Like a bunch of carnival barkers, the advocates of “single-payer” health care are loudly touting the Census Bureau’s latest claims about the uninsured. So, I guess it’s once again time to point out that this statistic has very little meaning in the larger context of health care reform.

First, it isn’t by any means clear that the figures released yesterday are accurate. In March, the Census Bureau had to revise its 2004 and 2005 figures downward because it had exaggerated the number of uninsured Americans. A similar revision will no doubt be required to fix yesterday’s stats.

Moreover, as I have pointed out here, the total number of uninsured reported by the Census Bureau significantly overstates the number of chronically uninsured. The actual number of year-round uninsured is about half of the 47 million figure reported yesterday.

Also, as I have pointed out here, lack of insurance doesn’t mean lack of care. EMTALA guarantees that all patients who seek care in America’s ERs will be treated.  And, the erroneous claims of the single-payer crowd notwithstanding, free hospital and primary care are also widely available.

But the real problem with focusing so heavily on the plight of the uninsured is that it is a symptom. The actual disease is a morass of perverse incentives created by the very government that single-payer advocates would put in charge of our entire health care system.

If covering “the uninsured” is the primary focus of our attempts at health care reform, the real disease will continue to metastasize.

Conflict of interest? Gross negligence? Nope. Just speak out against free care given to illegal immigrants.

Such is the fate of a Dr. Gene Rogers in Sacramento, CA.

Here’s my favorite part of the story:

“I’ve seen cases and case histories of patients who essentially have come up from Mexico for the express purpose of being treated here, and then leaving to return home,” Dr. Rogers said. “I’ve watched illegal immigrants brazenly demand free, non-emergency health care that was meant for our poorest citizens. I’ve heard them and their families complain. They feel entitled to it.” Dr. Rogers filed a lawsuit in 2003 after county officials “stonewalled” him when he questioned why they were cutting budgets while still providing non-emergency medical treatment to people who have no legal right to be in the country.

You know, there is something wrong when you get fired for trying to uphold the law.

Somehow I missed this article in JAMA back in March. The authors examined emergency room use (the most expensive type of care) among those with high-deductible policies and those in a traditional HMO. According to the article, “High-deductible health plans have been promoted as a means of reducing overutilization but could also be related to worse outcomes if patients defer necessary care.” The objective of the study was to “determine the relationship between transition to a high-deductible health plan and emergency department use for low- and high-severity conditions and to examine changes in subsequent hospitalizations.”

The results were that repeat visits to the emergency room dropped significantly among those with high-deductible plans. There was also a small drop among referrals from the emergency room to hospitalization.

The article wasn’t fully able to explore how the difference affected health outcomes. However, the drop in repeat visits occurred heavily among the “low-severity” group. This suggests that people cut back on emergency room visits when emergency room visits are least necessary.

Gee, it seems that individuals are pretty good judges of their own health needs. Who knew?

It is common for advocates of government-run health care to quote WHO statistics in order to document the alleged inferiority of American health care. A perennial favorite purports to show that the U.S. barely edges out Cuba in some categories.

I have pointed out before that the WHO makes no attempt to verify the health care statistics it receives. Well, here’s an op-ed by a Cuban physician that should make it abundantly clear why government apparatchiks should not be taken at their word: 

I witnessed how medical directors, high-ranking administrators and heads of departments manipulated statistics using deceptive formulas to adjust data in order to reach goals imposed by “El Commandante” Fidel Castro. 

This kind of statistical subterfuge should come as no surprise to students of history. In the Soviet Union, the statistics reported to the central authorities were right on target even as the wheels were coming off the system.

It is in the nature of centrally-controlled bureaucracies, even under regimes considerably less oppressive than those of Cuba and Russia, to produce bogus statistics. All of the incentives push in that direction.

It is not, however, incumbent upon us to accept them like credulous children. Nor should we allow bogus stats to be used as a justification for imposing government-run health care on the United States.

David: I found Megan McArdle’s piece very interesting (most things she writes usually are). Her argument about the immorality of a single-payer system’s transfer of resources is impressive. Yet she concedes a huge point that she shouldn’t:

A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick.

If that was true, one could argue that there is some morality in a single-payer system in that it transfers resources from those who are healthy to those who are sick. But it doesn’t.

