we” can do for “them.”

While it is true that black mothers get less prenatal care than white mothers and have higher infant-mortality rates, it is also true that women of Mexican ancestry get less prenatal care than white women and yet have lower infant-mortality rates. But, once people with the prevailing social vision see the first set of facts, they seldom look for any other facts that might go against the explanation that fits their vision of the world.

No small part of the current confusion between “health care” and medical care comes from failing to recognize that Americans can have the best medical care in the world without having the best health or longevity because so many people choose to live in ways that shorten their lives.

There can be grave practical consequences of a dogmatic insistence on external explanations that allow individuals to escape personal responsibility. Americans can end up ruining the best medical care in the world in the vain hope that a government takeover will give us better health.

Economic issues are approached in the same way. People with low incomes are seen as a problem for other people to solve. Studies that follow the same individuals over time show that the vast majority of working people who are in the bottom 20 percent of income earners at a given time end up rising out of that bracket.

Many are simply beginners who get beginners’ wages but whose pay rises as they acquire more skills and experience. Yet there is a small minority of workers who do not rise and a large number of people who seldom work and who — surprise! — have low incomes as a result.

Seldom is there any thought that people who choose to waste years of their own time (and the taxpayers’ money) in school need to change their own behavior — or to visibly suffer the consequences, so that their fate can be a warning to others coming after them not to make that same mistake.

It is not just the “non-judgmental” ideology of the intelligentsia but also the self-interest of politicians that leads to so much downplaying of personal responsibility in favor of external explanations and external programs to “solve” the “problem.”

On these and other issues, government programs are far less likely to solve the country’s problems than to solve the politicians’ problem of getting the votes of those whose think the answer to every problem is for the government to “do something.”

Questions for the Congress

2009-10-26T05:31:00.000-04:00

Our friends at the Heritage Foundation welcome the opportunity for open discussion on the Healthcare issue. With the debate in full swing, there are ongoing questions that all the congressmen should be asked.

The facts related to the Liberal agenda and links are also included thanks to Heritage.org

Can you promise me that I will not lose my current plan and doctor?

President Obama says it is “not legitimate” to claim the “public option is somehow a Trojan horse for a single-payer system.” But Reps. Barney Frank (D-MA), Jan Schakowsky (D-IL), and Nobel Prize winning economist Paul Krugman have all admitted that the public option will inevitably lead to government-run health care. The independent and non-partisan Lewin Group estimates that about 83.4 million people would lose their private insurance if Obamacare became law.

Can you promise that you and your family will enroll in the public plan?

Members of Congress and their families currently receive health care through the popular, and completely public-option-free, Federal Employees Health Benefits Program (FEHBP) which allows members of Congress to choose between 283 private health insurance plans. Sen. Tom Coburn (R-OK) proposed an amendment that would require all members of Congress and their staffs to enroll in the newly-created public health insurance plan. His amendment passed by just one vote in the Senate Health Committee. In the House, Rep. Dean Heller (R-NV) offered a similar amendment and all 21 Democrats on the House Ways and Means Committee voted it down. If the public plan is so great, then Members of Congress should by willing to forfeit their private coverage and join the millions of Americans who would be moved into the public plan.

Can you promise that Obamacare will not lead to higher deficits in the long-term?

President Obama said that he would not support health care legislation that would add to the national deficit. But Congressional Budget Office director Douglas Elmendorf has stated that the House health care legislation would “generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.” To help Obama keep his promise, Rep. Patrick Tiberi (R-OH) offered an amendment that would require the Secretary of Health and Human Services to submit an annual report to the President and Congress, comparing the expected revenue and spending under the bill’s provisions for the upcoming 10-year period. In the event that projected spending under the bill outpaced revenue, the Secretary would have to reduce spending so that it would not exceed revenue. Democrats defeated Tiberi’s amendment.

Can you promise that government bureaucrats will not ration health care for patients on the public plan?

President Obama promised on July 22 that health care reform would keep the government out of health care decisions, but both the House and Senate bills call for an increased role of comparative effectiveness research (CER). More information on health care effectiveness is good as long as doctor’s and patients are the ones empowered to use that information. Conservatives in both the House and Senate offered amendments prohibiting the use of CER by government to mandate, deny, or ration care. These anti-rationing amendments were defeated in both the House and Senate.

Can you promise me that my tax dollars will not fund abortions?

The House bill, as currently drafted, allows the Secretary of Health and Human Services to outline the minimum benefits that must be included in any health plan. There is no specific provision in the bill that would require insurance coverage of abortion. However, since the decisions over benefits are left to the Secretary of HHS, with recommendations from a newly created Health Care Benefits Advisory Committee, there is nothing to prevent the current or future Secretary from including abortion coverage in Americans’ health insurance. Conservatives in both the House and Senate offered amendments that would prohibit the use of taxpayer dollars to fund abortions. The tax payer funded abortion bans were defeated in both the House and Senate.

Since none of them will be able to offer reasonable answers to any of these questions, we are hopeful that more and more Americans will see through this charade being played by Obama and his fanatical friends.

10 reasons why America lost the Olympics

2009-10-23T06:10:00.000-04:00

10. Dead people can't vote at IOC meetings

9. Obama distracted by 25 min meeting with Gen. McChrystal

8. Who cares if Obama couldn't talk the IOC into Chicago? He'll be able to talk Iran out of nukes.

7. The impediment is Israel still building settlements.

6. Obviously no president would have been able to acomplish it.

5. We've been quite clear and said all along that we didn't want the Olympics.

4. This isn't about the number of Olympics "lost", it's about the number of Olympics "saved" or "created".

3. Clearly not enough wise Latina judges on the committee

2. Because the IOC is racist.

1. It's George Bush's fault.

The Non-Healthcare crisis

2009-10-22T05:41:00.001-04:00

In this op-ed from David Limbaugh, he explains why Obama cannot afford to tell the truth and give all the information about the numbers.

David Limbaugh : Obama Can't Afford To Tell Truth on Health Care - Townhall.com

President Barack Obama is spreading disinformation about health care almost as quickly as he's driving up the national debt, such as that 47 million Americans can't get health care and that a government takeover would be a panacea.

Democrats have constantly demagogued the 47 million uninsured figure to gin up public fear about the scarcity of health care access, especially for the poor. They follow up with the promise that under their plan, we would achieve universal access. But both are untrue.

In "The Top Ten Myths of American Health Care," Sally Pipes points out that while there are some Americans who simply can't afford health insurance, many millions who can afford insurance choose not to buy it and "very likely would not want to be 'rescued' by mandatory socialized medicine."

In the first place, the 47 million number is grossly inflated. The Congressional Budget Office survey generating it included those who were uninsured for any part of a year, despite the fact that almost half of these remain uninsured for an average of only four months.

Some 38 percent of this 47 million -- almost 18 million -- make more than $50,000 a year, and 10 million of them make more than $75,000. Of all the uninsured groups, this is the only one that is growing, because in a still-free country, they've made their own decision not to buy expensive insurance while (most of them) are young and healthy. The Census Bureau also reports that more than 10 million of the uninsured are not American citizens.

But how about the very poor? Well, it turns out that the Democrats are shedding crocodile tears here, as well. Pipes explains that "as many as 14 million of the 45.7 million uninsured -- poor and low-income Americans -- are fully eligible for generous government assistance programs like Medicare, Medicaid, and SCHIP." But "they're just not enrolling in the programs."

So while Obama tells us that almost 8 million children lack health insurance, he doesn't disclose that 5 million of them only lack insurance because they haven't been enrolled in the available programs. Not only would this fact undermine the urgency of his appeal; it illustrates that even under his "universal access" plan, not everyone would acquire coverage anyway. Indeed, the CBO has estimated that some 17 million would remain uninsured if the Democrats' plan were implemented.

Yes, there are people who fall through the cracks (Pipes' words) -- mostly those who earn less than $50,000 per year but too much to qualify for government help. When it's all said and done, there are probably about 8 million of these "chronically uninsured," who really can't afford insurance and don't qualify for help -- though they are able to receive emergency room care. And many of these 8 million would be better able to afford coverage if government regulations and mandates hadn't driven up the costs so much.

But how urgent do you suppose Obama's call for universal coverage would sound if he were to come clean with these figures? The truth is he couldn't get to first base if he used the 8 million figure instead of 47 million.

But there's another important factor to keep separate, as well. There's a major difference between a lack of insurance and a lack of care. Under Obama's socialized medicine scheme, not only would universal insurance coverage be impossible to achieve but also access to medical care and the scope of care would be dramatically reduced, as it has been in every socialized system in the world and in our own government health programs.

It is axiomatic that price controls result in rationing and waiting lines, and many of the very people Obama is using to shame us into supporting socialized medicine would suffer drastic reductions in the quantity, scope and quality of care. Hit hardest would be the elderly. Big Brother would make the decision as to scope and even quality of care. Chilling evidence for this is already in the draft bills and in Obama's unwitting admissions to that effect.

It is true that our health care costs are very high and rising at alarming rates, but not for the reasons Obama wants you to believe. Rather, it's because we Americans demand greater quality care and medications (and we get them), which are expensive, and because of already excessive government interference with free market forces.

It's no wonder costs are skyrocketing when government-mandated coverage requirements choke competition and prevent more affordable plans and when 60 percent of Americans have employer-provided health insurance and don't directly pay for their care, which necessarily increases demand (and prices).

The solution lies in unleashing market forces (more on this later), not the tyrannical hand of government.

So when you really figure out that it's not about healthcare, access, or insurance for the majority of Americans, you have to ask yourself what the underlying motive truly is.

The answer is power and control that the radical left wing wants to obtain.

NHS is a Worse Value

2009-10-21T05:32:00.000-04:00

Here is an article in the BBC reaffirming the claim that the American Healthcare system is better and more efficient than their own NHS (National Health Service)

BBC News HEALTH NHS 'worse value than US provider'

This begs the question as to why the liberal democrats really want to model a better system after one that itself claims to be inferior.

The answer is quite simple. It’s not about healthcare as much as it is about government control.

This should once again bring up the question as to what is the role of government.

2009-2010 Flu Shots

2009-10-20T05:31:00.001-04:00

The FDA approved influenza vaccine for the 2009-2010 season is widely available and recommended, but it is important to note that the vaccine will not protect against the H1N1 flu virus.

The H1N1 vaccine is now available and will be administered at most of the local schools starting this week.

The public needs to understand that the vaccine is not 100 percent effective but most studies support the fact that vaccination is the best protection against the flu and that high-risk Americans should be vaccinated.

High risk individuals for the seasonal flu are young children, elderly people, and those with chronic medical conditions including heart disease, lung disease and diabetes. The H1 N1 seems to be targeting more pregnant women and young children and sparing the elderly.

As for the seasonal flu vaccine; what to include in it is always somewhat of a guessing game and some years provide better protection than others. But the H1N1 vaccine was designed and targeted directly at the H1 N1 virus and will be much more effective.

So quit procrastinating and get your Flu shots

Newest Pertussis Study

2009-10-19T05:13:00.001-04:00

In a recent study in Pediatrics, children who do not receive the regular schedule of vaccines due to parent choice are more likely to get whooping cough than their fully immunized peers. Certainly this shouldn’t come as any surprise.

The study showed that 11% of cases of pertussis (whooping cough) in a Kaiser Permanente pediatric sampling in Colorado were linked to declined vaccines on the part of parents, and the number of parents refusing immunizations for their children is growing.

These results dispel one of the commonly held beliefs among vaccine-refusing parents, that children are not at risk for vaccine-preventable diseases.

The number of whooping cough cases has grown since the 1980s and there are still deaths every year from the disease.

The study reviewed medical records of children age 2 months to 18 years old in the Kaiser Permanente Colorado health plan from 1996 to 2007. During the study, there were 156 confirmed cases of whooping cough. Children in these cases were compared to 595 control children who didn't get whooping cough.

Results of the government-funded study indicated that those children where parents declined vaccines were 23 times more likely than vaccinated children to get the infection.

It is studies like these that lend support to getting the recommended vaccines including the H1N1 vaccine that many parents are electing to forego because of irrational fears.

Historical Revisionism with Different Morals

2009-10-16T05:00:00.000-04:00

Here are Two Different Versions and Two Different Morals!

OLD VERSION:

The ant works hard in the withering heat all summer long, building his house and laying up supplies for the winter.

The grasshopper thinks the ant is a fool and laughs and dances and plays the summer away.

Come winter, the ant is warm and well fed.

The grasshopper has no food or shelter, so he dies out in the cold.

MORAL OF THE STORY: Be responsible for yourself!

MODERN VERSION:

The ant works hard in the withering heat al l summer long, building his house and laying up supplies for the winter.

The grasshopper thinks the ant is a fool and laughs and dances and plays the summer away.

Come winter, the shivering grasshopper calls a press conference and demands to know why the an t should be allowed to be warm and well fed while others are cold and starving.

CBS, NBC , PBS, CNN, and ABC show up to provide pictures of the shivering grasshopper next to a video of the ant in his comfortable home with a table filled with food. America is stunned by the sharp contrast.

How can this be, that in a country of such wealth, this poor grasshopper is allowed to suffer so?

Kermit the Frog appears on Oprah with the grasshopper, and everybody cries when they sing, 'It's Not Easy Being Green.'

Jesse Jackson stages a demonstration in front of the ant's house where the news stations film the group singing, 'We shall overcome.' Jesse then has the group kneel down to pray to God for the grasshopper's sake..

Nancy Pelosi & John Kerry exclaim in an interview with Larry King that the ant has gotten rich off the back of the grasshopper, and both call for an immediate tax hike on the ant to make him pay his fa ir share.

Finally, the EEOC drafts the Economic Equity & Anti-Grasshopper Act retroactive to the beginning of the summer.

The ant is fined for failing to hire a proportionate number of green bugs and, having nothing left to pay his retroactive taxes, his home is confiscated by the government.

The story ends as we see the grasshopper finishing up the last bits of the ant's food while the government house he is in, which just happens to be the ant's old house, crumbles around him because he doesn't maintain it.

The ant has disappeared in the snow.

The grasshopper is found dead in a drug related incident and the house, now abandoned, is taken over by a gang of spiders who terrorize the once peaceful neighborhood.

MORAL OF THE STORY: Be careful how you vote in 2010.

Judicail Activism

2009-10-15T05:47:00.000-04:00

A couple of months ago, we saw that Judicial activism is still alive and well in the 9th Circuit Court. This time, the most overturned appellate court had issued another ruling that is sure to proceed to the Supreme Court and will likely be overturned. We heard very little about this in the liberal media.

The 9th Circuit overturned an injunction in a district court case, allowing the state of Washington to force a pharmacy to stock and dispense morning-after pills.

Religious reasons are the rationale behind their decision, but the ruling goes even further by impinging on private businesses what they can and cannot stock.

Business owners make decisions all the time about their inventory and what they do and do not stock. Even apart from religious grounds, which are protected by the Constitution, business owners that don’t want to sell Tylenol, or widgets, or chlorine for swimming pools, should be able to decide that on their own. If customers object to their policies, they will find other businesses to patronize. The government has a public interest in telling retailers what they cannot sell for safety reasons (like dynamite, as an example), but should not force business owners to sell something they personally object to.

This is an intrusion on businesses and Judicial Activism by the radical 9th Circuit.

AMA sends letter Over new ARRA rule

2009-10-14T05:43:00.000-04:00

It has been several months since the AMA sent this letter http://www.ama-assn.org/ama1/pub/upload/mm/399/letter-hhs-guidance-securing-phi.pdf to the Dept. of Health and Human Services related to the new mandates on healthcare providers implemented in the American Recovery and Reinvestment Act of 2009.

As typical of Washington, they implement new burdensome rules but never actually define or give specifics on how to follow or be compliant.

This letter was trying to get some answers on the question of how to make protected health information (PHI) unusable, unreadable, or indecipherable to unauthorized individuals and prevent triggering the breach notification requirement in this new legislation.

As of this date, there are still little specifics on how we can comply with the new regulations.

IU study on overuse of specialty care

2009-10-13T05:32:00.000-04:00

In a recently-released report by the Indiana University Center for Health Policy it was suggested that Hoosiers use specialists too often and it increases medical costs. The report also supported the medical home concept as a means to contain health care spending.

The health care home model is virtually the same as the primary care physician but it emphasized more control of the PCP. The PCP would coordinate and oversee all aspects of that patient’s care as well as coordinate visits with specialists. This is the way it should work anyway but there is not enough time or reimbursement to primary care doctors to make this feasable.

The study showed that in Indiana, patients tend to see a specialist without first consulting a primary care physician. The study noted that the state has more specialists than the national norm, and a shortage of family doctors and pediatricians which leads to the increased utilization of specialists.

It also showed that medical students in Indiana are increasingly choosing to specialize rather than enter primary care further impacting Indiana’s shortage of primary care physicians. The report showed that increasing reimbursement for primary care physicians and other primary care providers would help attract additional students to enter primary care.

But when you see Indiana legislators failing to address the problem, there is little hope of much change. The Medicaid rates in Indiana have not increased for more than 15 years even though every other aspect and cost of medicine has dramatically increased.

The problem is well-known, but the actions from legislators has been dismal. If insurance were used as it was intended and not for every aspect of care, things would change. When patients have more financial liability in the process, they make better value decisions.

New EMR surveys

2009-10-12T05:41:00.000-04:00

In two recent surveys (the Deloitte study here and the Kaiser study here) more and more patients would like physicians to offer more online access.

The Deloitte survey showed that 60 percent of respondents wanted online access to their doctors, medical records, test results and same-day appointments and one in four said they would pay physicians more for the online convenience.

The Kaiser Family Foundation study found that 72 percent of patients believed quality and coordination of medical care would improve if physicians used electronic health records (EHR), but it was also noted that EHRs would not necessarily result in cost savings.

During a recent medical informatics summit in Indianapolis it was also noted that patients want online services, and liability carriers are offering discounts for doctors who offer secure online health records.

At the end of last year about 13 percent of physicians were prescribing electronically, but with the incentives available through Medicare’s e-prescribing incentive program, it will likely increase to some degree. But it is very unlikely that the majority will use EHR’s until the cost benefit ratio improves dramatically and certainly won't change much until we see how bad Obama is going to effect us with his radical agenda.

