Max Baucus

“Public Option” Is a Gimmick That Won’t Improve Healthcare

by Hans Bader on October 26, 2009 · 1 comment

in Deregulate to Stimulate, Economy, Health and Illness, Healthcare, Insurance, Politics as Usual, Precaution & Risk, Sanctimony

In the Washington Post, Robert J. Samuelson explains in the “Public Plan Mirage” how the so-called “public option” contained in congressional health-care reform bills is just a gimmick: “It pretends to control costs and improve access to quality care when it doesn’t.” Steve Chapman wrote earlier about the “‘Public Option’ Health Care Scam.”

In other news, a study by PriceWaterhouseCoopers found that the provisions in the Senate health care “reform” bill sponsored by Sen. Max Baucus (D-Mont.) would add $1,700 a year to the cost of family coverage in 2013 and $600 for a single person. By 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.

CEI’s Greg Conko calls the Baucus bill “worse than the disease.”  In a recently-released paper, “A Cure Worse than the Disease: Obama Care Won’t Cut Costs, But May Cut Quality,” Conko notes that most of the alleged cost-cutting measures in the Baucus bill merely shift costs from the federal government onto the states or private payers, without reducing long-term health care inflation.  The only measures that could conceivably reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

A new study by the Oliver Wyman consultancy found that provisions contained in the health-care reform bills, like guaranteed issue and community rating mandates, would drive up premiums by 50 percent for individual policies and 19 percent for small group plans.

A study from the Independence Institute says that ObamaCare would drive up inflation and medical-care costs, while shrinking the economy.

As CEI’s Conko notes, many states have highly concentrated markets.  In Hawaii, Rhode Island, and Alaska, for example, 95 percent or more of the health insurance market is served by just two insurers.  But Obama and congressional Democrats oppose letting insurers compete across state lines, blocking competition that could make health insurance cheaper.  Other countries with cheaper health insurance permit insurers to compete nationally.

ObamaCare would raise taxes.  It would also explode state and federal budget deficits, and would actually cost $2 trillion — far more than its promised $800 billion price tag.  It also ignores needed reforms that would actually reduce the costs of health care, like steps to reduce the cost of defensive medicine, which wastes $200 billion annually.  And it contains special-interest pork, like racial preferences.

Health Insurer Competition and Democratic Saber Rattling

by Greg Conko on October 20, 2009

in Culture, Health and Illness, Healthcare, Insurance, Regulation, Zeitgeist

Last week, after the industry association America’s Health Insurance Plans released a study showing that premiums would rise 18 percent under the Senate Finance Committee’s reform proposal, top Democrats took to the airwaves to condemn the industry for standing in the way of health care reform.  President Obama used his Saturday radio address to accuse the industry of using “deceptive and dishonest” attacks to derail reform legislation.  And Obama and congressional Democrats threatened to repeal the McCarran-Ferguson Act, which exempts insurers from most federal regulation, including antitrust laws.

It is true that a handful of states have highly concentrated markets.  In Hawaii, Rhode Island, and Alaska, for example, 95 percent or more of the health insurance market is served by just two insurers.  But, federal intervention would do nothing to address this problem.  After all, insurers are still governed by state competition law, which prohibits anticompetitive practices.

The main benefit insurers get from McCarran-Ferguson is antitrust immunity for sharing the actuarial data on which firms individually base their premiums.  Ordinarily, information sharing of that kind of  would be a big no no, since it suggests pricing collusion.  But, state insurance laws permit it because it helps small insurers gain access to a sufficiently large pool of information to set premiums at an appropriate level.

The only way federal antitrust enforcement could significantly reduce market concentration would be to break up the firms into smaller pieces—think of the dissolution of John D. Rockefeller’s Standard Oil trust, or the break up of AT&T’s local service monopoly into seven regional Baby Bells.  But, as Boston University health economist Austin Frakt  notes:

“Taxpayers will be best served by insurers with sufficient market power to bargain down provider rates, but with not quite enough power to keep the savings (“rents”) for themselves.  … How to balance the power of insurers and providers is far from simple. Many have pointed to the alleged dominant market position of insurers as a substantial source of high health care costs. However, the health economics literature supports the notion that recent increased market power of insurers does not lead toward monopolistic pricing, but rather it provides a counter-balance to the power held by hospitals and provider groups.”  (Hat tip, Tyler Cowen.)