In most single-payer systems, it isn’t all that difficult to get an appointment with a primary-care physician. But if you need something more, like a visit with a specialist, diagnostic test, or elective surgery, you’ll face the very real prospect of being put on a waiting list or a cancellation.

The end result is that single-payer systems tend to transfer resources away from those who are very ill to those with few to no health problems. That would be immoral enough if that result were incidental. But it is by design.

Any government-run system like single-payer is ultimately run by politicians. Politicians design policy to maximize the votes they get in the next election; meeting needs is a secondary concern at best. What does this mean for health care policy? John Goodman puts it best:

Why do national health insurance schemes skimp on expensive services to the seriously ill while providing so many inexpensive services to those who are only marginally ill? Because the latter services benefit millions of people (read: millions of voters), while acute and intensive care services concentrate large amounts of money on a handful of patients (read: small numbers of voters). Democratic political pressures in this case dictate the redistribution of resources from the few to the many.

Because of their desire to win reelection, politicians distribute resources in ways that will maximize the chances that they will get 50% + 1 the next time the voters go to the polls. If those who the doctor for a minor (or no) ailment in any given year represent more voters than those who have serious illnesses, then the resources will be distributed more toward the former. That makes single-payer a system that does damage by design.

And that makes it all the more immoral.

As I have pointed out before, the monolithic support of “progressives” for socialized medicine has less to do with its economic or medical viability than with their need to feel morally superior to the hoi polloi. However, as Megan McArdle points out, the morality of government-run health care is open to considerable question: 

A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick … But wholesale transfers to large classes, from large classes, are not good moral philosophy unless those classes are very well specified to the moral effect you are trying to achieve.  

She believes that such transfers are justifiable only if the group receiving the wealth is needier and less fortunate than the class from whom the wealth is to be extracted. Moreover, it must be shown that the latter group is somehow responsible for the condition of the former. McArdle thinks single-payer fails to meet any of these criteria. 

As a class, are the old and sick needier than the young and healthy? No they are not. They have more assets and less poverty than any other group … As a class, are the old and sick unluckier than the young and healthy? Considering people as beings with duration in both time and space, no they are not … As a class, are the young and healthy more responsible for the bad health of the old and sick? Quite the reverse.

For my part, I prefer to discuss health care reform on the basis of efficiency. The objective data clearly demonstrate that government-run health care is wasteful and does a very poor job of resource allocation. Still, McArdle makes a good case that it is also immoral. 

Dr. Brian Day, a surgeon and entrepreneur, assumes the presidency of the Canadian Medical Association this week. Dr. Day isn’t simply a critic of government-run health care, he may be that country’s leading critic – in the 1990s, he founded a private, for-profit surgery center, then challenged the government to shut him down. Dr. Day promises to use his term to popularize the idea of a vibrant private sector for Canadian health care.

A New York Times profile of Dr. Day can be read here. My take on his election was published by the National Post. For his inaugural speech as president of the CMA, see this link.

John Edwards:

I’m going to be honest with you—I don’t know a lot about Cuba’s healthcare system. Is it a government-run system?

Amy Ridenour does a great job tackling the absurd treatment by the mainstream media and the political left (but I repeat myself) of this story. A man named Stanley Reimer killed his wife because, supposedly, he couldn’t afford to pay her medical bills.

Two thoughts:

1. I’m not surprised that the mainstream media and political left (I repeat myself again) are trying to use this as an indictment of our health care system. They seem to want life to imitate art. After all, if taking hostages resulted in nationalized health care in the movies, maybe a murder will make it happen in real life.

2. Does anyone doubt that Reimer is using health care expenses as an excuse for killing his wife? (Well, at least one dunderhead does.) Killers often use “societal trends” in an attempt to get off. Now that health care is such a salient topic, it was probably only a matter of time before a murderer tried to use “medical bills” in the hopes of getting light treatment.

According to “the most comprehensive analysis of the issue yet produced,” the U.S. has the best 5-year cancer survival rate of 22 countries studied. Although the Telegraph focuses on the dismal performance of Great Britain’s imploding system of socialized medicine, it also provides a chart showing the best performers.

