Consumer Power Report #203

Published November 20, 2009

With all the public opinion polls going against them and the likelihood of losing a very large number of seats in next year’s elections, what in the world are the Democrats thinking? How can they be so suicidal, you might ask?

It’s not all that mysterious. They have come to believe their own propaganda — which is one of the most dangerous things to do for people in public life.

They have convinced themselves that the reason they lost in 1994 is not because they over-reached on health care, but because they failed to deliver. If they had succeeded in enacting the Clinton plan, they would have been re-elected handily, they think.

They understand the polls are against them now, but that is only because evil Republicans have been deceiving the public about what the bills would do. Once the bills are passed, the deceptions will end. The storm clouds will break, the sun will shine through, and the angels will sing Hallelujah!

But they have to be brave and steadfast and heroically stand firm against the storm.

Pity they are unfamiliar with English literature, or they might take a lesson from the Ancient Mariner. This albatross will still be around their necks come next November.



Well, after a great deal of back and forth with the CBO to get the “score” down to some acceptable level, Harry Reid has introduced his bill and the CBO has issued a preliminary report. Now the Senate looks like it will imitate the House in having a rare Saturday session to take the next step — agreeing to debate it on the floor. This will take 60 votes to overcome a Republican filibuster.

Conservative groups are trying to peel off a couple of Democrats to vote against cloture. The argument is that Reid’s bill is not close enough to acceptable to go to the floor. It is doubtful this will work. Even Nebraska’s Ben Nelson, one of the most likely votes against the bill, is hinting that he will support moving the debate to the Senate floor.

If the Democrats succeed, they will take off for Thanksgiving and come back for the floor debate between now and Christmas, hoping to get approval before Christmas. If that works there will be a conference between the House and Senate to reconcile differences, then back to the floor of each house for final enactment and the president’s signature before his State of the Union speech, they hope.

There are plenty of potential glitches, however. These are mostly on the big, sweeping policy provisions like abortion coverage, coverage of non-citizens, taxes and penalties, and provision of a government insurance option.

There is very little debate over the details that will ultimately make or break the program should it ever become law. These include exactly what is going to be cut from Medicare? What benefits will be required in private coverage? What happens if people decide to pay the penalty rather than sign up for coverage? How are the states going to pay for their share of expanded Medicaid? And ten thousand others that will have a profound effect on each and every American for decades to come.

SOURCE: Reid’s Bill;CBO Report; WaPo side by side of House and Senate bills; Good summary from FreedomWorks


Meanwhile public opinion continues to erode — to alarming levels. The latest Gallup survey is especially eye-opening. Every November since 2000 it has been asking people whether they “think it is the responsibility of the federal government to make sure all Americans have healthcare coverage.” Every year about 60 percent have said yes and fewer than 40 percent have said no. In 2006 it reached 69 percent in favor and a mere 28 percent opposed.

But the idea has been losing support steadily over the past three years until this November, when 50 percent said no, it is not a federal responsibility, and only 47 percent said yes.

Similarly, support for replacing the current system with a new government-run system has tanked in the past year, to the point that 62 percent want to keep the current system and only 32 percent say it should be replaced.

SOURCE: Gallup

Quinnipiac University has just released a new survey that applies more directly to the current debate. It finds a clear majority of people disapprove of the bill passed by the House — 51 percent opposed and only 35 percent in favor. And even a greater share (53 percent) specifically disapprove of President Barack Obama’s handling of the health care issue.

SOURCE: Quinnipiac

Scott Rasmussen and Doug Schoen try to make sense of Obama’s tanking approval ratings in an op-ed in The Wall Street Journal. They write, “Mr. Obama’s approval among likely voters has dropped to the low-50s in most polls, and the most recent Rasmussen Reports poll of likely voters shows him slightly below the 50% mark. This is a relatively low rating for new presidents. Mr. Obama’s approval rating began to slide in a serious way in early July, triggered by a bad unemployment report. A look at more detailed data shows why Mr. Obama’s ratings are likely to drop even further.”

They say, “The CNN poll also shows that in addition to health care, a majority of Americans disapprove of how Mr. Obama is handling the economy, Afghanistan, Iraq, unemployment, illegal immigration and the federal budget deficit. Put simply, there isn’t a critical problem facing the country on which the president has positive ratings.”

And they add, “An NBC/Wall Street Journal poll conducted from Oct. 22-25 found that the president’s personal ratings have suffered a similar decline. His rating for being honest and straightforward has fallen eight points from January to 33% and his rating for being firm and decisive has fallen 10 points to 27%.”

Then they conclude, “Unless Mr. Obama changes his approach and starts governing in a more fiscally conservative, bipartisan manner, the independents that provided his margin of victory in 2008 and gave the Democrats control of Congress will likely swing back to the Republicans, putting Democratic control of Congress in real jeopardy.”

SOURCE: Wall Street Journal


The poll numbers are bad for Democrats, but no better for Republicans. Writing in Forbes, Shikha Dalmia notes that while the Republicans are busy fretting over the “public option” they are missing out on the message that could actually resonate with the public: freedom. They have completely overlooked the damage mandatory coverage will do to working people across America.

She writes, “By insisting on the removal of the public option–instead of the individual mandate–as the price of doing business, Republicans have missed a major opportunity to put Democrats on the defensive and change the terms of the debate.”

She goes on to argue, “the problem is that Democrats don’t need the public option to engineer a ‘federal takeover of our health care system.’ All they need is the power to force Americans to purchase insurance. A mandate will fundamentally alter the relationship between Americans and their government. Instead of the government being accountable to them, they will become accountable to their government.”

