Sen. Tom Coburn On Health Care Reform

A Timeless Declaration of Conservatism by President Reagan

In listening to this speech - which invariably leaves liberals in a state of shock and conservatives breathless - I am reminded of the timelessness of true conservative principles. The left endlessly chants their mantra that "the era of Reagan is over, stop living in the past". What they either fail to see - or see and try to ignore - is that Reagan's message is timeless. It is Conservatism. The reverence and admiration for Reagan stems not from a cult of personality - as is the sorry case for our current President - but from the fact that he held and operated on a set of conservative principles that are correct in any age, any situation.

Political, economic, military and social circumstances change and their contemporary problems change. However, the correct set of principles that shoudld be used to address them does not change: Conservatism. Just as no two physics problems are exactly the same, the underlying principles of force, energy, inertia, etc apply to coming up with a solution.

Reagan reminds us that the set of principles we need to use to address todays challenges are the same that our Founding Fathers and generation after generation of Americans have used to address theirs: Conservatism.

Listen to Reagan and remember what a real leader sounds like. What a real Conservative sounds like. Listen to him and then go out and work to get people with his principles into government.

And A New Winner Weighs in......The Senate Heath Care Bill!

On Monday the Senate Finance Committee unveiled the legislative text of S. 1796 — dubbed “America’s Healthy Future Act” — revealing to fans of legislative “bloatware” a new one for the record book!

Not only does this latest entry in the Congress League’s 111th season “monster bill” competition outstrip all other current contenders in the Health Division, it even eclipses the previous all-time division titleholder.

At a staggering 1,502 pages, the Finance Committee bill dwarfs the Senate HELP Committee’s 839 page bill (S.1679), and is nearly one-and-a-half times the size of this season’s closest divisional competitor, the 1,018 page House “Tri-Committee” bill (H.R. 3200).

However, what really has Congress League fans talking is that, for the first time in fifteen years, a team has set a new all-time division record for gigantic, unintelligible, unaffordable, over-regulatory, federal legislation.

Indeed, the big news is that S. 1796 has dethroned the previous all-time champion in the League’s Health Division — the 1993 Clinton “Health Security Act” (S.1757, 103rd season). For nearly a decade and a half, the record set by the 1,364-page “Clinton Bill” — or “the doorstop,” as health policy experts, many of whom still keep souvenir copies on their bookshelves, affectionately know it — stood unchallenged. Not any more. With its extra 138 pages of heft, the Finance Committee bill beat the old Clinton bill record by a full ten percent!

Furthermore, when this Congress League season is over — and the record keepers have finished checking their statistics — S. 1796 may end up setting other records as well. With still a year to go in the current season, many fans would now not be surprised if it ended with the Senate Finance team taking home the League trophy for the season’s biggest piece of damaging legislation.

It is just another fascinating turn in what is proving to be one of the most exciting seasons ever in Major League Legislating.

It started early, when in February teams from the Appropriations Division turned in an impressive performance with their 758 pages of pork-riddled, deficit expanding, special-interest-feeding “Stimulus” legislation (H.R. 1).

But by July the House Energy and Commerce Committee team had vaulted to the top of the league tables with a stunning 1,427-page “Cap and Tax” energy bill (H.R. 2454) containing breathtaking new levels of regulation and economic damage. It was a virtuoso performance that impressed even the most jaded observers and left fans of other teams forced to admit that this season’s trophy was clearly E&C’s to lose.

Now, in October, all that has changed. The Finance Committee bill has jumped into first place, but it only holds a 75-page edge over the still-pending energy bill. Meanwhile, rumors persist that the “Harry Reid and the Chamber of Secrets” team plans to put out yet another health care bill with potential to be a title contender. There are even scattered reports that the House Speaker’s team may try to bulk-up the Tri-Committee bill to get it back in the running — though adding the extra 500 pages that would be needed to make it competitive in this newly super-charged contest could prove difficult.

What it all adds up to are lots of fans and League officials excited by the prospect that the second half of this season could offer a pennant race to remember!

Global Warming Fears Cool Off

'Scientific consensus' should be put on the stand
Climate fear promoters, knowing that they will lose an open, honest public debate, fear a trial moreso. There are some important pieces of evidence that cast into serious doubt the case for manmade global warming. If the climate is being affected adversely and continually, we should see record temperatures, right? The evidence that shows that no continents have set a record high temperature since 1974.
September 15, 2009by MARC MORANO

An issue for which the science is supposedly "settled" by a complete "consensus" of scientists would seem to offer the perfect opportunity to win over a skeptical public once and for all. But look no further than global warming movement's effort to ignore the U.S. Chamber of Commerce's call to put the science on trial, involving cross-examinations, witnesses, and a judge to make a final ruling.

