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Posts Tagged ‘health care’

Libertarian praise for Trump’s health care vision

Posted by Richard on January 30, 2019

The Independent Institute’s Dr. John C. Goodman has been called the father of Health Savings Accounts, and his two books and numerous articles and op-eds on health care make  a strong case for free-market reforms in health care and health insurance. In a new Forbes column, he notes that “the most serious problems in the health care marketplace are almost always the result of ill-conceived public policies” and has high praise for the Trump administration’s health care reform proposals:

For most of the past half century, health economics has been dominated by the idea that private sector medicine has numerous flaws – flaws that must be corrected by government.

Fortunately, the conversation is about to change.

The Trump administration has produced an astonishingly bold document:  Reforming America’s Healthcare System Through Choice and Competition.This is the first time any administration has explicitly acknowledged that the most serious problems in health economics arise not because of market failure, but because of government failure. It is also the first time the federal government has committed to the idea of liberating the medical marketplace. In many ways the document builds on and extends ideas I first discussed in Regulation of Medical Care (Cato) almost four decades ago and that Gerald Musgrave and I discussed in Patient Power (Cato) almost three decades ago.

Although cooperation from Congress and state governments is necessary and desirable, the Trump administration is accomplishing a lot through executive authority alone. I described some of the most important of these changes in a recent post.

The introductory letter from the cabinet secretaries is at the link Goodman provides, along with a link to the entire 120-page PDF. I’ve only read the introduction and dipped into a couple of topics that caught my interest, in particular “Governments and Market Failure in Healthcare,” which begins as follows (emphasis added):

It is a common refrain that healthcare is “unique,” and in some ways, it is. But “unique” is frequently used to imply that free-market principles that govern other major sectors of the economy cannot be applied to healthcare. The reasons given for the uniqueness of healthcare vary, but some of the most common are: the difficulties involved in shopping for services, the expertise gap between patients and healthcare professionals (asymmetric information), economies of scale intrinsic to the sector, and the predominant reliance on third-party payers. The merit of these commonly cited reasons for why healthcare is unique is considered below.

Notably, government policies promote some of these features, particularly third-party payment. While some of these features do limit the application of free-market principles, the common claim that the healthcare sector as a whole cannot function under free-market principles is not true. Notably, government policies promote many factors that prevent the free-market from operating. Specifically, government has encouraged excessive third-party payment, created counterproductive barriers to entry, incentivized opaque pricing practices, skewed innovation activity, and placed restrictions on the reimbursement policies of government programs. Overall, these practices have resulted in less choice, less competition, and sub-optimally functioning markets that deliver higher prices and lower quality.

Sounds pretty good to me.

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Michelle Malkin on Marijuana

Posted by Richard on May 31, 2017

No, not like that. Like this:

Let’s talk about marijuana.

Specifically, let’s talk about how and why I came to be one of the countless parents across America (and around the world) who have let their chronically ill children try it.

Read the whole thing. It’s excellent.

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Mindless application of the Body Mass Index

Posted by Richard on March 27, 2014

Check out what’s categorized as “borderline obese” by a British NIH nurse who mindlessly applied the crude instrument called the Body Mass Index (BMI) to a female bodybuilder. By all means, scroll down for the photos.

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Obamacare is an abysmal failure by its own standard

Posted by Richard on March 27, 2014

The raison d’être for Obamacare is to provide health insurance coverage for the 30 million to 50 million people (depending on whose wild-ass guess you believe) uninsured. How’s it doing so far?

The Obama administration and its media shills have been crowing that 5 million people have “enrolled” for Obamacare on the state and federal exchanges. When asked how many of those have actually paid the first month’s premium, they claim they don’t know, although their own rules require insurance companies to report that information monthly. Estimates of the number of “enrollees” who haven’t actually completed the process by paying their premiums range from 20% to 25%.

So let’s do a little math. Assuming 20% of the 5 million “enrollees” haven’t paid brings the number covered down to 4 million. According to the management consulting firm McKinsey, as of the end of February, 27% of the “enrollees” were previously uninsured, but they were even less likely to have paid their premiums than the previously insured. McKinsey’s number crunching arrives at an estimate that only 14% of those actually now covered were previously uninsured.

