More government involvement in healthcare will make things worse

Two articles:

First, Dick Morris and Eileen McGann:

THE elderly were the first group to turn against President Obama's health-care proposals, alienated by the plans to cut $500 billion cut from Medicare. The young and the uninsured may be the next to jump ship -- out of worry over about the huge premiums they'd have to pay.

Requiring everyone to buy insurance will impose a massive tax on all who now are uninsured. The Congressional Budget Office projects that it would force the middle-income uninsured to pay on average more than 15 percent of their income.

The poor will still have Medicaid. But for those earning more, the required premiums will be worse than any tax increase. For example, CBO estimates that when the program is fully implemented -- by 2016 -- an individual earning $32,400 a year would have to pay $4,100 in premiums before getting any subsidy. With deductibles and co-payments, he'd have to shell out $5,600 a year, or 17.3 percent of his income. A family of four, making $80,000 a year, would have to pay about $10,500 in premiums alone -- with deductibles and co-payments, up to $15,000 or just under 20 percent of income.

And if they don't buy insurance, they'll face federal fines that begin to approach these same premium levels. They won't be able to buy what they truly need -- catastrophic-only coverage at a lower premium -- that won't satisfy ObamaCare's "minimum insurance" mandate.

The young and uninsured will catch on: This bill is designed to force healthy people who don't have health insurance -- and may neither need nor want it -- to buy it anyway, in order to raise the money to subsidize those who do need it.

Obama has pledged only to increase taxes on the rich. But his program essentially taxes the core of the middle class (those making $30,000 to $80,000). It will make them overpay in order to pick up the slack for others who need the extra coverage.

In other words, health-care "reform" is a health-care tax dressed up as a program to cover the uninsured.

Read the rest, in which it is made clear that the Dem's can't fund this 'reform' without alienating someone whose support they need.

The Democrats reject changes -- tort reform, and reform of regulations to allow insurers to compete across state lines -- that would improve medical coverage and care for consumers. And they're ignoring real problems, like the rampant fraud afflicting Medicare and Medicaid, and the scourge of nosocomial infections and superbugs that overwhelm our hospitals and kill thousands of people every year.

Next, if you haven't already seen it, is food for thought from David Goldhill of the Atlantic Monthly. He advocates a more consumer-driven medical system combined with an individual mandate for catastrophic coverage and extensive use of HSA's. The article is long and my excerpts don't represent all of the author's arguments, so read the whole thing if you're interested.

Almost two years ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.

It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.

[. . .]

Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.

[. . .]

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.

[. . .]

But let’s forget about money for a moment. Aren’t we also likely to get worse care in any system where providers are more accountable to insurance companies and government agencies than to us?

Before we further remove ourselves as direct consumers of health care—with all of our beneficial influence on quality, service, and price—let me ask you to consider one more question. Imagine my father’s hospital had to present the bill for his “care” not to a government bureaucracy, but to my grieving mother. Do you really believe that the hospital—forced to face the victim of its poor-quality service, forced to collect the bill from the real customer—wouldn’t have figured out how to make its doctors wash their hands?

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