Tag Archive | "healthcare reform"

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On the Hidden Dangers of Comparative Effectiveness

Posted on 10 April 2011 by Editor

Originally posted 2009-06-18 21:15:49. Republished by Blog Post Promoter

As part of the stimulus spending package approved by the government earlier this year, funding in the amount of $1.1 billion was included to sponsor research into comparing the relative effectiveness of one form of medical treatment to another. Such research, as the program’s sponsors and supporters argued, would over time reduce the net cost of medical services by determining which medical procedures offer the lowest cost treatment to address common ailments. Armed with such information, it was further argued, doctors and medical professionals would apply this additional economic data in their decision to prescribe specific medicines and treatments.

On the surface this would seem to make good common sense in that it would provide some stabilizing relief to the increasing costs to the government of operating the country’s medicaid, medicare and veteran benefit systems. However, some of the less known aspects of the research bring out a number of troubling issues. Among these is the inclusion of studies which add the dimension of patient characteristics (such as age, gender, lifestyle) into the formula of overall effectiveness. As a result, effectiveness is defined in terms of a cost-benefit ratio as applied to a specific type of individual. For example, a comparative value is placed on the benefit of curing an illness in an 80 year-old versus 20 year-old man.  When faced with limited resources the results of the research would then be intended to provide guidance as to how those limited resources should be applied and when to apply available cures relative to the cost and benefit that such cures would provide. In the case cited, the 80 year-old man has little chance of receiving priority consideration.

While such policy is widely accepted in many European countries, I dare say to any American pondering such gross delegation of power over life and death decisions this has to be deeply concerning. There are numerous specific opportunities to bring new efficiency and reduce the resulting costs associated with providing healthcare. National electronic medical records, individual (not employer) management of healthcare insurance subscription, tax incentives to support wellness and health awareness are all excellent examples.

The recipe is to make individuals more responsible for the management of their health and medical matters. Delegating this to a disinterested third part, especially a government bureaucracy is tantamount to relinquishing one’s freedom.

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Quotation of the Day:

“Liberty means responsibility. That is why most men dread it.”
George Bernard Shaw (1856 – 1950)
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Daniel Hannan on the American Past and Future

Posted on 10 April 2011 by Editor

Originally posted 2009-08-13 20:55:56. Republished by Blog Post Promoter

Brian Brown
August 11, 2009
Humane Pursuits

Last week Daniel Hannan, the member of the European Parliament best-known for his scathing dressing-down of Prime Minister Gordon Brown, delivered a lecture at The Heritage Foundation. It’s a good 40 minutes or so, but well worth watching–Hannan articulates American political principles better than most Americans, and warns against chasing a technocratic solution to health care or any other problem.  Though he underestimates how far America has already walked down the path of rationalism, he is an entertaining speaker who has a penchant for quietly working great political thought into his words (see if you can find the subtle not-quite-quotations of Edmund Burke).  Watch it here.

One of Hannan’s more insightful points responds to the question of why, if Britain’s statist government is so bad, British voters have not long since gotten rid of it (Britain has had government-run health care since 1948).  Hannan blames it on the temperamental conservatism of the British people–its resistance to change, its fear of (relevant to Bryan’s point) an abstract alternative that does not yet exist.  Though Hannan faults such conservatism in this case, his criticism is gentle, almost as if he were reproving a particularly close friend for a well-intentioned mistake.

Appropriate enough, since Hannan’s speech ultimately defends such conservatism against the kind of revolutionary liberalism that brought about government health care in the first place.  At the heart of such liberalism is the belief that life as we currently know it is intolerable and must be radically changed.  At the heart of conservatism is the belief (conscious or not) that life as we currently know it is worth living.

The significance of this distinction is that the revolutionary liberal wishes to reshape the world in the here and now, while the conservative wishes to preserve it and pass it on, preferably somewhat improved, to the next generation.  To borrow Anna’s analogy, conservatism holds less potential for a brand-new building, but also less potential for the destruction of generations-old foundations.  Hannan urges his listeners not to forget how good their foundation is–not to forget that life, as they know it, is worth living.

In its respect for its foundations, Hannan argues, it is the American way–not the utopian dreams of radical reformers–that is truly oriented toward the future.  The genius of the American people, as Hannah Arendt once observed, “consisted in the extraordinary capacity to look upon yesterday with the eyes of centuries to come.”