The Riches of Aging

2009-10-09T05:47:00.000-04:00

I have silver in my hair

Gold in my teeth

Stones in the kidneys

Sugar in the blood

Lead in the feet

and an inhaustible supply of natural gas

I never thought I'd accumulate such wealth!

H1N1 Information

2009-10-08T05:31:00.000-04:00

Many people are asking about the H1N1 vaccine and if they should get it for themselves or their kids.

We are recommending the vaccine and trying to follow the CDC recommendations and the summary is as follows. The biggest issue is that everyone is wanting Tamiflu and it really is not recommended for everyone because the majority of people have mild self-limiting disease. But it takes more time talking patients out of getting the prescription because for the majority of them, thier insurance pays for it. For patients who have to pay the $60 or more for the prescription, they usually choose to ride out the symptoms.

This is another perfect example of how when patients have more of the burden of the cost, they choose more wisely and are more cost-conscious

Recommended Use of Influenza A (H1N1) 2009 Monovalent Vaccine

ACIP recommends that vaccination efforts should focus initially on persons in five target groups (Box) whose members are at higher risk for influenza or influenza-related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants aged <6 href="http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm#box#box">Box).
Initial Target Groups

When vaccine is first available, ACIP recommends that programs and providers administer vaccine to persons in the following five target groups (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel,§
4. persons aged 6 months--24 years, and
5. persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.¶

These five target groups comprise an estimated 159 million persons in the United States. This estimate does not accurately account for persons who might be included in more than one category (e.g., a health-care worker with a high-risk condition). Vaccination programs and providers should begin vaccination of persons in all these groups as soon as vaccine is available.

Subset of Target Groups During Limited Vaccine Availability

Current projections of initial vaccine supply indicate that establishment of a subset of the five initial target groups will not be necessary in most areas. However, demand for vaccination and initial supply might vary considerably across geographic areas. If the supply of the vaccine initially available is not adequate to meet demand for vaccination among the five target groups listed above, ACIP recommends that the following subset of the initial target groups receive priority for vaccination until vaccine availability increases (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel who have direct contact with patients or infectious material,
4. children aged 6 months--4 years, and
5. children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.

This subset of the five target groups comprises approximately 42 million persons in the United States. Vaccination programs and providers should give priority to this subset of the five target groups only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups.

Antiviral Chemoprophylaxis

The infectious period for persons infected with the 2009 H1N1 virus appears to be similar to that observed in studies of seasonal influenza. Infected persons may shed influenza virus, and potentially be infectious to others, beginning one day before they develop symptoms to up to 7 days after they become ill. Children, especially younger children, and persons who are immune compromised can shed influenza virus for longer periods. However, the amount of virus shed generally correlates with magnitude of fever and for these recommendations, the infectious period for influenza is defined as one day before until 24 hours after fever ends.

Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

**Persons who are at higher risk for complications of influenza and are a close contact of a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period.

**Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period. Information on appropriate personal protective equipment is available at: Infection Control for Patients in a Healthcare Setting and might be updated frequently as additional information on transmission becomes available.

· Antiviral agents should not be used for post exposure chemoprophylaxis in healthy children or adults based on potential exposures in the community, school, camp or other settings.
· Chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the last contact with an infectious person.
· Chemoprophylaxis is not indicated when contact occurred before or after, but not during, the ill person’s infectious period as defined above.

Patients given post-exposure chemoprophylaxis should be informed that the chemoprophylaxis lowers but does not eliminate the risk of influenza and that protection stops when the medication course is stopped. Patients receiving chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.

For antiviral chemoprophylaxis of 2009 H1N1 influenza virus infection, either oseltamivir or zanamivir is recommended (Table 1). Duration of post-exposure chemoprophylaxis is 10 days after the last known exposure to 2009 H1N1 influenza.

Oseltamivir was authorized for use for chemoprophylaxis under the EUA for children younger than 1 year of age, subject to the terms and conditions of the EUA. (See Treatment and Chemoprophylaxis for Children Younger than 1 Year of Age, below.) Age-based dosing recommendations are provided in the fact sheetsincluded with the EUA letter of authorization, however weight-based dosing is an alternative preferred by some experts who are currently conducting studies of oseltamivir use in this age group.

An emphasis on early treatment is an alternative to chemoprophylaxis after a suspected exposure. Persons with risk factors for influenza complications who are household or close contacts of confirmed or suspected cases, and health care personnel who have occupational exposures, can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their health care provider for evaluation and possible early treatment if clinical signs or symptoms develop. Health care providers should use clinical judgment regarding situations where early recognition of illness and treatment might be an appropriate alternative to chemoprophylaxis.

Persons at ongoing occupational risk for exposure (e.g., health care personnel, public health workers, or first responders who are working in communities with influenza outbreaks) should carefully follow guidelines for appropriate personal protective equipment. Efforts to reduce the risk of exposure or infection for healthcare personnel should include appropriate administrative controls (e.g. having health care personnel stay home from work when ill, and triaging for identification of potentially infectious patients), cough and hand hygiene, personal protective equipment, and vaccination when available.

**information taken from CDC website

Potential New Development for Memory Diseases

2009-10-07T06:02:00.000-04:00

Although years away from clinical use, in the May 7 issue of Nature, they report on a new gene that when activated functions as a negative regulator of learning and memory. By using other genes and/or drugs, this can be targeted and repressed leading to enhanced learning and memory.

With the population aging and more and more dementia (Alzheimer’s) being seen, hopefully, this research will allow us to someday develop and test one of these HDAC2-selective inhibitors for human diseases associated with memory impairment.

That is unless the Obamacare plan passes and then research and development on issues like this will likely be minimized. After all, the Obama supporters have little use for older folks with dementia.

Trampoline injuries

2009-10-06T05:46:00.000-04:00

As we leave the summer behind, we will see less of certain types of injuries. One of these will be with trampolines. During the increased use in summer came an increase in the number of associated injuries. A recent study analyzed 50 cases presenting to the accident and emergency department at a hospital over six weeks and compared the injuries with the safety guidelines provided by the Royal Society for the Prevention of Accidents

The most important factor associated with trampoline injury is having too many users on a trampoline at one time. The results showed that the lightest person is five times more likely to be injured and the severity of the injury also increases with the mismatch between child and adult weights. 80% of user suffered injury and 74% were when multiple users were on the trampoline. 64% occurred on trampolines without a safety net. The most common injuries were 54% legs, 32% arms, and 14% head, neck, face and chest.

A child of around 45 lbs can experience a force equivalent to a 10 feet fall when bouncing with an adult of 170 lb individual.

It was found that adult supervision is crucial in preventing trampoline injuries and the most influential role of a supervising adult is to ensure safety guidelines are followed, exuberance is controlled, and help is provided with setting up and dismounting from the trampoline.

As a side note, it was also found that children have been hurt while being supervised or bouncing with adults who have been drinking and therefore alcohol and trampolines are a poor combination

Socialism we should demand

2009-10-05T05:35:00.000-04:00

From our friends at Hot Air » Blog Archive » A Modest Proposal, 2009 Edition, we should definitely consider this proposal as we move closer towards Socialism. I am sure none of my legal friends would have any problem with this.

Ladies and gentlemen of the Hot Air community, I have discovered an unfair disparity in access to a vital resource based on the economic condition of the consumer. This disparity is not just egregious, but it threatens the very core of our American way of life. People routinely get denied adequate and competent service on the basis of their ability to pay, even though they have a right to it, while the rich eat up all the resources with their ability to access the best and brightest in the field. And in the instance of fairness, the federal government needs to find a solution and impose it on the industry as a whole.

I refer, of course, to legal representation.

Oh, sure, in an emergency, the government will foot the bill for a public defender to represent the poor and indigent, but that’s hardly a comfort to those who needed a lawyer before getting into the emergency condition in the first place. Besides, while we have many dedicated public defenders, it’s hardly a news flash that the wealthy can afford much better representation and have a much better chance of prevailing in court in criminal cases. When the poor, working class, and middle class end up in that emergency situation, they can lose their homes and property to pay for decent legal care — and that shouldn’t happen in America, should it?

After all, unlike health care, Americans actually do have a Constitutional right to legal representation in court. Some will scoff and say the lack of a lawyer, or a bad lawyer, can’t cause your death. Those critics may want to talk with the inmates who got freed from Death Row and lifetime prison sentences after having mediocre attorneys lose cases when the defendant was really innocent. Bad or nonexistent legal representation can take years off of your life, and can definitely get you killed.

Even beyond that, though, the wealthy and connected have access to a much wider range of legal services than even the middle class can afford. Estate planning, trust funds, tax shelters — all of these can be expertly provided to those with the resources to afford them, while other Americans get second-class status in our legal system. For those who aspire to egalitarianism of result, this arrangement should be such an affront that it demands real action — now.

I propose that the government impose a single-payer system on the legal profession. Instead of charging private fees, all attorneys would have to send their bills to LegalCare, a new agency in the federal government. Because the government can bargain collectively, they can impose rational fees for legal services instead of the exorbitant billing fees attorneys now charge. Three hundred dollars an hour? Thing of the past. Everyone knows that the government can control costs through price-setting; now we can see this process applied to the legal system, where the government has a large interest in seeing cost savings.

How will we pay for LegalCare? I take a page from the House surtax method here, which will disproportionately hit doctors in a wide variety of disciplines. In this case, I propose a 5.4% surtax on lawyers, judges, lobbyists, and political officeholders at the state and federal level. They’re the ones who have enriched themselves through this inequity in the legal system. After all, why should we all have to pay for the single-payer legal system when we can penalize lawyers instead?

Now, this will have some impact on the legal-services market. On the downside, we’ll have fewer attorneys. Law schools will get a lot less competitive as students avoid the law and the limited amount of money available through LegalCare, and existing attorneys may leave the profession as well as they fail to make enough money from the price-controlled compensation they get from the government. All this will mean longer wait times and rationing of services as people flood attorneys’ offices to demand services disconnected from the actual cost to provide them. It may take a couple of years to get a will done, so start when you’re young.

On the plus side … we’ll have fewer attorneys. And politicians! Best of all, everyone will get the same level of legal care regardless of their ability to pay, thanks to LegalCare and the government-imposed rationing of a resource to which we have a right to access at any time we want, for any reason we want.

Addendum: In case anyone misses the point, this is a satire. However, I wouldn’t put it past certain statists to consider this a pretty good idea…

Those Frustrating Days

2009-10-02T05:43:00.000-04:00

Did you ever have one of those days when you just want to say "Aw Crap"

The following photos are impressive for the magnitude of the destruction both in cost, effort to fix and ego.

But none even come close to the last picture that will cost us more than we can imagine and certainly brings more choice words than "Aw Crap"

The Modest Healthcare Proposal

2009-10-01T05:35:00.002-04:00

Philadelphia’s “The Bulletin” recently had an interesting article published on the Healthcare dilemma. The link is here: A Modest Health-Care Proposal - The Philadelphia Bulletin Archives

Sure, the viewpoint is radical, but isn’t this really what some of the fanatical left really want?

A Modest Health-Care Proposal
By Sheldon Richman, For The Bulletin
Sunday, September 20, 2009

Enough dithering! President Barack Obama says it’s time to act on health care. I agree.

But act how? Are we really going to be happy with the pussy-footing proposals floating around Congress? All the so-called reformers want to do is tinker with insurance regulations. But how effective would that be, considering that the insurance companies themselves support the changes?

We have taken our eyes off the ball, people. Let’s get back to first principles. Mr. Obama’s premise is that we have a right to health care. A right.

America was founded on the idea of rights — inalienable rights. No one can take them away. I assume that when people say that health care is a right, they mean that health care is an inalienable right. Mr. Obama apparently agrees. In his speech before Congress he called for free services, such as physical exams, colonoscopies, and mammograms. Free! You have a right to those things.

Well, OK. But why stop at free preventive services? Why not free treatments, free surgery, free drugs, and so on? We need those things as much as a physical exam. If we have a right to health care and if we are unable to obtain those services, our rights have been denied or violated. That is something the advocates of health-care “reform” say we must not tolerate.

Okay, let’s not tolerate it. Let’s make sure no one’s right to health care is violated. Let’s get serious for a change.

But how? I can think of only one efficient way to accomplish this. Let’s enslave the providers of medical services — doctors, nurses, paramedics, dentists, chiropractors, acupuncturists, psychiatrists, and the rest. My proposal may shock people, but I am confident that this feeling will wear off as we think about how logically it flows from the principle that we have a right to health care.

First, let me point out that there is no other good alternative. Any other system designed to deliver health care as a matter of right will have gaps through which the least fortunate inevitably will slip. Isn’t that the problem we’re trying to fix? Obama’s approach isn’t much better. He wants to force the insurance companies, with taxpayer subsidies if necessary, to insure everyone — healthy or sick, young or old — at the same price. He might even like a government insurance option, though he can’t make up his mind whether or not that is an essential feature of his plan.

Regardless, it’s a bad plan. Requiring insurance companies to pay for our medical care misses the point. Where do you think insurance companies get their money? From us! What kind of right to health care is it if we end up paying for it anyway? Obama means well, but his plan is a shell game.

On the other hand, enslaving the doctors and other providers would have none of the defects of the current system or the leading reform plans. It goes right to the source. We have a right to health care? Fine. Force the doctors to provide it.

Of course, this wouldn’t be free. I’m no pie-in-the-sky utopian. The doctors and the others would have to be fed, clothed, and housed. They’d need certain comforts. That’s understood. But it would be far easier to keep a lid on costs by enslaving the providers than by the patchwork system we have now, or would have under Mr. Obama’s plan.

The biggest problem I can see is that if doctors are going to be our slaves, no one will want to be a doctor. Most people don’t relish the idea of being slaves even in the national interest. They’re selfish that way.

We certainly can’t be a world-class country without doctors and nurses, so I have a solution to this problem: conscription. President Obama should direct the nation’s schools to look out for students with an aptitude for biology and direct them into medical studies. Then, at the appropriate time, the government should draft those young people into the newly created U.S. Medical Service Corps.

I know what you’re thinking: As word of this got around, the best students will play dumb. If that happens, we’ll have no other choice than to pick our doctors by lottery.

Summary on the Countries

2009-09-30T05:40:00.000-04:00

For the past couple of weeks, we have described the Healthcare situation in various European Countries based on the critique from the CATO Institute.

I think anyone with an open mind can readily see that no country has a perfect solution to Healthcare and each has their own unique problems.

What can be taken from the review is that no country has yet figured out how to cover 100% of their population. Some come close, but all are with problems.

The things that are most apparent in the review are:
1. Countries with the lowest healthcare costs typically are those where patients have a direct financial role in the decision process.
2. The seemingly more successful systems are employing more free market competitive mechanisms
3. Most are offering secondary private policies for better access, care, and flexibility
4. More government involvement has historically made things worse in most of the systems.
5. out of pocket expenditures range from 8.5% of wages to nearly 31.5% in Switzerland and with co-pays in most of the countries ranging from 10-40%
6. Many of the countries whether they admit it or not, are transitioning to a system that is looking more American.

With this is mind, we need to ask why the Democrats are attempting to radically change our current system when most other countries and working towards a system closer to ours?

I’ve said before that we do have things that can be improved and there are solutions that both parties already agree on to help. So why not make some incremental changes now and quit trying to overhaul a system that works for about 87% of the population.

Germany's Healthcare System

2009-09-29T05:13:00.003-04:00

The last country we will examine is Germany. The article is from the CATO institute; The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Germany

Germany ranked 25th in the WHO ratings. (287) Despite that low ranking, however, the country is worth examining because it is frequently cited as a model by advocates of national health care.

National health insurance in Germany is part of a social insurance system that dates back to Bismarck. All German citizens with incomes under €€ 46,300 (roughly $60,000) are required to enroll in one of approximately 250 statutory “sickness funds.” Those with higher incomes may enroll in the funds if they wish, or may opt out of the government system and purchase private insurance.(288) About three quarters of workers with incomes above the statutory limit choose to remain in the sickness funds, which currently cover approximately 90 percent of the population. Overall, insurance coverage is nearly universal. However, the number of uninsured has been rising, roughly tripling in the last 10 years to 300,000 people. (289) About 9 percent of the population purchases supplemental insurance to cover items that are not included in the standard benefits package. (290)

Sickness funds are financed through a payroll tax split equally between the employer and employee. The size of the tax varies depending on which fund the worker has chosen, but averages around 15 percent of wages.(291) Sickness funds are supposed to be solvent and self-supporting, but in reality the system ran a €€ 7 billion deficit in 2006.(292) The German government has proposed a 1 percent increase in the payroll tax, split evenly between employer and employee, starting next year.(293) In addition, general tax revenues finance capital costs for acute care hospitals and many rehabilitative services, especially for retirees.