Democrats know this of course.  And, in the end, it’s not clear that they really do intend to repeal McCarran-Ferguson, or if they’re just sending a signal to health insurers and other dissenters that “this is how we deal with people who stand in our way.”  As my wife said yesterday, they’re playing Chicago hard ball now.  They’ll do whatever it takes to win.

New Version of Obama Health-Care Plan Relies on Imaginary Savings, Costs More Than $2 Trillion, and Will Explode Federal and State Budget Deficits

by Hans Bader on October 15, 2009 · 1 comment

in Healthcare, Insurance, International, Politics as Usual, Regulation, Sanctimony

Health-care “reform” always costs more than predicted, as ObamaCare provisions have at the state level.  So the claim that the new, cheaper version of President Obama’s health care plan will cost only $829 billion, while not increasing the deficit, should be taken with a grain of salt.

Senate Majority Leader Harry Reid admitted that the actual cost will be more like $2 trillion, and health-care experts have given it a similar price tag of more than $2 trillion.

The reason for the lower $829 billion price tag was that the bill’s supporters promised to offset its costs by making massive cuts in Medicare that no one actually expects politicians to follow through on, since Medicare cuts infuriate seniors and doctors.

Year after year, Congress waives “the annual cut in fees paid by Medicare to physicians” mandated by an earlier law. Yet, now, backers of ObamaCare claim they will cut Medicare by much more to finance coverage of the uninsured. The most recent version of ObamaCare drafted by Senator Max Baucus of Montana claims it will also make “$240 billion in cuts to hospitals, home care providers, nursing facilities and hospices.” Based on Congress’s past track record, the chance of this happening is zero.

As economist and former Congressional Budget Office director Douglas Holtz-Eakin notes in the Wall Street Journal, the promised cuts to pay for ObamaCare will not happen: “Congress will not allow doctors to suffer a 24% cut in their Medicare reimbursements. Senate Democrats chose to ignore this reality and rely on the promise of a cut to make their bill add up. Taking note of this fact . . . destroys any pretense of budget balance.”

As Holtz-Eakin notes, some “middle-class families would get hit with a double-digit increase in their marginal tax rate” under this version of ObamaCare.

Moreover, state budget deficits and state taxes will increase under ObamaCare, which outsources costs to the states by requiring states to expand their Medicaid programs for poor people.

Backers of ObamaCare have refused to cut medical costs through tort reform, with Senate Majority Leader Harry Reid saying it will save “only” $54 billion. Yet they justify ObamaCare partly on the alleged need to prevent uninsured people from not paying their medical bills — even though unpaid medical costs are only 2 percent of all medical costs, a small multiple of the amount Reid admits could be saved from tort reform. (Tort reform would cut the wealth of trial lawyers, who are some of the biggest supporters of the Democratic Party.) In reality, tort reform would save far more than $54 billion.

The Pacific Research Institute estimates that just one type of cost that could be reduced through malpractice-lawsuit reform — defensive medicine — costs around $200 billion annually (which is almost as much as France spends annually on health-care for all of its citizens; France has no punitive damages, few lawsuits against doctors, and “loser-pays” rules).

One reform — setting up specialized health tribunals to hear malpractice cases — would be particularly helpful.  Using specialized health courts, rather than continuing to use uninformed juries, would provide more consistent rulings from case to case, eliminate meritless cases, reduce defensive medicine, and more speedily compensate injured people who truly are victimized by doctors’ carelessness. Such tribunals already exist in countries like “Sweden, Denmark, Finland, Iceland and New Zealand.”

