Never a dull moment in the health care battles, eh? No sooner do four of the Blue Dogs come to an agreement with Energy and Commerce Committee Chairman Henry Waxman, than the Progressive Caucus gets upset and threatens to take its ball and go home if it doesn’t get its way.
This is all a sobering experience for most Americans who don’t normally pay much attention to the workings of Congress. Many folks are amazed these clowns think they can run the entire health care system.
President Barack Obama doesn’t help the cause much. He is on television every day of the week, and the more he talks, the less people like his ideas. His town hall meetings and press conferences are exercises in tedium. And it is obvious he doesn’t know what he is talking about, beyond a few platitudes. He keeps repeating, “If you like the health care you have you can keep it.” But that simply isn’t true and people have already figured it out. They are reading the bill and they know it isn’t true.
Folks are getting more and more angry about being dismissed and lied to and that anger is showing up in public opinion polls and town hall meetings all over America. When Members of Congress get home next week, they will be meeting a transformed America that has no patience with the stench of arrogance coming out of Washington.
IN THIS ISSUE:
So, where to start in describing this mess? Let’s begin with what is happening out in the world. We and many other organizations have been all across America alerting people to the dangers of what is going on. In recent weeks, Heartland has sponsored half-day town hall meetings in Milwaukee, Indianapolis, Grand Rapids, Dallas, Atlanta, and Philadelphia, with more scheduled for August 13 in Chicago and September 15 in Detroit.
Write-up of Philadelphia meeting
Thursday morning, I was on 10 morning radio shows:
WLNI Lynchburg, VA
KFAB Omaha, NE
WOC Davenport, IA
KTRH Houston, TX
WSYR Syracuse, NY
WHLO Akron, OH
WTKS Savannah, GA
KOGO San Diego, CA
WHLO Akron, OH
KCOL Fort Collins, CO
While I’m plugging myself, I might also mention a short paper I wrote on Massachusetts that NCPA published, and a couple of op-eds, one on “My Two Point Plan” published in the American Spectator and another on the clumsy efforts of the special interests to get “seats at the table.” That was published in the South Town Star.
But with all of this, we are a small element of what is happening out there. I know a fellow who is a liberal health economist in St. Louis, and he is getting pretty grumpy about the prospects of ObamaCare. Realizing what is happening in St. Louis with the Tea Parties and Town Hall meetings, it is small wonder. I have never in my life seen anything like this, and neither has my friend. By the way, Alton, Illinois is just across the river from St. Louis and is part of the same metropolis.
McCaskill’s Office Locks Doors, Pull Blinds & Calls Cops on Tea Party Protesters
Claire McCaskill’s Office Holds Town Hall– Tea Party Breaks Out, July 27
St. Louis Tea Party Protester Fires Up the Crowd at McCaskill Town Hall
US Soldier Demands Apology From Senator Claire McCaskill at Town Hall
Hundreds Attend McCaskill’s Town Hall Meeting, Independence, MO
All of this is taking a toll on President Obama’s approval numbers and support for his health reform ideas. The New York Times pulled an interesting stunt. It posted an article headlined, “Poll Shows Obama’s Clout on Health Care Is Eroding,” but a few hours later when I pulled the article up again the editors had changed it to, “New Poll Finds Growing Unease on Health Plan.” I guess the editors thought the first version was too harsh on the Messiah. In any case, the poll itself found the president’s approval ratings have dropped 10 points to 58 percent and that “69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone.” But as usual with The New York Times, they don’t give you the poll itself, just their interpretation of it.
SOURCE: New York Times
MSNBC is a bit more informative. Its article says, “Poll: Obama loses ground on health care.” It cites an NBC/Wall Street Journal survey that finds, “Pluralities now say that the president’s health care plan is a bad idea, and that it will result in the quality of their care getting worse. What’s more, just four in 10 approve of his handling on the issue.” It puts his approval rating at 53 percent and says 36 percent now support his health care while 42 percent oppose it.
