Healthcare — free, top-quality, available, pick any two

In response to a commenter here I wrote the following:

Healthcare — free, top-quality, available, pick any two. I have lived under multiple healthcare systems. If the price for “free” and “available” is involuntary euthanasia of the elderly, I’ll pass. If “free” and “available” means “7th-rate”, so will I. If “free” means “whoever has the best connections gets the best quality care”, it’s just “inequality” in a different way. (Except, of course, that the “deserving” New Class of bureaucrats, academia, and “helping” professions think they will get first dibs in a system run by them.)

Israel comes the closest to a workable socialized medicine system (thanks to an unusually healthy age pyramid) and even their system is increasingly becoming two-tier: gold-plated for those able to afford private care and bare-bones for everybody else.

Old Maggie had it dead to rights: “The trouble with socialism is that eventually you run out of other people’s money.” It was 0bama’s misfortune (but also his innumeracy — a common characteristic of “wordsmith intellectuals”, in my experience) to try and implement more socialist schemes just as the state ship was reaching the shoals of bankruptcy. [I couldn’t resist the Monty Python reference :-)]

Market for gov’t health insurance for the uninsured much smaller than thought

Classical Values has one post up I cannot resist quoting:

We Told You So

In today’s fierce moral urgency of change news, it turns out the market for government health insurance for the uninsured is about 50 times smaller than Obamacare proponents told us it would be. Of course, we opponents of Obamacare were arguing last year this problem was overblown, and it appears in retrospect even our most parsimonious estimates were vastly too generous:

Mr. Obama declared at the time that “uninsured Americans who’ve been locked out of the insurance market because of a pre-existing condition will now be able to enroll in a new national insurance pool where they’ll finally be able to purchase quality, affordable health care–some for the very first time in their lives.”So far that statement accurately describes a single person in North Dakota. Literally, one person has signed up out of 647,000 state residents. Four people have enrolled in West Virginia. Things are better in Minnesota, where Mr. Obama has rescued 15 out of 5.2 million, and also in Indiana–63 people there.

Combined federal-state enrollment is merely 8,011 nationwide as of November 1, according to HHS.

This isn’t what HHS promised in July, when it estimated it would be insuring 375,000 people by now, and as many as 400,000 more every year.

Megan McArdle notably aroused considerable fear and loathing when, immediately post-passage, she called, in her usual admirably empirical way, for Obamacare proponents to attempt to measure their claims for the program against the actual outcomes over the coming years, and made her own predictions. That sound of pounding feet you hear in the background is those people running as far as they can as fast they can from those arguments today.

UPDATE: To put this failure in perspective, consider the resources necessary for the federal government and the 27 states who offered their own policies to implement this measure. It’s very likely taxpayers have actually paid more for administration than enrollees have received in benefits.

Which is, of course, precisely the point: “they’re building empire”. And the only “fierce moral urgency of change” here was putting the Deemocrats [sic] back in power, and creating conditions under which so many people would be beholden to the state that a Deemocrat majority would be guaranteed for generations. “Some things, the more you understand them, the more you loathe them.” (Robert A. Heinlein)

Veterans Administration discovers “menstrual disorders” in… men

Government healthcare at work! And indeed, SNAFU doesn’t begin to describe this.

Last month, a decorated Gulf War hero received a letter from the Veterans Affairs Administration that said: We are working on your claim for menstrual disorder.

There was just one problem: The claim was submitted for fibromyalgia.

Make that two problems: The claim was submitted by Glenn McBride, a 40-year-old man from Roanoke, Va., who most definitely does not get menstrual cramps.

[…]

The Department of Veterans Affairs is notorious for bungling health care benefits, and its Roanoke regional office, which handled McBride’s claim, has long been considered among the worst.

In September 2009 a surprise inspection found the office was collapsing under the weight of its own bureaucratic incompetence. Literally.

Its filing system — floor-to-ceiling stacks of overfilled file cabinets and loose claims folders — weighed twice as much as the building’s structure allowed, threatening the lives of everyone inside. Inspectors also found missing and improperly filed, stored and processed claims, among other problems. The regional office was ordered to overhaul the health care processing center completely.

By last month, six months later, there should have been some improvement. Instead, McBride received a letter that included this perplexing request for additional information:

“On the VA Form 21-4138, Statement in Support of Claim you sent on October 8, 2009, you included menstrual disorder. Please specify what you intended to claim for this condition.”