Benefits are extensive, covering physicians, hospital and chronic care, diagnostic tests, preventive care, prescription drugs, and part of dental care. In addition to the medical benefits, sickness funds provide sick pay to those who cannot work due to illness, ranging from 70 to 90 percent of the patient’s last gross salary, for up to 78 weeks. (294)

The central government and state governments split the regulation of the health care system. The central government establishes the national global budget for health care spending, defines any new medical procedures to be included in benefit packages, and sets reimbursement rates for physicians. Some of this is accomplished through legislation, while the rest is handled through negotiations between the National Association of Sickness Funds and the National Association of Physicians. At the state level, state associations of sickness funds and physicians negotiate overall health budgets, reimbursement contracts for physicians, procedures for monitoring physicians, and reference standards for prescription drugs.(295) The bargaining power in these negotiations clearly lies with the sickness funds backed by the government, allowing them to effectively impose fee schedules and other restrictions on providers. The purchasing power of a German physician’s wages is now about 20 percent that of a U.S. physician. (296) This has led to physician strikes as recently as 2005. (297)

Although Germany spends less on health care than the United States, both as a percentage of GDP and per capita, expenditures have been rising at an alarming rate in recent years. Friedrich Breyer, an economist from Konstanz University, estimates that health care spending could reach 30 percent of GDP by 2020 unless significant changes are made. (298)

The German government has responded by beginning to cut back on benefits. In 2004, sickness funds stopped covering eyeglasses, lifestyle medications, and all over-the-counter drugs. Co-payments were imposed for the first time, such that Germans now pay €€ 10 per quarter to see a general practitioner, €€ 10 per day of hospital stay, €€10 per prescription, and for certain specialty services.(299) The highest co-payments are 10 percent for prescription drugs. Overall, Germans pay out of pocket for about 13 percent of total health care spending; only slightly less than Americans. (300) Preliminary evidence suggests that the introduction of cost sharing has slightly reduced utilization and spending. (301)

In 2006, Chancellor Angela Merkel proposed a sweeping set of health care reforms that included creating a centralized health fund, shifting financing in part from payroll taxes to general revenues, trimming benefits, imposing greater cost sharing, and making the system more transparent. She was forced to abandon the package in the face of public and political opposition. (302)

The degree of health care rationing in Germany is the subject of considerable debate. Unlike many OECD countries, the German government does not compile data on waiting lists.(303) One frequently cited study suggests that Germans are no more likely than Americans to wait more than four weeks to see a specialist. (304) The WHO says, “Waiting lists and explicit rationing decisions are virtually unknown.”(305)

However, at least one study concludes that rationing is occurring for the elderly and those with terminal illness, and concludes that “the question remains as to whether lives at advanced ages could be saved if age rationing were discontinued and maximum medical treatment were to be applied to everyone, irrespective of their age.”(306) In addition, a survey of German hospitals reported that “waiting times were prolonged” due to both a lack of capacity and hospital target budgets that make the treatment of sickness fund patients with serious conditions financially unattractive.(307)

Also, Germans have less access to modern medical technology than Americans. The United States has four times as many MRI units per million people and twice as many CT scanners. (308) The situation would undoubtedly be worse without the existence of the small private insurance sector. Although small as a proportion of total health spending, private insurance puts competitive pressure on sickness funds, pushing them to expand their quality and services. At one time, CT scanners were even rarer in the public system, available only under exceptional circumstances and after long waits, yet relatively common in the private sector. Competition forced the public sector to add more CT scanners. (309)

Some analysts blame price restrictions and reimbursement rates for increasing bureaucratic interference in how German physicians practice medicine. Physicians trying to work within the maze of reimbursement caps and budget restrictions have no financial incentive to provide more than the minimally necessary care. That has led to questions of quality assurance, and the government has responded with ever greater micromanagement of practice standards. The result has been a huge increase in red tape for physicians and a general loss of innovation. (310)

Germans seem aware of the need to reform their health care system. In a 2004 poll, 76 percent of Germans thought health care reform was “urgent,” while an additional 14 percent thought it was “desirable.” However, Germans are split nearly down the middle about what that reform should be. Roughly 47 percent would like to see an increase in private health care spending, whereas 49 percent would not. Similarly, 45 percent of Germans believe that more patient choice would improve health care quality, whereas 50 percent do not. The reluctance to fully embrace market reforms undoubtedly stems from a long-standing German belief in social solidarity. By a margin of 81 to 18 percent, Germans believe that equal access to the same quality of care for everyone is more important than their own access to the best possible care.(311)

Costs and demographics will eventually force changes in the German system. However, given the failure of Chancellor Merkel’s reforms, change is unlikely in the near future.

The Swiss Healthcare System

2009-09-28T05:40:00.000-04:00

Today it is the Swiss healthcare system that is being critiqued.

The article is from the CATO institute; The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Switzerland

Of all the countries with universal health care, Switzerland has one of the most market- oriented systems. Indeed, the Swiss government actually pays for a smaller amount of total health care expenditures than the U.S. government, 24.9 percent versus 44.7 percent. (250) (See Figure 3.)

The Swiss system is based on the idea of managed competition, the same concept that underlay the 1993 Clinton health care plan and Mitt Romney’s reforms in Massachusetts. (251) Managed competition leaves the provision of health care and health insurance in private hands but creates a highly regulated artificial marketplace as a framework within which the health care industry operates.(252)

Swiss law requires all citizens to purchase a basic package of health insurance, an individual mandate. Coverage is close to universal, estimated at 99.5 percent.(253) This level of compliance is due in part to the Swiss national character and may not be replicable in the United States where the record of complying with mandates is much more mixed (even if such a mandate were desirable). (254) For example, nearly 100 percent of Swiss drivers comply with their country’s mandate for automobile insurance, compared with only 83 percent of U.S. drivers. (255)

The term “basic benefits package” is somewhat misleading since the required benefits are quite extensive, including inpatient and outpatient care, care for the elderly and the physically and mentally handicapped, long-term nursing home care, diagnostic tests, prescription drugs, and even complementary and alternative therapies.(256)

Insurance is generally purchased on an individual basis. Few employers contribute to the purchase or provide insurance. (257) The policies are provided by private insurers. Currently, some 93 insurers operate in Switzerland, although not every insurer operates in every canton, or region.(258) Originally, insurers were required to be nonprofit entities, but that restriction was eliminated in 2002.

Insurers cannot reject an applicant on the basis of health status, and all policies are community rated within a geographic area, meaning that the healthier pay higher premiums to subsidize the less healthy. One exception to community rating is for nonsmokers, who can receive premiums as much as 20 percent lower than smokers. A formula adjusts premiums based on sex and age. (259) The geographic variation can be significant, with premiums differing as much as 50 percent between cantons. (260)

Unable to compete on the basis of managing and pricing risk, and required to offer nearly identical basic benefits packages, insurers compete primarily on price. Since they cannot reduce costs by risk management or benefit design, they generally manage prices by varying the level of deductibles and co-payments. Individuals can purchase expensive policies with very low deductibles and co-payments, or far less expensive policies with high deductibles or extensive co-payments. Thus, premiums vary according to their cost-sharing attributes and plan type, running from $1,428 per year for a plan with a deductible of approximately $2,000 to $2,388 for a plan with a $250 deductible. (261)

Because employers do not pay for workers’ health insurance, the Swiss are exposed to the full cost of their insurance purchases. As a result, many Swiss have opted for high-deductible insurance. Thus, with high deductibles and extensive co-payments, the Swiss pay out of pocket for 31.5 percent of health care, twice as much as in the United States.(262) (See Figure 4.)

Recently, there has also been a growing market in managed care plans that, like those in the United States, offer lower premiums in exchange for limitations on access to specialists and other services. Premiums for such plans run around $1,900 per year. (263)

The Swiss government offers subsidies to low-income citizens to help them purchase a policy. Subsidies are based on both income and assets, and the maximum available subsidy covers the cost of an average premium in the individual’s canton. These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance. They do not, however, pay the entire cost of insurance because the Swiss do not want to create an incentive for subsidized individuals to choose the most expensive plan with the lowest deductibles and co-payments. (264) Roughly one-third of Swiss citizens receive some form of subsidy, and approximately 19 percent of all health insurance premiums are paid with government funds. (265)

Swiss insurers operate as cartels to negotiate provider reimbursements on a cantonal basis. Providers must accept the negotiated payment, and balance-billing is prohibited. If insurers and providers are unable to reach agreement on a fee schedule, canton governments are empowered to step in and impose an agreement. There are no restrictions on where physicians may set up practice, so to some degree providers can vote with their feet, moving to cantons that offer higher reimbursements, a practice that has led to physician shortages in some areas. (267)

The system includes both public and private hospitals. (268) Private hospitals negotiate reimbursement with insurance cartels and physicians in the same manner. Public hospitals are operated by cantons, which negotiate reimbursement rates with insurers and provide subsidies to the hospitals. In some cantons, individuals with only the basic insurance plan must use public hospitals; supplementary insurance (see below) is required for admission to private hospitals.

Recently some providers have begun operating outside the negotiated fee schedules. A separate supplemental insurance market is starting to develop to cover the cost of these providers, which are presumed to offer higher quality or more advanced services. Supplementary insurance also allows access to private hospitals in those cantons that do not permit access under the basic insurance plan. Even within public hospitals, supplementary insurance can be used to pay for services such as private rooms that are not covered under the basic plan. By some estimates as many as 40 percent of Swiss citizens have purchased supplemental insurance. (269)

The Swiss do not impose a global budget on their health care system and have therefore avoided the waiting lists common in other systems. In addition, the Swiss have a high degree of access to modern medical technology, but it has come at a cost. The Swiss spend 11.5 percent of GDP on health care, second only to the United States. (270)

Since Swiss health care consumers are exposed to the cost consequences of their health care decisions, this trade-off between access and cost can be presumed to reflect the desires of Swiss patients. They have chosen high quality care even though it costs them more. Given that economists consider health care to be a “normal good”—that is, consumption rises along with income—and Switzerland is a wealthy nation, such a decision seems entirely reasonable.(271)

At the same time, it is notable that Swiss health care spending remains below that of the United States for nearly comparable care. Strong evidence suggests that the exposure of Swiss consumers to the cost consequences of their health care decisions has made them more conscious consumers and helped limit overall health care costs. As Regina Herzlinger and Ramin Parsa-Parsi of Harvard have concluded, “Cost control may be attributed to the Swiss consumer’s significant role in health care payments and the resulting cost transparency.”(272)

The transparency of the system also makes it responsive to consumer preferences. The WHO survey ranked Switzerland second only to the United States in terms of responsiveness to patients’ needs for choice of provider, dignity, autonomy, timely care, and confidentiality. (273)

The Swiss generally seem pleased with their system. Earlier this year, Swiss voters overwhelmingly rejected a proposal to replace the current system with a single-payer plan; more than 71 percent of Swiss voters turned down the proposal in a nationwide referendum. (274)

Nonetheless, the Swiss system has its own problems, most of them predictable outgrowths of the individual mandate and the regulation inherent in managed competition. In most markets, consumers impose a certain discipline on prices because they can refuse to buy a product if it costs too much. The individual mandate removes this power since consumers must purchase the product (in this case, insurance) even if they believe the cost outweighs the value. Moreover, the establishment of a government defined benefits package is an open-ended invitation to special interests representing various health care providers and disease constituencies, who can certainly be expected to lobby for the inclusion of additional services or coverage. (275)

Public choice dynamics are such that providers (who would make money from the increased demand for their services) and disease constituencies (whose members naturally have an urgent desire for coverage of their illness or condition) will always have a strong incentive to lobby legislators for inclusion under any minimum benefits package. The public at large will likely be unaware of the debate or see resisting the small premium increase caused by any particular additional benefit as unworthy of a similar effort—a simple case of concentrated benefits and diffused costs.(276)

That is exactly what has happened in Switzerland, leading to a growing expansion of the basic benefits package. In particular, a powerful hospital and physician lobbying coalition known as the “Blue Front” was able to demand a significant expansion in covered benefits in exchange for a relaxation of “any willing provider” laws so as to permit managed- care contracts. (277)

The expansion of benefits has driven up the cost of insurance, a cost only partially offset by larger deductibles. Although the proportion of health expenditures paid out of pocket remains high, it has decreased by roughly 10 percent in the past decade. (278)

Moreover, the growth in covered benefits has helped drive up costs for the system as a whole, as the Swiss become more insulated from the costs of their health care purchasing decisions. If that trend continues, it could undermine the cost transparency that is at the heart of the Swiss system.” As Uwe Reinhardt has noted, “Over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven aspects of the Swiss system.”(279)

Evidence shows that the community rating requirements are creating distortions within the Swiss market, leading to the over provision of care to the healthy and the under provision of care to the sick. (280) In addition, the prohibition on risk management discourages the development of new and innovative products. Peter Zweifel of the University of Zurich, a member of the Swiss Competitive Committee which oversees insurance regulation, believes that a return to some degree of risk-rating is essential to the long-term success of the Swiss system. (281) As Zweifel puts it, “Let competition work its magic. Let those who are bad risks get the message that they need to become better risks, if possible. If not possible, [they would] still get a subsidy which [keeps their costs] down to little more than 8–10 percent of taxable income.”(282)

Third, the cartel structure for negotiating reimbursement schedules can create a number of distortions. Effectively monopsony purchasers, the cartels have enormous leverage when it comes to negotiations. Not surprisingly, physicians have tended to set up practice in cantons with the highest levels of reimbursement, leading to shortages in other areas. Reimbursement rates have reportedly created wasteful incentives—for example, hospitals shifting patients from outpatient to inpatient care. (283) And the combination of increased demand and low reimbursement has led to the first signs of queues for the most complex surgeries. (284)

In addition, the negotiations freeze in place a pricing structure that inhibits the development of innovative approaches that do not tie payments to specific benefits. This includes both managed care approaches and health services integration. (285)

Finally, Switzerland has some of Europe’s strongest regulation of nonphysician health care professionals. (286) As a result, patients are often forced to use more expensive providers where a less expensive professional would do.

All of the above combine to undermine the consumer-driven nature of Switzerland’s health system. Despite these problems, the Swiss system provides a useful lesson for the United States about the value of consumer directed health care. In particular, we can see that when the cost of insurance becomes more transparent, consumers shift their purchasing preferences toward true insurance (spreading catastrophic risk), rather than purchasing prepayment for routine, low-cost services. That gives consumers an overall incentive to make cost-versus-value decisions when purchasing health care, resulting in reduced costs while maintaining individual choice and quality care.

The Obama Saga

2009-09-25T05:35:00.002-04:00

And it came to pass in the Age of Insanity that the people of the land called America, having lost their morals, their initiative, and their will to defend their liberties, chose as their Supreme Leader that person known as "The One."

He emerged from the vapors with a message that had no meaning; but He hypnotized the people telling them, "I am sent to save you." My lack of experience, my questionable ethics, my monstrous ego, and my association with evil doers are of no consequence. I shall save you with hope and Change. Go, therefore, and proclaim throughout the land that he who preceded me is evil, that he has defiled the nation, and that all he has built must be destroyed. And the people rejoiced, for even though they knew not what "The One" would do, he had promised that it was good; and they believed. And "The One" said " We live in the greatest country in the world. Help me change everything about it!" And the people said, "Hallelujah! Change is good!"

Then He said, "We are going to tax the rich fat-cats." And the people said "Sock it to them!" "And redistribute their wealth." And the people said, "Show us the money!" And the he said, “redistribution of wealth is good for everybody."

And Joe the plumber asked, “Are you kidding me? You're going to steal my money and give it to the deadbeats??" And "The One" ridiculed and taunted him, and Joe's personal records were hacked and publicized. One lone reporter asked, "Isn't that Marxist policy?" And she was banished from the kingdom!

Then a citizen asked, "With no foreign relations experience and having zero military experience or knowledge, how will deal with radical terrorists?" And "The One" said, "Simple. I shall sit with them and talk with them and show them how nice we really are; and they will forget that they ever wanted to kill us all!" And the people said, "Hallelujah!! We are safe at last, and we can beat our weapons into free cars for the people!"

Then "The One" said "I shall give 95% of you lower taxes." And one, lone voice said, "But 40% of us don't pay ANY taxes." So "The One" said, "Then I shall give you some of the taxes the fat-cats pay!" And the people said, "Hallelujah! Show us the money!" Then "The One" said, "I shall tax your Capital Gains when you sell your homes!" And the people yawned and the slumping housing market collapsed. And He said... "I shall mandate employer-funded health care for every worker and raise the minimum wage. And I shall give every person unlimited healthcare and medicine and transportation to the clinics." And the people said, "Give me some of that!" Then he said, "I shall penalize employers who ship jobs overseas." And the people said, "Where's my rebate check?"

Then "The One" said, "I shall bankrupt the coal industry and electricity rates will skyrocket!" And the people said, "Coal is dirty, coal is evil, no more coal! But we don't care for that part about higher electric rates." So "The One" said, Not to worry. If your rebate isn't enough to cover your expenses, we shall bail you out. Just sign up with the ACORN and you troubles are over!"

Then He said, "Illegal immigrants feel scorned and slighted. Let's grant them amnesty, Social Security, free education, free lunches, free medical care, bilingual signs and guaranteed housing..." And the people said, "Hallelujah!" and they made him king!

And so it came to pass that employers, facing spiraling costs and ever-higher taxes, raised their prices and laid off workers. Others simply gave up and went out of business and the economy sank like unto a rock dropped from a cliff. The banking industry was destroyed. Manufacturing slowed to a crawl. And more of the people were without a means of support.

Then "The One" said, "I am the "the One"- The Messiah - and I'm here to save you! We shall just print more money so everyone will have enough!" But our foreign trading partners said unto Him. "Wait a minute. Your dollar is not worth a pile of camel dung! You will have to pay more... And "The One" said, "Wait a minute. That is unfair!!" And the world said, "Neither are these other idiotic programs you have embraced. Lo, you have become a Socialist state and a second-rate power. Now you shall play by our rules!"

And the people cried out, "Alas, alas!! What have we done?" But yea verily, it was too late. The people set upon The One and spat upon him and stoned him, and his name was dung. And the once mighty nation was no more; and the once proud people were without sustenance or shelter or hope. And the Change "The One" had given them was as like unto a poison that had destroyed then and like a whirlwind that consumed all that they had built.

And the people beat their chests in despair and cried out in anguish, "give us back our nation and our pride and our hope!!" But it was too late, and their homeland was no more.

So ask yourself; Is this really happening or is it a very bad dream?

How many of our liberties and freedoms can Obama and the Democrats destroy in 4 years?

**original source of satire not found

The Netherland System

2009-09-24T05:45:00.000-04:00

Next we go to the Netherlands which is also one of the countries touted by many as an example of what we should model ourselves after. Again, the report is from the CATO institute report. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Netherlands

Aside from Switzerland, the Netherlands has perhaps the most market-oriented national health care system in Europe. That was the case even before 2006, when a series of reforms introduced even more market mechanisms.

The old pre-2006 Dutch system resembled Germany’s. Dutch workers with incomes below €€ 32,600 were required to enroll in one of 30 government-controlled “sickness funds.” Those with higher incomes had the option of enrolling in the funds if they wished, or opting out of the government system and purchasing private insurance. Sickness funds were financed through a payroll tax and a flat-rate, per-capita premium. (208)

The funds provided a uniform package of benefits including physician and hospital care, specialist care, diagnostic tests, prescription drugs, and dental care for children. (209) While consumers could switch funds annually, there was little competition between funds and few consumers actually switched.