Climate fear promoters, knowing that they will lose an open, honest public debate, fear a trial moreso. There are some important pieces of evidence that cast into serious doubt the case for manmade global warming.
Just this year came a series of inconvenient developments for the promoters of man-made global warming fears. A small sampling of developments include: New peer-reviewed studies, real world data, a growing chorus of scientists dissenting (including more UN IPCC scientists), open revolts in scientific societies, more evidence that rising CO2 is a boon for the atmosphere, and the Earth's failure to warm.
Those are just the broad strokes. What about the specifics? As the climate fear activists point fingers and regress into amusing rants, the global warming fear movement is collapsing.
There has been no significant global warming since 1995, no warming since 1998 and global cooling for the past few years. This follows a peer-reviewed analysis showing that the 20th century was not unusually warm.
In addition, a global temperature analysis on April 24, 2009 found that "no continents have set a record high temperature since 1974."
On May 1, 2009, the American Physical Society (APS) Council decided to review its current climate statement via a high-level subcommittee of respected senior scientists. The decision was prompted after a group of over 80 prominent physicists petitioned the APS revise its global warming position.
The physicists wrote to APS governing board: "Measured or reconstructed temperature records indicate that 20th-21st century changes are neither exceptional nor persistent, and the historical and geological records show many periods warmer than today."
There has been the failure of the oceans to warm, and Antarctic ice continues to grow. Even the poster child of the warming fear campaign, the Arctic, is not cooperating. Sea ice there grew more than the size of Texas over the last two years.
The hits keep coming from Down Under too. New Zealand Climate Scientist Chris de Freitas revealed on May 1, 2009 that "warming and CO2 are not well correlated." De Freitas added, "the effect of CO2 on global temperature is already close to its maximum. Adding more has an ever decreasing effect."
Australian Geologist Dr. Ian Plimer wrote on August 8, 2009: "At present, the Earth's atmosphere is starved of CO2...One big volcanic eruption can add as much CO2 in a day as humans do in a year."
Perhaps this body of evidence, bolstered by a good deal more, is why a U.S. government scientist said recently that if a climate trial occurred "only those with religious convictions of warming would continue to hold any support for man-made global warming."
Certainly there is enough strong evidence to knock back overreaching efforts to legislate and regulate everyday activities that involve carbon dioxide. If global warming activists and the Administration continue to avoid an official court hearing, we will have to continue putting the "science" on trial.
In a world where there's more than a reasonable doubt about catastrophic global warming, the verdict is easy to predict.
Marc Morano is executive editor of ClimateDepot.com, a global warming and eco-news center founded in 2009.

A Public Option Leads to Less Competition and

EECONOMIC VIEW
The Pitfalls of the Public Option

By N. GREGORY MANKIW
Published: June 27, 2009
IN the debate over health care reform, one issue looms large: whether to have a public option. Should all Americans have the opportunity to sign up for government-run health insurance?


President Obama has made his own preferences clear. In a letter to Senators Edward M. Kennedy of Massachusetts and Max Baucus of Montana, the chairmen of two key Senate committees, he wrote: “I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”

Even if one accepts the president’s broader goals of wider access to health care and cost containment, his economic logic regarding the public option is hard to follow. Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider. We don’t need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices.

An important question about any public provider of health insurance is whether it would have access to taxpayer funds. If not, the public plan would have to stand on its own financially, as private plans do, covering all expenses with premiums from those who signed up for it.

But if such a plan were desirable and feasible, nothing would stop someone from setting it up right now. In essence, a public plan without taxpayer support would be yet another nonprofit company offering health insurance. The fundamental viability of the enterprise does not depend on whether the employees are called “nonprofit administrators” or “civil servants.”

In practice, however, if a public option is available, it will probably enjoy taxpayer subsidies. Indeed, even if the initial legislation rejected them, such subsidies would be hard to avoid in the long run. Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed — correctly, as it turned out — that the federal government would stand behind Fannie’s and Freddie’s debts, and this perception gave these companies access to cheap credit. Similarly, a public health insurance plan would enjoy the presumption of a government backstop.

Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance. Instead, the public plan would likely undercut private firms and get an undue share of the market.

President Obama might not be disappointed if that turned out to be the case. During the presidential campaign, he said, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.”