Averaging the rates for men and women, the top five performers are as follows: United States (64.6%), Sweden (61.0%), Iceland (59.8%), Finland (58.5), and Switzerland (57.9%). The worst performer was Scotland. England was fifth from the bottom.

One of the most ironic findings involved the correlation between survival rates and per capita health care spending, Despite the fact that we are constantly bombarded by propaganda to the effect that U.S. health care is “too expensive,” that turns out to be an advantage:

A second article, which looked at 2.7 million patients diagnosed between 1995 and 1999, found that countries that spent the most on health per capita per year had better survival rates.

So, here’s a question for all of the people who claim that we in the United States spend too much on health care: Would you rather have a health care system that saves you money or one saves your life?

In his book, America Alone, Merk Steyn offers the following quip about Canada’s system of socialized medicine:

They’re now pioneering the ultimate expression of government health care: the ten-month waiting list for the maternity ward.

He goes on to tell the story of a woman who was forced to have her baby in Alberta because there were no maternity beds available where she lives in British Columbia. Well, it appears that the wondrous Canadian health care system has now perfected its ten-month strategy.

It turns out that the rare identical quadruplets recently born in Montana were delivered in the U.S. because the Canadian health care system had (you guessed it) no available maternity beds. The AP describes what the parents had to go through in order to find a hospital bed:

The Jepps drove 325 miles to Great Falls for the births because hospitals in Calgary were at capacity.

This is like being forced to drive from Boston to Philadelphia to find a hospital bed! Are there really people out there who actually believe it would be a good idea for the U.S. to emulate such a system?

Being perpetually in the market for health care myths to debunk, I should be grateful for idiotic “news” reports like this. I must confess, however, that I’m getting a little tired of repeatedly excavating the facts from beneath this particular pile of statistical manure. Nonetheless, I guess I’ll get out my shovel once again.

First, as David Hogberg explains here, there is no uniform standard for collecting and reporting national health indicators. Life expectancy stats from different countries are gathered using different criteria and methods. Thus, “life expectancy” in the U.S. is not the same thing as “life expectancy” in Bosnia.

Second, even if there were a uniform standard, there is no international agency that collects its own comprehensive data on life expectancy. The WHO, the OECD, and other such organizations simply accept what they are given by the various reporting regimes. And much of the information they receive is highly suspect.

Finally, even if a uniform standard existed and the reported data could be verified, life expectancy between countries is still not an “apples to apples” proposition. Factors like crime, poverty, obesity, tobacco use, and even the number of highways vary widely between countries and have a significant effect on such statistics.

The bottom line is that international comparisons of life expectancy data, as they are now being collected and reported, are virtually meaningless. Such comparisons are useful only to journalists with column-inches to fill, advocacy groups with axes to grind, and the ever-increasing hordes of the intellectually lazy.

The advocates of socialized medicine, their claims for Canadian health care having been repeatedly exposed as wildly inaccurate, are now promoting a new single-payer paradise: France. Economist’s View links to a typical example of this in the Boston Globe:

The WHO rated [the French system] the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country’s population.

As with similar claims made for Canadian health care, this is misleading.  As David Gratzer points out, French health care providers are not quite as “responsive” as the passage suggests:

During an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died.

As to the “health and longevity of the country’s population,” Frenchmen with prostate cancer might disagree:

The survival rate for prostate cancer is 81.2 percent here [in the United States], yet 61.7 percent in France.

And French health care isn’t cheap. The Globe piece makes a passing reference to its high cost, but fails to discuss the financial crisis outlined in The Guardian.

A government commission has warned that without fundamental reforms France’s national health service … will collapse within the next 15 years.

The French government made an effort to institute some of the “fundamental reforms” recommended by the commission, but its health employees were not amused:

Doctors and hospital staff on Thursday marched on the Health Ministry in Paris, accusing the government of planning to privatise medical care.

And then there’s that “best in the world” designation. As David Hogberg has pointed out, the WHO ranking includes:

… not only outcomes like how well a health-care system cures disease, but also something called “fairness in financing.”

This dubious standard deliberately stacks the deck in favor of government-run health care systems.  When it is removed, the ranking changes dramatically.

So, once again, the evangelists of socialized medicine are trying to pass off a sow’s ear as a silk purse. Aucune vente.