Click here to see the VA’s menstrual letter in all its “glory”. And weep.

One really (ahem) wonders why most Americans don’t think government-run healthcare is a great idea… 😉

Physicians ‘going Galt’

Hot Air has a thread up on a 63-year old dermatologist (a low-burnout specialty, mind you) in Scottsdale, AZ, who announced on his office door that he would retire before BHOzoCare went into full effect. There’s an interesting, lively discussion in the threads that suggests he’s just the tip of the iceberg.

In case you think a dermatologist mostly deals with teen acne anyhow, think again:

The man is in Arizona, skin cancer capital of the US and home to lots and lots of elderly people; he’s been in practice since the 70s; he’s talking about Medicare patients.[…] One Arizona retirement community can provide (or could previously provide) enough Medicare customers to keep several dermatologists in business.

The phenomenon of physicians refusing to accept new Medicare patients is not new. Now, apparently, another phenomenon begins: ‘cash-only practices’, where health care providers do not accept insurance of any kind but only ‘cash on the barrel’. If you can get a refund from the insurance company yourself, more power to you; if not, it’s your problem.

Also, get this nugget from the comments:

If the 63-year-old deciding to retire doesn’t bother you, maybe a 47-year-old deciding to will? My sister-in-law is 47, and is overworked in her practice under the current system. She hates to think of giving up the work she trained for so many years to do, and has spent nearly two decades becoming a respected professional in.

But there is a strong probability that she will do just that if Obamacare isn’t repealed. The rewards would no longer outweigh the expense and aggravation. Her good friend and partner (in a multi-physician practice) is also looking at the same thing. If they quit the practice, it will almost certainly have to break up, and its partners reevaluate their professional arrangements and even life choices.

My brother and sister-in-law aren’t sure what they’ll do. He’s an electrical engineer, and the two of them would be employable overseas, which is something they’ve been seriously considering. They hate to uproot the kids, but what matters is opportunity and a promising future.

What they will not decide is that Lynne will remain in practice in the US, under the worse conditions that are inevitable with Obamacare. It’s not even just workload and pay. As the Arizona doctor’s comments make clear, it’s loss of professional discretion while still being stuck with all the liability, and higher penalties. It just won’t be worth it. A very large number of those who have the option of dropping out will.

In the past, professionals would seek to immigrate to the USA in search of oppostunities. Now we have some seeking to emigrate to do so. The world is standing on its head.

And here is a cold shower for those of us who thought that NPs (nurse practitioners) are always a ‘good enough’ replacement for MDs:

I went to the doctor for what I thought was just a chest cold. Certainly that’s all that the signs pointed to. The nurse did a quick check and made a few notes. My doctor, an amazing woman, spent time with me and asked several dozen questions while giving me an increasingly serious set of tests.

Finally , she called for her nurse and told her to get a wheelchair, and get me straight to the (attached) hospital. The nurse looked as confused as I was. The doctor made a call to the emergency room and off I went for a battery of tests and treatments I was sure were a waste of time.

Sometimes the body can’t recognize an infection, gives up fighting an infection, or simply doesn’t know how to do so. You’ve probably heard of similar things, though often described incorrectly with such terms as “walking pneumonia”, etc

Hours later in the ICU, oxygen on high and a mix of powerful IV antibiotics and steroids pumping into my arms, I found out how close I had come to dieing. I still have some scarring and reduced lung function, and take medication to this day.

My doctor saved my life, the nurse would have given me a z pack and sent me home. That is why you use a GP. They can find that 1 out of 100 case. Sure, a nurse might get 99 right, but what if it’s your turn to be the outlier? Maybe your son, or daughter? Will you still feel that doctors aren’t really neccesary?

I, through experience, disagree.