But let’s be generous and assume that more of them have paid premiums since February. Heck, let’s be real generous and assume that a full 25% of the 4 million were previously uninsured. That’s 1.25 million.

Divide 1.25 million by 50 million or by 30 million, and you discover that Obamacare has covered somewhere between 2.5% and 4% of the previously uninsured. Epic fail.

And to achieve that underwhelming result, it’s cost millions of the previously insured their insurance plan of choice, forced millions more to pay higher premiums, and resulted in probably tens of millions having a smaller provider network that may not include their doctor or hospital of choice. Not to mention saddling insurance companies with a process so screwed up that, if it isn’t fixed soon, many (most?) may just stop offering individual (and probably small group) health insurance entirely.

One could be forgiven for suspecting that the real purpose of Obamacare all along was to destroy the private health insurance market in order to replace it with a British-style, government-run, single-payer socialist system. After all, one of the architects of this abysmal failure has said as much.

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Colorado’s dismal Obamacare numbers

Posted by Richard on December 6, 2013

Colorado is one of the 16 states that set up their own health care exchange to implement Obamacare. It’s called Connect for Health Colorado, and it seems to be much more functional than the Fed’s (not that that’s saying much). But they’ve posted their metrics for October 1 through November 30 online, and the numbers aren’t pretty.

During the first two months of operation, they say that “Enrollments” were 74,270. But 64,290 (over 86%) of those were people pushed onto Medicaid. Only 9,980 actually signed up for a private insurance policy. Since the feds have decided to use the “honor system” instead of any income verification, there’s no telling how many of the 64,290 understated their income and aren’t actually qualified for Medicaid (or how many of the 9,980 are getting insurance premium subsidies for which they aren’t actually qualified). According to, a third of those on Medicaid in Illinois (pre-Obamacare) aren’t actually eligible. There, too, virtually every Obamacare enrollee has ended up on Medicaid.

Of course, all those new Medicaid enrollees may end up with a bad case of buyer’s remorse when they discover the level of care and choice of providers they’re stuck with (fewer and fewer doctors are accepting Medicaid patients due to the very low level of reimbursements, and those that do practice assembly-line medicine).

Much more devastating for Obamacare’s supporters are the demographics for Connect for Health Colorado’s enrollees. Fully 43% of the 74,270 are ages 55-65, and another 18% are ages 45-54. A mere 11% are ages 26-34, the “young invincibles” that the Obama administration was counting on to subsidize the older folks who are much greater consumers of health care. That’s an epic fail.

Each passing day seems to bring more bad news for Obamacare, and the poll numbers reflect that. It’s too bad that there isn’t a political party with the commitment to  limited government and competence in messaging to take advantage of the situation.

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Setting the bar low

Posted by Richard on December 3, 2013

There’s a Denver Public Schools institution a few blocks from my house. On the fence around its playground, there’s a big colorful banner that proudly proclaims:

McKinley-Thatcher Elementary School

I was reminded of that when I read Steven Hayward’s PowerLine post about declaring that “ is no longer a total disaster.”

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The cheapest food on the planet

Posted by Richard on July 6, 2012

Here’s something else from Mark J. Perry, the cockeyed optimist of the dismal science:

Relative to our total household spending, Americans have the cheapest food on the planet – only 6.6% of the average household budget goes to food consumed at home.  European countries like Spain, France and Norway spend twice that amount on food as a share of total expenditures, and consumers in countries like Turkey, China and Mexico spend three times as much of their budgets on food as Americans.

Another measure of food affordability, total food expenditures in the U.S. as a share of disposable income (see chart above, USDA data here), shows that food has become more affordable in the U.S. over time.  Spending on food has fallen from more than 25% of the average American’s income in 1933 to only 9.4% in 2010, an all-time low.  Between 1980 and 2010, the share of disposable income spent on food in the U.S. fell from 13.2% to 9.4%, which is equivalent to almost a 4% increase in the average American’s disposable income over the last 30 years.   And a number of countries in the list below spend more on food as a share of household expenditures today than Americans spent on food during the Great Depression.

Americans spend less on food as a share of our household expenditures than consumers anywhere else in the world.

Most goods and services have gotten cheaper, better, or both over time. It’s called progress. I can think of two main exceptions, which keep taking a larger and larger share of the average American’s income. Both are largely under the control of the government, with lots of regulations and subsidies (!): education and health care.

