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So where will Americans end up going for health care?

Obama has often said that he would like a health care system like they have in Canada. Look at how so few doctors these days are taking new Medicare patients. If that type of pricing policy is applied across the board, we would see fewer doctors providing services there also.

A Canadian study released Wednesday found that many provinces in our neighbor to the north have seen patients fleeing the country and opting for medical treatment in the United States.
The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993.
Specialist physicians surveyed across 12 specialties and 10 provinces reported an average total wait time of 19 weeks between the time a general practitioner refers a patient and the time a specialist provides elective treatment — the longest they have ever recorded.
In 2011, Canadians enrolled in the nation’s government-dominated health service waited long periods of time for an estimated 941,321 procedures. As many as 2.8 percent of Canadians were waiting for treatment at any given time, according to the Institute.
“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to the Institute. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.” . . .

On a related note:

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.
The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court. . . .

Government created drops in drug production

healthcare Regulation

Have you wondered why there seems to be shortages of important medical drugs? Well, it appears that the answer is actually pretty straightforward. From the Washington Examiner:

President Obama's Food and Drug Administration has caused "a public health crisis" -- a prescription drug shortage over the past two years -- by increasing the number of threats issued to raid and close drug manufacturing plants, according to House investigators.
"This shortage appears to be a direct result of over-aggressive and excessive regulatory action," House Oversight and Government Reform Committee Chairman Darrell Issa, R-Calif., said . . .
The committee report concluded that a significant portion of the drug shortage is a problem of the Obama administration's making. "Among shuttered manufacturing lines that occurred over the previous two years, the committee’s review did not find any instances where the shutdown was associated with reports of drugs harming customers," the report says, noting a 30 percent drop in the manufacture of certain prescription drugs at the largest manufacturers in the country. . . .
The FDA sent just 474 such letters in 2009, but that number spiked to 1720 in 2011. "A common sense approach to regulations must be restored at the FDA," the committee report advised . . . .

New York taxing both unhealthy and healthy activities

healthcare Taxes

Well, if the government is going to put a heavy tax on healthy activities, this must justify them putting a really heavy tax on unhealthy ones. From the WSJ:

The New York Department of Taxation and Finance decided that yoga studios fall into a category of businesses -- specifically weight control or health salons -- that must pay the city's levy, officials said.
The decision was revealed last April in a bulletin from the department and now is sinking in as yoga studios across the city prepare their taxes.
The state -- which collects the city's sales tax -- already began auditing yoga studios, presenting them in some cases with bills for back sales taxes for the past three years.
"We do see this as a fairness issue," according to Edward Walsh, a spokesman for the Department of Taxation and Finance, noting that Pilates studios have to pay sales tax. "Businesses that provide similar services should be subject to the same taxes in the city." . . .

More Mandates in Obamacare

healthcare obamacare Regulation

From ABC News:

The individual insurance requirement that the Supreme Court is reviewing isn't the first federal mandate involving health care. There's a Medicare payroll tax on workers and employers, for example, and a requirement that hospitals provide free emergency services to indigents. Health care is full of government dictates, some arguably more intrusive than President Barack Obama's overhaul law. It's a wrinkle that has caught the attention of the justices. Most of the mandates apply to providers such as hospitals and insurers. For example, a 1990s law requires health plans to cover at least a 48-hour hospital stay for new mothers and their babies. Such requirements protect some consumers while indirectly raising costs for others. One mandate affects just about everybody: Workers must pay a tax to finance Medicare, which collects about $200 billion a year. It's right on your W-2 form, line 6, "Medicare tax withheld." Workers must pay it even if they don't have health insurance. Employees of a company get to split the tax with their employer. The self-employed owe the full amount, 2.9 percent of earnings. . . .

Paul Krugman's embarrassingly weak analysis on the Supreme Court debate over health care

healthcare obamacare paulkrugman SupremeCourt

Krugman's piece on Friday, "Broccoli and Bad Faith," continues his trend for polemics over accuracy or analysis.

Let's start with the already famous exchange in which Justice Antonin Scalia compared the purchase of health insurance to the purchase of broccoli, with the implication that if the government can compel you to do the former, it can also compel you to do the latter. That comparison horrified health care experts all across America because health insurance is nothing like broccoli. Why? When people choose not to buy broccoli, they don't make broccoli unavailable to those who want it. But when people don't buy health insurance until they get sick -- which is what happens in the absence of a mandate -- the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain. As a result, unregulated health insurance basically doesn't work, and never has. . . .