National Public Radio also conducted a survey and found 47 percent now oppose the plan while 42 percent support it. And Pew Research did a poll finding 44 percent oppose and 38 percent support “the health care proposals being discussed in Congress.”
SOURCE: Real Clear Politics
Rasmussen’s daily tracking poll of likely voters is downright grim for the president. It finds 28 percent “strongly approve” of his performance while 40 percent “strongly disapprove,” for a net negative 12 percent. The latest survey also finds that, “Just 23 percent believe health care costs will go down if health care reform is passed. Most (53 percent) expect prices would rise.”
SOURCE: Rasmussen Reports
On the other hand, there is gold old Time magazine, which also conducted a survey. But this one polled half again as many Democrats as Republicans (at least they revealed that information, unlike The New York Times). Even they could only come up with an even split of “46 percent to 46 percent, when asked if they approved or disapproved of Obama’s handling of health care.” Other than that they found, “On the details of the plan, respondents remained supportive of many of the rough outlines of the health-reform effort as originally described by President Obama.” When it got more personal, even this heavily Democratic poll group was worried about the effect on their own lives. “By significant margins, survey respondents said they believe the final health-reform legislation is likely to raise health-care costs in the long run (62 percent), make everything about health care more complicated (65 percent) and offer less freedom to choose doctors and coverage (56 percent).”
SOURCE: Time Magazine Survey
There is plenty of analysis out there about how all this is going badly for Obama. I won’t go into detail but just offer a Whitman’s Sampler.
Obama has aura but doesn’t know how to legislate, by Michael Barone
How Obama Stumbled on Health Care, by Kimberly Strassel
Plan still $820 billion above target, by Chuck Blahous
Democrats’ New Worry: Their Own Rich Voters, by Jonathan Weisman
Obama may have to wait for health care passage, by Ricardo Alfonso-Zaldivar
The more people learn about what is in these bills, the more opposed they become. That is precisely why Tom Daschle, Obama’s preferred choice for secretary of HHS and health czar, recommended keeping legislation vague and moving it through fast. That was smart advice, but Congress simply cannot resist any opportunity to micro-manage. So we have thousand-page bills that dictate every teensy-weensy aspect of how the health system will perform.
Now folks are beginning to read the damned thing and they don’t like what they see. For instance, Betsy McCaughey stumbled upon the mandated coverage for end-of-life counseling for everybody on Medicare. It isn’t clear if seniors would be required to receive that counseling, but that isn’t the point. The point is that Congress has no business prescribing the specifics of end-of-life counseling in the first place. That is between the patient and a doctor.
Plus Congress takes dubious little notions and inflates them into universal truths–that may not be true at all. Ms. McCaughey writes, “The harshest misconception underlying the legislation is that living longer burdens society. Medicare data prove this is untrue. A patient who dies at 67 spends three times as much on health care at the end of life as a patient who lives to 90, according to Dr. Herbert Pardes, CEO of New York Presbyterian Medical Center.” Do these people have any idea what they are doing?
SOURCE: Wall Street Journal
Congress also likes nurses but isn’t so crazy about doctors, so another provision of the bill would require nurse midwives to be paid the same as obstetricians, even though the level of training and expertise isn’t even close. An article by Adam Brickley in CNS News quotes a spokeswoman for the nurse midwives as saying, “certified nurse midwife is basically an advanced practice registered nurse, similar to a nurse practitioner, but they go through their own program of study, typically it’s a graduate — a master’s degree program, and they are trained in providing all kinds of women’s health care throughout the life span, basically from adolescence through menopause, but obviously midwives have kind of a specialty in maternity care services.” So she concedes that midwives have far less training than physicians. But Congress likes ’em, so who cares?
SOURCE: CNS News
In CNN Money Shawn Tully warns about “5 freedoms you’d lose in health care reform.” He says, “page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.” He summarizes his article by saying, “If you prize choosing your own cardiologist or urologist under your company’s Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests — you may be shocked to learn that you could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution.”
