By Diana Furchtgott-Roth - For a study in contrasts, look no further than President Obama’s State of the Union Address. The president, in a spasm of fiscal responsibility, asked Congress to freeze discretionary non-defense spending for three years, for $250 billion in savings over the next decade. Then, he proposed student loan write-offs, new middle-class entitlements, and reiterated support for expensive high-speed rail and $1 trillion health “reform.”
Mr. Obama declared, “By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year… I will not walk away from these Americans, and neither should the people in this chamber. As temperatures cool, I want everyone to take another look at the plan we’ve proposed. ”
The Democrats’ health proposal featured overarching regulation on insurance companies governing what benefits their policies must offer and what range of prices they could charge; a requirement that individuals buy conforming policies; cuts in Medicare; a panel to determine allowed cost-effective treatments; and taxes on expensive plans, high-income individuals, and on employers who don’t offer the right kind of health insurance.
There has to be a better way to combine fiscal responsibility with health care reform. For better ideas, look no further than the food stamps program, which costs about $56 billion a year, and gives low-income people a debit card to use at stores to buy whatever food they choose. This approach to subsidizing nutrition allows freedom of choice and gets few complaints.
But imagine if, instead of food stamps, the government delivered bags of groceries to people’s front doors. Complaints would soon abound, because people probably would not like the contents. Some might say that they didn’t want Corn Flakes, they wanted granola. Others might reject Velveeta in favor of Kraft Slices, or chicken in favor of beef.
The Democratic health insurance bills take a similar approach, specifying what coverage people must buy. But one size does not fit all well.
Representative Paul Ryan, Republican of Wisconsin has applied the food stamps idea to health reform. In his Road Map for America’s Future, reintroduced this month, Americans would take refundable tax credits – $2,300 for singles and $5,700 for families – and choose private insurance. All insurance plans that are licensed in a particular state would be eligible, and each company would be free to set its own premiums. Low-income individuals would get extra tax credits so they could buy the same kind of health care as other Americans.
Medicare would remain the same for current beneficiaries and for those 55 and older when they reach 65. But when those born in 1955 or later become eligible for Medicare at age 65, their plan would change. They would receive $11,000, adjusted for inflation, to buy a Medicare certified plan. Those with lower incomes or with more serious health conditions would receive more funding.
Under Mr. Ryan’s plan, health insurance companies could offer high-deductible plans carrying lower premiums combined with health savings accounts, or more traditional managed care or fee-for-service plans. Persons with high-cost chronic illnesses, such as hemophilia or diabetes, would be placed in special affordable state high risk pools, with subventions paid by the government.
On Wednesday, Congressional Budget Office Director Douglas Elmendorf wrote to Mr. Ryan to tell him that this plan reduced health care costs and the federal deficit. He said: “Under the proposal, national health expenditures would almost certainly be lower than they would under the alternative fiscal scenario. Federal spending for health care would be substantially lower, relative to the amount in that scenario, for working-age people and the Medicare population.”
On Monday, October 19, Senator Jon Kyl of Arizona shared with his colleagues in the Senate what he has been hearing from his constituents on Health Care Reform. Senator Kyl gave a 20-minute presentation in which he aptly articulated the concerns most Americans are expressing about the Health Care Reform bill. Although it is a bit long, this is a “must-see” speech for everyone who cares about the future of health care in America.
This is a presentation given by Dave Racer at the annual meeting of Association of American Physicians on October 2, 2009. Click here to order copies of Racer’s book, “Facts Not Fiction on Health Care.”
‘We must ensure that well-intentioned efforts to bring about “change” are not exploited to create a federally controlled system that promises health care for all, but creates an oppressive bureaucracy hostile to human life and to the integrity of the patient physician relationship…’
Catholic Medical Association
Open Letter to Catholics and Catholic Organizations
September 21, 2009
Members of the Catholic Medical Association have been carefully monitoring the process and content of the health-care reform debate from our unique perspective as Catholic physicians. We are familiar with contributions made to the national debate by other Catholic organizations.
As efforts to enact health-care reform legislation intensify, we would like to share our perspective on some prudential aspects of health-care reform and work collaboratively with others to shape legislation in harmony with the Catholic faith. These thoughts reflect years of experience serving patients and families in medical practice while endeavoring to apply the full spectrum of Catholic medical-moral and social teaching.