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The power to destroy

Posted by Richard on July 3, 2012

Howard Rich at Investor’s Business Daily:

Nearly two centuries ago Daniel Webster stood before the U.S. Supreme Court on behalf of James McCulloch, head of the Baltimore branch of the Second Bank of the United States.

At issue were two basic questions: Did the federal government have the authority to establish a bank? And did states have the authority to tax that bank (and by extension the federal government)?

“An unlimited power to tax involves, necessarily, the power to destroy,” Webster famously argued in opposition to the latter question. Chief Justice John Marshall agreed, parroting Webster’s words almost verbatim in his ruling. “That the power to tax involves the power to destroy … (is) not to be denied,” Marshall wrote.

Yet this “undeniable” premise — first invoked in 1819 on behalf of an onerous expansion of federal authority — has been explicitly rebuked 193 years later in support of an even more onerous expansion of federal authority. In fact the destructive power of taxation has just been extended far beyond a mere list of items subject to duties, imports or levies — it can now actually compel participation in the private sector.

More than at any other time in American history, the power to tax has indeed become the power to destroy — our economy, our liberty and perhaps one day even our lives. Chief Justice John Roberts’ refusal to rein in this destructive force will have immediate and lasting reverberations.


Apologists for Roberts have argued that his opinion cleverly constrained the Commerce Clause — as if he didn’t have the option of making the same finding as part of a majority striking down Obamacare in its entirety, and as if there were no dispute regarding Roberts’ ruling (see numerous July 1-3 posts on the Volokh Conspiracy about whether Roberts’ discussion of the Commerce Clause is a holding or a dictum).

Even if the ruling modestly restricts the federal government’s powers under the Commerce or Necessary and Proper Clause, so what? The power to tax is the power to destroy. And Roberts has given them permission to impose punitive taxes for failing to obey their dictates. Limited government, my ass.

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The power to tax and broccoli

Posted by Richard on June 28, 2012

During oral arguments on Obamacare, Justice Alito asked if the federal government can force us to buy broccoli. In today’s ruling, Chief Justice Roberts has answered that question: No, but it can force us to pay a penalty “tax” for failing to buy broccoli.

So, although the Commerce Clause doesn’t quite give the federal government unlimited power, it effectively has unlimited power anyway.

So says what passes for a conservative justice.

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Obamacare upheld 5-4, Roberts joins statists

Posted by Richard on June 28, 2012

Chief Justice John Roberts wrote the majority opinion, basically arguing, “We can’t stretch the Commerce Clause far enough to justify the individual mandate, but the penalty is sort of like a tax, so let’s just call it a tax. And everyone knows that the government can do whatever it wants with regard to taxes. Oh, but Congress said it’s not  a tax … so I guess it’s not really a tax, and the Anti-Injunction Act doesn’t apply.”

Based on such nonsense, the entire monstrosity survives. Because of this unprincipled “mainstream conservative” weasel. Disgusting.

Scalia, Kennedy, Thomas, and Alito joined in a dissenting opinion, and Thomas also filed his own dissenting opinion. I look forward to reading that one.

Bill Wilson of Americans for Limited Government:

The U.S. Constitution died today.  The underlying hope and belief that our nation’s founding document protected individual freedoms from an ever encroaching government is a thing of the past based upon this ruling.  It is inconceivable how these nine lifetime appointed jurists could have decided to keep a law that is such a blatant intrusion into each of our lives, but the result of their decision is that individuals can no longer rely on the federal government power being limited by anything other than the political pressure their individual elected representatives feel.  Ultimately, the Supreme Court has opted out of the battle to retain our freedoms, and has thrown in entirely with those who advocated for unlimited government authority.  It is truly a sad day for our nation.


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Obamacare pace car

Posted by Richard on June 9, 2012

Pretty funny picture. Most of the caption suggestions are pretty lame, but I like this one:

Is this one of those “Cadillac” health plans we keep hearing about?

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The bogus auto insurance comparison

Posted by Richard on March 28, 2012

In debates over Obamacare’s health insurance mandate, its defenders invariably trot out the comparison with mandatory auto insurance. I’m really getting tired of it. But I’m even more tired of what a crummy job Obamacare opponents do of countering that bogus argument. Inevitably, the first thing out of their mouths is something like “that’s a state mandate, not a federal mandate.” Next, they usually stammer that “driving on public roads is a privilege.” Talk about missing the key point!

