Health Care Archive


2014 Musings….


Some random thoughts on the year that has passed…

  • Personally, an excellent year, on all fronts.
  • For the country…not so great.  At the very least, it was troubling to watch a country attack its men on the thin blue line, instead of working with the police force to make reforms to better us all.  It was disturbing to watch many supposedly intelligent people on the left fall into the trap of believing emotions before facts.  And most troubling, it is worrisome that our leaders, especially the President of the United States, appears not to have any type of learning curve, as he proposes to make his old mistakes all over again.
  • 2014 was a horrible, no good, terrible year for liberalism, and as a corollary, President Obama and Democrats.  More and more of their views of the world, as is, was discredited.
  • On foreign policy, ISIS proved Obama’s view of the Middle East was incorrect from the beginning; and he appears to be ready to repeat the same mistake in Afghanistan.
  • On the economy, we continue in our relatively stagnant path.  You know things are bad when Democrats are celebrating sub-3% GDP growth; things are better, but that is a poor barometer when millions remain out of work and out of the workforce all together.
  • On many basic issues (police use of force stories, Keystone pipeline, voter ID/intimidation, minimum wage) liberals continue to hide from basic facts and reality, to the detriment of all.
  • The biggest success story for Democrats was Obamacare; and even that comes with caveats.  The easy part of the program, delivering relatively free Medicaid benefits to millions of poor, is largely over.  On the other hand, they are largely failing on making the exchanges more affordable for the middle class.  Premiums are not increasing (a trend that has been going on now since 2004, before Obamacare was even a dream) but that doesn’t mean the pricing pressures have gone away.  In fact, there is some evidence it is getting worse.
  • Republicans had a very decent year.  They had no major detrimental scandals, for the most part.  They carried out their plan for the midterm election, and brought it successfully to fruition, even though they were outspent in many cases.  The increased majority in the House, and the retaking of the Senate, was a major coup, and all honest assessments will admit they did pretty much as well as they possibly could have.
  • I didn’t bother to do a movie review this year…because I saw so few movies.  I will say that I loved Guardians of the Galaxy and the Winter Soldier.  The X-Men movie, as well as the Hunger Games sequel were solid.  Other than that, not many movies impressed me much this year.
  • On the TV front, we continue to see the golden age of geekdom.  Whether it is the Walking Dead, Game of Thrones, Agents of Shield, Arrow, The Flash…you are living in the golden age of science fiction and fantasy. Enjoy it.
  • For 2015, I doubt politically we will achieve much.  I think the GOP is going to propose (and likely pass) a fair amount of decent legislation; Obama will simply obstruct. I think Obamacare will muddle along, with many of the same problems, and a host of new ones (especially the IRS rules that are impending).  On foreign affairs, things will get worse with ISIS, because Obama isn’t serious about confronting them; Iran will come a year closer to the bomb; and our other enemies will largely ignore the US.
  • Economically, I do believe we are improving.  But that improvement will continue to be asymmetrically targeted to the 1%.  The rich and upper middle class are continue to do quite well, as stocks and real estate surge and rebound.  The rest of the country, sadly, will continue to lag.  Obama’s policies will continue to widen the wealth gap, as it has done since the beginning of his presidency.
  • On the sports front, looking very much forward to watching how Jim Harbaugh leads the Michigan Wolverine football team.
  • 2014 was a mundane year for movies; the same cannot be said for 2015.  Avengers: Age of Ultron, the final Hunger Games, Fantastic Four, Jurassic World, James Bond’s SPECTRE, Terminator: Genisys, Ant-man, Minions, Mission: Impossible V, Ex-Machina, Pixar’s The Good Dinosaur and Inside Out, Mad Max: Fury Road, Disney’s Tomorrowland…a fantastic list, all culminating in the king of them all, Star Wars Episode VII: The Force Awakens.  My kid is giggling in glee for a movie that won’t come out for a year; that should tell you all you need to know.
  • 2015 looks to be a banner year on many fronts.  I wish all of you the best of luck in the coming year.

Thoughts On Halbig

HALBIG!!!! - Kirk screaming Khan - Meme Generator

There were two major Obamacare rulings scheduled to come out this year…and both ended up coming out within hours of each other on Tuesday.

In Halbig v. Burwell, the D.C. Appeals court ruled that the subsidies in the Affordable Care Act were intended only for exchanges established by states…thus excluding millions of participants in the Federally run exchange. Hours later, the 4th Circuit Court of Appeals, in King v. Burwell, declared virtually the opposite.

The legal arguments have been going on for a long time, and there are a lot of great discussions, some which are linked from Nicholas Bagley, Michael Cannon, Jonathan Adler, and others that will take you through the circuitous legal arguments.  If you are really interested, this podcast with Mr. Bagley and Mr. Adler could be fruitful for your search to understand more about the debate.

But here are my brief takes on the results of both cases:

1. The Halbig decision is a major boost to the momentum of the case of PPACA opponents.

Despite the 4th circuits ruling taking the steam out of the excitement over Halbig, this has to be a major victory for Misters Cannon and Adler, who were two of the earliest proponents for a case attacking the legal justification for subsidies in the Federal exchanges.  Even in the 4th circuit ruling, the court admits the litigants had a fairly reasonable cause to bring the suit, because the text of the law is quite clear that the subsidies are only for state-run exchanges.

This is key for the following reason: it now serves as an impetus for the Supreme Court to take up the case.  Although many liberals and others are arguing that because Halbig is likely to lose in the D.C. court on en banc session it will remove some of the justification for the Supreme Court to take up the case, that doesn’t by itself remove the legal and logical conflict of the case.

This doesn’t insure that the case will be resolved by the highest court in the land…but it increases the probability greatly.  Make note there are two additional cases also working their way through the District courts.  All this from a case where Mr. Adler once remarked he thought the chances of ultimate legal success were very, very low.  Not bad, all things considered.

2. Liberal arguments about ‘activist’ and ‘politicized’ judges are silly and naive.

Liberals howled today when the Halbig ruling was released, calling it a ‘highly politicized ruling by activist conservative judges’.

They yet were silent when the 4th circuit, in a ruling that relied highly on political arguments to make their case, ruled the reverse.

Furthermore, liberals are now relying on the en banc review of the case in the D.C. court, precisely because it is political.  The reason liberals are so confidant there is because of the large Democrat advantage in that court overall.

I think we can go back and forth about politicization of the courts, and which judges are activist or not.  But to rely on that  for your legal understanding of the case is simply naive.  Both sides have legitimate legal arguments, based in long-standing jurisprudence.  This is actually a complicated and difficult case…and to avoid giving credence to either side is being unfair.

3.  The ambiguity in the law weakens the government’s case far more than the litigants.

If you read the two rulings today, what you see is the D.C. court relied highly on the actual text of the PPACA.  Its argument was that the text was quite clear that the state exchanges were supposed to benefit from subsidies, while the Federal exchange would not.