Hannan channels Arendt’s observation in his remarks, arguing that America’s ability to bind itself back to a beginning, to build on the foundation chosen by generations past, is what enables it to keep its constitutional promise to pass on the building to future generations.  In one of his most poignant lines, Hannan warns that in chasing European-style statism, “You are breaking faith with your founders, and also with your posterity.”

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Brian Brown writes for Humane Pursuits

Article has been published with the author’s permission

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To Sur, With Love

Posted on 10 April 2011 by Editor

Originally posted 2009-07-28 17:17:53. Republished by Blog Post Promoter

by Rick SincereRickSincere
July 16, 2009

As part of the gargantuan (1,000-page-plus) health care “reform” package introduced by members of the Democratic majority in Congress, the Obama administration proposes to raise taxes through a “surtax” on Americans who earn the most money.

The Washington Post explained this “soak the rich” policy in a front-page article on July 15:

The surtax would start at 1 percent and rise to 5.4 percent on income exceeding $1 million. Combined with the expiration next year of tax cuts enacted during the Bush administration, the surtax would drive the top federal tax rate to 45 percent, the highest level since lawmakers rewrote the tax code in 1986.

The Washington Times, for its part, points out that this raises U.S. marginal tax rates to their highest levels since the 1980s:

A new surtax of 5.4 percent in the health care bill, which would apply to married couples’ income above $1 million, would bring the top federal income tax rate to 45 percent.

After consideration of state and local income taxes and the Medicare payroll tax, which applies to all wage and salary income, taxpayers in 39 states would face a top marginal income tax rate of more than 50 percent, according to a study by the Tax Foundation, a nonprofit tax research group based in the District.

“That means government would be taking more than half of every additional dollar from high-income taxpayers,” said Tax Foundation President Scott Hodge. “The lowest tax rate would be 47 percent – and that’s in the nine states that don’t tax wages.”

Businesses say the surtax would hurt the economy.

“The intention of this plan is to tax high-income households, but the real victims would be America’s small-business owners,” said Thomas Donohue, president of the U.S. Chamber of Commerce. “Placing a big tax burden on the small-business community would rob them of the resources they need to create the jobs that will lead us out of the recession.”

President Obama would be wise to look to history to see what happened the last time a president made a surtax the centerpiece of his economic program. (Some might object that this is a “health care” program. That’s true, up to a point. The fact that the bill has been referred to the Finance Committee in the House suggests that this is really a revenue bill.)



In Yanek Mieczkowski’s 2005 book, Gerald Ford and the Challenges of the 1970s, the Dowling College historian relates what happened when Ford proposed a 5 percent surtax on all incomes above $15,000 (more than it sounds like; remember, these were 1974 dollars) in his first major economic legislative package:

As what he termed “the acid test of our joint determination to whip inflation in America,” Ford pronounced the cornerstone of his new economic program, a one-year, 5 percent surcharge on corporate and personal incomes. The surtax was directed at individuals with yearly earnings of $15,000 or more for married taxpayers and $7,500 for the unmarried. (Taxpayers would have to figure out what they normally owed the government, then add the 5 percent surtax to it.) The advantages of the surtax were that it would be mildly progressive, since the rich would pay more, and temporary, lasting only the calendar year 1975. Nor was it onerous. For example, a single person earning $15,000 would pay a federal income tax of $2,549; the surcharge would add $78. (p. 121)

Despite its modest appearance, Ford’s proposal was met with strong opposition, especially from the Democrats who held a majority in Congress (a majority that would grow substantially after the midterm elections a few weeks after his proposal was announced). Republicans were not too fond of it, either.

Ford took a political risk by proposing a surtax less than a month before congressional elections. Unveiling a tax increase at such a time was like unleashing a skunk at a picnic; representatives and senators ran in the opposite direction, refusing to embrace or even come close to it. Officeholders facing difficult reelection battles, such as GOP senators Bob Dole of Kansas and Marlow Cook of Kentucky, deserted their president rather than support the proposal….