Of course, we are not starting from scratch. Because many Americans are happy with their current health care, moving immediately to a single-payer system is too radical a change to be politically tenable. But for those who see single-payer as the ideal, a public option that uses taxpayer funds to tilt the playing field may be an attractive second best. If the subsidies are big enough, over time more and more consumers will be induced to switch.

Which raises the question: Would the existence of a dominant government provider of health insurance be good or bad?

It is natural to be skeptical. The largest existing public health programs — Medicare and Medicaid — are the main reason that the government’s long-term finances are in shambles. True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending.

A dominant government insurer, however, could potentially keep costs down by squeezing the suppliers of health care. This cost control works not by fostering honest competition but by thwarting it.

Recall a basic lesson of economics: A market participant with a dominant position can influence prices in a way that a small, competitive player cannot. A monopoly — a seller without competitors — can profitably raise the price of its product above the competitive level by reducing the quantity it supplies to the market. Similarly, a monopsony — a buyer without competitors — can reduce the price it pays below the competitive level by reducing the quantity it demands.

This lesson applies directly to the market for health care. If the government has a dominant role in buying the services of doctors and other health care providers, it can force prices down. Once the government is virtually the only game in town, health care providers will have little choice but to take whatever they can get. It is no wonder that the American Medical Association opposes the public option.

To be sure, squeezing suppliers would have unpleasant side effects. Over time, society would end up with fewer doctors and other health care workers. The reduced quantity of services would somehow need to be rationed among competing demands. Such rationing is unlikely to work well.

FAIRNESS is in the eye of the beholder, but nothing about a government-run health care system strikes me as fair. Squeezing providers would save the rest of us money, but so would a special tax levied only on health care workers, and that is manifestly inequitable.

In the end, it would be a mistake to expect too much from health insurance reform. A competitive system of private insurers, lightly regulated to ensure that the market works well, would offer Americans the best health care at the best prices.

The health care of the future won’t come cheap, but a public option won’t make it better.

N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President George W. Bush.

Dr. Spock: The Needs of the Few Outweigh the Needs of the Many?

Healthcare Reform: A Bitter Pill to Swallow
Geoffrey on October 22, 2009

The American healthcare system, as presently configured is unsustainable and will eventually collapse.

It will collapse due to developing demographic pressures. We are well into the beginnings of that collapse. Without substantive reform, in 5-20 yrs the infrastructural problems endemic to our current healthcare system plus the demographic pressures of a large aging baby boomer generation and smaller succeeding generation(s) of young tax-paying adults…will overwhelm it.

However, private health care can survive and even thrive, if the problems affecting it are addressed.

Extra-structural reforms that retain cohesiveness with the current healthcare system can yield substantive and highly positive results. Just eliminating the current third party healthcare system, common-sense tort reform and allowing the offering of health insurance across state lines would greatly improve the current system by reducing costs.

However, those improvements will not address the heart of the liberal demand; universal healthcare.

That demand is fueled by the premise that a compassionate and wealthy society cannot in good conscience allow needless suffering to go unaddressed. Certainly that is a worthy goal, the disagreement lies in how we go about the pursuit of it.

The heart of the matter is that we presently face a trade-off. We can continue to have excellent healthcare for 90% of Americans, with the remaining 10% or 35 million Americans having at most basic healthcare and many with little beyond emergency care…or we can have basic healthcare for everyone, but healthcare demonstrably poorer for everyone but the economic elite.

The proof of this assertion is that participants in single payer systems such as Canada and the UK typically wait much longer to see doctors than in the US and are frequently denied treatment bureaucrats deem ‘not to be cost-effective’. This is the primary reason why every year, of the 1.6 million Canadians who receive US healthcare, more than 400,000 Canadians visit strictly to avail themselves of the US healthcare system. In the UK, there is increasing reportage of treatment being primarily determined by the age of the patient… with treatment of age-related conditions being deemed not cost-effective. Britain is letting its old die, all in the name of saving money.

To the degree to which, in the name of compassion, we ‘make’ insurance ‘affordable’ through a public option, it will impose major consequences: greatly increased wait times, treatment availability determined by its ‘cost-effectiveness’ and the consequence of an increasing tax burden upon the productive; the unintended result of an increasing tax burden upon the productive is just that of “the drowning man pulling under his rescuer and both drowning.

We can throw a drowning man a ‘rope’ and pull him to safety but he has to hold on to the rope. If he, for whatever the reason, refuses to grab hold of the rope, we cannot save him.

This is the hardest reality of the healthcare reform issue.