In the 4th Circuit ruling, they rely heavily on what the law implies.  They don’t as much rely on the true text of the law itself.  Also note that the 4th circuit struggled to find a contemporary statement from Congress during the debate that clearly stated they wanted subsidies on all exchanges…which in my mind, greatly weakens the government’s case as well.

This is not to say the 4th circuit was incorrect as far is jurisprudence is concerned. Mr. Bagley makes this argument in a piece from Greg Sargent:

As Bagley explains it to me, the core distinction is whether you are arguing that “Congress didn’t really mean what the statute said,” or whether you are arguing that “what the statute says doesn’t actually mean what you think it means.” The former, Bagley says, is a losing argument. But that is not what proponents of the law are arguing. As noted above, the statute does not clearly say that those on the federal exchange don’t get subsidies. Therefore, the question is not, “what does the statute say” — that is not actually clear — but “what does the statute mean.”

The D.C. court also referred to this ambiguity.  But they made what is (to me, at least) a more sound argument: that although there is some ambiguity, there is absolutely no clarity in what the law implied.  And if the implied intent was uncertain, and the textual intent quite clear…you should rely on the form that is clear.  No?

In fact, if you go back to the discussions during the Obamacare debate…there were a few discussions about limiting the Federal exchange subsidies.  Also recall: Democrats presumed that all states would be forced to expand Medicaid, and almost all states would create exchanges.  The necessity of a Federal exchange was a backstop, and no more.  I think the argument that Congress clearly, indisputably intended for subsidies to be available on all exchanges has dubious factual merits.  But that is moot; 4th circuit agreed with that argument anyway.

Just to close on this point; how tenuous was the government’s argument that the 4th circuit accepted today?  Their ruling states it quite clearly:

“the court is of the opinion that the defendants have the stronger position, although only slightly.”

That is not the statement that one would hold as a bedrock of certainty.

4.  Politically, this causes a problem for both parties. 

For Democrats, this continues the general public opinion that the ACA was written incompetently, had severe problems in implementation, and to this day remains on shaky ground.  Most Americans are not going to dig into the weeds on this; they simply know that courts are ruling both ways, which makes the entire system appear shaky at best.

For Republicans, this is no slam dunk either.  For example, if Halbig becomes the law of the land, won’t that place enormous pressure on Republican governors to establish exchanges?  At least 5 million people will lose Federal subsidies if the court ruling goes into effect.  In this environment, can GOP Governors simply ignore those people?  And remember, even without this onslaught of complaints, GOP governors were already accepting Medicaid expansion in one form or another.  I find it highly unlikely that the GOP could simply ignore the political pressure on this.

5. All of this was caused by the incompetence of Congress.

When Nancy Pelosi said, “We need to pass it to find out what is in it”, THIS is what she meant.  Today, in Halbig…we found out what is, and isn’t, in the Affordable Care Act.

A careful proofreading and understanding of the plan would have resulted in people realizing the contradiction that government was literally, in textual form, preventing the Federal government from providing the same subsidies as the states were allowed to.

Now, liberals are arguing what the intent of the law was.  That is a fair argument, but generally, the safest way to understand what was intended in a law?  Is to clearly state that intent within the law.

That was not done here.

The rush to passage, the inability to allow public comment, and the negligence of Congress in failing to read their own bill led to this.  Simple as that.


Couple points in conclusion.

First off, I respect a lot of people, many named above, that have varied views on the results in this case.  Clearly I am on one side of this as far as the legal argument goes, but I think that most of those on the other side are honest participants in the debate.  I fully stipulate that both sides have legitimate legal and logical arguments for their position.

That, in turn, is what makes cases like these so hard.  There is simply no right answer.  It is thoroughly possible that Congress wrote the bill, in the literal sense, not to provide subsidies to those on the Federal exchange.  It might even be true they intended that result.

What is also possibly true is, at the very same time, they intended for everyone to have access to those very same subsidies.  Simply put, I don’t think those that voted on this bill understood the full extent and connotations of the items they were voting on.

The rest of us should be wary of attacking one set of jurists over the other as well.  These courts were put in this terrible position because of the incompetence of Congress; therein lies the blame.  That these judges now have to play Solomon ultimately is not their fault.

One final point: as a physician, this entire train wreck is horrible for our patients.  Congress committed an act of malpractice by not clarifying these issues before passage.  Even if Halbig is overturned (the result I expect and predict), that doesn’t really truly solve the problem, because the law remains ambiguous on this and numerous other issues.  We really should demand better from our political leaders, and hold them to account when they make such enormous blunders. I doubt that will happen however.


2010 Predictions…A Look Back

So you can see my predictions of the year 2010 here, if you wish.  My 2010 predictions weren’t too bad…but in hindsight, I have to say that I have outdone myself.  Regular typeface is my original prediction, and bold is my current commentary…

  • President Barack Obama will sign a health care reform bill…but not until well after the State of the Union, and only with a lot of difficulty.  Democrats will fight another civil war on the public option, taxes, abortion, and illegal immigrants.  CORRECT!
  • Democrats will try for a third stimulus, in which Obama will try to focus on tax cuts, but progressives in the House will push him to spend more on government programs.  CORRECT!  ASSUMING YOU ARE COUNTING THE CURRENT TAX BATTLE.
  • Obama’s Budget Director forecasts a 4.0% growth rate next year…the rate of growth will be much less, closer to 2.5% for the year.  SO FAR, ACCURATE.
  • We will see narrowing of job losses in the beginning of the year, but some of it will be smoke and mirrors as the government hires 700,000 temporary workers to carry out the 2010 census.  By the end of 2010, the overall rate of unemployment will still be in the double digits.  CLOSE.  WE ARE SLIGHTLY UNDER 10%.
  • The stock market will have a mediocre year, rising 7-8% to around Dow 11,300 by the end of next year.  Businesses, however, will again be profitable.  Hiring will start in earnest in the end of 2010.  NOT BAD…THE DOW IS UP ABOUT 8% FOR THE YEAR.
  • The Federal Reserve, in a bid to halt inflationary pressures, will increase Fed rates by middle of the year.  The dollar will actually gain value…and gold will stabilize or drop in price.  However, oil prices will rise to around $100/barrel.  WRONG.  THE FED IS STILL TRYING TO FLUSH MONEY INTO THE SYSTEM.  OIL IS AROUND $80.
  • Legislatively, Democrats will have greater and greater difficulty in passing anything.  Cap-and-trade, immigration reform, and card check will all die an ignoble death.  TRUE.
  • Obama’s attempts at budget deficit control will go to naught, as Democrats fight among themselves over which they should do:  tax increases or budget cuts.  Ultimately, nothing will be done, and the deficit for 2010 will be around $1.5 trillion…or about the same as 2009.  In other words, matching the largest national yearly deficit in world history.  CORRECT!
  • Almost nothing will get done by Congress, as Democrats (not Republicans) will virtually bring the legislature to a standstill.  FALSE.  REPUBLICANS STOPPED MOST EVERYTHING, TO THEIR CREDIT.
  • By summer, Tea Party protests will be ravaging the nation, as the protesters fight for control of the Republican Party.  Conservatives will be pitted against moderates, and in most races, the conservative will triumph; for example, Rubio probably will oust Crist in Florida.  Democrats will giggle in glee, remembering the outcome of NY-23.  But who has the last laugh?  ABSOLUTELY, POSITIVELY CORRECT!
  • Obama’s poll numbers will stabilize in the spring, as unemployment numbers artificially are leveled off.  However, as the year progresses, and unemployment stays in double digits, Obama’s popularity will drop below 40%.  As time goes on, Obama will be blamed more and more for the economy, and his laying the blame with the prior administration will sound more and more like whining.  FALSE.  ALTHOUGH MUCH IS TRUE, OBAMA’S POPULARITY HAS LEVELED IN THE MID-FORTIES.
  • Republicans will gain 8 Senate seats.  I will be more specific in my 2010 election prediction article, but briefly I predict Arkansas, Colorado, Connecticut, Delaware, Illinois, Nevada, Pennsylvania, and New York to flip (I know, I am an optimist).  I predict Republicans will pick up 40 seats in the House, just short of the majority, but will try to entice additional Blue Dogs to switch parties.  It will be that close.  2010 will be a historic landslide, ala the Second Republican Revolution.  NOT BAD!  REPUBLICANS GAINED 6, NOT 8, SENATE SEATS.   AS FOR CONGRESS, I WAS CLEARLY PESSIMISTIC, AS THE GOP PICKED UP 63 SEATS…BUT CORRECT ABOUT THE LANDSLIDE!