We believe we are facing a crisis, not only in health-care financing and delivery, but in the health-care reform process itself. As is often noted, the word “crisis” can mean either danger or opportunity. The United States has the opportunity (and obligation) to craft effective, ethical responses to the crisis in health-care financing and delivery. But there also exists a real danger that misguided legislation could make our current problems even worse. This is a critical time for Catholics to work together to formulate solutions based upon authentic moral, social, and economic principles,
The failings of the U.S. health-care financing and delivery system are well-known. Many people lack consistent access to affordable health insurance and are unable to obtain appropriate healthcare services in a timely manner. Health-care services are expensive and fragmented. These problems result largely from misguided incentives in tax, employment, and government policy.
One unfortunate result of this has been increasing third-party payer intrusion into the patient physician relationship, with significantly deleterious consequences. All Catholics should agree on the fundamental ethical and social principles proposed by the Church. The question we are faced with, after decades of misguided policies, is how should we apply these teachings so as to provide universal access to quality health-care insurance and services in a cost-effective, ethical manner?
Bills passed out of committees in the House and Senate this summer rely heavily on the federal government to dictate solutions. They empower a small group of unelected government bureaucrats and committees to determine the composition and cost of health insurance policies, the reimbursement of providers, the approval of treatments, etc. We think this government controlled approach is flawed in principle and ineffective, if not dangerous, in practice. This approach clearly violates the principle of subsidiarity first articulated by Pope Pius XI in Quadragesimo anno, n. 79, and recently reaffirmed by Pope John Paul II in Centesimus annus, n. 48 and Pope Benedict XVI in Caritas in veritate, n. 47.
• This approach has been and will be ineffective. The federal government has a very poor track record of managing large programs in a cost-effective manner. Medicare will be insolvent by 2017 and faces a $37 trillion unfunded liability. Medicaid’s problems are well-known. Costs have run out of control in most states, and 40 percent of physicians no longer accept Medicaid because low reimbursement rates do not even cover the overhead expense of providing care. Adding millions of people to this flawed government system (as proposed by the Senate H.E.L.P. Committee bill) is not meaningful health insurance reform.
• This approach, moreover, is dangerous given the current Administration’s repeated failures to accord proper respect for the dignity of human life. Reversing the Mexico City Policy and providing federal funding for human embryonic stem-cell research are only the best known of a whole series of proposals denying respect for human life. In addition, the Administration seems intent upon institutionalizing such policies making it difficult, if not impossible, to overturn them in the future. While there have been some misunderstandings about provisions relating to end-of-life consultations; serious concerns remain regarding funding for care of the seriously ill and dying. All are aware that a significant percentage of health-care spending occurs in the last months of a person’s life, and we are facing a demographic tsunami of aging baby boomers. Giving the federal government the power, and primary responsibility, to contain medical expenditures could threaten the provision of medical care to the most vulnerable, the elderly and chronically ill. We believe there are better approaches to achieving meaningful health-care reform and meeting our common goal of making health-care coverage truly universal and genuinely affordable.
• We should advocate for legislation making it possible for individuals and families to purchase health insurance that meets their needs and also respects their values. This could be achieved by re-assigning the tax deduction for health insurance from employers to individuals. And bringing appropriate incentives from the market economy to health insurance companies will increase competition and correct the problem of regional insurance monopolies, thereby reducing costs of insurance and medical care. Such reforms would address the needs of the great majority of people. Congress can also tailor programs to assist those most in need, the working poor, the unemployed, and those currently uninsurable due to preexisting conditions.
• We should encourage greater individual accountability in health-care spending. Since 70 percent of health-care spending is for conditions directly influenced by personal behavior, there is considerable potential for improved health and reduced spending by encouraging healthier lifestyles with appropriate financial incentives. In general, reforms encouraging individual ownership of health insurance and personal responsibility for spending on medical care are more likely to reduce costs in an ethically acceptable manner than are those increasing the power and control of third parties.
• Before supporting the creation of another large government program, we should work to reform those already in existence and demonstrating serious difficulty in controlling costs. Medicaid needs an extensive overhaul to ensure quality care for the poor and just compensation for providers.
In conclusion, we call upon all Catholics and Catholic organizations to reaffirm their support for the foundational ethical and social teachings of the Church which provide a framework for authentic health care reform, and to unite as one in an uncompromising commitment to defend the sanctity of life and the conscience rights of all providers as essential parts of health-care reform. And we also respectfully urge all Catholics and Catholic organizations to place a greater emphasis on respecting the principle of subsidiarity across the spectrum of issues in health-care financing and delivery during the coming legislative debates. Experience indicates that medical decisions are best made within the personal context of the individual patient-physician relationship rather than within some remote, impersonal, and bureaucratic agency, whether governmental or corporate. We are convinced that if this important principle of Catholic social teaching is not correctly upheld, then short-term measures to defend the right to life and respect for conscience will ultimately fail and the patient-physician relationship will be irreparably compromised.