Also from the comments, an interesting link on hidden (de facto) rationing in 0bamacare

Robert J. Samuelson: The looming US budget crisis

Robert J. Samuelson, a journalist who takes his duty to objectivity so seriously that he refuses to vote  in any elections, has a must-read piece on the looming US budget crisis. Some gleanings:

When historians recount the momentous events of recent weeks, they will note a curious coincidence. On March 15, Moody’s Investors Service — the bond rating agency — published a paper warning that the exploding U.S. government debt could cause a downgrade of Treasury bonds. Just six days later, the House of Representatives passed President Obama’s health-care legislation costing $900 billion or so over a decade and worsening an already-bleak budget outlook.[…]

Let’s be clear. A “budget crisis” is not some minor accounting exercise. It’s a wrenching political, social and economic upheaval. Large deficits and rising debt — the accumulation of past deficits — spook investors, leading to higher interest rates on government loans. The higher rates expand the budget deficit and further unnerve investors. To reverse this calamitous cycle, the government has to cut spending deeply or raise taxes sharply. Lower spending and higher taxes in turn depress the economy and lead to higher unemployment. Not pretty.

Greece is experiencing such a crisis. Until recently, conventional wisdom held that only developing countries — managed ineptly — were candidates for true budget crises. No more. Most wealthy societies with aging populations, including the United States, face big gaps between their spending promises and their tax bases. No one in Congress could be unaware of this.

Two weeks before the House vote, the Congressional Budget Office released its estimate of Obama’s budget, including its health-care program. From 2011 to 2020, the cumulative deficit is almost $10 trillion. Adding 2009 and 2010, the total rises to $12.7 trillion. In 2020, the projected annual deficit is $1.25 trillion, equal to 5.6 percent of the economy (gross domestic product). That assumes economic recovery, with unemployment at 5 percent. Spending is almost 30 percent higher than taxes. Total debt held by the public rises from 40 percent of GDP in 2008 to 90 percent in 2020, close to its post-World War II peak.

To criticisms, Obama supporters make two arguments. First, the CBO says the plan reduces the deficit by $143 billion over a decade. Second, the legislation contains measures (an expert panel to curb Medicare spending, emphasis on “comparative effectiveness research”) to control health spending. These rejoinders are self-serving and unconvincing.

Suppose the CBO estimate is correct. So? The $143 billion saving is about 1 percent of the projected $12.7 trillion deficit from 2009 to 2020. If the administration has $1 trillion or so of spending cuts and tax increases over a decade, all these monies should first cover existing deficits — not finance new spending. Obama’s behavior resembles a highly indebted family’s taking an expensive round-the-world trip because it claims to have found ways to pay for it. It’s self-indulgent and reckless.

But the CBO estimate is misleading, because it must embody the law’s many unrealistic assumptions and gimmicks. Benefits are phased in “so that the first 10 years of [higher] revenue would be used to pay for only six years of spending” increases, a former CBO director, Douglas Holtz-Eakin, wrote in the New York Times on March 20. Holtz-Eakin also noted the $70 billion of premiums for a new program of long-term care that reduce present deficits but will be paid out in benefits later. Then there’s the “doc fix” — higher Medicare reimbursements under separate legislation that would cost about $200 billion over a decade.[…]

So Obama is flirting with a future budget crisis. Moody’s emphasizes two warning signs: rising debt and loss of confidence that government will deal with it. Obama fulfills both. The parallels with the recent financial crisis are striking. Bankers and rating agencies engaged in wishful thinking to rationalize self-interest. Obama does the same. No one can tell when or whether a crisis will come. There is no magic tipping point. But Obama is raising the chances.

Krauthammer: VAT is coming

Charles Krauthammer: The VAT is coming  [Read the whole thing]

OBAMA KNOWS that the debt bomb is looming, that Moody’s is warning that the Treasury’s AAA rating is in jeopardy, that we are headed for a run on the dollar and/or hyperinflation if nothing is done.

Hence his deficit reduction commission. It will report (surprise!) after the November elections.

What will it recommend? What can it recommend?

Sure, Social Security can be trimmed by raising the retirement age, introducing means testing and changing the indexing formula from wage growth to price inflation.

But this won’t be nearly enough. As Obama has repeatedly insisted, the real money is in health care costs – which are now locked in place by the new Obamacare mandates.

That’s where the value-added tax comes in. For the politician, it has the virtue of expediency: People are used to sales taxes, and this one produces a river of revenue. Every 1 percent of VAT would yield up to $1 trillion a decade (depending on what you exclude – if you exempt food, for example, the yield would be more like $900b.).