As for my ever pathetic sports predictions:

  • Alabama will defeat Texas for the BCS Championship.  CORRECT!
  • The San Diego Chargers will finally break through and win the Super Bowl.  NOT QUITE.
  • Kansas Jayhawks will win the NCAA Basketball championship.  NOPE.
  • Pittsburgh Penguins will repeat as NHL Champions; the L.A. Lakers will repeat as NBA championships in a classic series over the Boston Celtics.  LAKERS CORRECT, PITTSBURGH NOT SO MUCH.
  • The United States will finish 3rd in the medal count at the Olympics.  WAY TOO PESSIMISTIC!
  • The Red Sox will outduel the Yankees, and win the World Series.  NOT EVEN CLOSE.
  • O.K., my ‘homer’ picks were horrendous last year.  Here we go:  The Pistons will miss the playoffs, and get the 8th pick in the Lottery.  The Red Wings will lose in the 2nd round of the NHL playoffs.  The Tigers will miss the postseason once again, this time by 5 games.  The Lions…who cares; I am a Redskins fan!  The Skins will get Mike Shanahan as coach, dump Jason Campbell as QB, and will draft Sam Bradford with their first round pick, which will guarantee that he will be a major flop in the NFL.  And my beloved Michigan Wolverines will get back to a bowl…but only an average one.  FRANKLY, NOT BAD, NO?

Oh, and of course, the obligatory JibJab piece:


The End of the Honeymoon


The Media/Obama Love Affair is apparently over...sigh...

Ah, it must have been glorious while it lasted, huh Mr. President?

You know what we saw today in the White House Press Briefing Room?  The end of the honeymoon.  Oh, and what a glorious time it was for the press…a time when the young President, with the beautiful family, could do no wrong, and love and cherry blossoms were in the air…

Well, it pretty much ended in a big, hollow thud on Tuesday.

To Mr. Obama’s credit, he came out strong in the press conference, finally condemning the Iranian regime for attacking protesters…of course, it was 10 days too late, but still, give him what little credit he deserves.  He specifically mentioned Neda, the young woman who was killed with video taping, who has since become a virtual martyr for the cause.  Still, it took her death on YouTube to get Obama to make a strong stand against the regime.

But the press (gasp!) was still not satisfied.

Clearly, it started with Iran.  The opening statement was strong…but the press surprisingly didn’t buy it.  The obviously question, finally from Fox News’ Major Garrett: “What took you so long?”   The president responded by saying, in part, “we’ve been entirely consistent, Major, in terms of how we’ve approached this.”  Garrett followed by asking if the Iranian delegation was still invited to July Fourth celebrations at the White House.  Obama conspicuously avoided giving a straight answer. (The White House changed their answer the next day…).

Um, yeah.  First, NO MEDDLING.  Now, MEDDLING.  Sure.  But it got even worse.  Here’s an exchange between Mr. Obama and NBC’s Chuck Todd:

Todd: Mr. President, I want to follow up on Iran. You have avoided, twice, spelling out consequences. You’ve hinted that there would be from the international community, if they continue to violate — and you said “violate these norms.” You seemed to hint that there — there are human rights violations taking place.

MR. OBAMA: I’m not hinting. I think that when a young woman gets shot on the street when she gets out of her car, that’s a problem.

Todd: Then why won’t you spell out the consequences that the Iranian people…

MR. OBAMA: Because I think that we don’t know yet how this thing is going to play out. I know everybody here is on a 24-hour news cycle. I’m not. OK?

Ouch.  And that from NBC…yikes.

Then, in what was a planned question, Obama flubbed again.  Nico Pitney of the Huffington Post (which, incidentally, has done an excellent job filtering news from Iran) asked this question from an internet poster from Iran:

Under which conditions would you accept the election of Ahmadinejad? And if you do accept it without any significant changes in the conditions there, isn’t that a betrayal of — of what the demonstrators there are working to achieve?

Great question!  Except, Obama did his classic avoidance routine.  He stated he didn’t have inspectors on the ground during the election, and he couldn’t verify if it was rigged or not.  Then he said it was the Iranian people’s decision if the government was legitimate or not.  Great, except the question was how Mr. Obama would view that legitimacy.  Talk about avoiding the question.  So in the end…we still don’t know.  I am sure that the Iranian poster was happy that the President at least got the chance to avoid his question.

Jake Tapper from ABC then noted that Mr. Obama had not answered a previous question on health care from David Jackson of USA Today (after two minutes of speaking, mind you) on whether he would sign a bill without a public option.   Obama was not pleased.  I bet this is a tougher question on health care than Obama will get on his ABC News special

Reporters then grilled him on his smoking habit…Obama was not happy.  Mr. Obama would later knock a reporter’s attempt to tie his smoking habit to yesterday’s tobacco legislation because, he argued, the bill is focused on children.   “I think it’s fair, Margaret, to just say that you just think it’s neat to ask me about my smoking as opposed to it being relevant to my new law,” he said.  He followed that up by stating that he never smoked in front of his children.  Note that he does smoke in front of the rest of America, including our children.

This was a mess of a press conference for Obama.  Forget the debacle of stuff he did mention…he didn’t even use the following words:  Iraq, Afghanistan, Korea, Pakistan, Soldiers, War.  I guess those things aren’t that important to Barack Obama.

Sure, there was still ridiculous questions still given by reporters who are still in the daze of love for the President.  But for the first time, reporters from most of the mainstream media outlets asked legitimate questions, which Obama just could not handle.