SOURCE: CNN Money
Congress is groping for ways to finance this thing and every day they come up with a swell new idea. One day it is a tax on soda pop, the next day it is botox, next a value-added tax on everyone, and then a “surtax on the rich,” and so on. They don’t want to limit the exclusion for high-cost insurance coverage because labor unions like that high-cost insurance coverage. Politico reports that, “White House officials are embracing a plan to tax “gold-plated, Cadillac” insurance policies, giving momentum to an idea that is receiving bipartisan consideration on Capitol Hill.” This is the nifty new idea Sen. John Kerrey came up with — instead of making insurance coverage taxable income for the people who get it, we’ll tax the insurance company itself if they sell a “gold-plated health plan.” Apparently, no one stops to think , “let’s see now, if we tax the insurance company, where will it get the money to pay it? Oh, by raising the cost of the coverage to the employer! But if the employer pays more for the coverage where will it get the money from? Oh, by lowering workers’ wages! So, who ends up paying for it after all this smoke and mirrors? Who else? The same workers we were trying to help.”
Next, they come up with the swell idea to cut costs by enshrining a new “Independent Medicare Advisory Council” (IMAC) with the power to — do what, exactly? Nobody is really sure — set payment policies, whatever that means. It would be made up of five “experts,” so you know it must be a good thing. Only problem is, CBO can’t figure out how it would cut costs, either. So The New York Times reports, “The Congressional Budget Office said Saturday that a new agency proposed by President Obama as a way to cut health costs might save only $2 billion in its first four years, and that there was a high probability that ‘no savings would be realized.'”
Shoot! Don’t you hate it when that happens?
SOURCE: New York Times
COUPLE OF MORE ON DARTMOUTH AND GAWANDE
Hal Andrews and John Morrow wrote an outstanding blog item on “Lost in D.C. with The Dartmouth Atlas.” They say, “We are frankly appalled at how The New Yorker article by Dr. Atul Gawande has seemingly become the guidepost of reform for policymakers. The reason is that the conclusions that The White House and much of Congress have drawn from The New Yorker article are, at best, suspect and, at worst, completely wrong. Reengineering 20% of the economy is a large task, in our view, and getting the facts straight is important.”
They find that looking at the entire population, instead of just what is reported through Medicare, McAllen, Texas compares quite favorably to El Paso. For instance, “McAllen’s average cost per case is $315.00 less than in El Paso, representing in total $23.6 million in incremental costs that could be saved if all of the El Paso cases had been treated in McAllen hospitals. For policymakers who are concerned about the price paid by the uninsured, the average charge per case is $7,841 more in El Paso than in McAllen.”
Also, “the “excessive” costs attributed to McAllen do not occur in McAllen, or even in Hidalgo County. A full 6 percent of McAllen residents left McAllen for care to other markets such as Brownsville, Houston, San Antonio, Corpus Christi, and Dallas! A total of $283 million in charges migrated away from McAllen, yet those costs are attributed to the population and demographics of the beneficiaries living there. As a result, the Dartmouth Atlas analysis overestimates the costs attributed to McAllen.
It’s an important analysis that deserves your attention, but I don’t expect the Obama White House to pay any heed.
SOURCE: Health Care Value Blog
In a similar vein, NCPA’s Andrew J. Rettenmaier and Thomas R. Saving also question the value of the Dartmouth numbers. They make the point that Medicare spending does not accurately predict population-wide spending. They say, “For example, although Louisiana is the highest-spending Medicare state and South Dakota is the lowest, average per-capita health care spending for the whole population is actually lower in Louisiana ($5,040) than it is in South Dakota ($5,327).” And they add, “It appears that high Medicare spending is often associated with lower spending on the non-Medicare/Medicaid population and vice-versa. This observation is consistent with cost-shifting between public and private payers, although there may be other explanations as well.”