OK, so if you wait until you are sick before you buy health insurance, you drive up the price of insurance for others. But the exact same argument exists for broccoli. If broccoli makes you healthier and you don't eat it, you are more likely to get sick and you will shift up the demand curve for health care, raising the price of insurance.

unregulated health insurance basically doesn't work, and never has. . . .

Krugman is well-known for his assertions. If you got rid of insurance regulations, prices would be set according to risk.

I was struck, in particular, by the argument over whether requiring that state governments participate in an expansion of Medicaid -- an expansion, by the way, for which they would foot only a small fraction of the bill -- constituted unacceptable "coercion." One would have thought that this claim was self-evidently absurd. After all, states are free to opt out of Medicaid if they choose; Medicaid's "coercive" power comes only from the fact that the federal government provides aid to states that are willing to follow the program's guidelines. If you offer to give me a lot of money, but only if I perform certain tasks, is that servitude? . . .

The discussion before the Supreme Court was over "coercion," not "servitude." "Coercion" means to impose a cost on others. As any economist knows, costs are always opportunity costs. Giving up money represents an opportunity cost. But let me make it simple for Krugman: You take money from me by force and give it back only if I do want what you want me to do. That sure seems like coercion.

How the costs of Obamacare are going to ramp up quickly

deficits healthcare obamacare

Over the eleven years from 2012-2022, Obamacare will add an average of $114 billion a year to the deficit. From 2015 to 2022, the average increase in the deficit rises to $148 billion a year. The CBO numbers can be found in Table 2 is available here. Of course, if the Supreme Court strikes down the individual mandate, that will increase the average annual deficit over the 2015-2022 period by about $7 billion a year.

Thanks to Tony Troglio for the link.

Another year of faster than promised increases in health insurance prices after Obamacare

healthcare Insurance obamacare Regulation

Last year I had this post available here. This year we have this news:

The good news is that the cost of employer-sponsored health insurance is growing at a stable rate. The bad news is that the rate still exceeds inflation and worker wage increases, according to a survey from benefits consultant Towers Watson and the National Business Group on Health.
The annual cost of health coverage will rise nearly 6 percent to an average of $11,664 per employee in 2012, said the survey, which was released Thursday. The employee portion of that bill — or what comes out of worker paychecks — will climb, on average, 9.3 percent to $2,764. . . .

A question for Sandra Fluke

healthcare

Just out of curiosity, if Fluke can't afford contraceptives, why can't she ask her boyfriends to themselves buy condoms before they come over? This woman is 30 years old and if she can't afford the $15 to $50 that the pill supposedly costs each month, can she use condoms? I just looked online and you can get condoms for about 43 cents each (free shipping). So having sex once a day for the year would cost her about $157. The average price for the pill would be about $390 a year. Cut these costs in half if she can get her boyfriends to chip in equally.

The Obama administration rejects Dem Gov. Jerry Brown's attempts at modest health care cost savings

governmentwaste healthcare obamacare

Even very modest co-pays will make people use resources more responsibly. Why be careful at all with what you ask for if the price to you is zero? Co-pays for drugs ($3) and doctor visits ($5) seem very trivial compared to their true costs. From the WSJ's Political Diary.

Strapped with a $13 billion deficit last year, Mr. Brown sought to squeeze $1.6 billion of savings out of the state's Medicaid program. Since more than half of the state's Medicaid dollars come from the federal government, Mr. Brown had to request waivers from Health and Human Services Secretary Kathleen Sebelius to implement many of his cost-saving solutions. While Ms. Sebelius last year signed off on a 10% rate cut to providers, which was projected to save the state about $600 million, she drew a line in the sand on the governor's request to charge Medicaid recipients a co-pay for drugs ($3) and doctor visits ($5).

The co-pays would save the state more than $300 million a year, but the Obama administration reasoned that they would deter recipients from seeking treatment and thus restrict health-care access. While in Washington, D.C., for the National Governors Association's winter meeting earlier this week, Mr. Brown lobbied Obama senior advisor Valerie Jarrett and Ms. Sebelius again for a waiver but didn't sound too optimistic about his prospects. The governor said that Ms. Sebelius had raised "legal issues" about charging co-pays and indicated that there were other ways to reduce Medicaid costs, which she didn't specify.

Trouble is, the Obama administration won't countenance limiting eligibility or introducing incentives that encourage doctors and patients to use health resources more judiciously. . . .