She adds, “During the campaign, Obama himself successfully stopped poor Hillary dead in her tracks by reminding voters at every turn of her tyrannical plans to force them to purchase coverage. So why aren’t Republicans doing the same to Obama?”

Why? Because Republicans “themselves are deeply conflicted about the mandate.” They don’t seem to have any problem telling everyone what to do. It’s just that they want to be the ones doing the telling.

SOURCE: Forbes

We were thrilled to see our friend Eric Novak, MD get the attention he deserves in a column by George Will in the Washington Post. Mr. Will cites Dr. Novak for his efforts to bring a constitutional amendment protecting the rights of Arizonans to choose their own health plan and their own doctor on the ballot in that state. Of course, the Goldwater Institute was also essential to the effort.

Mr. Will writes, “Proponents were outspent five to one by opponents who argued, meretriciously, that it would destroy Arizona’s Medicaid program, with which many insurance companies have lucrative contracts. Nevertheless, the proposition lost by only 8,687 votes out of 2.1 million cast, and Arizonans will vote on essentially the same language next November.”

He goes on to discuss the constitutionality of an individual mandate, and cites two quotes from federal agencies, one from the Congressional Budget Office (CBO) in 1994 that said, “The government has never required people to buy any good or service as a condition of lawful residence in the United States,” and another this year from the Congressional Research Service (CRS) that said, “it is a novel issue whether Congress may use the [Commerce] Clause to require an individual to purchase a good or service.”

One thing rarely mentioned in these discussions is the difference between state and federal authority in these matters. It isn’t enough to say “the government” can or can’t do something. There are things the states may do that are withheld from the federal government. I expect this is one of them.

SOURCE: George Will

The Fund for Personal Liberty has announced “it will challenge the constitutionality of any government mandate requiring individuals to purchase health insurance, if Congress passes legislation including such a mandate.” This is the same group that has been sponsoring the lawsuit against Medicare challenging the rule that anyone who refuses to accept Part A must sacrifice their Social Security Benefits.

The fund’s lead counsel, Kent Masterson Brown, said in a press release, “Any mandate to purchase health insurance is an invalid exercise of the powers granted to Congress by Article I, Section 8 of the Constitution of the United States. The Fund for Personal Liberty was created for the purpose of litigating for individuals’ healthcare liberty and freedom, and it will promptly challenge the constitutionality of any mandate to purchase health insurance.”

And Martha de Forest, executive director of The Fund for Personal Liberty, said, “A one-size-fits-all solution to our health care needs denies us our freedom to individually contract for insurance on terms acceptable to each of us — or, not at all. To preserve health freedom, we must keep lawmakers and bureaucrats in check by restoring constitutional constraints that prohibit limits on personal liberty.”

SOURCE: Fund for Personal Liberty


The Wall Street Journal opines that “the most dangerous parts of ObamaCare aren’t receiving the scrutiny they deserve–and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a ‘global budget’ on Medicare, with radical implications for U.S. medicine.” It adds, “Prominent health economist Alain Enthoven has likened a global budget to bombing from 35,000 feet, where you don’t see the faces of the people you kill.”

The article continues, “As envisioned by the Senate Finance Committee, the commission–all 15 members appointed by the President–would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.”

GDP plus 1 percent?! That has never happened, will never happen, and should never happen. It is arbitrary bean-counting at its worst.

But the Journal concludes, “The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn’t make decisions in the best interests of patients, but in the best interests of government.”

SOURCE: Rationing

We are already getting previews of this rationing. This week alone the U.S. Preventive Services Task Force dropped its long-standing recommendation that women over the age of 40 get regular mammograms and be taught how to screen themselves for lumps, and then the American College of Obstetrics and Gynecologists came out with a new recommendation that women below the age of 21 not get pap tests for cervical cancer.

These may or may not be rational recommendations, but there are two big problems with them: First, they are complete turn-arounds from what the exact same “experts” have been espousing with absolute certainty for decades. If they have been wrong all these years, why should we be confident they are right this time?

Second, every such change in policy is now suspect as being politically motivated. Once politics enters the health care equation, this is inevitable, whether it is true or not.

These are only the latest in a string of reversals. Just recently the National Committee for Quality Assurance abruptly dropped its recommendations on lowering glucose in diabetics because it was discovered that in some cases following its guidelines could harm or even kill patients.

And two years ago it was found that, while hormone replacement therapy (HRT) might be effective in treating the symptoms of menopause and lowering the risk of colon cancer and dementia, it also raised the risk of breast cancer, stroke, and ovarian cancer. Suddenly all the guidelines that had been developed were thrown out the window.

It certainly doesn’t inspire confidence that a “committee of experts appointed by the president” will have any positive contribution to make on health care decision making. I think I will stick to talking to my doctor, thank you.

SOURCE: Washington Post on Mammograms; Wall Street Journal on the New Recommendations; Washington Post Cervical Cancer Screening

Another strange idea was presented in the New England Journal of Medicine. Three PhDs and a lawyer have decided that the way to “Control U.S. Health Care Spending” is to base payments on a “bundle” of services. Why this would lower costs is beyond me. If paying a fee for a service encourages over-use (a premise I disagree with), why would paying a fee for a “bundle” of services be any better?

I expect this is just a re-naming of “pay-for-performance” (P4P). But since there is no evidence that P4P has ever worked anywhere it has been tried, and plenty of evidence that it does not, the same people have renamed the same idea “bundling” and are trying to sell the same snake oil in a different bottle.

SOURCE: NEJM on Bundling