The new Dutch system operates on the theory of managed competition like Switzerland (see below). Both the social health insurance program and the alternative private health insurance option were replaced by a requirement that all Dutch citizens purchase a basic health insurance plan from one of 41 private insurance companies. Although a fine may be imposed for failure to comply, there is no comprehensive system for identifying citizens who do not meet the mandate. An estimated 1.5 to 2 percent of the population is currently uninsured. (210)

The required plan, which covers minimum benefits set by the government, includes general practitioner and specialist care, hospital stays, some dental care, prenatal care, some medicines, and travel expenses. In one interesting innovation, most of the required benefits are specified in terms of “functions of care” rather than by provider category. Thus, “rehabilitation care” is required, but no particular type of rehabilitation provider is mandated. (211) This may mean that the benefits package will be less susceptible to manipulation by provider interest groups, but it is much too early to tell.

The Health Ministry sets premiums, which average around €€ 100 per month for an individual. Insurance companies can offer varying deductibles, ranging from €€ 150 to €€1,000 per year, allowing for a small level of price competition. Policies can also offer rebates of up to €€225 if a policyholder uses no health services in a given year beyond seeing a primary care physician. (212) About 90 percent of the population also buys supplemental insurance covering services over and above the required standard benefits package. (213)

Employers generally pay half of insurance premiums, with individual workers picking up the other half.(214) Individual premiums are tax deductible.(215) Subsidies, or care allowances, that help low- and middle-income income workers purchase the basic insurance plan are extensive and reach well into the middle class. Currently, 5 million Dutch citizens qualify for some level of subsidy on a sliding scale based on income. (216) Those subsidies are financed through a tax on salaried workers. Because of the high levels of subsidy, the Dutch government remains a large source of health spending, one area of significant difference with the Swiss system. (217)

Insurers negotiate quality, quantity, and price of services with providers. Notably, many insurers require providers to document the quality of the care they provide, frequently relying on evidence-based guidelines and performance metrics. (218)

Some insurers provide care directly, using their own staffs and their own facilities, such as primary care centers and pharmacies. Other insurers contract with a network of providers similar to U.S. preferred provider organizations (PPOs). Patients can go out of network but will receive only partial reimbursement. Most insurers require a referral from a primary care provider before a patient can see a specialist. (219) Pharmaceutical prices are capped nationwide at the average price of medicines in a therapeutic class. Individuals may choose more expensive drugs but must pay the difference out of pocket. (220)

The new system has been in place for only two years, which is not enough time to permit a thorough evaluation. However, preliminary indications suggest that it is an improvement over the pre-2006 system. (221)

Dutch consumers appear to have embraced the reforms. Consumer organizations are participating in negotiations with providers, insurers, and lawmakers. The system is becoming more transparent, with far greater information available regarding both price and quality.

Consumers seem willing to make decisions and change insurers on the basis of price and quality. Price competition under the new system has increased significantly and at least 20 percent of Dutch consumers have switched insurers. (222) When the system was initiated, the Dutch government predicted premiums would cost €€1,106 on average. However, competition has forced the average premium down to €€1,028, 097.6 percent below the prediction.(223) Overall, the new system is estimated to have increased the purchasing power of Dutch households by as much as 1.5 percent.(224) However, not everyone has been a winner. The community rating requirement has resulted in steep increases in premiums for younger workers who were more heavily subsidized under the old system. (225)

Under the old system, waiting lists were widespread—for example, more than three months for a hip replacement and two months for a prostatectomy or hysterectomy. (226) One study estimated that at least 100 heart patients died each year while on waiting lists.(227) Early evidence suggests that some improvement has come as a result of the 2006 reforms.(228)

Hospitals are beginning to compete by expanding services such as neurosurgery and radiation therapy.(229) Although some experts have expressed concern that smaller hospitals offering these services may not have sufficient utilization rates to ensure quality and efficacy, the expanded availability of services will likely increase access to care and reduce queues.(230)

The new system may even be having a positive impact on health care costs. Since the new system took effect, health care costs have been growing at an annual rate of just 3 percent, compared to more than 4.5 percent in the year before the reforms. (231)

The jury is still out, and the Dutch system still falls well short of a true free market, but the Netherlands appears to have taken a big step in the right direction.

The Greek Healthcare System

2009-09-23T05:35:00.002-04:00

Today we look at Greece as referred to in the CATO institute report. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Greece

Although ostensibly an employer-based system, the Greek system operates more like a single- payer system in that it is highly centralized and regulated. Virtually every aspect of health care financing and provision is strictly controlled by the Ministry of Social Health and Cohesion.(189) Some attempts have been made to decentralize decision making, with 17 regional organizations having some responsibility for implementing policy and managing the delivery of health care, but most power remains with the central government.

Greek employers must enroll their workers in one of 35 “social insurance funds,” funded in part through a payroll tax and in part through general tax revenues. Unlike Germany, where employers have a choice among competing sickness funds, Greek social insurance funds are specific to industry sectors. The range of benefits offered by each fund, the contribution rates, and the types of providers that the insured can access are all determined by the Ministry of Social Health and Cohesion. (190)

Certain funds known as “noble funds,” primarily used by government workers, the banking sector, and public utility workers, offer more extensive benefits and require smaller worker contributions. The powerful unions representing workers from these sectors have consistently blocked attempts to merge these funds with other social insurance funds or to allow buy-ins from other industry sectors. (191)

Social insurance funds reimburse doctors in two ways. Some providers are employed directly by the funds at fund-operated clinics and are effectively salaried employees. Others practice privately but contract with funds to provide care. Contract physicians are reimbursed on a fee-for-service basis, but reimbursement rates are extremely low. Balance-billing is prohibited.

In theory, funds provide first-dollar coverage, with no deductibles and low co-payments for only a few services. However, as discussed below, most physicians demand “informal” payments in exchange for treatment.

In addition to the social insurance funds, the National Health Service employs physicians and operates hospitals. The NHS operates parallel to the social insurance funds, acting essentially as a back-up mechanism, although it may be the principal provider of health services in some rural areas. It also provides health care for the uninsured and the elderly.

In addition to NHS hospitals, other public hospitals contract with the social insurance funds. In both cases, the Ministry of Social Health and Cohesion determines not only the hospital’s budget, but the number of personnel, the specialties of the personnel, salary levels, number of beds, and the purchase of technology. Budgets are rigidly monitored and hospital administrators have little leeway. (192) Hospitals are reimbursed on a per diem payment system, a type of a fixed charge. (193)

NHS hospitals in particular are considered substandard. Most suffer from severe staffing shortages caused by low pay and poor living conditions in rural areas. It has been estimated that less than half of authorized medical positions are actually filled. (194) Low salaries have also led to personnel shortages in public hospitals associated with social insurance funds. (195)

A series of reforms implemented in 2005 imposed a referral requirement for hospital admissions. Patients seeking free treatment in a public NHS hospital must have a referral from a general practitioner, who acts as a gatekeeper. Private practice physicians may not make referrals to public or NHS hospitals. (196) Unfortunately, general practitioners are in severely short supply. Greece needs an estimated 5,000 general practitioners to meet demand. In actuality it has only around 600. (197)

Despite overlapping health plans, the Greek system falls short of universal coverage. About 83 percent of the population is covered for primary care (on par with the United States), and about 97 percent for hospital care. (198) In theory, the uninsured can always receive treatment by walking into an NHS clinic or hospital. Only about 8 percent of Greeks have private supplemental health insurance, although this percentage has risen substantially in the past few years and further growth is predicted. (199)

Accurate information on waiting lists is difficult to come by. According to the WHO, “although ‘patient registries’ at the hospital level do exist, there is no systematic data processing available at any level of care,” to provide adequate analysis.(200) However, most observers agree that waiting lists are a severe problem at almost every level of care, and particularly bad at both NHS and public hospitals. An examination of waiting lists at Athens hospitals by the Ta Nea newspaper found the wait for surgery was as long as six months; for an outpatient appointment with either the hypertension or neurology departments, 150 days. Even simple blood tests required a month-long wait. (201)

The Greek system has developed a level of endemic corruption as patients have sought ways around the system’s rationing, bureaucracy, and inefficiencies. For example, Greeks routinely provide physicians with “informal” payments for seeing a patient from a sickness fund that has not contracted with the doctor, for moving a patient up in the queue, or for providing treatment outside government guidelines. In addition, physicians actively attempt to persuade patients to move from a doctor’s sickness fund contract to the doctor’s private practice. Patients who switch pay out of pocket but receive faster and better care. Even NHS physicians see private patients on the side. (This practice was illegal until 2002 but went on despite the prohibition). (202) Physicians also receive payments for referrals to private hospitals or diagnostic centers. Such informal out of- pocket payments made up 42 percent of total health expenditures in 2002, fully 4.5 percent of GDP.(203) Essentially, the Greek health care system is funded through payroll taxes, general tax revenue, and bribery.

In addition, the health care bureaucracy has become highly politicized. Every staff appointment in the public health sector must be approved at the ministry level. All hospital administrators and other health officials are appointed on the basis of political affiliation with the governing party, often with little regard for relevant training or other qualifications. (204)
Not surprisingly, Greece has far less modern health care technology than the United States. The United States has more than twice as many MRI units per million people and 20 percent more CT scanners. (205) Much of the state-of-the-art equipment that does exist is clustered in the country’s small number of private clinics and hospitals. Indeed, the vast majority of high technology biomedical tests are performed by the private sector. (206)

One study summed up the problems with the Greek health care system this way:

The Greek health system does not yet offer universal coverage and has fragmented funding and delivery. Funding is regressive, with a reliance on informal payments, and there are inequities in access, supply and quality of services. Inefficiencies arise from an over reliance on relatively expensive inputs, as evidenced by the oversupply of specialists and undersupply of nurses. Resource allocation mechanisms are historical and political with no relation to performance or output; therefore providers have little incentive to improve productivity. (207)

That would appear to be a fairly accurate summary.

The Portugal System

2009-09-22T05:38:00.000-04:00

Today we lay out the case for the Portugal Healthcare system referred to in the CATO institute report. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Portugal

The Portuguese health care system is a classic, universal, centrally run National Health System, a single-payer system funded through taxes with comprehensive benefits provided free or with little cost at the point of service.(171) Also, a number of occupation-related health insurance schemes—originally intended to be integrated into the NHS—now coexist with it.

The primary source of care is the NHS, which is funded primarily through general tax revenues, accounting for approximately 13 percent of all government expenditures.(172) In theory, the NHS operates within an annual global budget for health care spending. In reality, it regularly exceeds this budget by a wide margin, necessitating supplemental funding. Portugal is one of the few OECD countries where public health care spending has been rising as a proportion of total health spending, up more than four percentage points since 1997.(173)

Theoretically, benefits under the NHS include all necessary inpatient and outpatient health care services including specialists, diagnostic tests, mother and child care, and prescription drugs. On paper, no health-related expense is specifically excluded from coverage by the NHS, though in reality services such as dental care and rehabilitation therapy are seldom provided.(174) Copayments are required for diagnostic tests, hospital admissions, consultations with specialists, and prescription drugs, where copayments can run to 40 percent or higher.(175)

Primary care physicians and hospitalbased physicians are public employees, paid directly by the NHS. However, NHS doctors are permitted to practice privately as well, and roughly half do so.(176) Specialists are often in private practice and are reimbursed by the NHS on a contractual basis.

About 25 percent of the population, mostly government workers, military, telecommunication workers, and their families, remain under a series of industry or occupation-based insurance schemes, known collectively as “subsystems,” which are a legacy of the country’s pre-NHS health care system.(177) These plans were originally intended to be incorporated into the NHS, but their powerful constituencies have prevented that from occurring. Participants in the subsystems pay a premium equal to approximately 1 percent of their salary. Benefits are generally superior to those offered through the NHS.(178) Not surprisingly, premiums fall far short of what is needed to finance benefits. The resulting shortfall is shifted to the NHS.

In addition, approximately 10 percent of the population has private insurance, usually through their employer.(179) Private insurance generally pays for hospital and specialty care but not for primary care physicians. Policies are medically underwritten and have no requirement for renewability, meaning insurers can raise premiums or drop customers with extremely high claims.(180)

Choice of provider is heavily constrained under the NHS. Every citizen must choose a primary care physician from a list of those available within a specified geographic area. This area is usually based on the person’s area of residence but may be based on the area of employment. The average general practitioner serves as many as 1,500 people, though some may have more than 2,000 patients, leading to long waits and difficulties in getting appointments. People may change GPs only by applying in writing to the NHS and explaining their reasons.(181)

Access to specialists or hospital care, except in emergencies, requires referral from the patient’s GP. Since this is often difficult to secure in a timely manner, patients often seek care through hospital emergency rooms. By some estimates, at least 25 percent of emergency room patients do not need immediate treatment.(182)

Despite guarantees of “universal coverage,” access to care remains a serious problem. Waiting lists are so long and so prevalent that the European Observatory on Health Systems says that they veer toward “de facto rationing.”(183) Currently, more than 150,000 Portuguese are on waiting lists for surgery, out of a population of just 10.6 million.(184) However, that may understate the problem in poorer and rural areas, which have fewer health resources and less access to care.(185) Modern health technology is far less available than in the United States. The United States has almost seven times more MRI units per million people, and 20 percent more CT scanners.(186)

To avoid waiting lists, Portuguese patients frequently pay out of pocket to see physicians in private practice. In some cases, Portuguese patients have crossed the border to receive treatment in Spain.(187)

While there appears to be a consensus in Portugal that the system needs some kind of reform, weak governments and strong structural interest groups have combined to prevent the development of any consensus over the direction reform should take.(188) For the moment, Portugal drifts.

The Norwegian System

2009-09-21T05:32:00.001-04:00

Today we lay out the case for the Norwegian Healthcare system and again taken from the CATO institute. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Norway

Norway has a universal, tax-funded, single payer, national health system. All Norwegian citizens, as well as anyone living or working in Norway, are covered under the National Insurance Scheme. Norwegians can, however, opt out of the government system by paying out of pocket. In addition, many Norwegians go abroad for treatment to avoid the waiting lists endemic under the government program. (151)

The system is financed through general tax revenues, with no earmarked or dedicated tax for health care. (152) Thus, health care becomes one large contributor to a tax burden that consumes 45 percent of GDP. Among industrialized countries, only Sweden has a higher tax burden. (154)

Benefits are extensive and include inpatient and outpatient care, diagnostic services, specialist care, maternity services, preventive medicine, palliative care, and prescription drugs. At public hospitals, there are no charges for stays or treatment, including drugs. However, small co-payments may be charged for outpatient treatment and for treatment by a general practitioner, psychologist, or psychiatrist. The program also provides “sick pay” and disability benefits. (155) As Michael Moore has noted, the Norwegian system will even pay for “spa treatments” in some cases. (156)

Although the central government retains overall responsibility for and authority over the system, some management and funding responsibilities have devolved to regional and municipal governments. In general, municipal governments are responsible for primary health care, while four regional health authorities are responsible for specialist care. (157) Prior to 2002, public hospitals were run by local or county governments. In the face of chronic problems, notably long waiting lists and rising costs, the central government took direct control of all public hospitals in January 2002.(158) A small number of private hospitals do exist outside the public system.

The government sets a global budget limiting overall health expenditures, and setting capital investment expenditures for hospitals. Most general practitioners and physician specialists outside hospitals receive a fixed salary, although some specialists working on a contract basis receive both an annual grant and fee-for-service payments. Reimbursement rates are set by the government and balance-billing is prohibited. Most other health care personnel are salaried government employees. (159)

Patient choice of physician is constrained. All Norwegian citizens must choose a general practitioner from a government list. The GP acts as a gatekeeper for other services and providers. Patients may switch GPs, but no more than twice per year and only if there is no waiting list for the requested GP. (160) Specialists may only be seen with a referral from the GP.

The Norwegian health care system has experienced serious problems with long and growing waiting lists.(161) Approximately 280,000 Norwegians are estimated to be waiting for care on any given day (out of a population of just 4.6 million).(162) The average wait for hip replacement surgery is more than four months; for a prostatectomy, close to three months; and for a hysterectomy, more than two months.(163) Approximately 23 percent of all patients referred for hospital admission have to wait longer than three months for admission.(164)

The Norwegian government has responded by repeatedly and unsuccessfully attempting to legislate waiting lists out of existence. For example, under the 1990 Patients’ Rights Act, patients with a condition that would lead to “catastrophic or very serious consequences” have a right to treatment within six months, if the treatment is available.(165) In 2001, after several government reports had documented repeated violations of this policy, the government passed a new mandate requiring that a patient’s medical condition be at least “assessed” within 30 days.(166) Despite these paper guarantees, waiting lists have not been substantially reduced.(167)

Moreover, such delays may represent only the tip of the iceberg when it comes to rationing care in Norway. In some cases, care may be denied altogether if it is judged not to be cost-effective. As Knut Erik Tranoy, Professor Emeritus at the Centre for Medical Ethics of the University of Oslo and an original member of the government’s Health Care Priorities Commission, explains:

It is important to see (a) that, in a public health service of the Nordic type, any given amount of resources always has alternative uses. And (b) it is neither medically nor morally defensible to put scarce resources to uses which will foreseeably yield less favorable outcomes than other uses—save fewer lives, cure fewer patients.(168)

Tranoy differentiates between Norwegian style systems of national health care and “a health care system where patients buy services in a market, and where justice means equality of opportunity to buy what you need. Decisions about alternative use are then (largely) patients’ decisions.”(169)

While Norwegians generally report that they are “fairly satisfied” with the way their health care system is run, there has been growing discontent over such issues as the ability to choose a health care provider, involvement in decisions regarding care or treatment, and waiting times—which has been an ongoing issue in Norwegian politics. (170) However, at this time there doesn’t appear to be any widespread movement for larger reform.

Pondering the Question

2009-09-18T05:40:00.000-04:00

Clunkers...

I guess I must be on the wrong page…

A vehicle at 15 mpg and 12,000 miles per year uses 800 gallons a year of gasoline.

A vehicle at 25 mpg and 12,000 miles per year uses 480 gallons a year.

So, the average clunker transaction will reduce US gasoline consumption by 320 gallons per year.

They claim 700,000 vehicles – so that’s 224 million gallons / year.

That equates to a bit over 5 million barrels of oil.

5 million barrels of oil is about ¼ of one day’s US consumption.

And, 5 million barrels of oil costs about $350 million dollars at $75/bbl.

So, we all contributed to spending $3 billion to save $350 million..

How good a deal was that???