No state mandates that you carry collision and comprehensive insurance on your car (or, for that matter, insure yourself against injury). Of course,  if you borrow money to buy a vehicle, your lender will require that you have collision and comprehensive insurance as a condition of making the loan; they have a legitimate interest in protecting the property that secures the loan.

But state mandatory auto insurance laws only require you to purchase liability insurance (and in five states, uninsured motorist coverage) in order to cover property damage or injury to someone else. The purpose is to indemnify others against damages you cause. In some states, in lieu of liability insurance you can post a bond or provide other evidence of financial responsibility. In a couple of states (South Carolina and Virginia), you can just pay an uninsured motorist fee (around $500) and be on your way.

Whether that’s a legitimate exercise of state power is arguable. I say it’s not. If I’m concerned about being hit by someone who’s not financially responsible, I can buy uninsured motorist coverage (I am and I do). If I choose not to, I’ve voluntarily assumed the risk that I’ll be unable to recover damages from someone who hits me. But I sure wouldn’t man the barricades over the issue. On the long, long list of examples of government overreach, that one has to rank very near the bottom.

In any case, mandatory automobile liability insurance is not analogous to a mandatory health care policy on yourself (whose prime purpose in Obamacare is to force healthy people to subsidize the less healthy) and is entirely irrelevant to the debate over Obamacare.

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A grim anniversary

Posted by Richard on March 24, 2011

One year ago today, ObamaCare became the law of the land. In the Wall Street Journal, freshman Senator Ron Johnson (R-WI) offered a personal and moving op-ed piece about this abomination and the consequences if it's not repealed:

Today is the first anniversary of the greatest single assault on our freedom in my lifetime: the signing of ObamaCare. As we consider what this law may do to our country, I can't help but reflect on a medical miracle made possible by the American health-care system. It's one that holds special meaning for me.

Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived.

The infant was rushed to another hospital where a surgeon performed a procedure at 1 a.m. that saved her life. Eight months later, when her heart was the size of a small plum, an incredibly dedicated and skilled team of medical professionals surgically reconstructed it. Twenty-seven years later, the young woman is now a nurse in a neonatal intensive care unit where she is studying to become a nurse practitioner.

She wasn't saved by a bureaucrat, and no government mandate forced her parents to purchase the coverage that saved her. Instead, her care was provided under a run-of-the-mill plan available to every employee of an Oshkosh, Wis., plastics plant.

If you haven't guessed, this story touches my heart because the girl is my daughter, Carey.

Please go read the whole thing.

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Liberty Legal Foundation on Florida court ruling

Posted by Richard on January 29, 2011

I gave two cheers when the Virginia district court ruled that Obamacare's individual mandate is unconstitutional. I gave three cheers when the Florida district court ruled that, since the Democrats chose not to include a severability clause in that legislative monstrosity, the entire thing is unconstitutional. The Liberty Legal Foundation's Van Irion was pleased, too, but put the ruling into perspective (via email; emphasis in original): 

I was actually pretty disappointed with the Virginia Court when it found the individual mandate unconstitutional, but then found that it could sever the individual mandate from the rest of the bill. Now at least one Federal court has corrected that mistake.

I’m also disappointed that both Courts explicitly stated that Congress has the power to regulate health care and insurance. My immediate reaction was that both judges must be reading some other Constitution. The Constitution I have does not list “regulation of health care” within the enumerated powers granted to Congress. Then I remember, they’re following Wickard v. Filburn.

You see, District Courts work under the assumption that they must follow existing precedent from higher courts and rarely even consult the Constitution. Both the Virginia and Florida Courts were simply applying Wickard v. Filburn when they re-affirmed Congress’ general authority to regulate healthcare. This is why our Obamacare Class Action lawsuit must go all the way to the Supreme Court to get Wickard v. Filburn overturned.