Surprise increase in the cost of Obamacare for next fiscal year

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Some technicalities apparently have some real consequences. So much for Obama's promises about how much Obamacare would cost.From the AP:

Cost estimates for a key part of President Obama's health care overhaul law have ballooned by $111 billion from last year's budget, and a senior Republican lawmaker on Friday demanded an explanation.
House Ways and Means Committee Chairman Dave Camp, R-Mich., wants to know by Monday why the estimated ten-year cost of helping millions of middle-class Americans buy health insurance has jumped by about 30 percent.
Administration officials say the explanation lies in budget technicalities and that there are no significant changes in the program.
The revised numbers, buried deep in the president's budget, stumped lawmakers and some administration officials for most of the week. At a congressional hearing Tuesday, Health and Human Services Secretary Kathleen Sebelius, who is in charge of carrying out the health care law, indicated she was unaware of the changes.
At issue are subsidies that will be provided under the health care law to help middle class people buy private coverage in new state insurance markets that will open for business in 2014.
Last year's budget estimated the cost of the aid to be $367 billion from 2014-2011. This year's budget puts it at $478 billion over the same time period. . . .

When Doctors need medical what choices do they make?

healthcare

From the WSJ:

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. . . .

Cost of government risk insurance double what was previously estimated

governmentwaste healthcare Insurance obamacare ObamaDishonest

Only a fraction of the people who were supposed to sign up for this program have done so (see here). The government has gone all out to try to convince more people to sign on to it. But the costs for those who have turned out to be wildly higher that the Obama administration had estimated. From the Washington Post:

The health-care law set aside $5 billion for a Pre-Existing Condition Insurance Plan, meant to provide health insurance to those who had been declined coverage by private carriers. Since its launch last summer, nearly 50,000 Americans have enrolled in the program.

The PCIP program will phase out in 2014, when insurers will be required to accept all applicants regardless of their health-care status.

Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.

The costs also are significantly higher than those of similar high-risk pools that many states have operated for decades. States spent an average of $12,471 on enrollees in 2008, according to the National Association of State Comprehensive Health Insurance Plans.

The Obama administration has spent $600 million of its $5 billion budget for the program over the past 18 months. . . .

So much for the Obama administration claim that mandating abortion and contraception coverage would lower insurance costs

healthcare Insurance ObamaDishonest Regulation religion

Obviously it is right that people will pay for these benefits one way or the other. From The Hill Newspaper

The insurance industry is concerned it will take a hit from the Obama administration’s mandate that they provide birth control in health plans for employees of religious organizations that object to the coverage.

Publicly, the health insurance industry has avoided getting involved in the fight.

But in private, the industry is dubious of the administration’s argument that the insurance industry wouldn't take a hit because birth control is cheaper than unwanted pregnancies.
The trade group America's Health Insurance Plans has limited its comments to saying it worries about the "precedent" the mandate would set. The concern is that the government could eventually require health plans to cover any number of preventive services – even prescription drugs - without copays or deductibles, under the theory that they save money in the long-term.

Privately, however, insurers say there's nothing "free" about preventing unwarranted pregnancies. They say the mandate also covers costly surgical sterilization procedures, and that in any case even the pill has up-front costs.

"Saying it's revenue-neutral doesn't mean it's free and that you're not paying for it," an industry source told The Hill. . . .

Regulation is out of control in the US

financialmarkets healthcare Regulation

From The Economist magazine:

A Florida law requires vending-machine labels to urge the public to file a report if the label is not there. The Federal Railroad Administration insists that all trains must be painted with an “F” at the front, so you can tell which end is which. Bureaucratic busybodies in Bethesda, Maryland, have shut down children’s lemonade stands because the enterprising young moppets did not have trading licences. The list goes hilariously on. . . .

Consider the Dodd-Frank law of 2010. Its aim was noble: to prevent another financial crisis. Its strategy was sensible, too: improve transparency, stop banks from taking excessive risks, prevent abusive financial practices and end “too big to fail” by authorising regulators to seize any big, tottering financial firm and wind it down. This newspaper supported these goals at the time, and we still do. But Dodd-Frank is far too complex, and becoming more so. At 848 pages, it is 23 times longer than Glass-Steagall, the reform that followed the Wall Street crash of 1929. Worse, every other page demands that regulators fill in further detail. Some of these clarifications are hundreds of pages long. Just one bit, the “Volcker rule”, which aims to curb risky proprietary trading by banks, includes 383 questions that break down into 1,420 subquestions. . . . .

of the 400 rules it mandates, only 93 have been finalized. . . .

Next year the number of federally mandated categories of illness and injury for which hospitals may claim reimbursement will rise from 18,000 to 140,000. There are nine codes relating to injuries caused by parrots, and three relating to burns from flaming water-skis. . . . .