LEMON PICKER

The woman applying for a job in a Florida lemon grove seemed to be far too qualified for the job.

The foreman frowned and said, "I have to ask you this; have you had any actual experience in picking lemons?"

"Well, as a matter of fact, I have!" she replied.

"I've been divorced three times and I voted for Obama."

The Spanish System

2009-09-17T05:45:00.000-04:00

Today we lay out the case for the Spanish Healthcare system and again taken from the CATO institute. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Spain

Spain’s national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions. The Spanish Constitution guarantees all citizens the “right” to health care, including equal access to preventive, curative, and rehabilitative services; but responsibility for implementing the country’s universal system is being devolved to regional governments. The degree and speed of devolution is uneven, however, with some regions only recently achieving maximum autonomy.(111)

Coverage under the Spanish system is nearly universal, estimated at 98.7 percent of the population. The system provides primary health care, including general health and pediatric care, outpatient and inpatient surgery, emergency and acute care, long-term disease management, and prescription drugs (although some drugs may require a co-payment). Many mental health services, particularly outpatient services, are excluded, as is cosmetic surgery.(112)

The federal government provides each region with a block grant. The money is not earmarked: the region decides how to use it. The block grant itself is based primarily on a region’s population with some consideration given to other factors such as the population’s demographics. Regions may use their own funds to supplement federal monies.

Not surprisingly, health care spending varies widely from region to region. The differences in expenditures, as well as in spending priorities, lead to considerable variance in the availability of health resources. For example, Catalonia has more than 4.5 hospital beds per 1,000 residents, while Valencia has just 2.8.(113)

Spanish patients cannot choose their physicians, either primary care or specialists. Rather, they are assigned a primary care doctor from a list of physicians in their local community. If more specialized care is needed, the primary care physician refers patients to a network of specialists. Unlike U.S. managed care, it is not possible to go “out of network” unless the patient has private health insurance (see below). This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting lists.

Waiting lists vary from region to region but are a significant problem everywhere. On average, Spaniards wait 65 days to see a specialist, and in some regions the wait can be much longer. For instance, the wait for a specialist in the Canary Islands is 140 days. Even on the mainland, in Galacia, the wait can be as long as 81 days. For some specialties the problem is far worse, with a national average of 71 days for a gynecologist and 81 days for a neurologist.(114) Waits for specific procedures are also lengthy. The mean waiting time for a prostatectomy is 62 days; for hip replacement surgery, 123 days.(115)

Some health services that U.S. citizens take for granted are almost totally unavailable. For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives. There are very few public nursing and retirement homes, and few hospices and convalescence homes.(116)

As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 12 percent of the population currently has private health insurance. (This amounts to double coverage since opting out of the government system is not allowed.(117)) In larger cities such as Madrid and Barcelona, the number of privately insured reaches as high as 25 percent. Overall, private insurance payments account for 21 percent of total health care exenditures.(118) More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24 percent of health care spending in Spain is out of pocket, more than any European country except Greece and Switzerland, and even more than the United States.(119)

Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.(120)

There are also shortages of modern medical technologies. Spain has one-third as many MRI units per million people as the United States, just over one-third as many CT units, and fewer lithotripters.(121) Again, there is wide variation by region. For example, two regions, Ceuta and Melilla, do not have a single MRI unit.(122) The regional variation is important because Spaniards face bureaucratic barriers in trying to go to another region for treatment.

All hospital-based physicians and approximately 75 percent of all other physicians are considered quasi–civil servants and are paid a salary rather than receiving payment based on services provided. Compensation is based on years of practice or the attainment of certain professional credentials, with across-the board annual increases unrelated to merit, performance, or patient satisfaction.(123)

As a result, Spain has fewer physicians and fewer nurses per capita than most European countries and the United States. The lack of primary care physicians is particularly acute.(124)

Even so, Spaniards are generally happy with their system. Nearly 60 percent describe their system as good, the second highest favorability rating in Europe. (France was first.)(125) Accordingly, health care reform does not rank high on the average Spaniard’s political agenda. One observer described health care as “conspicuous by its absence as a major issue” in recent elections.(126) Only about 46 percent of Spaniards describe the need for reform as “urgent,” while 35 percent see reform as “desirable.” And Spaniards are less inclined toward market-based reforms than most other European countries. Only 42 percent of Spaniards believe that it should be easier for patients to spend their own money on health care, and only 58 percent believe that giving patients more control over spending will improve quality. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with waiting lists.(127)

The Japanese System

2009-09-16T05:35:00.002-04:00

Today we lay out the case for the Japanese Healthcare system and again taken from the CATO institute. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Japan

Japan has a universal health insurance system centered primarily around mandatory, employment-based insurance. On the surface, Japan’s national health insurance program defies easy description, comprising some 2,000 private insurers and more than 3,000 government units. However, in a broader sense, the system encompasses four principal insurance schemes.

The Employee Health Insurance Program requires companies with 700 or more employees to provide workers with health insurance from among some 1,800 “society managed insurance” plans. Nearly 85 percent of these plans cover a single company and can be thought of as similar to the self-insurance plans operated by many large U.S companies. Most of the rest are industry-based. About 26 percent of the population participates in these plans. (128)

Such plans are financed through mandatory employer and employee contributions, effectively a payroll tax. The total contribution averages around 8.5 percent of wages. It is generally split evenly between employer and employee, although some companies assume slightly more than half the contribution. As a result, workers contribute about 45 percent of payments overall. (129) It should be noted that studies have found that the majority of the burden of the employer’s contribution to health insurance is borne by the employees in the form of reduced wages. (130)

These contributions are frequently insufficient to operate the insurance plans. In 2003, more than half lost money. (131) A number of companies have responded by dissolving their individual plans and entering larger industry-based plans. However, growing costs continue to pressure many businesses.

Workers in businesses with fewer than 700 workers must enroll in the government run, small-business national health insurance program. This plan covers about 30 percent of the population and is funded primarily through mandatory contributions, around 8.2 percent of wages, and supplemented by government funds. (132)

The self-employed and retirees are covered under the Citizens Insurance Program administered by municipal governments. Funding comes primarily from a self-employment tax, but additional revenues come from an assessment on the society-managed insurance programs discussed above and the small business program. General revenue contributions from the national government are used to plug shortfalls.

Finally, the elderly are covered through a fund financed by contributions from the other three schemes, as well as contributions from the central government. The elderly do not pay directly into this plan, known as the Roken, but contribute to the plan they were enrolled in while employed. The Roken is simply a cost sharing mechanism. (134)

A number of small programs exist to handle special populations such as farmers, fishermen, and government workers. The unemployed remain under their former employers’ plan, although they are not required to continue contributing. Private supplemental insurance exists, but very few Japanese carry it. Private health insurance pays for less than 1 percent of total Japanese health care spending.

Benefits under all four schemes are extremely generous, including hospital and physician care, as well as dental care, maternity care, prescription drugs, and even some transportation costs. There are no restrictions on hospital or physician choice and generally no preauthorization or gatekeeper requirements. Significant co-payments accompany most services, ranging from 10 percent to, more commonly, 30 percent (capped at $677 per month for a middle-income family). As a result, the average Japanese household pays about $2,300 per year out of pocket.(135) Overall out-of-pocket expenditures amount to roughly 17 percent of total health care spending.

The vast majority of hospitals and clinics in Japan are privately owned, but because the government sets all fee schedules, the distinction between privately and publicly owned is irrelevant for patients. Reimbursement for both hospitals and clinics is on a fee-for-service basis, with the government setting fees and prescription prices.

The fee schedule is identical for inpatient and outpatient treatment. Because hospitals must absorb both physician and capital costs from the same level of reimbursement, the tendency has been to shift patients to outpatient services. (136) Recently, some attempts have been made to introduce alternate reimbursement mechanisms for hospitals, including DRGs and Diagnosis and Procedure Combinations— classification systems that tie reimbursements more closely to the resources that a particular patient consumes. But the medical establishment has resisted, and only about 80 hospitals participate in the experiment. (137)

Hospital physicians are salaried employees. Nonhospital physicians work in the private sector and the government sets their reimbursement schedules. Generally, reimbursement is on a fee-for-service basis, although recently some chronic conditions have been “price bundled” into a single fee. Reimbursement schedules are set within the context of an overall global budget on health spending, but the division of resources is the subject of extensive negotiation with providers.

The fee schedule reflects both the Japanese style of medicine and attempts to contain costs. For example, because of a strong cultural bias against invasive procedures, surgery tends to be reimbursed at a much lower rate than nonsurgical procedures. (138)

The fee-setting system has had serious corruption problems. Because the fees for each of more than 3,000 procedures or services are set individually and adjusted every two years on an individual basis, it is possible to manipulate particular fees without attracting much attention. (139) In 2004, a group of dentists was indicted for bribing the fee-setting board. (140)

In addition, the reimbursement schedule for physicians creates an incentive for them to see as many patients as possible. The result is assembly line medicine. Two-thirds of patients spend less than 10 minutes with their doctor; 18 percent spend less than 3 minutes. (141)

On the other hand, the Japanese, like Americans, practice a very technology-intensive style of medicine. Capital investment in technology has been given high priority, and the Japanese have at least as much access to technology such as MRI units, CT scanners, and lithotripters as patients in the United States.(142) Because the government imposes uniform fee schedules on hospitals, there is no price competition. Instead, hospitals attempt to lure patients by having the best technology. While this can benefit patients, it has also led to queues at the best hospitals and a black market with “under the table” payments for faster access. (143)

Some restrictions have been added in the last few years, capping the number of diagnostic imaging procedures that a hospital can perform in a calendar month, as well as reducing the fees for those services.(144) These changes have not led to visible rationing yet but could in the future.

To date, Japan has done a fairly good job of controlling costs without resorting to the rationing common in many universal care systems. This is due in part to factors outside the health care system, such as generally healthy lifestyles, low vehicle accident rates, low crime rates, low rates of drug abuse, and other cultural factors.(145) One study estimated that 25 percent of the difference in health care spending between the United States and Japan is attributable to a lower incidence of disease and 15 percent to less aggressive practice styles.(146) But rationing has also been avoided through the management of the health care system and the imposition of significant consumer cost sharing.

Nonetheless, spending is beginning to escalate, especially in government-managed programs such as the Roken, where there has been less of an attempt at cost sharing and cost containment. As one observer explained:

We Japanese have a tendency to go to the hospital even when we have only minor ailments such as the flu, headaches, or stomach aches. If medical expenses are not high and we do not feel well, then why not go see a doctor and get some medication. . . . The result, of course, is that waiting rooms of clinics and hospitals are full of people. Everyone is welcome and there are, in fact, regular customers. Sometimes elderly people come to see a friend and the hospital waiting room becomes a sort of salon. (147)

This problem is aggravated by the demographics of a rapidly aging society. By some estimates, the elderly are responsible for 90 percent of the aggregate increase in Japan’s health care costs. (148) If current trends continue, Japan will almost triple its government spending on health care in the next 20 years.(149) And the situation will only grow less stable with time. Japan is expected to lose 35 million workers by 2050, with 35 percent of its population in retirement. (150) This raises questions of how a system that relies on payroll taxes for funding can continue to fund rising costs even as its payroll base shrinks.

The Italian System

2009-09-15T06:02:00.001-04:00

Today we look at Italy and once again, the information is from the same source. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Italy

Italy’s national health care system is rated second in the world by the WHO.(89) Yet a closer examination shows the system to be deeply troubled, plagued with crippling bureaucracy, mismanagement and general disorganization, spiraling costs, and long waiting lists.

Generally, the Italian system is similar to the British National Health Service but enjoys more decentralization. The central government sets goals on how money should be spent, monitors the overall health status of the nation, and negotiates the labor contracts of medical staff. The Italian Constitution was changed in 2001 such that the national government now sets the “essential levels of care” regions must meet, but regional governments still control their own autonomous budgets and distribute resources to the local level.

In theory, under the “fiscal federalist” provisions of this reform, discretionary central transfers should have dropped sharply, local tax bases and tax sharing should have increased, and “equalizing” transfers should have been standardized and linked to objectives for controlling costs and increasing quality. However, poorer regions and powerful special interests have strongly resisted these changes. Reform therefore remains incomplete, and financial transfers from the central government are still based on historical spending patterns. (90)

Thus, while the national Ministry of Health continues to outline funding needs based on weighted capitation and past spending, recent reforms have shifted more and more power and responsibility to regional governments who set their own budgets. The regions establish one or more Local Health Authorities, which are responsible for the provision of care either through government-run hospitals and clinics or by contracting with private providers. (91) It should be noted that governance in Italy is often as much art as science, and regions frequently fail to implement rules, guidelines, reimbursement schedules, and budgets set by the central government.(92)

Financing comes from both payroll taxes and general revenues. Payroll taxes have a regressive structure, starting at 10.6 percent of the first €€ 20,660 of gross income and decreasing to 4.6 percent of income between €€20,661 and €€ 77,480. The remainder of funding comes from both federal and regional general taxation, including income and value-added taxes. (93) The central government redistributes resources to compensate to some degree for inequalities among regions. Even so, most regional health authorities run significant deficits. Overall, regional deficits top 1.8 percent of GDP. (94)

Inpatient care and primary care are free at the point of treatment. However, co-payments are required for diagnostic procedures, specialists, and prescription drugs.(95) The size of such co-payments has crept steadily upward over the past decade and now runs as high as 30 percent for some services.(96) Several attempts have been made to impose co-payments for a broad range of services, including primary care, but have collapsed in the face of public protests.(97) In addition, nearly 40 percent of the population (the elderly, pregnant women, and children) are exempt from co-payments.(98)

Italians have limited choice of physician. They must register with a general practitioner within their LHA. They may choose any GP in the LHA but may not go outside it. Except for emergency care, a referral from a GP is required for diagnostic services, hospitalization, and treatment by a specialist. Despite these limits, Italians enjoy more choice of physician than do the British or Spanish.

Most physicians are reimbursed on a capitated basis (i.e., according to the number of patients served over a given time period rather than the services actually provided), although some hospital physicians receive a monthly salary. Hospitals are generally reimbursed according to DRGs, with rates set by the central government—though regions sometimes disregard those rates and set their own.

Private health insurance is available in Italy but is not widespread. Where offered, it is usually provided by employers. About 10 percent of Italians have private health insurance, below the percentage in most OECD countries. According to the insurance industry, this is partly because it is not possible to opt out of the National Health System and because health insurance premiums are not tax deductible.(99) Private health insurance allows free choice of doctors, including specialists, and treatment in private hospitals. Even without private insurance, however, many Italians use private health resources (and presumably pay out of pocket). Estimates suggest that as much as 35 percent of the population uses at least some private health services. (100)

Although Italy spends a relatively low percentage of GDP on health care, expenditures have been rising rapidly in recent years and have consistently exceeded government forecasts. (101) Between 1995 and 2003, total health care spending rose by 68 percent.(102) The Italian government has taken various steps to try to control costs, such as reducing reimbursement rates, increasing co-payments, reducing capital expenditures, contracting with private providers, and limiting prescription drugs. All of these measures have met with protests, including physician strikes, and many have been repealed after only a short time. (103)

The Italian government does not provide official information on waiting lists, but numerous studies have shown them to be widespread and growing, particularly for diagnostic tests. For example, the average wait for a mammogram is 70 days; for endoscopy, 74 days; for a sonogram, 23 days. (104) Undoubtedly, this is due in part to a shortage of modern medical technology. The United States has twice as many MRI units per million people and 25 percent more CT scanners. (105) Ironically, the best-equipped hospitals in northern Italy have even longer waiting lists since they draw patients from the poorer southern regions as well.(106)

If delays become excessive, patients may seek permission from the regional government to obtain treatment from private doctors or hospitals at NHS expense. A recent court decision allows patients whose life would be endangered by delays under the NHS to seek treatment in private hospitals even without prior permission from the regional government.

Italy has imposed a relatively strict drug formulary as well as price controls, and has thereby succeeded in reducing pharmaceutical spending, long considered a problem for the Italian health care system. In 2006, Italian drug prices fell (or were pushed) 5 percent, even as drug prices rose in the United States and much of the rest of the world. However, the savings came at a cost: the introduction of many of the newest and most innovative drugs was blocked. (107)

Conditions in public hospitals are considered substandard, particularly in the south. They lack not just modern technology, but basic goods and services; and overcrowding is widespread. Conditions are frequently unsanitary. For example, one of the largest public hospitals in Rome was recently found to have garbage piled in the hallways, unguarded radioactive materials, abandoned medical records, and staff smoking next to patients. (108) Private hospitals are considered much better and some regions have contracted with private hospitals to treat NHS patients.

Dissatisfaction with the Italian health care system is extremely high, by some measures the highest in Europe. (109) In polls, Italians say that their health care system is much worse than that of other countries and give it poor marks for meeting their needs. Roughly 60 percent of Italians believe that health care reform is “urgent,” and another 24 percent believe it is “desirable.” In general, Italians believe that such reform should incorporate market-based solutions. More than two-thirds (69 percent) believe that giving patients more control over health care spending will improve the system’s quality. And 55 percent believe that it should be easier for patients to spend their own money on health care. (110)

However, given the general dysfunction of the Italian political system, and the entrenched opposition of special interest groups, substantial reform is not likely anytime soon.

The French System

2009-09-14T05:30:00.000-04:00

Today we’ll show the French System.

As stated before, these assessments are taken from the CATO institute report. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

France

Some of the most thoughtful proponents of national health care look to France as a model of how such a program could work. Jonathan Cohn of theNew Republic has written that “the best showcase for what universal health care can achieve may be France.”(44) Ezra Klein of the American Prospect calls France “the closest thing to a model structure out there.”(45) The French system ranks at or near the top of most cross-country comparisons and is ranked number one by the WHO.(46)

Although the French system is facing looming budgetary pressures, it does provide at least some level of universal coverage and manages to avoid many of the problems that afflict other national health care systems. However, it does so in large part by adopting market-oriented approaches, including consumer cost sharing. Other aspects of the system appear to reflect French customs and political attitudes in such a way that would make it difficult to import the system to the United States.