Our Obamacare Class Action lawsuit is STILL unique because it is the only lawsuit against Obamacare that begins and ends with one argument: the commerce clause does not grant unlimited power to Congress, therefore Wickard v. Filburn must be overturned. I may sound like a broken record, but this message needs to be repeated until everyone in America understands it. For the first 150 years after the Constitution was ratified, all courts agreed that the Commerce Clause gave Congress only the authority to prevent individual states from implementing burdensome regulations on interstate commerce. Then the FDR-packed Supreme Court destroyed our Constitutional Republic by re-interpreting the commerce clause, eliminating all limits on Congressional authority.

The goal of all of the State-filed lawsuits is to get rid of Obamacare any way they can. That is an admirable goal, but it falls short of the more important goal. Liberty Legal Foundation’s goal is NOT simply to overturn Obamacare. Our goal is to restore Constitutional limits on Congressional authority so that when the political winds shift again, Congress can’t repeat a similar massive power grab.

Obamacare is simply the latest and worst example of Congressional abuse of authority. So, it became our tool to overturn Wickard v. Filburn. For 150 years the courts got the Commerce Clause right. For the past 68 years they got it wrong based solely on the political motivations of a handful of judges. There is more historical precedent supporting our arguments than supporting Wickard. This is a fight we can win! And success means Obamacare will be overturned AND our Constitutional Republic will be restored.

I urge you to join me as a plaintiff in the Obamacare Class Action lawsuit. All you need to do is go to Liberty Legal Foundation and sign on with a minimum donation of $1 (if you can afford more, please give more).

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Obamacare costs more kids their health care coverage

Posted by Richard on November 30, 2010

Remember "If you like your health care plan, you can keep your health care plan"? Long before Obamacare was passed, almost everyone who examined that promise objectively knew that it wouldn't be kept. Since passage, the falseness of that promise — to be precise, the mendacity, since the President isn't stupid enough to have really believed it when he said it — has become increasingly clear, as more and more people have had their coverage canceled, and more and more organizations have requested waivers from the feds.

The waivers exempt the organizations from onerous and costly new government mandates, allowing them to continue existing health care plans that fail to meet those mandates. In the absence of such waivers, millions more would be left without the health care plan they like and were promised they could keep.

Since the Obama administration clearly prefers a government of men to a government of laws, it's no surprise that who gets a waiver and who doesn't is solely at the discretion of some unelected administration lackeys. And it's no surprise that the list of waiver recipients includes quite a few unions. 

But it seems that a New York SEIU affiliate either forgot to file for a waiver or filed and didn't get it. Or maybe they just decided the new mandates were a good excuse to ditch the coverage for children of their low-wage members:

One of the largest union-administered health-insurance funds in New York is dropping coverage for the children of more than 30,000 low-wage home attendants, union officials said. The union blamed financial problems it said were caused by the state’s health department and new national health-insurance requirements.

The fund is administered by 1199SEIU United Healthcare Workers East, an affiliate of the Service Employees International Union.

The fund informed its members late last month that their dependents will no longer be covered as of Jan. 1, 2011. Currently about 6,000 children are covered by the benefit fund, some until age 23.

The union fund faced a “dramatic shortfall” between what employers contributed to the fund and the premiums charged by its insurance provider, Fidelis Care, according to Mitra Behroozi, executive director of benefit and pension funds for 1199SEIU. The union fund pools contributions from several home-care agencies and then buys insurance from Fidelis.

“In addition, new federal health-care reform legislation requires plans with dependent coverage to expand that coverage up to age 26,” Behroozi wrote in a letter to members Oct. 22. “Our limited resources are already stretched as far as possible, and meeting this new requirement would be financially impossible.”

Behroozi estimated that the fund faced a $15 million shortfall in 2011 and more in the following years for the coverage of workers’ children.

The affected union members are home-care workers, and their health-care costs are said to be comparatively high and growing. So the union had already started dumping those workers from their health care plan before Obamacare passed, cutting enrollment in half over the past three years. And now it's lobbying for the state of New York to pick up more of the tab. Unfortunately for them, the state of New York doesn't seem to have a lot of extra money lying around looking for some deserving union to benefit. 

There's a certain poetic justice to seeing the SEIU, Obamacare's biggest supporters, run afoul of the costly mandates they helped bring about. But the rank-and-file members must be wondering what all those union dues they've been paying have gotten them. Why, it's almost as if all that talk about how the union protects them from exploitation by evil capitalists were a load of crap!

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