First Gratzer, now Catron. Sigh. I’m just not feeling the love on this blog right now.

Here is the crux of Catron’s argument:

To some extent, however, Hogberg is allowing the perfect to be the enemy of the good. It’s not without its problems, but Rudycare is vastly superior to anything put forward by the other Republican presidential candidates. And, goodness knows, it’s far better than anything we’re likely to get from Hillary.

So, despite the flaws that Hogberg so eloquently exposes, I’m still enthusiastic about “Hizzoner’s” plan.

However, to let the perfect be the enemy of the good, one has to be setting up the perfect as the standard, which I am not doing. Rather, it is the Mayor himself who has set the standard when he said, “The future of America’s healthcare system lies in free-market solutions, not socialist models.” How are the parts of his health care reform that expands government consistent with a “free-market solution”? They’re not.

No, one does not have to make the perfect the enemy the good to make a legitimate case that Rudy’s plan could be much, much better.

That will be the unofficial motto of our health care system should it be taken over by the government. It is important to keep in mind that politicians have to please voters to get elected, and any health care policy they make will, first and foremost, be designed to win votes. Whether it will actually improve our health will, at best, be incidental.

For proof of this, take a look at this article in the New York Times:

Despite promises by Congress to end the secrecy of earmarks and other pet projects, the House of Representatives has quietly funneled hundreds of millions of dollars to specific hospitals and health care providers under a bill passed this month to help low-income children.

Instead of naming the hospitals, the bill describes them in cryptic terms, so that identifying a beneficiary is like solving a riddle. Most of the provisions were added to the bill at the request of Democratic lawmakers.

One hospital, Bay Area Medical Center, sits on Green Bay, straddling the border between Wisconsin and the Upper Peninsula of Michigan, more than 200 miles north of Chicago. The bill would increase Medicare payments to the hospital by instructing federal officials to assume that it was in Chicago, where Medicare rates are set to cover substantially higher wages for hospital workers.

Lawmakers did not identify the hospital by name. For the purpose of Medicare, the bill said, “any hospital that is co-located in Marinette, Wis., and Menominee, Mich., is deemed to be located in Chicago.” Bay Area Medical Center is the only hospital fitting that description.

For those that don’t know, Medicare’s reimbursement rates are based on geography, with areas with a higher-cost of living getting higher reimbursement rates. Obviously, designating an area as part of Chicago (when clearly it isn’t) will result in higher reimbursement rates.

But, the Times does get one thing wrong:

The primary purpose of the bill is to expand the Children’s Health Insurance Program while enhancing benefits for older people in traditional Medicare. But a review of the bill by The New York Times found that it would also direct millions of dollars a year to about 40 favored hospitals, by increasing their Medicare payments.

No, the primary purpose is to maximize votes. People are more likely to vote for a politician if he or she is perceived as doing something for those adorable little crumb-crunchers. That’s why we do not have a State Trial Lawyers’ Health Insurance Program.

Next,

Representative Marcy Kaptur, Democrat of Ohio, won extra money for St. Vincent Mercy Medical Center in Toledo. Under the House bill, the hospital would be “treated as located in the same urban area as Ann Arbor, Mich.,” more than 40 miles away.

Lawmakers did not identify St. Vincent by name, but referred to a hospital with Medicare provider number 360112. That is the identification number for St. Vincent.

Scott E. Shook, senior vice president of St. Vincent, said this provision would bring $6 million a year in additional revenue to the hospital.

“Ann Arbor has a higher Medicare payment rate that reflects the higher wages there,” Mr. Shook said.

Steven D. Fought, a spokesman for Ms. Kaptur, said the congresswoman was happy to help because “St. Vincent is a major employer, a source of good jobs in a community that has been hard hit by globalization and grievously hurt by the loss of manufacturing jobs.”

Of course, what she doesn’t say is that there are quite a few votes to be won there as well.

The same thing will happen should we give the whole health care system over to the government. Politicians will use it as a way to maximize their election chances, with little regard to whether it helps people’s health.

Anyone on the left who tries to convince you otherwise is either naïve or dishonest.

My latest, in the pages of City Journal.