Welcome back to the real world, Mr. President.


Medicare: The Preamble to the Public Option

c/o Michael Ramirez, IBD

c/o Michael Ramirez, IBD

The Health Care debate has been heating up in the last few days.  This week, the CBO estimated that Democrats plan to cover health care will cost, at the low end, $1.6 Trillion…or more than 50% more than Obama has stated.  Another CBO report said that if they implement the Public option, and slowly roll it in, that 15 million of the 45 million people now without insurance could be covered; at a cost of $1 trillion. $1 trillion for a 1/3 solution?  Not much of a bargain for a public option that is supposed to ‘reduce costs’.  And the public is starting to notice.

So when Democrats talk about the ‘Public option’ on medical care, what are they talking about?

Let us simplify it:  they are talking about making Medicare universally available.  They want a similar program to cover people from birth to death.

Here is the problem:  Medicare has no answers to the major problems with our health care system either.

That’s the message of a report yesterday by a commission that advises Congress on the federal medical program for older Americans.  To eliminate wasteful spending, policymakers must transform economic incentives for doctors, hospitals and other providers of medical services — though it isn’t clear how, according to the report.

To illustrate what it might take to save Medicare, the commission describes how primary-care doctors, specialists and hospitals could be reorganized into “accountable care organizations” (commonly referred to as ‘bundling payments’) whose members would receive bonuses if the organizations met quality and cost targets. To ratchet up the incentives, health-care providers that fail to meet cost and quality targets could be penalized, the report says.  Even then, any projected savings would be highly uncertain, the report says. What is certain is that Medicare cannot maintain its current trajectory, it adds:

“If current spending and utilization trends continue, the Medicare program is fiscally unsustainable. . . . Part of the problem is that Medicare’s fee-for-service payment systems reward more care — and more complex care — without regard to the quality or value of that care.”

Yes.  This is the system that Barack Obama wants to bring to your front door.  Some Democrats, including Tom Daschle, are asking Obama to move past the public option for a number of reasons.  Daschle has joined a bipartisan commission called the Bipartisan Policy Center with George Mitchell, Bob Dole, and Howard Baker calling for a much more conservative health care plan…one that is surprising closer to my own health care plan.

Even worse, Mr. Obama is not telling the truth on this issue.  Many groups (such as the American Medical Association and Insurers of America) are against this, because they believe that this will push private insurers out.  Mr. Obama accused people like me of lying about this.  Is he calling liberal Democrat Russ Feingold a liar? Because Feingold has clearly stated that the public option will lead to a single payer system.  I am sorry, but it is not me that is failing to tell the truth.  I ask one simple question:

How many totally independent health care plans are there for people over age of 65?

The answer is none.  Yes, there are some HMOs and others that work with the government Medicare system, and provide care.  But totally independent?  There are none. Why?  Because Medicare has such a price advantage and monopoly, that there is no competition to be had.  Second, the monopoly is like any other monopoly…smaller players have great trouble competing.  Furthermore, once you give a ‘free’ option, who would choose to pay for it?

People will argue that if Medicare is cheaper, why not continue with it?  Simple:  it is not significantly cheaper.  For one, many of the costs in Medicare are hidden costs; the government shows them in other accounting methods, and not clearly within the Medicare system.  Second, health insurers pay corporate taxes, while Medicare dollars don’t.  And since the Medicare fund is going to run out in less than a decade, those tax dollars are essential to the long term funding of Medicare.  Additionally, in some senses private insurance already subsidizes public insurance.  The public systems (Medicare, Medicaid, and the Veterans Affairs Administration) don’t pay enough to meet costs…so those costs are shifted to patients with private insurance.  Ed Morrissey at AIP has an excellent, more detailed explanation of this.

Second, how does Medicare keep costs low?  Easy:  they ration.  They ration care to patients, and ration payments to doctors.  It is estimated that doctors and hospitals only get around 30% of what they bill.  Let me ask you:  if you went to work , and your boss paid you 1/3 of what he said he would pay you, how would you feel?

Oh, and if you don’t think this is an authoritarian?  Listen to this:

Getting doctors to join accountable care organizations may require pressure, MedPAC Executive Director Mark E. Miller told reporters: “If you want people to voluntarily organize, you may want to make sure that the current system isn’t as pleasant a place to be.”

Understand the repercussions.  Doctors already are stretched to the breaking point, even though they make good incomes.  What will they do if you restrict their incomes even further?  They will provide less service.  They have no incentive to provide after hours services, weekend services, etc.  Right now, they do those things because it is financially beneficial for them to do it.  You think hospitals can or will maintain the same level of services they do now, if they get even less funding?  Of course not.  Government officials would like to think physicians would remain static in their actions:  that is a true lie.

So in short, we come down to the simple reality, no matter what name calling Mr. Obama is involved in:  the only way the Mr. Obama’s plan reduces costs is by rationing, one way or another.  That is a fact, Mr. President.


Health Care: How to Control Costs

I am going to try to focus on particular issues within the health care debate, largely because many platitudes are used, but no one gets to the heart of the matter.

Today, President Barack Obama went to talk to the American Medical Association, and talked about how to reduce costs.  And to promote it, he used scare tactics:

“If we do not fix our health care system, America may go the way of GM — paying more, getting less and going broke,” Obama told the AMA’s 158th annual meeting.

He is at least open to some of the more conservative proposals, but his allies in Congress are a different story all together.  Additionally, the President said he may consider tort reform, but without any caps.  That defeats the purpose, frankly, and doctors are unlikely to support that.

How far the President will go to push against the liberal left is still to be seen.  Obama however did make a complete misstatement:  that the public option won’t hasten the downfall of private medical insurance in this country.  That is a fact, no matter how much Obama denies it.  Obama can call me a liar to the day I die…but he is still wrong.  Heck, his own HHS Secretary Kathleen Sibelius said virtually the exact thing in 2007…maybe he should call her a liar as well:

Ultimately, cost, of course, is the biggest problem.  So much so that Democrats are somehow trying to avoid using the CBO numbers…which would be unprecedented.  But the CBO is saying that Obama’s plan as-is would cost $1 trillion…and still not cover 30 million people.  If you wanted to cover everyone, the cost shoots up to $4 trillon.  Yikes.  Additionally, they are using statistics that are outdated, or are totally wrong, thus making the argument even harder.  This is making it very difficult for Democrats to find the votes they need to pass the bill, even in the liberal Congress.

Therefore, cost is the main issue.  You solve this, everything else falls into place.  But let us face some realities right up front.

1. Costs, overall, will increase.

I went into depth on this in my health care review, which can be read here.  But basically, you are going to universally cover health care; so about 40 million uninsured, plus the additional 50 million underinsured. That is 90 million people who are largely not getting full health care coverage today.

Then, you will provide them with full health benefits, preventative care, etc.  Those things are costly, regardless of their longterm benefits.  Thus, upfront there will be an immense increase in health care spending, all things being equal.