It’s the ultimate cash cow. Obama will need it. By introducing universal health care, he has pulled off the largest expansion of the welfare state in four decades. And the most expensive. Which is why all of the European Union has the VAT. Huge VATs. Germany: 19 percent. France and Italy: 20%. Most of Scandinavia: 25%. [Israel’s is somewhat lower, at 16% — Ed.]

American liberals have long complained that ours is the only advanced industrial country without universal health care. Well, now we shall have it. And as we approach European levels of entitlements, we will need European levels of taxation.

Obama set out to be a consequential president, on the order of Ronald Reagan. With the VAT, Obama’s triumph will be complete. He will have succeeded in reversing Reaganism. Liberals have long complained that Reagan’s strategy was to starve the (governmental) beast to shrink it: First, cut taxes – then ultimately you have to reduce government spending.

Obama’s strategy is exactly the opposite: Expand the beast, and then feed it. Spend first – which then forces taxation. Now that, with the institution of universal health care, we are becoming the full entitlement state, the beast will have to be fed.

And the VAT is the only trough in creation large enough.

As a substitute for the income tax, the VAT would be a splendid idea.

Taxing consumption makes infinitely more sense than taxing work. But to feed the liberal social-democratic project, the VAT must be added on top of the income tax.

Ultimately, even that won’t be enough. As the population ages and health care becomes increasingly expensive, the only way to avoid fiscal ruin (as Britain, for example, has discovered) is health care rationing.

It will take a while to break the American populace to that idea. In the meantime, get ready for the VAT. Or start fighting it.

People of a classical-liberal bent in Western countries who see things going pear-shaped look to the USA as an alternative to immigrate to. At this rate, why should they bother?

Related news item:

Is 0bamacare constitutional?

JCM on C2 addresses the (un)constitutionality of 0bamacare:

In my wanderings through the innerwebz in pursuit of opinions regarding the Constitutionality of Health Care Reform (HRC), I came across a lot of stuff. And instead of doing a massive link dump, I’ve chosen to bore you with with my own take on all those opinions and add my own to the cacophony.

The ORP (Obama – Reid – Pelosi) Troika is basing HRC on three legs to make their argument for the Constitutionality of the bill. Presuming they care about such esoteric notions as Constitutionality.

1 – The General Welfare clause.

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

2 – The Interstate Commerce Clause

Article 1 Section 8

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

3 – The taxing power granted in the 16th Amendment.

The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration.

Summarizing as briefly as possibile the objections to bringing HRC under one or all of this clauses. The objections will be as insofar as possible from the postion of an Constitutional Originalist. I will not be considering the shift away from original intent, especially since the FDR and the New Deal courts.

General Welfare

This clause has two limitations in original intent. The first is it is constrained by enumerated powers of Article 1 Section 8. Second is that it is GENERAL not INDIVIDUAL.

Health Care especially the provision of health care is not an enumerated power of Congress. Madison was quite clear, the General Welfare Clause is constrained by the enumeration of powers. Note the specific language used in Article 1 Section 8. . . . and general Welfare of the United State; . . .

Could Health Care be construed in some manner as General Welfare of the United States? The answer would [s]till be no. General, means just that. The “welfare” the action provides is for the General public that benefits The United States, everyone equally and simultaneously. General Warfare would by no means consider diminishing one person, to benefit another. Even at [its] best HRC is still individual welfare. The difference is having a military to protect all of us, and a soldier assigned as a personal bodyguard.

Commerce Clause

Congress is empowered to regulate commerce. In [its] original intent, it was the commerce, not industry and production that was regulated. Again note the language, to regulate Commerce with . . . , and among the several States, . . . the purpose of the commerce clause was to keep trade and business, especially between states, free and open. They expressly did not want tariffs and disparate rules making trade between the states more difficult. The commerce clause restricts the states, not businesses and industry from operating.

This clause is the singularly […] most abused, it has become the way to regulate business in the United States. Not only business, but the lack of business. In Wickard the court ruled individual production[,] of a product for individual consumption, was interstate commerce and therefore subject to regulation. HRC takes that concept to the final stage, that the lack of commerce, i.e. choosing not to buy health insurance is interstate commerce.

Taxing Powers

This why the IRS is being included in HRC as the revenue generating and enforcement authority. This amendment give the power to tax to Congress, it doesn’t give Congress the power to provide a service to the people, and most definitely not the power to use the coercive power to government to require individuals accept a service provided.