Rudolph Giuliani’s recently announced health care strategy has been getting mixed reviews. The Left’s carefully coordinated denunciation was, of course, no surprise. Less predictably, some free market advocates, like Cato’s Michael Cannon, have also been underwhelmed. David Hogberg is among those whose enthusiasm for Rudycare is tepid. His American Spectator piece on “Hizzoner’s” plan explains why:

The more I look at Giuliani’s plan, the more it seems to me that it is, to use a football analogy, a field goal at best. Not altogether bad, but quite a ways from a desired touchdown.

As the field goal analogy suggests, Hogberg likes some aspects of Giuliani’s strategy, particularly those features dealing with the FDA and the tax code:

Parts of his plan are quite good. For one, he wants to scale back the regulatory process at the Food and Drug Administration so it is less costly to bring new drugs to market. The best part of his plan is the tax exclusion that will allow those without employer-based coverage to have a deduction up to $15,000 for the purchase of health insurance.

So, what’s Hogberg’s beef? Well, his main problem with Rudycare is the expansion of government’s role as envisioned by the plan:

For example, it gives block grants to the states to “improve health care quality and make health insurance more affordable.”  Given the mess states have made in causing health insurance to be unaffordable, it’s curious why the Mayor wants to fund them with the expectation that they can now make it more affordable.

This is, of course, an excellent point. And Hogberg has similarly thought-provoking reservations about Giuliani’s vision of an IT partnership between government and the private sector, and his plan to allow the definition “affordable coverage” to be set by bureaucrats. 

To some extent, however, Hogberg is allowing the perfect to be the enemy of the good. It’s not without its problems, but Rudycare is vastly superior to anything put forward by the other Republican presidential candidates. And, goodness knows, it’s far better than anything we’re likely to get from Hillary.

So, despite the flaws that Hogberg so eloquently exposes,  I’m still enthusiastic about “Hizzoner’s” plan.

Louis Wittig weighs in at the Weekly Standard.

That headline is a shocker, I know. Go here for the CNN video.

First, Hillary says, “No other country has, that is an advanced country, has so many of its citizens without health care.”

Is the good Senator ignorant of EMTALA, which requires any emergency room to give treatment to any person who requires it? Perhaps what she means is that people do not have health insurance, but that is different from health care. And as nations like Britain and Canada have shown, having insurance does not guarantee access to health care. As the Canadian Supreme Court said upon ruling unconstitutional a law that banned private health care, “access to a waiting list is not access to health care.”

Next, Hillary says, “The outcomes in countries…that have a uniform national system are better, on balance, than they are in this country. I can give you the statistics, and you can shake your head.”

I wonder what statistics she is referring to? Life expectancy and infant mortality?

Finally, you’ll notice that Hillary’s response is delivered in that schoolmarm, authoritarian tone that (1) makes you prefer hearing nails on a chalkboard and (2) makes pretty clear that Hillary isn’t interested in listening to anyone who disagrees with her. And if you doubt that last point, here is her closing remark to that gentleman:

You come and introduce yourself to myself staff and we will try to give you some information if you are interested in being educated instead of being rhetorical.

Do we really want a woman who is so convinced of her superiority in charge of our health care system, let alone be president?

(Oh, and if you want a good sense of how screwed up our politics are when it comes to race, watch the clip that follows on whether Barack Obama is black enough.)

David: Great post!

However, I think that Pho op-ed came up a little short. The reason the compensation for PCPs stinks relative to specialists is Medicare’s “prospective payment system.” That system is pretty much one of price controls, and like all price controls, it either creates a shortage or a surplus – or, in this case, both. Medicare apparently underpays for services for PCPs and overpays for ones for specialists. Adding to this is that most private insurance companies follow Medicare’s lead when determining what to pay for services.

Thus, you have an entire reimbursement system that creates a shortage of PCPs and a surplus of specialists. Of course, for a price system to work properly it must be based on supply and demand, but that’s just a boring old notion from stodgy economists – no fun for social engineers.

And if you want to read about how Medicare’s prospective payment system came about, see this book. Actually a pretty good read for a very technical subject.

The Health Wonk Review features a post in which Matthew Holt, after seemingly interminable throat-clearing, stumbles across one of the most serious problems facing American health care:

We have a huge over-preponderance of specialists who both earn way more than primary care physicians, and use considerably more resources.