France provides a basic level of universal health insurance through a series of mandatory, largely occupation-based, health insurance funds. These funds are ostensibly private entities but are heavily regulated and supervised by the French government. Premiums (funded primarily through payroll taxes), benefits, and provider reimbursement rates are all set by the government. In these ways the funds are similar to public utilities in the United States. The largest fund, the General National Health Insurance Scheme, covers most nonagricultural workers and their dependents, about 83 percent of French residents. Separate insurance plans cover agricultural workers, the self-employed, and certain special occupations like miners, transportation workers, artists, clergy, and notaries public. Another fund covers the unemployed. These larger insurance schemes are broken down into smaller pools based on geographic region. Overall, about 99 percent of French citizens are covered by national health insurance.

The French health care system is the world’s third most expensive, costing roughly 11 percent of GDP, behind only the United States (17 percent) and Switzerland (11.5 percent). Payroll taxes provide the largest source of funding. Employers must pay 12.8 percent of wages for every employee, while employees contribute an additional 0.75 percent of wages, for a total payroll tax of 13.55 percent. In addition, there is a 5.25 general social contribution tax on income (reduced to 3.95 percent on pension income and unemployment benefits). Thus, most French workers are effectively paying 18.8 percent of their income for health insurance. Finally, dedicated taxes are assessed on tobacco, alcohol, and pharmaceutical company revenues.(47)

In theory, the system should be supported by these dedicated revenues. In reality, they have not been sufficient to keep the program’s finances balanced. The National Health Authority sets a global budget for national health care spending, but actual spending has consistently exceeded those targets.(48)

In 2006, the health care system ran a €€10.3 billion deficit. This actually shows improvement over 2005, when the system ran an €€11.6 billion deficit.(49) The health care system is the largest single factor driving France’s overall budget deficit, which has grown to €€ 49.6 billion, or 2.5 percent of GDP, threatening France’s ability to meet the Maastricht criteria for participation in the Eurozone.(50) This may be just the tip of the iceberg. Some government projections suggest the deficit in the health care system alone could top €€29 billion by 2010 and €€ 66 billion by 2020.(51)

In general, the funds provide coverage for inpatient and outpatient care, physician and specialist services, diagnostic testing, prescription drugs, and home care services. In most cases, the services covered are explicitly specified in regulation. However, some “implicit” benefit guarantees occasionally result in conflicts over what benefits are and are not fully covered.(52)

Most services require substantial copayments, ranging from 10 to 40 percent of the cost. As a result, French consumers pay for roughly 13 percent of health care out of pocket, roughly the same percentage as U.S. consumers. (53) Moreover, because many health care services are not covered, and because many of the best providers refuse to accept the fee schedules imposed by the insurance funds, more than 92 percent of French residents purchase complementary private insurance.(54) In fact, private insurance now makes up roughly 12.7 percent of all health care spending in France, a percentage exceeded only by the Netherlands (15.2 percent) and the United States (35 percent) among industrialized countries.(55)

The combination of out-of-pocket and insurance payments means that nongovernment sources account for roughly 20 percent of all health care spending, less than half the amount spent in the United States but still more than most countries with national health care systems.(56)

The private insurance market in France is in many ways less regulated than the U.S. market. For example, while 20 U.S. states require some form of community rating or put limits on health insurance premiums, private health insurance in France is largely experience rated. No regulations specify what benefits must be included in coverage or mandate “guaranteed issue”; and pre-existing conditions may be excluded. The only significant restriction requires “guaranteed renewability” after two years of coverage.(57) More than 118 carriers currently offer some form of private health insurance coverage.(58)

In general, French patients pay up front for treatment and are then reimbursed by their government health insurance fund and/or private insurance. The amount of reimbursement, minus the copayment, is based on a fee schedule negotiated between health care providers and the national health insurance funds. These fee schedules operate similarly to the diagnostic-related groups (DRGs) under the U.S. system.

Although reimbursement levels are set by the government, the amount physicians charge is not. The French system permits providers to charge more than the reimbursement schedule, and approximately one-third of French physicians do so.(59) In some areas, such as Paris, the percentage of physicians who bill above reimbursement schedules runs as high as 80 percent.(60) In general, however, competition prevents most physicians from billing too far outside negotiated rates; and physicians employed by hospitals, as opposed to those in private practice, do not have the same ability to charge more than the negotiated rate.

The government also sets reimbursement rates for both public and private hospitals, which are generally not allowed to bill beyond the negotiated fee schedules. While fees are restricted, private hospitals (called cliniques), which account for 37 percent of all short-stay hospital beds and half of all surgical beds, control their own budgets, whereas public hospitals operate under global annual budgets imposed by the Ministry of Health.

Health care technology that the National Health Authority has categorized as “insufficient medical service rendered” cannot be purchased by public hospitals, and its use at cliniques is not reimbursable through national insurance schemes.(61) Yet in denying reimbursement for such technology, the French government admits that when a product with an insufficient medical service rendered is de-listed from reimbursement, this does not imply that it is not efficient for a given pathology, but simply that the government prefers to commit its resources to other reimbursements which it deems more useful from a collective point of view.”(62)

In general, the quality of French health care is high, but there are problem areas. Until very recently, the French have generally had quick access to their primary care physician of choice. Now, a growing problem, nomadisme medical, wherein patients go from one doctor to another until they find one whose diagnosis they prefer, is driving up costs to the system. (63) The government has responded by increasing copayments and attempting to limit physician reimbursements.

Much of the burden for cost containment in the French system appears to have fallen on physicians. The average French doctor earns just €€ 40,000 per year ($55,000), compared to $146,000 for primary care physicians and $271,000 for specialists in the United States. This is not necessarily bad (there is no “right” income for physicians) and is partially offset by two benefits: 1) tuition at French medical schools is paid by the government, meaning French doctors do not graduate with the debt burden carried by U.S. physicians, and 2) the French legal system is tort-averse, significantly reducing the cost of malpractice insurance.(64) The French government also attempts to limit the total number of practicing physicians, imposing stringent limits on the number of students admitted to the second year of medical school.(65)

However, French physicians have shown growing resistance to efforts at limiting physician reimbursement with several recent strikes and protests.(66) In the face of growing budgetary problems, future conflict may well be brewing.

More significantly, the government has recently begun imposing restrictions on access to physicians. A 2004 study by the High Council on the Future of Health Insurance raised questions about “the legitimacy of the complete freedom enjoyed by health professionals in setting up their private practice.”(67) And in 2005, the government adopted a system of “coordinated care pathways.” Under the new system, which operates very much like managed care in the United States, patients are encouraged to choose a “preferred doctor” and to follow the “pathway” suggested by that doctor. The effect is both to lock patients into a choice of primary care physician and to establish a “gatekeeper” who limits access to specialists, tests, and some advanced treatment options.(68)

So far, the new system has been more of a gentle push than a mandate. If the new system is not used, copayments may be slightly higher or reimbursements slightly lower, much like going “out of network” in the United States. But if costs continue to rise, the new system may be extended and made more rigorous.

Of more immediate concern, global budgets and fee restrictions for hospitals have led to a recurring lack of capital investment, resulting in a shortage of medical technology and lack of access to the most advanced care. For example, the United States has eight times as many MRI units per million people and four times as many CT scanners as France.(69) This partially reflects the more technology-reliant way of practicing medicine in the United States, but it has also meant delays in treatment for some French patients. Also, strong disparities are evident in the geographic distribution of health care resources, making access to care easier in some regions than others.(70) Thus, while the French system has generally avoided the waiting lists associated with other national health care systems, limited queues do exist for some specialized treatments and technologies. In some cases, hospitals in danger of exceeding their budgets have pushed patients to other facilities to save money.(71)

Finally, the government has tried to curtail the use of prescription drugs. The French have long had an extremely high level of drug consumption. French general practitioners (GPs) prescribe on average €€ 260,000 worth of drugs a year.(72)However, the National Health Authority has begun de-listing drugs from its reimbursement formulary.(73) Many French patients have responded by switching to similar, reimbursable drugs, but some patients may not be getting the medicine they need. For example, one study found that nearly 90 percent of French asthma patients are not receiving drugs that might improve their condition.(74)

Government regulation and bureaucracy have also been blamed for rigidity in the French system, preventing it from reacting quickly to changing circumstances. For example, mismanagement and the inability of the system to cope with emergencies were blamed in part for the deaths of 15,000 elderly individuals in the summer of 2003 during the European heat wave; and a shortage of hospital beds occurred in 2004 when a nationwide flu and bronchitis epidemic broke out.(75)

Although the changes made so far do not amount to rationing, 62 percent of French citizens report that they “have felt the effects” of the new restrictions.(76) Slightly less than half consider the waiting time between diagnosis and treatment to be acceptable.(77)

Valentin Petkantchin, a scholar with the Institut Economique Molinari, warns that France is in danger “of joining the group of countries [such as] the UK and Canada, where the existence of rationing of health care and waiting lists raises serious questions of access to treatments by those who need them.”(78) And some French health professionals have suggested that waiting times for care have begun to lengthen.(79)

The impact of all these cost containment measures is alleviated to some degree by the ability of French patients to privately contract for care outside the public system. If a drug is removed from the national formulary, patients may still purchase it if they are willing to pay for it themselves. The same is true for technology. Likewise, patients may ignore the “coordinated care pathway” and accept higher prices, paying more for immediate access.

In addition, the added resources from payments by private insurance have increased the supply of health care technology and services. By increasing the overall amount of capital available for investment above and beyond the restrictions imposed by the government system, private insurance payments increase the number of hospital beds and the amount of technology available within the system. The capital infused through private insurance may also increase the number and training of physicians.(80)

In essence, the French system avoids widespread rationing because, unlike true singlepayer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be:

Waiting lists for elective surgery generally tend to be found in countries which combine public health insurance (with zero or low patient cost sharing) and constraints on surgical capacity. Public health insurance removes from patients the financial barriers to access leading to high potential demand. Constraints on capacity . . . prevent supply from matching this demand. Under such circumstances, non-price rationing, in the form of waiting lists, takes over from price rationing as a means of equilibrating supply and demand.(81)
And Ezra Klein praises the French because [France’s ability to hold down health care costs] is abetted by the French system’s innovative response to one of the trickier problems bedeviling health-policy experts: an economic concept called “moral hazard.” Moral hazard describes people’s tendency to overuse goods or services that offer more marginal benefit without a proportionate marginal cost. Translated into English, you eat more at a buffet because the refills are free, and you use more health care because insurers generally make you pay up front in premiums, rather than at the point of care. The obvious solution is to shift more of the cost away from premiums and into co-pays or deductibles, thus increasing the sensitivity of consumers to the real cost of each unit of care they purchase.(82)

However, the benefits of private insurance are not equally distributed. The wealthy are more likely to be able to pay privately to escape the government system, creating in essence a two-tier system. That has resulted in a disparity in health outcomes based on income.(84) While this is certainly the case in the United States and elsewhere—and there is nothing wrong with the wealthy being able to pay more to receive better care—it demonstrates that the professed goal of entirely equal access is largely unattainable even under this government-run health system.

A 2004 poll showed that the French had the highest level of satisfaction with their health care system among all European countries. This is partly because their hybrid system has avoided many of the biggest problems of other national health care systems. Yet it also stems from French social character. For example, by a three-to-one margin, the French believe the quality of care they receive is less important than everyone having equal access to that care.(85) This means the French experience may not be easily transferable to the United States, which has a far less egalitarian ethic.

While satisfied with their care today, the French do express concern about the future. In particular, they acknowledge the need for greater cost control. This leads to the standard contradiction inherent in government services: most people are opposed to paying more (either through higher taxes or out of pocket), yet they worry that cost-control measures will lead to a deterioration of care in the future. There is no consensus on what French health care reform would look like. Still, some 65 percent of French adults believe that reform is “urgent,” and another 20 percent believe reform is “desirable.”(86)

Moreover there is growing dissatisfaction with the French welfare state—of which the health care system is a significant part—and the level of taxes necessary to support it. The recent election of French president Nicolas Sarkozy is widely regarded as a reflection of this new attitude.(87) Indeed, the new French government has made a crackdown on health care spending one of its top priorities..(88)

To sum up: the French health care system clearly works better than most national health care systems. Despite some problems, France has generally avoided the rationing inherent in other systems. However, the program is threatened by increasing costs and may be forced to resort to rationing in the future.

The French system works in part because it has incorporated many of the characteristics that Michael Moore and other supporters of national health care dislike most about the U.S. system. France imposes substantial cost sharing on patients in order to discourage over-utilization, relies heavily on a relatively unregulated private insurance market to fill gaps in coverage, and allows consumers to pay extra for better or additional care, creating a two-tier system.

This is clearly not the commonly portrayed style of national health care.

Riddle of the Day

2009-09-11T05:45:00.001-04:00

Hillary, Biden and Obama were on a donkey, at the edge of a cliff. The donkey got spooked and jumped off the cliff.

Who was saved?

America

Great Britain System

2009-09-10T05:32:00.000-04:00

Since Britain is always touted as one of the programs to model after, I thought it would be the next best one to list.

As stated before, these assessments are taken from the CATO institute report. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

Great Britain

Almost no one disputes that Britain’s National Health Service faces severe problems, and few serious national health care advocates look to it as a model. Yet it appears in Moore’s movie SiCKO as an example of how a national health care system should work, so it is worth examining.

The NHS is a highly centralized version of a single-payer system. The government pays directly for health care and finances the system through general tax revenues. Except for small copayments for prescription drugs, dental care, and optician services, there are no direct charges to patients. Unlike many other single-payer systems such as those in Canada and Norway, most physicians and nurses are government employees.

For years, British health policy has focused on controlling spending and in general has been quite successful, with the system spending just 7.5 percent of GDP on health care.(232) Yet the system continues to face serious financial strains. In fiscal year 2006, the NHS faced a deficit of £700 million, according to government figures, and as much as £1 billion, according to outside observers.(233) This comes despite a £43 billion increase in the NHS annual budget over the past five years.(234) By some estimates, NHS spending will have to nearly triple by 2025 just to maintain the current level of services.(235)

And that level of services leaves much to be desired. Waiting lists are a major problem. As many as 750,000 Britons are currently awaiting admission to NHS hospitals. These waits are not insubstantial and can impose significant risks on patients. For example, by some estimates, cancer patients can wait as long as eight months for treatment.(236) Delays in receiving treatment are often so long that nearly 20 percent of colon cancer patients considered treatable when first diagnosed are incurable by the time treatment is finally offered.2(37)

In some cases, to prevent hospitals from using their resources too quickly, mandatory minimum waiting times have been imposed. The fear is that patients will flock to the most efficient hospitals or those with smaller backlogs. Thus a top-flight hospital like Suffolk East PCT was ordered to impose a minimum waiting time of at least 122 days before patients could be treated or the hospital would lose a portion of its funding.(238) As the Daily Telegraph explained:

In a real competitive market, increased demand can allow prices to rise, thus increasing profits, which allow the market to grow. Efficient producers can then reduce their unit costs and their prices, and so give a better deal to the consumer. The prevailing logic is that the more customers who are served—or products that are sold—in a given period of time, the better the business does.
But PCTs have budgets that are predetermined by Whitehall spending limits, and there is no way for them to conjure extra revenue out of the air or to grow their market. As a result, the hospitals that are most successful in providing prompt treatment are running through the finite resources of their PCTs at an unacceptably rapid rate.(239)

The problem affects not only hospitals. There are also lengthy waits to see physicians, particularly specialists. In 2004, as a cost-cutting measure, the government negotiated low salaries for general practitioners in exchange for allowing them to cut back the hours they practice. Few are now available nights or weekends.(240) Problems with specialists are even more acute. For example, roughly 40 percent of cancer patients never get to see an oncology specialist.(241)

The government’s official target for diagnostic testing is a wait of no more than 18 weeks by 2008. In reality, it doesn’t come close.(242) The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent. Overall, more than half of British patients wait more than 18 weeks for care.(243)

Explicit rationing also exists for some types of care, notably kidney dialysis, open heart surgery, and some other expensive procedures and technologies.(244) Patients judged too ill or aged for the procedures to be cost-effective may be denied treatment altogether.

Recently, the British government introduced some tiny steps toward market-based reforms. Under the experimental London Patient Choice Project, patients who have been waiting longer than six months for treatment are offered a choice of up to four alternate providers. This experiment has been extended nationwide for coronary heart patients who have been waiting longer than six months.(245)

Some proposed solutions are far more radical. David Cameron, leader of the Conservative Party, has proposed that the NHS be allowed to refuse treatment to individuals who don’t practice healthy lifestyles, for example, who smoke or are overweight. Then again, he has also proposed that the government pay for gym memberships and subsidize the purchase of fresh fruit and vegetables.(246)

A small but growing private health care system has emerged in the UK. About 10 percent of Britons have private health insurance. Some receive it through their employer, while others purchase it individually. In general, the insurance replicates care provided through the NHS and is purchased to gain access to a wider choice of providers or to avoid waiting lists.(247) Private health insurance is lightly regulated and risk-rating is allowed. The British government treats health insurance more or less the same as other types of insurance.(248)

The British public is well aware of the need for reform. Nearly two-thirds of Britons (63 percent) say that the need for reform is “urgent,” while another 24 percent believe it is “desirable.” Fully 60 percent of Britons believe that making it easier for patients to spend their own money on health care would improve quality.(249) Yet Britons are also extremely proud of their health care system and wary of any reforms that would “Americanize” it.

The Canadian System

2009-09-09T05:40:00.002-04:00

As the congress returns from the August break and resumes the Healthcare debate, I thought it would be relavent to share thoughts on the various healthcare plans from many of the other nations.

One of the best, concise and probably least biased reports come from the CATO institute. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis

I plan to share the text from the Policy analysis on each of the various countries over the next couple of weeks so that the pros and cons of each program can be thought about and possibly discussed.

We should be able to learn from all of them and hopefully not make similar mistakes. I think most people will see that the more successful programs have similarities: Patients have more direct financial involvement; there is more free market competition and less government bureaucracy.

A Few Thoughts on Canada

Canada is another country that did not make the top 20 health care systems in the WHO rankings (it finished 30th), and few serious advocates of universal health care look to it as a model. As Jonathan Cohn puts it, “Nobody in the United States seriously proposes recreating the British and Canadian system here—in part because; as critics charge . . . they really do have waiting lines.”(312) However, since the press still frequently cites it as an example, it is worth briefly examining.