2.  The myth of Medicare’s ‘efficiency’

This is a complete fairy tale.  From the Wall Street Journal:  Medicare was created in 1965, U.S. health spending has risen about 2.7% faster than the economy and on current trend would hit 20% of GDP within a decade. Every public or private attempt to arrest this climb has failed: wage and price controls in the 1970s, the insurance industry’s “voluntary effort” in the ’80s, managed care in the ’90s.  Here is how the Wall Street Journal editorializes it, and they are absolutely right:

Medicare is an ocean of money surrounded by people who want some. It is not only an entitlement to beneficiaries, but a de facto revenue entitlement to hospitals, physicians, nursing homes, durable medical equipment suppliers and the rest. Even a tweak to the Medicare fee schedule is the small-scale equivalent of closing a military base or trimming farm subsidies. The system will never be as rational as Mr. Orszag desires unless it is severed from politics.

And one other thing…let us remember that medicare itself does not pay taxes…like private insurers.

3. Information Technology is NOT NECESSARILY going to save money.

This is a farce.  As someone with IT background, IT will cost the American Health Care system billions.  Will it make the lives of doctors easier, and hopefully reduced mistakes?  Sure. I am all for IT for those reasons.  But there is proof that IT advances will increase cost, not decrease them; no proof, other than Obama’s word, has shown otherwise.

4. And above all, you want to control costs, you must ration care.

This is the pink elephant in the room.  Every other socialized health care system openly rations.  Obama is a smart man; he knows he has to, but is not willing to be honest with Americans about it.

This is the real reason our costs are skyrocketing.  We are the greatest innovators in medicine, by far.  About 90% of the medical patents in the world come from here.  Why?  Because we are a Petri dish of innovation.  We try technologies long before they are proven as cost beneficial.  Technology moves at such a fast rate, it would be impossible to test all the devices before implementing them; it would stop medical innovation to a stand still.

And most of the Medicare savings Democrats talk about?  They come directly from rationing of care.

Obama is now facing more pressure to reduce costs, but he is doing it in all the wrong ways.  First, he proposes to slow the rate of increase of hospital reimbursements, which will threaten the already shaky hospital system.  He plans to reduce Medicare payments; for doctors, medicare already pays less than 30% of costs…how many doctors do you think will start to opt out of the system?  Eventually, they will have to, because the reimbursements will be less than their own costs.

In addition, the president is proposing to reduce subsidies for hospitals that care for the uninsured as the number of uninsured falls. That would generate $106 billion over a decade, the White House said. Payments would be slowed beginning in 2013. By 2019, payments would be 25% of what hospitals had received in 2013, updated for inflation.  That may be reasonable, if a full system is implemented.

Obama is keeping his major cost savings hidden…likely because he has no really proposition for the hard decisions necessary to really reduce costs.  Moving dollars from one category to another is not cost savings; it is playing a shell game.  His weekly address on June 12 is an example of how nonspecific he is trying to be:

The New York Times had a fairly good editorial about the failure of doctors to reduce costs as well.  They are right in many ways, but they miss some vital points.   First, most doctors do not benefit from over treating patients; this is a small minority of doctors that have interests in their own testing agencies, commonly called self-referral.  For example, if a orthopedic surgeon owns his own MRI center, he is more likely to sent patients for an MRI; there are multiple studies that show this.  However, a family practioner who has no interest in the MRI center is more likely to order tests that are needed.  Obama and the Democrats are avoiding this issue, because of powerful medical lobbies.  Second and maybe more important, the most common reason for doctors to order too many studies is a simple one:  lawsuits.  Tort reform would potentially help in alleviating that.

All right.  So that is where we are.  So how do we move forward?

1. Make insurance personal, and not employer based.

It is frankly illogical and stupid to have your employer be responsible for your health care.  Few things are more personal than your health care choices; do you really want your boss making those decisions?  Additionally, health care should be readily portable.  You should have to think twice about switching jobs because of health care.

There are two reasons why people are still demanding employers pay for health care.  One, historical; it has always been that way.  Second, inertia; people don’t want to take responsibility themselves.  Neither argument carries much weight.

Instead of giving employers a tax benefit for giving out insurance, we should make employers choose; either give that money in salary to employees, or continue to cover their employees.  Most will choose the former, because handling health care is a headache.  So ultimately, it becomes a personal responsibility.

That is a good thing.  Why?  Right now, patients have no idea how much health care costs.  Heck, most doctors don’t know what health care costs.   It is essential to get patients to realize that these things are costly, and certainly not free.  People make choices daily about everything else cost wise; why not health care?  Sure, we need guarantees for disasters and such, but short of that, a system framed on personal choice is much, much more likely to limit costs than one governed by the feds.

2. Give patients more choice AND more repsonsibility.

I am all for more freedom and choice.  That is ultimately what America is about.  Thus, the more rights we give to the individual, the more likely we will have success.  But rights in this society does not come without personal responsibility.

What do I mean by that?  What I mean is that costly procedures that have questionable benefit should not be regularly covered by insurance.  The prime example is life sustaining tools in the final months of life.  We need to change societal expectations about life and death.  Spending approximately $700 billion a year on the final three months of dying patient’s lives is just not smart.  We need to cover hospice care, palliative medicine, etc.  Now, if a family wants to keep grandpa on life support, that is fine…but that should come out of their own pocket.

Examples such as these can be found through out health care.  Why?  Because people don’t ‘pay’ for services in health care.  Thus, they feel entitled to everything.  By making patients make rational choices, we can reduce the waste of hundreds of billions of dollars quite easily.

3. Tort reform.

Obama at the AMA speech came out against caps for malpractice lawsuits, which in my humble opinion signficantly reduces his credibility on the issue of cost reduction.

This is contentious, and clearly as a physician I am not impartial.  But it is more than  just lawsuits.  There is a vicious cycle in medicine of practicing ‘defensive medicine’.  This is basically doctors order often unnecessary tests only because they feel legal retribution if they don’t.  This has to stop.  This has created a terrible culture of misspending in medicine in America.  We need a complete culture change, where we order tests that are unnecessary, and don’t blame doctors or the system when things still go awry.  Medicine is not a perfect science, even if our legal system wants it to be that way.  There should still be legal recourse for negligence, real mistakes, etc.  But this needs to be limited.

4. Decrease bureauocracy and red tape.

I don’t think there is any industry that has as much paperwork as medicine.  It is out of control.  From documentation, to billing, to legal issues, medicine is mired in paperwork.  It is estimated that private care physicians (family medicine, internal medicine, pediatrics) spend at least one quarter of their time on paperwork, and spend at least 1/3 of their overhead on those costs.  And it doesn’t stop there.  The federal government and state governments have overlapping regulations that make things even more complicated for physicians, hospitals, and insurers.  This whole system needs to be cleaned up.  We could reduced paper work by half, and increase physician productivity by one eighth in one single step.  The cost savings could be enormous.