Unfortunately, Holt fails to comprehend the significance of his discovery. Like most “progressives,” he sees economics as a zero-sum game, and thus concludes that the way to build up the ranks of primary care is to prevent people from becoming specialists:

What’s the rational answer? Do what most other countries do and restrict the amount of specialty positions available. Instead insist that most physicians focus on primary care which is both cheaper to the system and more cost-effective.

The implementation of such an economically naïve policy would have virtually no effect on the shortage of PCPs. Its primary result would be the creation of an additional shortage—of specialists. Deprived of the specialist option, the best and brightest will not suddenly become willing to work for submarket wages.

We have more specialists than PCPs because the pay is better for the former than for the latter. Why is PCP reimbursement so anemic? Well, as Kevin Pho points out in a recent op-ed, it is the direct result of government meddling.

And, Holt’s fond illusions notwithstanding, in “most other countries” whose bureaucrats have attempted to “manage” physician supply, there are shortages of PCPs and specialists. In Canada, for example, such policies have backfired horribly.

One of these days, “progressives” will figure out that the halt cannot be cured by increasing the ranks of the lame. Unfortunately, they will probably do a lot of damage before they finally discover the free market.

My thoughts over at AmSpec.

From Britain:

Every one of Britain’s specialist trauma beds is full, which means some patients can wait up to three weeks after their accident before badly broken bones can be repaired. The delay, says Mr Bircher, can jeopardise recovery. With nothing but praise for frontline staff, he says patients who have been critically injured in road or other accidents have to wait an average of 12 days – often in agonising pain – before they can receive the vital specialist treatment.

Also from Britain:

Thousands of arthritis sufferers will be denied treatment with proven benefits by a decision not to pay for a new drug.

Guidance issued by the National Institute for Health and Clinical Excellence (NICE), the watchdog that controls access to drugs on the NHS, will recommend today that the drug does not represent value for money, although it has been shown to improve dramatically the severest symptoms of arthritis in almost half of patients….

Abatacept, which has the brand name Orencia, is the latest of a new generation of drugs to be blocked by NICE on the ground that it is not cost-effective.

About 400,000 people in the UK have rheumatoid arthritis, of whom a tenth (40,000) have a severe form. Many benefit from a class of drugs called anti-TNFs but about a third do not. This group, of around 12,000 patients, could potentially benefit from new drugs such as abatacept. Its manufacturer, Bristol Myers Squibb, estimated in its application to NICE that around 3,500 patients a year would benefit.

The Land Down Under also has some problems:

STAFF at one of Queensland’s biggest hospitals are being told to reject sick, elderly people transferring from nursing homes, and hastily discharge all other patients….

A day earlier, a report found almost 144,000 Queenslanders were waiting to see a specialist. Some patients’ files were marked “never” to see a specialist.

Other recent health problems have included a dire shortage of radiographers, with cancer victims forced to wait long times for treatment; and diagnostic equipment being shut down.

And remember all those lefties claiming that waiting lists in Canada are exaggerated? Well, looks like a study in Health Affairs suggests that Canada doesn’t do a very good job at measuring wait times:

The research, published in the journal Health Affairs, suggests that Canada needs to undertake some major policy initiatives if it wants to seriously improve access to care, including:

– Developing national standards for measuring and reporting waiting times;

– Measuring the total patient waiting time – beginning with referral from a family physician, to consultation with a specialist, through to treatment. (Currently, waiting times are measured from consultation with a specialist to surgery.)

I’m back to agreeing with David Hogberg about everything (well, not everything). Following up on his Wisconsin post, I’d like to highlight John Stossel’s take on CheeseheadCare.

Moore’s Sicko is the 4th most successful grossing documentary in history. Or is it?

According to the New York Post, Hillary Clinton will soon be playing nurse for the cameras:

She will work a shift as a nurse at a Las Vegas hospital next week, it was disclosed yesterday … The high-profile event is part of the Service Employees International Union’s “Walk a day in my shoes program.”

Although the mental image of Hillary emptying bed pans provides something of a frisson, the more ominous aspect of this story is her partnership with the SEIU. The union’s president, Andy Stern, is a vocal supporter of the kind of “universal” health care that Clinton wants to foist on the country.