Although Canada is frequently referred to as having a “national health system,” the system is actually decentralized with considerable responsibility devolved to Canada’s 10 provinces and 2 territories. It is financed jointly by the provinces and the federal government, similar to the U.S. Medicaid program. In order to qualify for federal funds, each provincial program must meet five criteria: 1) universality—available to all provincial residents on uniform terms and conditions; 2) comprehensiveness—covering all medically necessary hospital and physician services; 3) portability—allowing residents to remain covered when moving from province to province; 4) accessibility—having no financial barriers to access such as deductibles or copayments; and 5) public administration—administered by a nonprofit authority accountable to the provincial government.

Federal financing comes from general tax revenue. The federal government provides a block grant to each province which amounts to around 16 percent of health care spending. However, most funding comes from provincial taxes, primarily personal and corporate income taxes. Some provinces also use funds from other financial sources like sales taxes and lottery proceeds. And some (British Columbia, Alberta, and Ontario) charge premiums, although health services cannot be denied because of inability to pay. The healthcare system is an enormous part of the Canadian welfare state. On the provincial level, the health care system amounts to between one-third and one-half of all social welfare spending.(313)

Provinces must provide certain benefits, including primary care doctors, specialists, hospitals, and dental surgery. Other benefits, such as routine dental care, physiotherapy, and prescription drugs, are optional. Some provinces offer substantial coverage for these services, some cover them only partially, and some do not cover them at all. Except for emergencies, treatment by specialists or hospital admission requires a referral from a primary care physician.

Provider reimbursement is set by each province, and some provinces restrict overall physician income. In general, however, reimbursement is on a fee-for-service basis. Hospitals are paid a specific pre-set amount to cover all noncapital costs. Capital expenditures must be approved on a case-by-case basis.

An increasing number of Canadians also carry private insurance, most often provided through their employer. Originally this insurance was designed to cover those few services not covered by the national health care system. At one time, all provinces prohibited private insurance from covering any service or procedure provided under the government program. But in 2005, the Canadian Supreme Court struck down Quebec’s prohibition on private insurance contracting.(314) Litigation to permit private contracting is now pending in several other provinces.

In addition to the public hospitals covered by the government, many private clinics now operate, offering specialized services. Although private clinics are legally barred from providing services covered by the Canada Health Act, many do offer such services in a black market. The biggest advantage of private clinics is that they typically offer services with reduced wait times compared to the public health care system. Obtaining an MRI scan in a hospital could require a wait of months, whereas it could be obtained much faster in a private clinic.

Waiting lists are a major problem under the Canadian system. No accurate government data exists, but provincial reports do show at least moderate waiting lists. The best information may come from a survey of Canadian physicians by the Fraser Institute, which suggests that as many as 800,000 Canadians are waiting for treatment at any given time. According to this survey, treatment time from initial referral by a GP through consultation with a specialist, to final treatment, across all specialties and all procedures (emergency, nonurgent, and elective), averaged 17.7 weeks in 2005.(315) And that doesn’t include waiting to see the GP in the first place

Defenders of national health care have attempted to discount these waiting lists, suggesting that the waits are shorter than commonly portrayed or that most of those on the waiting list are seeking elective surgery. A look at specialties with especially long waits shows that the longest waits are for procedures such as hip or knee replacement and cataract surgery, which could arguably be considered elective. However, fields that could have significant impact on a patient’s health, such as neurosurgery, also have significant waiting times.(316) In such cases, the delays could be life threatening. A study in the Canadian Medical Association Journal found that at least 50 patients in Ontario alone have died while on the waiting list for cardiac catheterization.(317) Data from the Joint Canada–United States Survey of Health (a project of Statistics Canada and the National Center for Health Statistics) revealed that “thirty-three percent of Canadians who say they have an unmet medical need reported being in pain that limits their daily activities.”(318) In a 2005 decision striking down part of Quebec’s universal care law, Canadian Supreme Court Chief Justice Beverly McLachlin wrote that it was undisputed that many Canadians waiting for treatment suffer chronic pain and that “patients die while on the waiting list.”(319)

Clearly there is limited access to modern medical technology in Canada. The United States has five times as many MRI units per million people and three times as many CTscanners.(320) Indeed, there are more CT scanners in the city of Seattle than in the entire province of British Columbia.(321)

Physicians are also in short supply. Canada has roughly 2.1 practicing physicians per 1,000 people, far less than the OECD average. Worse, the number of physicians per 1,000 people has not grown at all since 1990. And while the number of nurses per 1,000 people remains near the OECD average, that number has been declining since 1990.(322)

In addition, although national health care systems are frequently touted as doing a better job of providing preventive care, U.S. patients are actually more likely than Canadians to receive preventive care for chronic or serious health conditions. In particular, Americans are more likely to get screened for common cancers, including cancers of the breast, cervix, prostate, and colon.(323)

Canada has been relatively effective at controlling spending. The country spends about 9 percent of GDP on health care, a percentage that has risen only slightly over the last decade. Relative to average OECD expenditures, Canadian health expenditures have declined by 4 percent since 1997.(324) That cost control, however, has clearly come at the expense of access to care.

Canadians’ dissatisfaction with the problems in their system has been growing for some time. One survey showed that some 59 percent of Canadians believe that their system requires “fundamental changes,” and another 18 percent believe the system needs to be scrapped and totally rebuilt.(325) Still, Canadians are reluctant to embrace market reforms that are associated with the U.S. health care system—a system that Canadians disdainfully reject. As one observer put it:

Anxiety about Americanization and the constantly reinforced strain of national pride in Canadian health care coexist[s] with considerable uneasiness about the actual state of that care. It is as if, when Canadians look south across the border they swell with pride, but when they look within they shrink back, seeing many problems and feeling uncertainty about the future.

Canadians may jealously guard their system and resist “Americanizing” it, but even advocates of universal health care are coming to recognize that it does not provide a valid model for U.S. health care reform.

Michael Steele Visit

2009-09-08T05:13:00.000-04:00

For those readers who had not heard, my office had the rare opportunity and honor to host a private roundtable discussion with Michael Steele (the RNC Chairman) and with local republican leaders as well as local business owners and citizens.

Mr. Steele was extremely gracious in his short visit and was very motivating to our local Republican leaders. He spoke on the current healthcare debate and reiterated some of the Republican ideas that have been presented. They are similar to what I have posted before and include some of the following:

Implement tax code changes to give individuals tax breaks similar to companies eliminating the need to tie insurance to a particular job.

Too many patient who qualify for benefits under one of the federal or state plans either cannot or do not get signed up because of too much government bureaucracy. This needs to be simplified and streamlined

Reduce government mandates on insurance companies which now total around 1901. This would allow insurance companies to customize plans so people only bought what they needed or wanted. Why should a young healthy male need a personal policy that covers OB care.

Remove limitations on across-state-line purchases of health plans which would increase competition; bringing prices down.

Expand HSA, MSA accounts giving individuals control of their healthcare dollar

Implement some tort reform of which there is none mentioned in the nearly 1200 pages of the HR 3200 bill.

Allow vouchers for those truly in need of health insurance and allow them to purchase a policy through the free market just like everyone else.

Some of the media clips are linked here:

1. WISH-TV: http://www.youtube.com/watch?v=jnAUZegvlLE
2. WLKY-TV: http://www.wlky.com/news/20706024/detail.html (VIDEO ON SITE)
3. WAVE-TV: http://www.wave3.com/Global/story.asp?S=11041579 (VIDEO ON SITE)
4. FOX 41-TV: http://www.fox41.com/global/story.asp?s=11041945 (VIDEO ON SITE)
5. Louisville Courier-Journal: http://www.courier-journal.com/article/20090903/NEWS02/909030362/
6. News and Tribune: http://www.newsandtribune.com/local/local_story_246223542.html

Christian thoughts on Labor Day.

2009-09-07T05:42:00.000-04:00

Is there a difference between work and labor? For Christians, we view work as an integral part in the imago dei (the image of God).

The Bible tells us that everything began with God working for 6 days and resting on the seventh. When he placed Adam in the garden, His first gift was that of work and even though we don’t know directly why God asked man to work, it is suggested that the capacity to work---to create, to steward, and to care for what God had given--- is important. If the one who created us works; than we should find joy in it as well and perform it in a way that is honoring to our Creator.

But after the fall, work became more of labor. God called work good, but then cursed the ground, the raw material of our day-to-day activities. That curse condemned us to feelings of longing and lack when we can't quite accomplish the things we set out to do.

The creativity of man, then, while subject to the effects of the fall, is nevertheless a mirror-image of the creativity of God. It is designed to be a source of joy so fulfilling and wonderful that the Lord deemed it necessary to give us the fourth commandment in order to insure that we would set our work aside and rest at least one day a week!

It was designed so that our love of work is honoring our creator and we use our talents and abilities to further His kingdom. This is also why He gave us the Sabbath. God did not want us working every day even though it was designed to be joyful and many of us love what we do. Just as if we were a child or an adult doing some activity or playing and never wanted to stop, work was intentionally designed likewise.

So the Sabbath was made for man; not man for the Sabbath!

Enjoy the holiday and enjoy your work as it is honoring to our Creator!

Democratic Wildlife Change

2009-09-04T05:30:00.000-04:00

PETA and other environmentalists are surely going to have a fit with the newest evolving trend in our wildlife.

Animals that were formerly self-sufficient are now showing signs of joining the Democratic Party.

They have apparently learned to just sit and wait for the government to step in and provide for their care and sustenance.

This is a Democrat black bear in Montana nicknamed Bearack Obearma.

The Russian Experiment

2009-09-03T05:35:00.000-04:00

Here is a Russian perspective on Healthcare and the socialism of Medicine. Although no one believes we would end up like this, all single payer systems have similar problems and are not the answer to our healthcare needs.

What Soviet Medicine Teaches Us - Yuri N. Maltsev - Mises Institute

In 1918, the Soviet Union became the first country to promise universal "cradle-to-grave" healthcare coverage, to be accomplished through the complete socialization of medicine. The "right to health" became a "constitutional right" of Soviet citizens.

The proclaimed advantages of this system were that it would "reduce costs" and eliminate the "waste" that stemmed from "unnecessary duplication and parallelism" — i.e., competition.

These goals were similar to the ones declared by Mr. Obama and Ms. Pelosi — attractive and humane goals of universal coverage and low costs. What's not to like?

The system had many decades to work, but widespread apathy and low quality of work paralyzed the healthcare system. In the depths of the socialist experiment, healthcare institutions in Russia were at least a hundred years behind the average US level. Moreover, the filth, odors, cats roaming the halls, drunken medical personnel, and absence of soap and cleaning supplies added to an overall impression of hopelessness and frustration that paralyzed the system. According to official Russian estimates, 78 percent of all AIDS victims in Russia contracted the virus through dirty needles or HIV-tainted blood in the state-run hospitals.
Irresponsibility, expressed by the popular Russian saying "They pretend they are paying us and we pretend we are working," resulted in appalling quality of service, widespread corruption, and extensive loss of life. My friend, a famous neurosurgeon in today's Russia, received a monthly salary of 150 rubles — one third of the average bus driver's salary.

In order to receive minimal attention by doctors and nursing personnel, patients had to pay bribes. I even witnessed a case of a "nonpaying" patient who died trying to reach a lavatory at the end of the long corridor after brain surgery. Anesthesia was usually "not available" for abortions or minor ear, nose, throat, and skin surgeries. This was used as a means of extortion by unscrupulous medical bureaucrats.

"Slavery certainly 'reduced costs' of labor, 'eliminated the waste' of bargaining for wages, and avoided 'unnecessary duplication and parallelism'."

To improve the statistics concerning the numbers of people dying within the system, patients were routinely shoved out the door before taking their last breath.

Being a People's Deputy in the Moscow region from 1987 to 1989, I received many complaints about criminal negligence, bribes taken by medical apparatchiks, drunken ambulance crews, and food poisoning in hospitals and child-care facilities. I recall the case of a fourteen-year-old girl from my district who died of acute nephritis in a Moscow hospital. She died because a doctor decided that it was better to save "precious" X-ray film (imported by the Soviets for hard currency) instead of double-checking his diagnosis. These X-rays would have disproven his diagnosis of neuropathic pain.

Instead, the doctor treated the teenager with a heat compress, which killed her almost instantly. There was no legal remedy for the girl's parents and grandparents. By definition, a single-payer system cannot allow any such remedy. The girl's grandparents could not cope with this loss and they both died within six months. The doctor received no official reprimand.

Not surprisingly, government bureaucrats and Communist Party officials, as early as 1921 (three years after Lenin's socialization of medicine), realized that the egalitarian system of healthcare was good only for their personal interest as providers, managers, and rationers — but not as private users of the system.

So, as in all countries with socialized medicine, a two-tier system was created: one for the "gray masses" and the other, with a completely different level of service, for the bureaucrats and their intellectual servants. In the USSR, it was often the case that while workers and peasants were dying in the state hospitals, the medicine and equipment that could save their lives was sitting unused in the nomenklatura system.

At the end of the socialist experiment, the official infant-mortality rate in Russia was more than 2.5 times as high as in the United States and more than five times that of Japan. The rate of 24.5 deaths per 1,000 live births was questioned recently by several deputies to the Russian Parliament, who claim that it is seven times higher than in the United States. This would make the Russian death rate 55 compared to the US rate of 8.1 per 1,000 live births.

Having said that, I should make it clear that the United States has one of the highest rates of the industrialized world only because it counts all dead infants, including premature babies, which is where most of the fatalities occur.

Most countries do not count premature-infant deaths. Some don't count any deaths that occur in the first 72 hours. Some countries don't even count any deaths from the first two weeks of life. In Cuba, which boasts a very low infant-mortality rate, infants are only registered when they are several months old, thereby leaving out of the official statistics all infant deaths that take place within the first several months of life.

In the rural regions of Karakalpakia, Sakha, Chechnya, Kalmykia, and Ingushetia, the infant mortality rate is close to 100 per 1,000 births, putting these regions in the same category as Angola, Chad, and Bangladesh. Tens of thousands of infants fall victim to influenza every year, and the proportion of children dying from pneumonia and tuberculosis is on the increase. Rickets, caused by a lack of vitamin D, and unknown in the rest of the modern world, is killing many young people.

Uterine damage is widespread, thanks to the 7.3 abortions the average Russian woman undergoes during childbearing years. Keeping in mind that many women avoid abortions altogether, the 7.3 average means that many women have a dozen or more abortions in their lifetime.

Even today, according to the State Statistics Committee, the average life expectancy for Russian men is less than 59 years — 58 years and 11 months — while that for Russian women is 72 years. The combined figure is 65 years and three months.[1] By comparison, the average life span for men in the United States is 73 years and for women 79 years. In the United States, life expectancy at birth for the total population has reached an all-time American high of 77.5 years, up from 49.2 years just a century ago. The Russian life expectancy at birth is 12 years lower.[2]
After seventy years of socialism, 57 percent of all Russian hospitals did not have running hot water, and 36 percent of hospitals located in rural areas of Russia did not have water or sewage at all. Isn't it amazing that socialist government, while developing space exploration and sophisticated weapons, would completely ignore the basic human needs of its citizens?

"The filth, odors, cats roaming the halls, drunken medical personnel, and absence of soap and cleaning supplies added to an overall impression of hopelessness and frustration that paralyzed the system."

The appalling quality of service is not simply characteristic of "barbarous" Russia and other Eastern European nations: it is a direct result of the government monopoly on healthcare and it can happen in any country. In "civilized" England, for example, the waiting list for surgeries is nearly 800,000 out of a population of 55 million. State-of-the-art equipment is nonexistent in most British hospitals. In England, only 10 percent of the healthcare spending is derived from private sources.

Britain pioneered in developing kidney-dialysis technology, and yet the country has one of the lowest dialysis rates in the world. The Brookings Institution (hardly a supporter of free markets) found that every year 7,000 Britons in need of hip replacements, between 4,000 and 20,000 in need of coronary bypass surgery, and some 10,000 to 15,000 in need of cancer chemotherapy are denied medical attention in Britain.

Age discrimination is particularly apparent in all government-run or heavily regulated systems of healthcare. In Russia, patients over 60 are considered worthless parasites and those over 70 are often denied even elementary forms of healthcare.

In the United Kingdom, in the treatment of chronic kidney failure, those who are 55 years old are refused treatment at 35 percent of dialysis centers. Forty-five percent of 65-year-old patients at the centers are denied treatment, while patients 75 or older rarely receive any medical attention at these centers.

In Canada, the population is divided into three age groups in terms of their access to healthcare: those below 45, those 45–65, and those over 65. Needless to say, the first group, who could be called the "active taxpayers," enjoys priority treatment.

Advocates of socialized medicine in the United States use Soviet propaganda tactics to achieve their goals. Michael Moore is one of the most prominent and effective socialist propagandists in America. In his movie, Sicko, he unfairly and unfavorably compares health care for older patients in the United States with complex and incurable diseases to healthcare in France and Canada for young women having routine babies. Had he done the reverse — i.e., compared healthcare for young women in the United States having babies to older patients with complex and incurable diseases in socialized healthcare systems — the movie would have been the same, except that the US healthcare system would look ideal, and the UK, Canada, and France would look barbaric.

Now we in the United States are being prepared for discrimination in treatment of the elderly when it comes to healthcare. Ezekiel Emanuel is director of the Clinical Bioethics Department at the US National Institutes of Health and an architect of Obama's healthcare-reform plan. He is also the brother of Rahm Emanuel, Obama's White House chief of staff. Foster Friess reports that Ezekiel Emanuel has written that health services should not be guaranteed to
individuals who are irreversibly prevented from being or becoming participating citizens. An obvious example is not guaranteeing health services to patients with dementia.[3]

An equally troubling article, coauthored by Emanuel, appeared in the medical journal The Lancet in January 2009. The authors write that
unlike allocation [of healthcare] by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.[4]

Socialized medicine will create massive government bureaucracies — similar to our unified school districts — impose costly job-destroying mandates on employers to provide the coverage, and impose price controls that will inevitably lead to shortages and poor quality of service. It will also lead to nonprice rationing (i.e., rationing based on political considerations, corruption, and nepotism) of healthcare by government bureaucrats.