Frankly, the Obamacare and Democratic plan fails in all four of these steps. They are looking at costs savings from a very high level; how can we save dollars on Medicare and Medicaid, shift it to Obamacare; how can we increase taxes, etc.  Medicine ultimaately is about individuals, and if you want real cost savings across the board, you need to clean up the mess and minutia that is limiting the actual process of health care, instead of staring at accounting tables and tax receipts.

Please see the complete Neoavatara Health Care Plan Here.


McCarthyism, Obama-Style

The hatred and attempted suppression of free expression is reaching levels that I have never seen in my lifetime.

The left, who is now in charge of the White House, Congress, and has always been running the mainstream media, has tried to take tragedy after tragedy, and politicize it.  It started with the Kansas abortion doctor Dr. Tiller’s murder.  It culminated yesterday with the murder of a guard, Stephen Johns, at the Holocaust museum in Washington D.C. by an insane, antisemitic neo-Nazi.  Johns is clearly a hero, and his murder should be considered as such.

And somehow, the political right is to blame for these things.

First of all, let us be clear:  those murders were by wacko, lone wolf characters.  If you want an entire political belief system to be responsible for the insane actions of lone individuals, you are living in a dream world.  Second, some how the attack and murder of army recruiters in Arkansas did not achieve that kind of attention, because the media didn’t make that linkage to the extreme left that calls our soldiers ‘baby-killers’.  But you want to use the same logic, the linkage can be made.

Then we have the lead hypocrite, President Barack Obama.  After the murder at the Holocaust museum, Mr. Obama called for more vigilance against prejudice.

“This outrageous act reminds us that we must remain vigilant against anti-Semitism and prejudice in all its forms,” Obama said Wednesday.  “No American institution is more important to this effort than the Holocaust museum, and no act of violence will diminish our determination to honor those who were lost by building a more peaceful and tolerant world.”

Really?  Are you kidding?

This happened on the same day that Mr. Obama’s long time friend and preacher, Jeremiah Wright, came out and said that he could not voice his opinions to his friend the President, because ‘Jews’ are preventing him from talking to him.

Them Jews ain’t going to let him talk to me …. He’s got to do what politicians do. And the Jewish vote, the AIPAC vote that’s controlling him, that will not let him send representation to the Darfur Review Conference, that’s talking this craziness on Israel because they’re Zionists, they will not let him talk to somebody who calls a spade what it is. Ethnic cleansing is going on in Gaza—the ethnic cleansing of the Zionists is a sin and a crime against humanity.

Um, Mr. President…where is your vigilance against this prejudice?  I guess it is the same place it was in the 20 years you spent in Mr. Wright’s church…conveniently hidden.

The media has been absolutely abhorrent on these issues, led by the pseudo-network MSNBC.  I really believe that MSNBC is left of the Huffington least Huffington is honest about its position, but MSNBC still pretends to be somewhat objective.  Who are they kidding?

There is as much hate in the mainstream media as there is anywhere else. For the past 8 years, the media was perfectly happy calling for evil things to happen to the Bush Administration. People even wished for several of their deaths.  But that is not hateful, not at all.  Even now, we see the left attacking family members of conservatives (ala Palin’s daughters).  Do you think that a sex joke would have been acceptable against Chelsea Clinton in the nineties?  How about a joke about the Obama kids?  This is frankly disgusting. Public figures are fair game…families should always be off limits.  But the left is fine with that, as long as it is a right wing politican’s family that is being attacked.

What scares me most about all this is not that they are saying these things…let them say whatever they want.  What scares me is their attempts to limit my free speech.  Their hate is acceptable…ours is not.  Frankly, I think speech has become too extreme on both sides.  There will always be extreme wackos like the prolifer murderer and the antisemtic killer.  The fact that the neonazi hated Republicans and conservatives (including reports that the neocon magazine The Weeekly Standard was on his hit lists)is not even the point; the comparison should never have gotten that far.   Not to mention, some are reporting that he may be a registered Democrat; but I digress.  But as leaders, and people who are responsible and want what is best for our country, we should do better.  When supposed mainstream people like Paul Krugman blame Fox News for incidents like this, when they were in fact targets, it speaks to lack of intellectualism…these people are pure hacks, and should be ignored.

What is now acceptable on mainstream challenges is abhorrent.  And frankly, I will throw the President and his cohorts into the mix.  Mr. Obama can talk about talking down prejudice…yet he is failing on that same call for vigilance.


A Conservative Health Care Solution

We as conservatives better get ready for the Obamacare onslaught, because here it comes.

Barack Obama has stated as one of his major goals as President to push through a national health care reform package, preferably by the end of the year.  Frankly, Mr. Obama understands that this is his moment of opportunity. It is unlikely he will ever have more political clout and capital than he has at this very moment.

And Republicans have been virtually silent.

There is a simple reason for that:  They have had no plan for health care (with the exception of Mitt Romney; but his plan in action has been less than stellar…).

This is a simple harsh truth.  For years, we have Republicans make policy initiatives on the edges of this debate.  That is no longer enough.  Health care, very quickly, will become one of largest financial crises this country has ever faced, if nothing is done about it.  And consrevatives better have a workable plan when the time comes.

There are several conservative plans out there, including Newt Gingrich’s plan and Sen. Tom Coburn’s alternative.  Both have intriguing ideas, and are also dead on arrival.  There are three broad health care proposals out there right now:

  • Create a plan that resembles Medicare, administered by the Health and Human Services department.
  • Adopt a Medicare-like plan, but pick an outside party to run it. That way government officials would not directly control the day-to-day operations.
  • Leave it up to individual states to set up a public insurance plan for their residents.

I personally don’t like any of those choices.  I think we need a system where the federal government gives people the money, primarily by tax credits, to purchase their own care.  I also believe that insurance should cross state lines.

But there are allies popping up every day.  Joe Lieberman and Mary Landrieu have come out against a public plan, which is growing in negative popularity daily.  And many moderate Democrats have been fearful of the final budgetary numbers to come out for the total cost of the plan, with Obama already increasing the budget deficit by almost $4 trillion over the next five years.

Insurers have sort of signed on to the Obama plan, but are strongly against a system that would allow a public plan; they know that it would be the deathknell to private insurance in this country.  The American Medical Association has also come out against a public plan, stating that they want affordable health care but health services should be provided through private markets, as they are currently.  “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

But I till think conservatives must present a full, complete health care proposal, if for no other reason than to show a clear ideological comparison with the Obama Administration.  Obama wants a massively enlarged bureaucracy, for which we don’t have the money.  I think there is a better, most cost efficient, and more cost saving way.

I have had multiple blogs on this topic, including what is the problems in our health care system, as well as my page on larger goals and issues that must be addressed, that can be seen here.  But frankly, we must start with our basica tenets that must be achieved:

1.  Universal coverage – We must find a way to fund health care for all individuals.

2.  Universal applications of best practices – This is not to only to ensure high quality health care with uniform standards, but also to implement the most effective strategies.

3.  Improve health care IT, including better, more efficient methods of billing - This will reduce mistakes, reduce fraud, and in the long run hopefully reduce costs, though up front capital costs will be significant.