We noted above that we face not only a crisis in health-care financing and delivery, but a crisis in the current legislative process. We must ensure that well-intentioned efforts to bring about “change” are not exploited to create a federally controlled system that promises health care for all, but creates an oppressive bureaucracy hostile to human life and to the integrity of the patient physician relationship. It would be better to forgo long-needed changes in health-care financing and delivery in the short-term if these would lead to a long-term, systemic policy regime that is inimical to respect for life, religious freedom, and the goods served by the principle of subsidiarity. Rather than accept such an outcome, we should take the time required to implement reform measures that are sound in both principled and practical terms.
Health care reform is on everybody’s mind. And with good reason.
We have the highest quality health care in the world. Look no further than Minnesota’s Mayo Clinic, which is a world-class destination for care. But high costs put health care out of reach for millions of Americans, especially middle-class families that make too much for government subsidies but struggle to pay the bills. Similarly, small-business owners struggle because they cannot use big business’ economies of scale to get affordable coverage.
We must do something to contain costs and make the high-quality care we have more accessible to everyone.
While the government-run approach, also known as the public option or co-op, is getting the most notice, there are actually a number of less dramatic alternatives that can really make a big difference. Moreover, while some in Washington are talking about what’s being called the “nuclear option,” or a Democratic Congress and White House joining together to pass their reform proposals with no Republican input, many of these lesser-known alternatives individually have broad bipartisan support.
We shouldn’t get lost in the glamour of big overhauls and look past meaningful reforms, like association health plans that let small businesses bond together to reduce coverage costs or health savings accounts that let you save for care tax-free. Bigger is not necessarily better.
Changes to the tax code, for instance, would make care and coverage more affordable while preserving consumer choices.
I’ve introduced the bipartisan Health Care Freedom of Choice Act to put patients in charge of their health decisions by tweaking the tax code. Under current law, businesses are allowed to deduct the cost of employee health care from their taxes, while individuals and families cannot. This bias in favor of employer-provided coverage leads to higher costs overall and reduces accessibility to care.
My legislation would erase this bias and extend the same tax incentives to businesses and individuals alike. From co-pays and premiums to long-term care, vision and dental, your high out-of-pocket costs would no longer be a barrier to care.
I’ve also cosponsored the Empowering Patients First Act, which puts the focus of health care decisions back on the patient, where it belongs. This legislation includes a sliding scale refundable tax credit for lower income Americans. It also covers pre-existing conditions and protects employer-sponsored insurance.
The bill would increase consumer choice by allowing individuals to shop for their health insurance across state lines, similar to how we purchase auto insurance, creating competition and giving Americans the greatest value for the coverage that best fits their needs.
Allowing consumers to cross state lines to purchase insurance would apply positive pressure to end the burgeoning number of health insurance mandates. If you don’t want to pay for hair prostheses in your coverage, you shouldn’t have to, but one in five states mandates that you do.
According to a study by the Council for Affordable Health Insurance, each mandate typically increases the cost of health insurance coverage by up to 3 percent. And, they identified 1,961 mandates in 2008.
Another provision in this legislation would rein in the money wasted on frivolous lawsuits. Malpractice awards alone drive up the annual cost of U.S. health care by $20 billion to $40 billion a year. But even worse is the cost of defensive medicine, or responses a doctor utilizes primarily to avoid liability.One study by the American Academy of Orthopedic Surgeons puts the cost of defensive medicine at as much as $178 billion per year. We must have tort reform so that doctors can be doctors without fear of frivolous, career-ending lawsuits.
And we must have tort reform so that doctors don’t abandon difficult specialties because their medical malpractice insurance makes it cost prohibitive. Increasing numbers of obstetrician-gynecologists, for instance, won’t deliver babies any more; it’s just too costly. Patients — particularly in underserved areas — are the ones who lose when doctors are forced to drop these important specialties.
These are just a few of the health care proposals we can enact that won’t break the bank and can pass quickly and with broad bipartisan support.
Our nation’s deficit and debt are at all-time highs. Medicare and Medicaid are broke. Social Security is broke. Can we really afford to trust Washington when it asks you to entrust them with your health care saying it will not only reduce costs, but increase both accessibility and efficiency for all Americans?
‘We must ensure that well-intentioned efforts to bring about “change” are not exploited to create a federally controlled system that promises health care for all, but creates an oppressive bureaucracy hostile to human life and to the integrity of the patient physician relationship…’
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