Comprehensive tort reform would also reduce lawyers’ wages, resulting in some additional students choosing to go to medical school (where a critical shortage of doctors is projected over the next decade) rather than to law school (there are already too many lawyers, who sometimes can make work for themselves by bringing “creative” lawsuits).  At least two of my law school classmates had already gone to medical school before going to law school (one decided to become a medical malpractice lawyer). At least a dozen that I know of had considered going to medical school instead.  But life is easier as a lawyer, and you don’t get sued as much if you are a lawyer rather than a doctor.   As long as professionals like lawyers get paid a lot, doctors will have to be, too — greater “wage inequality” in the U.S. means that we have to pay doctors more than other countries do to get the same number of people to become doctors.  (The looming shortage of doctors is aggravated by arbitrary restrictions placed on highly-qualified immigrant doctors, who have to repeat their residencies all over again  in the U.S. even if they manage to immigrate to the U.S.)

Another reform opposed by Obama that would make health insurance cheaper would be to let people buy cheaper insurance across state lines, which an antiquated federal law now prevents.  Countries with cheaper health insurance permit national competition among insurers.

Martin Feldstein, one of Obama’s own advisors, has said that Obama’s health-care plan would explode the federal budget deficit and lead to “crippling deficits,” as well as “higher taxes, debt payments, and interest rates” that would cut America’s standard of living.  Feldstein also noted that Obama’s health-care plan would harm people with insurance, and predicted that it would lead to massive tax increases.  Other analysts have predicted that it will drive up medical costs and inflation.

Obama is relying on $2 trillion in imaginary savings to pay for his health care plan.   He is also relying on tax increases, which breaks Obama’s campaign promise not to raise taxes on the middle class.

Fact-checkers say Obama is lying about health-care.  CNN Money says ObamaCare would take away 5 freedoms.

Senate Finance Passes Health Reform Bill

by Greg Conko on October 13, 2009 · 4 comments

in Culture, Health and Illness, Healthcare, Regulation, Zeitgeist

Earlier today, Senator Olympia Snowe (R-Me.) announced that she would vote in favor of the health care reform bill authored by Senate Finance Committee Chairman Max Baucus (D-Mont.).  And, just about 30 minutes ago, the Finance Committee reported the bill out to the full Senate by a 14 to 9 vote, with all the Democrats and Snowe voting in favor.

As I wrote two weeks ago, however, Snowe may be getting more (or less) than she bargained for.  Once a bill is reported out of committee, it gets to be amended after debate by the entire Senate, and again when the final Senate compromise goes to conference and has to be reconciled with the House bill.  You may think you’re playing nice with your Senate Finance Committee colleagues and getting as good a deal as can be expected from that nice old Max Baucus.  But, trust me, Henry Waxman is ruthless.

Indeed, the House bill contains a government-run, or ”public,” health insurance option and a number of other key features that were steadfastly opposed by moderate Democrats and liberal Republicans on the Senate Finance Committee.  As the National Journal‘s Marilyn Werber Serafini wrote earlier today:

House Democrats have ruled out an excise tax on high-end insurance plans as a way to pay for health reform, although that is a primary revenue raiser in Senate Finance Committee Chairman Max Baucus’s plan. House Democrats are considering limiting their proposed health care surtax to individuals earning above $500,000 a year, and that leaves about a $100 billion funding shortfall for reform …

In the end, all of Sen. Snowe’s efforts to produce a compromise that the CBO now says will reduce the federal budget deficit during the ten-year budget window (which was laughable in the first place) are at risk of being for naught, since liberal Democrats remain committed to the public option and have even taken to demonizing Baucus for his willingness to compromise.

Obamacare’s Provisions Have Already Been Tried, and Failed, at the State Level

by Hans Bader on October 7, 2009 · 1 comment

in Features, Healthcare, Legal, Personal Liberty, Politics as Usual, Zeitgeist

When the Senate Finance Committee votes on President Obama’s health care plan, it won’t even have the text of the bill in existence.  It will just be voting on a summary of what the bill will supposedly contain. Senate Democrats voted down Republican proposals that the bill’s text be made available to Senators and the public 72 hours before the vote.

And the bill itself is likely to be changed by Senate leaders at the last minute, right before the Senate as a whole votes on it, “to add the public option provision they have long favored,” but removed from the Committee version of the bill to appease moderates.