4.  Transparency - We must make costs and effective practices known and easily accessible to the public.

5.  Tort and Malpractice Reform – It is essential to remove defensive medicine as part of the culture.  Therefore, legal tort reform is essential, while still balancing the legal rights of patients.

In general, I think these are the most important factors is attempting to achieve a long term, successful national health care program, and I don’t think there is much disagreement on these.

I personally have several suggestions for a conservative health care plan that meets those goals:

1.  Provide a refundable tax credit to every American to buy health insurance.

Right now, the tax code favors those working for large corporations, because they get a tax deduction for providing health care to their employees.  But remember, less than a quarter of people work for large corporations, and most new jobs in this country are formed from small businesses.  There is no reason, none at all, that your employer should be responsible for your health care, other than that has been the way it has been done.  Labor unions started this in the 1940s, because there were restrictions to pay increases; that clearly does not apply to the present day.  All reasons for employer paid insurance are pretty dumb, and there is no reason to continue an obviously flawed system.

A $6000 tax credit for families (or $3000 for individuals) would likely make insurance affordable for most people.  I think most people would be better off receiving more income, and then using that money and their tax credit to purchase the health care that would best fit them and their families.  Sure, there should be guidelines of basic, acceptable level of coverage…but I feel the responsibility is better off  in the hands of individuals.

2.  Provide an answer to affordability.

This is the most important issue for those that lack insurance today.  How can they afford additional health care premiums, at a time that they are living check by check?

First, we must establish that if private insurers are going to dominate the market, they must include all patients, regardless of health history.  You cannot leave a huge segment out of the insurance pool, and still expect to cut costs overall.  Yes, this regulation will make health insurance more expensive for most people, but it is a necessity.  It is one of the sacrifices that needs to be made to have universal care.  However, I also think that people that smoke, do drugs, etc. should have to pay more for their sins…life is about choices.  Maybe forcing people to pay for their sins may get them to make lifestyle choices that will improve their health…who knows.  But we have to be careful here…it is a thin line between healthy choices, and government intrusion on personal choice.

Second, make it clear to private insurers that if they can’t provide affordable health care, the government will.  This is an ultimatum, but also a frank reality.  Many Democrats are already preparing for a single payer national health care system.  Even a partial system with a large government controlled component would likely wipe out many private insurers.  A recent report by the Lewin Group, a numbers-crunching firm that serves government and private clients, found that a new government plan could radically alter that landscape.  If the public plan were open to all employers and individuals — and if it paid doctors and hospitals the same as Medicare — it would quickly grow to 131 million members, while enrollment in private insurance plans would plummet, the study found.  By paying Medicare rates the government plan would be able to set premiums well below what private plans charge. Employers and individuals would rush to sign up.  In all practical purposes it would set up a monopoly…one which the private market could not compete with.  And that will ultimately lead to the obvious…rationing (by one name or another).

Private insurers must control costs if they plan on surviving.  It is that simple.

3.  Provide Tort Reform

Even in this climate, doctors and insurers are more popular than lawyers.  The legal system has set up a culture where doctors waste money purely to cover their own malpractice liabilities.  It is costly to the nation.  The exact cost is difficult to calculate, but doctors understand that we don’t practice medicine the way other countries do precisely because of this ‘defensive’ mentality.

There must be a fair legal system that caps rewards, lowers malpractice premiums, while still giving patients recourse for mistakes.  The currents system is out of balance.

4. Expand Health Savings Accounts

This is an idea that Washington only got half right.  HSAs could potentially be the answer for those people in the middle of the economic spectrum that are struggling with health insurance.  Allow individauls, employers, and anyone else to donate to a HSA, with no limits.  They can help pay for their insurance premiums and any additional costs from that account.  Allow the account to accrue tax free.  This will allow individuals, instead of the government, to have the power to purchase their own health care, and make individual choices that best benefit them.

5. Improving Heath Care quality and transparency

I generally agree with President Obama’s push to modernize Health Care IT.  I don’t think it will provide the cost savings he is suggesting, but it is a good idea.

Implementing best practices will be more difficult, but possible.  I think we should replace the Centers for Medicare & Medicaid Services (CMS) with a board of doctors and scientists who will make decisions of what studies and practices are the most cost effeective and provide the best outcomes.  Today, CMS doesn’t really do that; they really look at what things cost today, and make judgements that way…that is a very poor way of handling health care.

If something falls outside of ‘best practices’, that doesn’t mean it is outlawed…just that it will not be covered by insurance.  I will give an example as a radiologist:  we get requests for MRIs of extremities because patients ‘bumped their arm’ or ‘fell off a bike’.  This is an absurd use of health care dollars, and there is no indication for that.  Doctors today do those test because they don’t want to fight with patients, and are afraid of lawsuits.  But implementing best practices gives doctors a clear guideline; if patients don’t want to follow it, that is fine; but it will cost them.

This is where the Health Savings Accounts come in to play.  If you prefer a different treatment, the insurer will fund the amount that they would have spent on their recommend treatment; you supplement that with HSA dollars to make the decision you want.  People will sometimes make decisions because of personal reasons, but it doesn’t mean the system should pay for them.  More often than not, patients will follow the best available advice, both because of the science and the cost.  That will cause market forces to make decisions that should, hopefully, reduce overall costs.

One last point on costs:  we should clearly print and publish what every medical procedure costs.  Patients should know exactly how much they are spending, and for what.  Transparency is essential in any free market system.

6. The Safety Net

Ultimately, the one real criticism liberals can have to a plan that allows for this much freedom is what to do with those people that fall through the cracks.  I have an answer.

First, if you don’t purchase your own insurance, your $6000 tax credit will still be used; it will be used to purchase a default health care plan.  The authors of the excellent book ‘Nudge’ give us a hint at the solution.  There should be a basic default, that the government puts you in even if you are too incompetent to choose your own plan.

The plan will be the most basic of plans, providing for preventative care and catastrophic care, and little else.  We must make people responsible for their own health care decisions, while still balancing the needs of the society as a whole.  Thus, these people that don’t make that choice will not receive a tax credit, and will in fact be paying more in taxes because they will not be able to deduct the amount from their income.  It is a penalty for being irresponsible.

Second, we need to make sure that all children are clearly covered under the plan.  This easily falls into my previous suggestion.

Third, I have a controversial suggestion:  those people who do not utilize preventative care, especially for their children, should be penalized.  I am not sure how to carry this out, I am still considering multiple suggestions.  But whether or not preventative care can provide cost savings is questionable; however, there is no debate that preventative care provides for healthier living and better quality of life.  I consider this one of the key benefits of health care reform.  However, our society has become so poor in following preventative care recommendations, I think that people, at least initially, must be forced into seeing their physicians on some regular basis.

So, what are the benefits of this kind of plan over Obamacare?