Obama administration explains whether the health care taxes are a tax or not

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Surprisingly little opposition to Obamacare's mandate that religious organizations provide contraceptions and abortions

Abortion healthcare obamacare poll

Given that Obamacare will force the provision of morning after pills, this is more than contraception. In any case, I am surprised that not much more than 50 percent of voters oppose this use of government force. Rasmussen Reports finds:

Half of voters do not agree with the Obama administration’s action forcing Catholic institutions to pay for birth control measures that they morally oppose. The latest Rasmussen Reports national telephone survey finds that 39% of Likely U.S. Voters believe the government should require a church or religious organization to provide contraceptives for women even if it violates their deeply held beliefs. Fifty percent (50%) disagree and oppose such a requirement that runs contrary to strong beliefs, while 10% more are undecided. . . .

Meanwhile, Obama appears to be giving a different cover to their policies. From Fox News:

Obama's chief spokesman and his top campaign strategist both said the administration was searching for ways to allay the concern of Roman Catholics who say the birth control mandate would force them to violate their religious beliefs against contraception. Senate Republican Leader Mitch McConnell said the policy was a "huge mistake" that the administration should reconsider. "And if they don't, Congress will act," McConnell said. . . .
Obama campaign strategist David Axelrod made the same point. "The real question is how do we get together and resolve this in a way that respects the concerns that have been raised but also assures women across this country that they're going to have the preventive care that they need," Axelrod said on MSNBC.
The comments by Axelrod and Carney created a sense that the White House's public emphasis has clearly shifted and that further accommodation would be considered. But there was no sign the administration would move to completely withdraw the rule, and it was unclear that the White House could strike the balance of ensuring contraceptive coverage for all while defusing the fierce opposition of some religious groups when those two points are in conflict. . . .

Apparently Justice Kagan was actually involved in Obamacare discussions while at DOJ

ElenaKagan healthcare SupremeCourt

From Fox News:

With just weeks until the U.S. Supreme Court considers the constitutionality of President Obama's health care law, there are new calls for Justice Elena Kagan to recuse herself from the case.
Her critics point to a 2010 case regarding a San Francisco health measure, in which then-Solicitor General Kagan's office filed an amicus brief touting the newly passed health care law.
In May 2010, after Kagan had been nominated to the nation's highest court, Principal Deputy Solicitor General Neal Katyal sent her a memo outlining the cases in which she had "substantially participated." Kaytal specifically referenced the Golden Gate case, noting that it had been "discussed with Elena several times."
That's enough to convince Heritage Foundation Senior Legal Fellow Hans von Spakovsky that Kagan shouldn't take part in the current health care case before the high court.
"I don't see how any ethical lawyer adhering to professional codes of conduct could not consider that they need to recuse themselves from this case," he said. . . .

Labor unions primary beneficiaries of Obamacare waivers

healthcare obamacare Regulation Unions

From the Daily Caller:

Labor unions continued to receive the overwhelming majority of waivers from the president’s health care reform law since the Obama administration tightened application rules last summer.

Documents released in a classic Friday afternoon news dump show that labor unions representing 543,812 workers received waivers from President Barack Obama‘s signature legislation since June 17, 2011.

By contrast, private employers with a total of 69,813 employees, many of whom work for small businesses, were granted waivers.

The Department of Health and Human Services revised the rules governing applications for health reform waivers June 17, 2011, amid a steady stream of controversial news reports, including The Daily Caller’s story that nearly 20 percent of last May’s waivers went to businesses in House Minority Leader Nancy Pelosi’s district in California. . . . .

Obama: Forcing more people off of private health insurance

healthcare Regulation

Kathleen Sebelius, secretary of Health and Human Services, has made a decision that Robert Samuelson argues will reduce the number of people on private health insurance. It all stems from Obamacare's mandated minimum coverage requirements for insurance.

The more coverage they include, the greater the subsidies from the federal government for the poor and near-poor who qualify for aid. It will be tempting to exploit the open-ended nature of these subsidies. The catch is that the millions of workers whose coverage isn't subsidized will see the squeeze on their wages intensify, while their employers may be put at a disadvantage with less generous states. . . .

Democrats react to Wyden-Ryan Medicare plan

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Even the New York Daily News gets it.

Reactions were typical of Washington. Partisan Democrats groused, knowing their ability to demagogue this issue had just taken a hit.

White House Communications Director Dan Pfeiffer said, “The Wyden-Ryan scheme” — note the cleverly derisive word — would “end Medicare as we know it for millions of seniors.” Baloney. The only thing certain to end Medicare as we know it is the status quo of Medicare itself.

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