The desire of Obamacare’s supporters to avoid any scrutiny or review of their bill is understandable, because its provisions have already been tried, and failed, at the state level.  As Peter Suderman of Reason (and formerly of CEI) notes in today’s Wall Street Journal, “The major provisions of ObamaCare already have been tried.  They’ve led to increased costs and reduced access to care” for people who once had private insurance.  The states that adopted these “reforms” have the most expensive and unaffordable health insurance.

Despite these state-level failures, President Barack Obama and congressional Democrats are pushing forward a slate of similar reforms. Unlike most high-school science fair participants, they seem unaware that the point of doing experiments is to identify what actually works. Instead, they’ve identified what doesn’t—and decided to do it again.

Obama is relying on $2 trillion in imaginary savings to pay for his health care plan.  Even Democratic governors have criticized its huge cost, much of which would be passed on to state taxpayers through higher state-government Medicaid costs. One of Obama’s economic advisers said his health-care plan would lead to “crippling deficits” and “higher taxes.”

It also breaks Obama’s campaign promise not to raise taxes on the middle class.  Americans for Tax Reform summarizes the tax increases in the trimmed-down version of Obamacare revealed by its principal drafter, Senator Max Baucus (D-Mont.). Here are just a few of those tax increases: an individual mandate tax of $900 per individual or $3800 per family (if you don’t have health insurance); an employer mandate tax of $400 per employee if health coverage is not offered; an “excise tax on high-cost health plans”; a “medicine cabinet tax”; capping flexible-spending accounts (FSA’s); abolishing most health savings accounts; and increasing tax penalties for HSAs.

This is part of a long line of broken promises, such as Obama’s pledge to enact a “net spending cut,” which he broke with huge budgets that will explode the national debt through $9.3 trillion in massively increased deficit spending.

Fact-checkers, including the Associated Press and Washington Post, say Obama has made many false claims about his health-care plan. For example, Obama claims that nothing in his health-care “plan will require you or your employer to change the coverage or the doctor you have.” But that’s not true of the House and Senate versions the plan. AP noted that, “the Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.”

ObamaCare has other dubious provisions, like its racial preferences, which drew criticism from the U.S. Commission on Civil Rights.

Senate Finance Committee Rejects Public Option

by Greg Conko on September 29, 2009 · 1 comment

in Culture, Features, Healthcare, Regulation, Zeitgeist

The Senate Finance Committee, by a 15 to 8 vote, rejected an amendment proposed by Sen. Jay Rockefeller (D-W.V.) to Committee Chairman Max Baucus’s (D-Mt.) health care bill that would have added a government-run, or ”public,” health insurance option to the overhaul proposal.  Joining all ten of the committee’s Republicans in voting “no” were five Democrats, including Baucus himself, Bill Nelson (Fla.), Kent Conrad (N.D.), Blanche Lincoln (Ark.), and Thomas Carper (Del.).  A second, and slightly less bad ”public option” amendment, sponsored by Sen. Charles Schumer (D-N.Y.) was also rejected by a 13 to 10 vote, with Sens. Nelson and Carper switching sides.

As I’ve written previously, the public option is not the worst aspect of the various health reform proposals, the purchase mandate is.  Still, these votes should be viewed as a strong positive, signalling broad concern about the extent of the Democratic position.

Of course, Liberal Democrats are fuming.  House Speaker Nancy Pelosi (D-Cal.) and House Commerce Committee Chairman Henry Waxman (D-Cal.) remain committed to a public option.  President Obama signalled his enduring support for it in his September 9 address to Congress, despite White House back-tracking from the public option during the August congressional recess.  And, now, two left-wing advocacy groups, the Progressive Campaign Change Committee and Democracy for America, have launched a television ad campaign condemning Baucus for his decision to move forward without a government-run health insurance option for the non-elderly middle class.

This should serve as a warning to conservative Democrats and liberal Republicans (Yes. I mean you, Olympia Snowe (RINO-Me.).  You may spend months negotiating a compromise with your Senate colleagues.  But, please remember that all that will be torn asunder once a bill is reported out of committee and gets to be amended after debate by the entire Senate, and again when the final Senate compromise goes to conference and has to be reconciled with the House bill.  You may think you’re playing nice with your Senate Finance Committee colleagues and getting as good a deal as can be expected from that nice old Max Baucus.  But, trust me, Henry Waxman is ruthless.