The program itself was a political bomb. The jumble of proposals gave the whole thing an eclectic feel, and the centerpiece — a tax increase — fell flat. One poll showed that Americans opposed the surtax, 58 to 34 percent. Members of Congress resisted it. Just two days after the speech, William Baroody warned Ford that it was “in serious trouble on the Hill and very unpopular politically” and that Congress was in no mood to reduce spending. Two weeks before the election [William] Seidman publicly acknowledged that the surtax faced an uphill struggle on Capitol Hill and called its prospects “uncertain.” The overwhelming Republican repudiation in the ensuing elections turned “uncertain” to “doomed.” Ford’s policy making was off to a rocky start. (p. 124; footnotes omitted)

In one of the more significant parenthetical partial paragraphs of any work of recent history, however, Mieczkowski writes:

(One economist’s skepticism about the surtax generated what later became a mainstay of Ronald Reagan’s “supply-side” economics. Arthur Laffer doubted that the 5 percent surtax would generate much revenue, and while dining at a restaurant with Ford administration members Don Rumsfeld and Dick Cheney, he drew a graph on a napkin to illustrate his belief that tax cuts — rather than increases — would raise more revenue because of increased business activity. His illustration became known as the “Laffer Curve.”) (p. 122)

Apparently other economists caught on, even if they hadn’t seen the napkin. Yanek Mieczkowski writes on page 130:

By November, many economists, realizing that Ford had miscalculated, urged him to drop the surtax proposal and switch his focus to fighting the recession. The president stuck by the surtax and still urged budget cuts.

In the end, the surtax proposal crashed and burned. Mieczkowski notes on page 131:

A political science axiom says that “the president proposes, Congress disposes.” Congress certainly disposed of Ford’s surtax, and quickly. Although he developed a fiscally balanced program incorporating many recommendations from the economic summit conferences, it was also like a multipronged barb that Congress could not swallow. And it soon became incongruous. The deteriorating economy, coupled with the inherent unpopularity of a tax increase, doomed Ford’s first major economic initiative. But that failure was fortunate; as events played out, a surtax would have aggravated the downturn. (emphasis added)

History teaches us, and not just in this example from the mid-1970s, that raising taxes during a recession is a bad idea.

Barack Obama and congressional Democrats have not absorbed this lesson of history and economics. Should they succeed in raising taxes to finance their ambitious program to socialize medicine, they — or, rather, we — will live to regret it.

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Rick Sincere is the editor of RickSincereThoughts

Article has been published with permission

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Under The Radar: 10th Amendment Movement Picks Up Steam

Posted on 10 April 2011 by Editor

Originally posted 2009-07-20 21:25:08. Republished by Blog Post Promoter

by Nancy Morgan
July 19, 2009

Millions of Americans watch with horror as the Obama administration continues to implement its own version of ‘change.’ Change that involves an unprecedented and systematic devolution of power to the federal government, in direct contravention of the Constitution.

From the pending takeover of 17% of economy under the auspices of health care reform, to the government takeover and subsequent ownership of automobile companies, to the unconstitutional interference in the formerly private market under the rubric of stimulating the economy. Not to mention the proposed cap and trade legislation which would give the federal government unlimited powers of taxation and regulation under the guise of saving the planet.

Totally ignored by elected officials of both parties is the tenth amendment of the Constitution, which states very clearly, “The power not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the States respectively, or to the people.”

Many Americans don’t agree with the left’s idea of a ‘living constitution’, arguing that the intent of the founders should govern the interpretation and application of the Constitution, not the whimsical and politically motivated present day politicians. And, largely unreported by the media, they are starting to stand up to the federal government.

To date, 37 states have introduced sovereignty resolutions, asserting their state’s sovereign rights under the tenth amendment.

Earlier this month, Louisiana became the seventh state, joining Alaska, North Dakota, South Dakota, Oklahoma, Idaho and Tennessee to officially adopt a resolution affirming their sovereignty. These states are putting the federal government on notice that politicians in Washington do not have the right, under the Constitution, to continue to impose their increasingly onerous federal mandates on sovereign states.

Some states, with Arizona leading the way, are going a step further.

Under Arizona’s Health Care Freedom Act, which was passed by the Arizona state legislature this month, a voting initiative will be placed on the 2010 ballot that, if passed, will allow Arizona to opt out of any federal health care plan.

Following Arizona’s lead, five other states — Indiana, Minnesota, New Mexico, North Dakota and Wyoming — are considering similar initiatives to opt out of federal health care for their 2010 ballots This, even before Congress has created the program.

Arizona is also preparing for the misnamed ‘climate’ bill, that passed the House this month. (With eight Republican votes.) The Arizona state Senate voted 19-10 to approve a bill banning the Department of Environmental Quality from enacting or enforcing measures with language pertaining to climate change.

Other states are stepping up to the plate and asserting their state’s sovereign right under the second amendment – a right that guarantees the right of the people to keep and bear arms.

On July 6, Florida introduced the Firearms Freedom Act which seeks to provide “that specified firearms, firearm accessories, and ammunition for personal use manufactured in state are not subject to federal law or regulation” in the State of Florida.