Real "savings" in a socialized healthcare system could be achieved only by squeezing providers and denying care — there is no other way to save. The same arguments were used to defend the cotton farming in the South prior to the Civil War. Slavery certainly "reduced costs" of labor, "eliminated the waste" of bargaining for wages, and avoided "unnecessary duplication and parallelism."

In supporting the call for socialized medicine, American healthcare professionals are like sheep demanding the wolf: they do not understand that the high cost of medical care in the United States is partially based on the fact that American healthcare professionals have the highest level of remuneration in the world. Another source of the high cost of our healthcare is existing government regulations on the industry, regulations that prevent competition from lowering the cost. Existing rules such as "certificates of need," licensing, and other restrictions on the availability of healthcare services prevent competition and, therefore, result in higher prices and fewer services.

Socialized medical systems have not served to raise general health or living standards anywhere. In fact, both analytical reasoning and empirical evidence point to the opposite conclusion. But the dismal failure of socialized medicine to raise people's health and longevity has not affected its appeal for politicians, administrators, and their intellectual servants in search of absolute power and total control.

Most countries enslaved by the Soviet empire moved out of a fully socialized system through privatization and insuring competition in the healthcare system. Others, including many European social democracies, intend to privatize the healthcare system in the long run and decentralize medical control. The private ownership of hospitals and other units is seen as a critical determining factor of the new, more efficient, and humane system.

End of Life Resuscitation

2009-09-02T05:45:00.000-04:00

It is studies like this that will fuel an Obama administration to proceed down a path of limiting care and eventually punishing doctors who don't agree.

According to a recent New England Journal of Medicine article, elderly patients who undergo in-hospital cardiopulmonary resuscitation have not had an increase in overall survival rates since the early 1990s and the results may be worse in men and minorities.

The report analyzed 1992 to 2005 fee-for-service Medicare data and identified 433,985 patients who underwent in-hospital cardiopulmonary resuscitation. There were only 18.3 percent who survived to discharge.

Although the survival rate did not significantly change during the study period, the researchers observed an increase in the proportion of patients who underwent in-hospital cardiopulmonary resuscitation before death. They also found that older age, male sex, chronic disease burden, admission from a skilled nursing facility, and African-American or other non-Caucasian race were associated with poorer survival.

This study lends more support to helping older patients make informed decisions prior to the need for resuscitation since the probability is low for survival and they didn’t report on the quality of life of those who did survive.

But what if you were the one that was saved and went on to lead a productive life with your family?

With Obamacare, this may be a mute point as these patients may not be allowed to be hospitalized in the first place as the cost benefit ratio used by the government would not be conducive to the bottom line.

VA End of Life Document

2009-09-01T05:31:00.000-04:00

Listed here is the controversial VA document about end of life care called "Your Life, Your Choices". http://www.rihlp.org/pubs/Your_life_your_choices.pdf

Although it does address many issues that patients and families should discuss, many of the questions are very leading and would certainly guide most people towards less aggressive measures.

The primary author of this workbook is Dr. Robert Pearlman who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

This document and the wording present end-of-life choices in a way that steers users toward predetermined conclusions.

The document has provocative questions as well as guilt inducing scenarios that would push most patients to answer a certain way.

It is also notable that when the VA panel of experts that sought to update the document between 2007-2008, they did not include any representatives of faith groups or disability rights advocates. But one organization was invited; the Hemlock Society (now euphemistically known as "Compassion and Choices").

In July 2009 there was a VA directive instructing its primary care physicians to raise advance care planning with all VA patients and to refer them to "Your Life, Your Choices."

There are better ways to discuss end of life care with patients and families and there should be strong consideration taken regarding their religious beliefs and preferences. Their religious leaders can also play a vital role in this although this documents mentions very little about that.

If Obama wants to be seen as compassionate towards the elderly and disabled, he needs to quit pushing this document and find a better way to address end of life care.

Baron Hill Forum

2009-08-31T05:00:00.001-04:00

Our illustrious Representative is finally scheduling a formal public event and evidently a second invitation event. I am not exactly sure if this second event is open to everyone or invitation only, but the following letter was received last week.

Tonight is the open town hall at IUS and this is an opportunity for our voices to be heard related to the disastrous healthcare bill that he voted to get out of committee.

Maybe he’ll be prepared to answer some of the tougher questions at this meeting but I'd be willing to bet, the democratic machine will have the audience stacked in his favor.

The Obama World

2009-08-28T05:30:00.000-04:00

Here is a perfect example of what an Obama healthcare system and his radical agenda will mean to everyday citizens.

http://aclu.org/pizza/images/screen.swf

Brace yourself citizens. You’ve had ample warning and there is still time to put an end to this!!

Letter to Editor

2009-08-27T05:30:00.001-04:00

Frustrations are mounting by many people since our Representative Baron Hill has wasted nearly all of the august recess before he finally decided to have some meetings. The delays has caused many people to submit letters to the local media in an effort to be heard.

With permission from the author, I am posting one of these letters to the editor that has been submitted to all of the local newspapers. But since we have no way of knowing if it will be published, we are at least going to give it some exposure here.

Town Halls and Public Discourse

I have watched with interest the many news clips from town halls across the United States. Sometimes they show the best side of public discourse. Sometimes they show the worst as both angry citizens and elected officials simply resort to name-calling. Our local Congressman, Baron Hill, has decided not to engage in any public forums during the recess and simply dismisses these angry citizens as “political terrorists.” I believe Baron Hill’s decision to avoid his constituents, with or without the ridiculous slander he used to rationalize it, to be the worst response of all.

As Thomas Jefferson said: “When a man assumes a public trust he should consider himself a public property.” I am 44 years old and, as Congressman Hill knows, have never even called my Congressman about anything until the past month. Not surprisingly, I am not alone in my sudden interest to express an opinion to my Congressman. Emails and calls, however, only generate form responses and polite conversations with uninformed staff. Regardless of his ultimate opinion on the healthcare debate, he owes it to his constituents to stand amongst us, state his opinions and answer questions. That, at a minimum, is his job.
Newspapers are supposed to be the advocates of free speech and public debate. It is past time for the newspapers in this District to call on Congressman Hill to debate publicly this important issue. After all, as Jefferson also said, “truth is the proper and sufficient antagonist to error, and has nothing to fear from the conflict.”

Rodney Scott

The VA Mistake

2009-08-26T12:10:00.000-04:00

Here is another perfect example of one of the government run programs in health care. 1,200 Gulf War Veterans Wrongly Told They Have ALS - Local News News Articles National News US News - FOXNews.com

How many disastrous examples do people need to understand the Government cannot run anything more efficiently than the private sector? Yes, coding mistakes happen, but not usually on a scale quite like this.

Hopefully they didn’t send these 1200 vets the end of life workbook to go through with their families.

Why are the malpractice attorneys not suing for wrongful diagnosis and pain and emotional suffering. Could it be because you cannot sue the VA system?

Tactics of the "Left"

2009-08-25T05:45:00.003-04:00

Andrew Breitbart has it right in this op-ed. The tactics of the “left” could never be highlighted as clearly as he does in this piece. Anyone reading the comments on the blogs also has seen this very clearly. What is so ironic is these same so called "intellectuals" or "progressives" are always claimng to be more "tolerant" than those on the consevative side. But reality is completely different. Maybe it is something they're smoking!

BREITBART: George W. Bush-by-proxy syndrome - Washington Times

There is an extensive body of writing from both sides of the political aisle that has analyzed the extraordinary depths of hatred leveled at former President George W. Bush.

His birth into a wealthy and politically connected family is where a lot of the animus starts. His rejection of his Connecticut roots and adoption of a rugged Texan persona naturally riled his birth-constituency. His disjointed speaking style also alienated many others - especially those who covered him in the Northeastern media. Naturally, some of his initiatives were controversial. His allies say he didn't do enough.

But all presidents make mistakes, pursue unpopular ideas, possess off-putting personality traits and don't do enough to appeal to their core supporters. Something far more insidious was at work in the hatred of our most recent former president.

Now that Mr. Bush is quietly going about his retirement, this strain of rage - the GWB43 virus - has spread like wildfire, finding unsuspecting targets, each granting us greater perspective into what not long ago seemed like a mysterious phenomenon isolated only on our 43rd president.

The first person to catch the virus was Sarah Palin, whose family also was infected, including, unforgivably, her children.

Then it was Joe the Plumber, for asking a question.

Next were the Mormons.

Then it was Rush Limbaugh - who hit back.

Next, tax-day "tea party" attendees were "tea bagged."

Then there was a beauty contestant.

And a Cambridge cop, too.

And now we have town-hall "mobs."

Smile ... you've been "community organized."

When put on the media stage, these individuals and groups have been isolated for destruction for standing in the way of a resurgent modern progressive movement and for challenging its charismatic once-in-a-lifetime standard-bearer, Barack Obama.

This is their time, we've been told. And no one is going to stand in the way.

The origins of manufactured "politics of personal destruction" is Saul Alinsky, the mentor of a young Hillary Rodham, who wrote her 92-page Wellesley College senior thesis on the late Chicago-based "progressive" street agitator titled, "There Is Only the Fight."

Mr. Obama and his Fighting Illini, Rahm Emanuel and David Axelrod, have perfected Mr. Alinsky's techniques as laid out in his guidebook to political warfare, "Rules for Radicals." In plain language, we see how normal, decent and even private citizens become nationally vilified symbols overnight - all in the pursuit of progressive political victory.

"Rule 12: Pick the target, freeze it, personalize it and polarize it. Cut off the support network and isolate the target from sympathy. Go after people and not institutions; people hurt faster than institutions. (This is cruel, but very effective. Direct, personalized criticism and ridicule works.)"

With the complicity of the mainstream media and abetted by George Soros' money and netroots nation, Mr. Bush never stood a chance.

But the more the virus spreads, the more we study it and, perhaps, find the cure. The repetitive use of the same technique against anyone who would dare stand up and oppose the progressive movement and especially its leader has exposed the game and rendered its tactics less effective.

In fact, one could make the argument that the Republican Party, usually slow on the uptake, has finally figured it out. There are no major Republican targets out there opposing Mr. Obama and his aggressive agenda. The conservative movement appears leaderless, but perhaps for the best.

Maybe that is the strategy: Standing back and letting the Obama machine flail in its pursuit of its next victim.

A grass-roots movement of average Americans has stood up, making it extremely difficult to isolate and demonize an individual.

Mr. Alinsky noted in "Rule 12" that it is difficult to go after "institutions." And attacking "tea baggers" and "mobs" has only created more resistance and drawn attention to the left's limited playbook. Even Americans expressing their constitutionally protected right to free speech are open game.

Now that many people are Googling the Alinsky rule book and catching up with the way Chicago thugs play their political games, Mr. Obama and the Fighting Illini are going to be forced to create new rules - or double down on the old ones.

Worse yet, as his approval ratings descend rapidly - Rasmussen has him at 47 percent, the lowest of his presidency - angry citizens may be turning the tables on him, using Mr. Alinsky against him.

They won't have to "freeze" and "personalize" him either. He's got 3 1/2 years left with the klieg lights focused on him. And if Mr. Obama can't get the economy rolling and continues to demonize everyday folks for his failures, he will be further isolated from sympathy and even ridiculed.

Yes, it's cruel - and effective.

Ask Mr. Bush, the magnanimous guy who gave the new president a heartfelt hug the day he took office. He knows.

Boy, I wish I could see his famous smirk right about now. I always loved how much they hated that.

• Andrew Breitbart is publisher of the news portals Breitbart.com and Breitbart.tv. His latest endeavor, Big Hollywood (http://bighollywood.breitbart.com), is a group blog on Hollywood and politics from the center-right perspective.

More Obama Falsehoods

2009-08-24T05:46:00.000-04:00

Obama’s recent townhall meeting was more of the same. Falsehoods, lies and misleading statements all while using the same straw man fallacy by stating it is this radical change or keeping the same system which isn’t sustainable. Here is a partial list from the “Morning Bell”

“I have not said that I was a single-payer supporter.” This is directly contradicted by candidate Barack Obama’s own website which quotes Obama at a rally in Ames, Iowa form 2008: “If I were designing a system from scratch I would probably set up a single-payer system. … So what I believe is we should set up a series of choices….Over time it may be that we end up transitioning to such a system.” So there you have in one paragraph the true purpose of Obama’s public option: a vehicle to slowly transition all Americans out of private coverage and into a government-run single payer health care system. This Trojan Horse view of the public option has been reaffirmed by Reps. Barney Frank (D-MA), Jan Schakowsky (D-IL), Washington Post blogger Ezra Klein, and New York Times columnist Paul Krugman.

“Under the reform we’re proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.” This statement is also plainly false. Again, as demonstrated above, the true purpose of Obama’s public option is to move Americans out of their private coverage and into government run health care. Independent, non-partisan analysis from the Lewin Group has confirmed the House bill, H.R. 3200, will do exactly that: About 88.1 million workers would see their current private, employer-sponsored health plan go away and would be shifted to the public plan.

“That’s what the health exchange is all about, is that you — just like a member of Congress — can go and choose the plan that’s right for you.” This statement isn’t false, but it is misleading. Members of Congress do purchase their health care through a health exchange: the Federal Employees Health Benefits Program (FEHBP). Through the FEHBP 283 private plans compete for federal employees’ health care dollars. The Heritage Foundation has long been a supporter of health reform that empowers consumers to utilize a FEHBP like system. But Obamacare is nothing like the FEHBP system. There is no government run public option competing with private plans in the FEHBP. So whenever Obama says that a health exchange already “drives down costs” he is right … but remember that this cost reduction is achieved purely by private health coverage without any “competition” from a government run public option.

“We have the AARP on board because they know this is a good deal for our seniors.” This is just plain false. The AARP released a statement late yesterday directly contradicting the President: “While the President was correct that AARP will not endorse a health care reform bill that would reduce Medicare benefits, indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate.”

“I just want to be clear, again: Seniors who are listening here, this does not affect your benefits. This is not money going to you to pay for your benefits; this is money that is subsidizing folks who don’t need it.” Under the current system, more and more seniors are discovering that it is becoming harder and harder to find and keep doctors who will accept Medicare patients. A 2008 survey found that 29% of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them. Obamacare will only make this problem worse by cutting $313 billion in Medicare reimbursements to health care providers over the next 10 years. This will only force more doctors to stop seeing Medicare patients. Obama also mentioned yesterday that he wants to pay for subsidized health care by killing the Medicare Advantage program. Medicare Advantage plans cover all of the traditional Medicare benefits and much more, including coordinated care and care-management programs for enrollees with chronic conditions as well as additional hospitalization and skilled nursing facility stays. 22% of all Medicare patients, which translates to 10.5 million seniors, are currently enrolled in Medicare Advantage plans.

“I said I won’t sign a bill that adds to the deficit or the national debt. Okay? So this will have to be paid for.” That is a nice promise, but so was Obama’s October 2008 promise that he would enact a “net spending cut.” We all know how that has turned out. The reality is that the Senate still has not figured out how to pay for their bill and the House bill would increase the budget deficit by $239 billion over the next ten years. CBO director Doug Elmendorf has said: “In sum, relative to current law, the proposal would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.”

“My belief is, is that [Obamacare] should not burden people who make $250,000 a year or less.” Both the House and Senate bills partially pay for Obamacare by imposing “employer mandates” or “pay or play” provisions that require employers to pay higher taxes if (a) they do not offer health insurance, or (b) they offer it but have employees who decline it and instead use the government system. Multiple studies have shown that such provisions cause both lower wages and lost jobs for low-income workers.

The Obama Commandments

2009-08-21T05:35:00.000-04:00

The Patriot Update has given us the following: “The Ten Commandments According to Obama” - A Free Press for the Conservative Revolution

After observing Obama on the campaign trail and during his first six months in office, we have concluded that our President lives and governs according to his own set of “Ten Commandments.” They’re certainly NOT the Ten Commandments you learned in Sunday School. In fact, many are the direct opposite! To prove that our conclusions are correct, you will find a link to source documentation for each commandment on the Patriot Update web site.

I. Thou shalt have no God in America, except for me. For we are no longer a Christian nation and, after all, I am the chosen One. (And like God, I do not have a birth certificate.) SOURCE

II. Thou shalt not make unto thee any graven image, unless it is my face carved on Mt. Rushmore. SOURCE

III. Thou shalt not utter my middle name in vain (or in public). Only I can say Barack Hussein Obama. SOURCE

IV. Remember tax day, April 15th, to keep it holy. SOURCE

V. Honour thy father and thy mother until they are too old and sick to care for. They will cost our public-funded health-care system too much money. SOURCE

VI. Thou shalt not kill, unless you have an unwanted, unborn baby. For it would be an abomination to punish your daughter with a baby. SOURCE

VII. Thou shalt not commit adultery if you are conservative or a Republican. Liberals and Democrats are hereby forgiven for all of their infidelity and immorality, but the careers of conservatives will be forever destroyed. SOURCE

VIII. Thou shalt not steal, until you've been elected to public office. Only then is it acceptable to take money from hard-working, successful citizens and give it to those who do not work, illegal immigrants, or those who do not have the motivation to better their own lives. SOURCE

IX. Thou shalt not discriminate against thy neighbor unless they are conservative, Caucasian, or Christian. SOURCE

X. Thou shalt not covet because it is simply unnecessary. I will place such a heavy tax burden on those that have achieved the American Dream that, by the end of my term as President, nobody will have any wealth or material goods left for you to covet. SOURCE

The moral decline of society is accelerating at a rapid pace under the Obama and Democratic leadership. But then, who is surprised

An Alternate Plan from Whole foods

2009-08-20T05:42:00.000-04:00

In a recent WSJ op-ed, there is a very sensible solution to fixing some of the problems with our healthcare system without the radical takeover by Obama and the Democrats.

The approach here is very sensible and would fix many of the problems regarding the expense of the system.

Although wiser lifestyle choices would go a long way in reducing medical costs and improving the health individuals, there is still a genetic component to many diseases that even excellent lifestyles cannot overcome.

Otherwise, this is a wonderful article.

John Mackey: The Whole Foods Alternative to ObamaCare - WSJ.com

The Whole Foods Alternative to ObamaCare

Eight things we can do to improve health care without adding to the deficit.

By JOHN MACKEY

"The problem with socialism is that eventually you run out of other people's money."
—Margaret Thatcher

With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people's money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

• 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.

• 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.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America
Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor's Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.