Obama Slaps Unconstitutional Gag Order on Critic of His Health Care Plan

by Hans Bader on September 25, 2009

in Bailout Watch, Healthcare, International, Labor, Legal, Nanny State, Odds & Ends, Personal Liberty, Politics as Usual, Regulation, Sanctimony

While Obama ally ACORN attempts to gag whistleblowers who exposed its role in a recent scandal, the Obama administration is trying to gag critics of its health-care plan, which the Congressional Budget Office says could wipe out many Medicare Advantage programs relied on by the elderly.  (“The Obama Administration wants to seriously curtail or end Medicare Advantage.”)

It has issued a gag order to Humana, a health insurer that provides Medicare Advantage services, ordering it not to tell customers about how Obamacare could reduce the availability of such services.  The gag order clearly violates the First Amendment, according to law professor Eugene Volokh, the author of a leading treatise on First Amendment law, and a former law clerk to Supreme Court Justice Sandra Day O’Connor.  The gag order has also been criticized by the Wall Street Journal, the San Francisco Examiner, and Senate Minority Leader Mitch McConnell, yet the administration obstinately insists on enforcing it.

The Supreme Court has said the First Amendment protects the free speech rights of businesses like Humana even when they are government contractors, in cases like Board of County Commissioners v. Umbehr, 518 U.S. 668 (1996).

Liberal Obama supporters hypocritically claim Humana should shut up because it’s receiving federal funds (an argument they would never make regarding artists funded by the National Endowment for the Arts), and because its claims are supposedly false (never mind that its truthful claims are echoed by the non-partisan Congressional Budget Office, which is headed by Democrat Douglas Elmendorf).

But as Professor Volokh and the Washington Supreme Court have recently noted, “false statements of fact about the government are generally protected” by the First Amendment.

Humana’s statements are predictions about the future, and thus by definition not provably false.   Moreover, they are chillingly accurate predictions, which is why Obama ally Senator Max Baucus (D-Mont.), who is drafting Obama’s health-care plan, asked Obama to ban them:

“On Tuesday, the Congressional Budget Office director told Mr. Baucus’s committee that its plan to cut $123 billion from Medicare Advantage—the program that gives almost one-fourth of seniors private health-insurance options—will result in lower benefits and some 2.7 million people losing this coverage. Imagine that. Last week Mr. Baucus ordered Medicare regulators to investigate and likely punish Humana Inc. for trying to educate enrollees in its Advantage plans about precisely this fact.”

The fact that Humana is a government contractor doesn’t make this censorship any more acceptable, since the government simply has no business policing criticism of itself as “false”:  federal courts have ruled that even false speech by government contractors and employees on matters of public concern can be protected, as cases like Johnson v. Multnomah County, 48 F.3d 420 (9th Cir. 1995) show.

Nor is there any evidence that Humana is using federal money to disseminate its message.  And any subsidies Humana might be receiving would not justify the Obama administration’s blatant viewpoint discrimination against it, since Obama allies that receive lots of federal subsidies are being allowed to trumpet their support for Obamacare freely.  Under the Supreme Court’s ruling in Rosenberger v. Rector of the University of Virginia, viewpoint discrimination is a forbidden, “egregious” form of discrimination even when the government is subsidizing a speaker; here, the federal government is plainly engaging in viewpoint discrimination, since it is letting AARP make blatantly false claims in favor of Obamacare that contradict CBO finds and basic budget math, while blocking Humana from criticizing Obamacare based on reasonable arguments echoed by the Congressional Budget Office).

The Obama administration’s position contradicts the position of the Clinton administration, which admitted that Medicare contractors have free speech rights.  (But then, Obama is well to the left of Bill Clinton and past presidents).

Obama’s health care plan would raise taxes, break promises, harm people with insurance, explode the budget deficit, destroy many inexpensive health-care plans, and take away important freedoms.