I am certain HRC will be challenged on all three legs, as well as other points. From an originalist perspective the decisions should be clear cut, HRC doesn’t have a Constitutional leg to stand on. How will the courts rule with the more contemporary interpretations, whether or not originalist interpretations will hold that is the trillion dollar question.

The ORP Troika also throw another thing on that the table, hoping to confuse the issue.

Health Care is a Right.

Umm, no. Health Care is NOT a Right. Yes, I know, I’m a mean, evil bitter clingy right winger. This is where subtitles of language are very, very important. To be clear, you do have a right to health care, but health care is not a right. There is a world of difference between the two phrases.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.

Rights are intrinsic, not extrinsic. The individual is endowed with rights. These rights are a component a condition of being an individual. Theses intrinsic, endowed, inalienable rights can be abridged, denied, suppressed, oppressed by men and governments. That doesn’t mean they still don’t existed [sic], just that these rights are being unjustly denied.

Rights are not extrinsic, they are not provided by external sources. The same forces that can deny them can protect them but not grant them. The founding of this country is based on the premis[e] that government deriving [its] just powers from the consent of the governed would protect those rights. Government is not the source, cannot provide a right. Government can merely can be a protector.

Access to health care has on impact on life, of that there is no doubt. Access to air also has and impact on life. It would be untrue to say, air is a right. You have a right to air, to maintain life. No one, can legally, morally or justly deny you air, generally that would be called murder. When air, or anything external is the right is where things run amok. When air is a right, it implies that air should, no must, be provided the individual. That someone else must breath for the individual. When something, air or health care is the right, it places demands on someone else to provide it for the individual. Not that the right to that “thing” be protected, but that, that “thing” be provided.

Placing this demand on another individual is an just denial of their rights. This is why rights are intrinsic, operating out from, exercised by the individual. Not provided to the individual. The individual can exercise his rights, unencumbered to go out and obtain health care. The right to health care.

This extrinsic vs. intrinsic view of rights is the core of Obama’s 2001 comments in an interview that the Constitution is flawed in that is a document of negative rights for government, instead of positive rights. When rights are intrinsic then government must be constrained from denying and abridging those rights, government must be limited in its power. With the positive rights model, government must be empowered to provide not only grant and provide rights, but provide the substance of those rights as well.

HRC is fatally flawed when viewed from an Originalists Constitution point of view but also from an the perspective of individual rights in the classical liberal point of view.

0bama arguing for positive instead of negative rights cuts to the heart of the difference between the American and French revolutions, with 0bama taking the French side, and classical liberalism the American side. At heart, it emanates from what Thomas Sowell calls the “constrained” vs. “unconstrained” visions of human nature.

In the unconstrained vision, all human problems are evntually amenable to solution if only the wisest men (the “anointed”) get the power to do so and guarantee every individual his/her every need, with the aid of a large government apparatus. “From each according to his ability, to each according to his need” is a classic expression of the unconstrained vision. (A physicist might say it presupposes a Newtonian, deterministic universe.) The unconstrained vision naturally leads to expansive government and “positive rights” of individuals (such as putative rights to a job, to a minimum level of income, to “free” education and “free” healthcare,…) Communism, Nazism, and Islamism are extreme “unconstrained” ideologies: more moderate examples are Euro-style social democracy and the clericalist welfare statism that goes by the name of “Christian democracy” in many European countries. American left-liberalism is likewise in the “unconstrained” camp.

In the constrained vision, the human power to solve human problems is limited by practical constraints, by the “law of unintended consequences”, and by the limits of human intellect —  be it an individual’s or the collective one of an oligarchy. (A physicist might think of a nondeterministic universe — quantum, chaotic, or both). As the constrained vision is inherently pessimistic about the ability of government (or any human endeavor) to cure all social ills, it tends to err on the side of caution where it comes to government power, and naturally leads to limited government constrained by negative rights (things government is not allowed to do to you or cannot force you to do). Classical liberalism and libertarianism are typical expressions of the “constrained” vision.

Note finally that the above discussion has not directly raised the Tenth Amendment and the limits it places on Federal power (although the Commerce Clause indirectly references it): “The powers 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.” In this context, “the United States” refers to “the Federal government”. Obviously, neither the Constitution nor the Amendments delegate the power to impose a healthcare mandate on citizens to the Federal government…