Morgen adds: The National Health Care Journal has been hosting an online debate all year, featuring notable health policy experts. (Including Uwe Reinhardt, who I quoted in an earlier post). Earlier this week they took up the question of what defines “universal coverage”, but ended up having an interesting debate on the trade-offs inherent in spending federal money in order to achieve this. It’s worth a look as they touch on several of the points that Geoffrey makes here.

Obama Care Takes a Losing Formula and Makes it Worse - Even The NYTimes (Maybe) Gets it

How an Insurance Mandate Could Leave Many Worse Off

By TYLER COWEN in The NYT
Published: October 24, 2009


AMERICANS seem to like the idea of broadening health insurance coverage, but they may not want to be forced to buy it. With health care costs high and rising, such government mandates would make many people worse off.

The proposals now before Congress would require just about everyone to buy health insurance or to get it through their employers — which would generally result in lower wages. In other words, millions of people would be compelled to spend lots of money on something they previously did not want, at least not at prevailing prices.

Estimates of this burden vary, but for a family of four it could range up to $14,000 a year over the next decade, according to the Congressional Budget Office. Right now, many Americans take the gamble of going without insurance, just as many of us take our chances with how much we drive or how little we exercise.

The paradox is this: Reform advocates start with anecdotes about the underprivileged who are uninsured, then turn around and propose something that would hurt at least some members of that group.

To ease the burdens of the insurance mandate, the reform proposals call for varying levels of subsidy. In some versions, such as the current Senate bill, subsidies are handed out to families with incomes as high as $88,000 a year. How long will it be before just about everyone wants further assistance, and this new form of entitlement spending spins out of control? It’s possible to lower insurance subsidies, but then the insurance mandate would impose a bigger burden on the people we are trying to help.

A subtler problem is what economists call “implicit marginal tax rates.”

The fiscal reality is that not all income groups can receive equal subsidies; as a family earns more, its subsidy would probably decrease, eventually falling to zero. But then we are taking money away from the poor as they climb into higher income categories. This is a disincentive to earn more, and the strength of the disincentive increases with our initial generosity. For many people, the health insurance aid would phase out when food stamps, housing vouchers and the earned income tax credit also end and the personal income tax kicks in.

This structure of incentives would likely discourage many parents from earning a better life for their children. Congress could tweak the subsidies so they don’t phase out so quickly, but then we’re back to very high fiscal costs and subsidies for many families in the higher income classes.

Defenders of a broad health insurance mandate argue that it will lower average costs in the health care market. The claim is that many of the uninsured are young, healthy or both, and that bringing them into the insurance pool might lower average premiums by spreading risk across low-cost groups. Yet Massachusetts has had a health insurance mandate for several years and this cost-saving mechanism does not appear to be kicking in.

At this point, it seems more plausible that the cost of health insurance will keep rising, just as the costs of health care services have continued to climb. The upshot is that the burdens of mandatory purchase, the subsidy costs and the associated implicit marginal tax rates will all increase, eventually to the point of unsustainability.

A further problem is “mandate creep,” which we’ve seen at the state level, as groups lobby for various types of coverage — whether for acupuncture, alcoholism and fertility treatments, for example, or for chiropractor services or marriage counseling.

There are now about 1,500 insurance mandates among the various states, and hundreds of others are under consideration. The dynamic at work here is that the affected groups have a big incentive to push for mandates, while most other people are unaware of the specific issues and don’t become involved.

Because mandates don’t stay modest for long, health insurance would become all the more expensive. The Obama administration’s cost estimates haven’t considered these longer-run “political economy” issues.

IF there is a problem with mandates, why do they seem to work in countries like Switzerland and the Netherlands? One answer is that mandates are more effective when health care cost inflation is under control, and both of those countries fare better at technocracy than the larger, less tightly ordered United States.

And mandates also fare better in those nations because of their greater equality of incomes. In other words, it’s less of a stretch to offer poorer people coverage that is roughly comparable to that of the wealthy.

If anything, however, European mandates will face growing problems, as health care cost inflation is spreading globally.

We’re often told that America should copy the health care institutions of Western Europe. Yet we’re failing to copy the single most important lesson from those systems — namely, to put cost control first. Instead, we’re putting our foot on the gas pedal and ratcheting up the fiscal pressures on the system, in the hope that someday, somehow, it will all work out.

As it stands, we’re on the verge of enacting a policy that is due to explode, penalizing many of the very people that it was ostensibly designed to help.

Tyler Cowen is a professor of economics at George Mason University.