  • No new huge government bureaucracy.  There is no need when individuals, and not someone is Washington, is making the choices.  Additionally, less government oversight means less power for the government to dictate how you live your life.
  • More choice (and responsibility) for individuals, while at the same time providing a safety net.
  • Key on those best practices that provide the best medical outcomes for the best price.  This may include limiting dollars spent on patients in the last months of life, which provides no benefit whatsoever to the patient, and is usually more about the mentality of the patient’s family.
  • The financial incentives to enter into a plan that focuses on preventative care over treatment of disease should in long run make us a healthier country.
  • Forcing patients to make decisions on their medical care hopefully will make them more knowledgeable about what they are spending on that care…and the hope is, those market forces which have NEVER been used in America properly can slowly drive down costs and misues of health care dollars.

I welcome any suggestions.  I believe this is a good starting point…one that can provide universal care, at a reasonable price, without creating a federal governmet behemouth that is sure to cost more and to fail in the primary goals I have stated, while at the same time maintaining individual freedoms.


Its About the Economy (and Jobs), Stupid…

Wal-mart, the bane of liberals because of its spotty benefits and lack of unions, is planning to open 150 stores this year, and to add up to 22,000 jobs in 2009.

Wal-Mart, still the target of criticism from union-backed groups for its pay and benefits, has improved its health insurance coverage and opened it to full- and part-time employees. The company says 94 percent of its employees have health coverage, either through Wal-Mart or another family member.  Other employee benefits include a 401(k) plan, stock purchases and discounts for workers making in-store purchases.

“At Wal-Mart, we offer competitive pay and benefits and real opportunities for our associates to advance and build careers,” Wal-Mart Vice Chairman Eduardo Castro-Wright said. “Job creation is just one way in which we’re working hard every day to help people across this country live better.”

So here, we have Wal-mart, the world’s largest retailer, adding jobs during the worst retail environment in a generation. Pretty remarkable.

Now, let us look at the other side of the coin.

Microsoft’s CEO Steve Ballmer today announced that the world’s largest software company would move some employees offshore if Congress enacts PresidentBarack Obama’s plans to impose higher taxes on U.S. companies’ foreign profits.  “It makes U.S. jobs more expensive,” Ballmer said in an interview. “We’re better off taking lots of people and moving them out of the U.S. as opposed to keeping them inside the U.S.”

U.S. tax rules let companies defer paying corporate rates as high as 35 percent on most types of foreign profits as long as that money remains invested overseas. Obama says he wants to end such incentives to keep foreign profits tax-deferred so that companies would invest them in the U.S.

Microsoft reported an overall effective tax rate of 26 percent for 2008 in its last annual report. “Our effective tax rates are less than the statutory tax rate due to foreign earnings taxed at lower rates,” the report said.

So, in other words, Obama’s tax revisions will not only cost America jobs (unless he nationalizes Microsoft and forces them to keep jobs here), but will also cost it tax dollars, which is the entire reason for the proposal in the first place.  Microsoft has, as its  first duty, to make profits, and Obama is making it more difficult to make those profits in the United States.  Additionally, Microsoft is one of the leading innovators in the world.  By forcing them to move more offshore, all you are doing is forcing innovation and dynamism to leave the United States.

Now, the jobs environment is certainly not all Obama’s fault.  But it is quickly becoming his problem.  This week the Labor Department announcee unemployment topping 9.4%, with approximately 2 million jobs lost since Inauguration day.  Eventually, no matter how much the media and Obama blame the past, this will become this Administration’s problem.  Obama’s answer has been to raise taxes, first on the rich, then on everyone else.  We are seeing the slow encroachment of this concept with his new potential tax on health care benefits.  He was totally against them, then was considering them, and now has practically accepted them as a practical reality.
Heck, even ultraliberals are lamenting this.  Harrison Ford, of all people, has put out an appeal to Congress to stop a potential tax and increased fees on millions of private plane owners.  His reasoning?  That the bill would cost millions of jobs in this country.

All of this fails to explain exactly how the Obama policy will create jobs and economic wealth.  It reminds me on a South Park episode about capitalism.  Gnomes ravage the city, stealing underpants, to make profit.  How exactly stealing the underpants will make profit, the gnomes don’t know…kind of like Obama’s tax plan.  No idea how it will create wealth, but doggoneit, some how, some way it will.  Change we can believe in!

Climate Change Hysteria

The Global Humanitarian Forum, led by former UN Secretary General Kofi Annan, has warned that 300,000 a year are dying because of global warming, and that more than 300 million people are already seriously affected by the gradual warming of the earth and that number is set to double by 2030.

That is all fine and dandy.  Except, it is a falsehood.

Now, before I get too far, here is what I believe:  I believe there is global climate change.  I don’t think you can deny that.  Is it caused by humans?  Well, I am not sure, but I think there is a fair probability that some of it may be affected by human actions.  I also don’t think it is easy to prove either way.

This report, however, is pure hysteria.

Why?  Well, read the intricacies of the report.  The methodology can be seen here.  Basically, they separate their findings into two categories:  weather related disasters, and gradual environmental degradation.  Fine.  Then they calculate how much of that is caused by climate change.  OK.

Here is the question:  HOW DO THEY ACHIEVE THIS NUMBER?

Easy.  They estimated it.  There was no scientific method in determining this…a bunch of so-called experts just pulled a number out of their hat (or other body parts) and stated this as a fact.  It is no such thing; it is only opinion.

Here is the other problem.  They don’t take any historical patterns into account.  None.  For example, have hurricanes, droughts, etc. actually increased in recent times?  There is no methodology to show that.  So, even if their arbitrary number of 300,000 people dying because of the environment is in fact correct, there is nothing in their study to show that the same proportion weren’t dying before the industrial age.

Here is one claim they make, straight from their report:  (the entire PDF can be downloaded here)

The international community agreed at the beginning of the new millennium to eradicate extreme hunger and poverty by 2015. Yet, today, climate change is already responsible for forcing some fifty million additional people to go hungry and driving over ten million additional people into extreme poverty.

Here is the problem.  Are those people in increased poverty because of global climate change?  Or does the global recession, increased gasoline and food prices, and global conflict affect that number?  Do they take that into account at all?  It does not appear so, looking at their methodology.

This is shoddy science at its worst.  Look, I am a big supporter of green technologies.  You can see some of my policy initiatives here.  I believe we need to alter our behavior for a multitude of reasons:  diminishing resources, geopolitical conflicts, etc.  But having shoddy research trying to back up these claims does not help the effort.  There is a reason that the majority of people in the United States don’t believe in global climate change:  because they feel others are trying to manipulate them.

You want to convince people something is happening?  First, place a few non-believers on your team.  Convince them.  There are a number of non-ideological scientists that don’t believe in human created climate change.  Convince them.  If you can convince them, you can convince anyone.  But like with this research, where every member is a hard core ideologue and firm believer in the results before the study was ever performed, it is purely propaganda, and not scientific research.

There are simple concepts and facts that would convince people to make changes in their lives that can make a significant impact on human produced pollution.  We should be doing that, before we start yelling ‘the sky is falling!’ to achieve our ends.

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