Increasingly, the representatives ‘we the people’ have elected to preserve and protect our rights, are ignoring the clear, unequivocal language of the Constitution. Our politicians seem unaware of the fact that the Constitution does not include congressional power to override state laws.

In fact, the power our representatives are now accruing to the federal government was expressly voted down, not once, but several times.

During the Constitutional ratification process, James Madison drafted the ‘Virginia Plan’ which advocated a strong federal government. It proposed, among other things, giving Congress legislative authority, and a veto over state laws. Each of Madison’s proposals was soundly defeated. Our founders clear intent was vesting all powers in the states, with but a few, listed exceptions.

Ever since 1938, when FDR used the occasion of the great depression to drastically expand the scope of federal government (Wickard vs Filburn) using an absurd reading of the Commerce Clause, this unconstitutional taking of power by the central government has gone virtually unchallenged. Until now.

Though the media has ignored these efforts, ‘we the people’ are starting to fight back, via our state and local representatives.

Politicians need to be reminded that our Constitution is still in effect. And Americans need to be reminded that just because some believe the trendy notion that our Constitution is a ‘living, breathing’ document, doesn’t make it so.

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Nancy Morgan is a columnist and news editor for RightBias.com
She lives in South Carolina

Article has been published with permission

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On the Health Care System We Aspire To

Posted on 10 April 2011 by Editor

Originally posted 2009-06-24 12:22:44. Republished by Blog Post Promoter

Today I got a call from my Mom. She and my Dad both live in the city I was born in – Warsaw, Poland. They are both elderly and live off of a government pension akin to the US social security system. The reason she called was to let me know of an excruciating pain she has recently been suffering from, resulting from a progressively degenerative neurological condition in her wrist. As all Poles are, she is entitled to free medical care in government health care facilities under the country’s universal health care insurance program. Trying to get help for her condition, she has visited with several general practitioners covered under her free plan, all of whom admit she needs to see a specialist. The last one finally crafted a referral for her and she is now scheduled to see a neurologist … in three months. Ouch !

Her options now include continuing to suffer the intolerable pain for the next 3 months or pay out of pocket to see a private specialist. The fee for a consultation with a neurologist in private practice exceeds two months of her pension income, but under the circumstances she will have to do just that. The costs of any resulting treatments, if not covered under the government health care plan, may have a devastating financial effect on her and my dad’s retirement lifestyle.

My parents could have opted to purchase private health care insurance coverage which provides access to services in private hospitals and clinics with the most skilled specialists but, because the government program is so dominant and pervasive, the cost of the private alternative is beyond the reach of most middle-class Poles. As a result, it is accessible to only the most affluent (or motivated by dire circumstances and lacking other options) individuals.

Interestingly enough, in many European countries the Polish medical system as a whole is actually touted as one of the better and when compared with the British system in particular, it receives accolades for efficiency and quality of care. What is underscored is the diminishing role of the public plan option and the progressively increasing percentage of services being offered under private insurance. The availability and increasing popularity of the private health care option is viewed with envy. A good summary of these changes in the Polish medical system can be found in this article from CMAJ (Canadian Medical Association Journal). With this shift, as more competition is introduced in the private sector and the dominance of the government program is lessened (or eliminated), my mom might yet one day be able to afford a private insurance plan and access to the highly skilled medical professionals in Poland, heretofore not accessible to her under her existing plan and her present means.

But in the US exactly the opposite direction is being proposed. There can be very little doubt, and certainly countless examples of dysfunctional government programs across Europe and other countries serve as an example, that a private health care system necessarily offers superior services at a competitive price. As I have written in a prior Naked Liberty article on the Dangers of Comparative Effectiveness, instead of experimenting with proven failed systems, the US should adopt targeted approaches to improving those parts of our current system which offer opportunities for improvement, such as for example the implementation of a national electronic medical records system and tax incentives to support wellness and health awareness.

What’s being proposed is like trading in your comfortable and dependable SUV for a Yugo just because you happened to have gotten a flat tire. Let’s fix the tire and get on with our lives without any more government intervening in it.

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Quotation of the Day:

“We should manage our fortunes as we do our health – enjoy it when good, be patient when it is bad, and never apply violent remedies except in an extreme necessity.“

Francois de La Rochefoucauld (1613 – 1680)

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We welcome your comments and suggestions, either directly inline, or via email to editor@nakedliberty.com. If you would like to have your article published in Naked Liberty, please contact the editor at the above email address.

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