Obama earlier showed contempt for the Constitution and the rule of law by radically expanding Bush’s  auto bailout, violating federal bankruptcy laws and the TARP statute in the process.  (The Obama administration ripped off taxpayers and retirees in the General Motors and Chrysler bailouts, in order to enrich the left-wing United Auto Workers union, in unnecessary bailouts that have cost at least $70 billion, drawing criticism even from the liberal Washington Post. Many commentators argued that the auto bailouts were illegal, such as the Heritage Foundation and Clinton administration Labor Secretary Robert Reich.)

He also demanded that a small country in Latin America (Honduras) violate its constitution by allowing the return to power of its left-wing ex-president and would-be dictator, imposing travel sanctions on its ordinary citizens as punishment for a ruling by its supreme court refusing to reinstate the ex-president, who was removed for violating his country’s constitution.  (The ex-president, Mel Zelaya, is a paranoid, erratic bully who claims he is being subjected to “mind-altering radiation and poison gas” and targeted by “Israeli mercenaries.”)

Big Health and Energy Tax Increases for the Middle Class from Obama and Liberal Congressmen

by Hans Bader on September 16, 2009

in Employment, Energy, Environment, Global Warming, Healthcare, Insurance, Natural Resources

The middle class is facing big tax increases thanks to Obama and liberal congressional leaders.

Even the trimmed-down version of Obama’s health-care plan recently announced by a ranking Senator contains lots of tax increases for the middle class (see below).

And the costly cap-and-trade energy legislation passed by the House and supported by Obama would lead to big tax increases in the name of fighting global warming, Administration officials privately have conceded, even though they publicly claim otherwise.  “Officials at the Treasury Department think cap-and-trade legislation would cost taxpayers hundreds of billion in taxes, according to internal documents circulated within the agency and provided to The Washington Times” by CEI.  It would also result in “loss of steel, paper, aluminum, chemical, and cement manufacturing jobs,” as jobs migrate overseas to countries which have fewer environmental protections than the U.S. does.

Obama earlier admitted that “under my plan of a cap and trade system, electricity rates would necessarily skyrocket.” As Obama admitted, that cost would be directly passed “on to consumers” — just the way Herbert Hoover’s excise tax increases were in 1932, aggravating the Great Depression. Although the tax’s supporters claim it will cut greenhouse gas emissions, it may perversely increase them and also result in dirtier air, as well as harming forests and water supplies.

Americans for Tax Reform summarizes the tax increases in the trimmed-down version of ObamaCare revealed by its principal drafter, Senator Max Baucus (D-Montana).  Here is a partial list:

· Individual Mandate Tax.  If you don’t sign up for health insurance, you will have to pay a tax in the following range:

Single

Family

100-300% FPL

$750

$1500

300+% FPL

$900

$3800

· Employer Mandate Tax. $400 per employee if health coverage is not offered.  Note: this is a huge incentive to drop coverage, as $400 is much less than the average plan cost of $11,000 for families or $5000 for singles (Source: AHIP)

· Excise Tax on High-Cost Health Plans.  New 35% excise tax on health insurance plans to the extent they exceed $21000 in cost ($8000 single)

· Medicine Cabinet Tax.  Americans would no longer be able to purchase over-the-counter medicines with their FSA, HSA, or HRA

· Eliminate tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D

· Report Employer Health Spending on W-2. This is clearly a setup for the easy individual taxation of employer-provided health insurance down the road.

· Cap Flex-Spending Account (FSA) Contributions at $2000. Currently unlimited.

· Backdoor Death of HSAs. By requiring that all plans (besides the few that are grandfathered) provided first-dollar coverage for most services, there would be no HSA-qualifying plans available from the Massachusetts-like exchanges

LibertyWeek 42: Hugo Chávez, Robber Baron

by Richard Morrison on May 12, 2009 · 1 comment

in CEI Projects, Podcast

Richard Morrison and Cord Blomquist bring back special guest co-host Jeremy Lott to create the work of art known as Episode 42. We start with the continuing buzz over the Supreme Court’s next member, President Obama’s trillion dollar healthcare plan, and an update on how Hugo Chávez is turning Venezuela’s petroleum reserves into his personal piggybank. We add good news from East Texas for beer drinkers, bad news from Europe for technophiles and sad news from Philly for basketball fans.

Listen to the episode HERE.