Now, why would the SEIU be so supportive of Hillary and socialized medicine? Here’s a hint: the majority of the SEIU’s members are employed in health care or in government. So, regardless of which version of “universal” health care Hillary and her congressional accomplices impose on the country, the SEIU wins.

If we wind up with straight socialized medicine, the number of government employees will increase dramatically, providing more potential members. And, if we get a “single-payer” system, the legislation will almost certainly include some sort of financial “incentive” for hospitals to become unionized.

Next week, when the headlines are full of Nurse Hillary and the SEIU, think long and hard about this.

David, one quick comment on Giuliani’s op-ed, specifically this line:

Most Republicans believe in expanding individual choice and decision-making.

Let’s see: When the GOP was in charge of the Senate and the Oval Office, it passed COBRA and EMTALA, two major expansions of government regulation into health care. When the GOP controlled both house of Congress, it passed HIPAA, another big expansion of government regulation into health care, plus a new government health insurance program, the State Children’s Health Insurance Program (SCHIP). Now, Republicans like Orrin Hatch and Chuck Grassley are leading the charge for a big SCHIP expansion. Finally, Republican Senator Pete Domenici is pushing for a nationwide “mental health parity” benefit mandate, one that President Bush says he will sign if it passes.

“Most” Republicans believe in believe in expanding individual choice? Heck, I’d settle for half.

One of the more frustrating aspects of the debate over SCHIP expansion has been the reluctance of its opponents to clearly point out the prevarications being used to promote this fraud. So, the clarity of this Examiner editorial is refreshing:

Let’s revise the old saw about knowing when politicians lie. Instead of “when his lips are moving,” it should be “when he says ‘it’s for the kids.’ ” Exhibit A is the debate on reauthorizing the State Children’s Health Insurance Program.

That’s right. The advocates of SCHIP expansion are lying. The bills concocted by the House and Senate are not “for the kids.” Together, they consitute a Trojan horse built to decieve the electorate into accepting socialized medicine. The Examiner calls on SCHIP’s promoters to come clean:

Democrats should ‘fess up that their real goal is to socialize American medicine … They should also admit that they’ve spun their budget projections to conceal the fact that they will have to raise taxes to pay for their proposal … 

Fat chance.

It’s a lazy Sunday evening, and you’re looking for some interesting reading.

Here are my recommendations.

1) Allan Hubbard’s essay in the Wall Street Journal

In “A Tax Cure for Health Care”, Hubbard — assistant to the president for economic policy and director of the National Economic Council — makes a coherent case against expanding government programs like SCHIP and argues for tax reform as a way to truly reform American health care.

Unfortunately, little is made of the President’s domestic proposals, either on the Hill or on Mainstreet.

But, with health care, the President now has a sweeping vision, one that offers a robust alternative to the Democratic ideas. This essay will have little impact on today’s debate, but that may not be true in a couple of years.

A summary can be found here.

The essay, available to WSJ subscribers, is here.

2) Regina Herzlinger in the Washington Post

What do you do if you’re a powerful professional association, rich with cash and influential, while your membership has been battered and bruised in recent rounds of health care battles? If you’re the AMA leadership, argues Prof. Herzlinger, you ignore the big issues and go after small innovative companies.

Herzlinger, who is also a senior fellow at the Manhattan Institute (as I am), takes the AMA to task for its recent decision to legally attack RediClinics and other primary care chains.

The essay can be found here.

3) Goodman in the Wall Street Journal

SCHIP is a hot topic – and John Goodman weighs in, with the single most concise attack of the Democrats plan you’ll find.

As Goodman observes, even under the current system, children’s health insurance is increasingly a ruse to cover adults, for example, Minnesota spends 61 percent of SCHIP funds on adults while Wisconsin spends 75 percent.

A summary can be found here.

The essay, available to WSJ subscribers, is here.

David: Thank you for the post. I think the following question you pose gets to the crux of the matter:

Don’t you think there is something compelling about a candidate who sees this as a contest between socialism and market reforms – and favors the latter?

The question is a bit rhetorical — of course I’m going to find compelling a candidate who favors the market over socialism. The pertinent question is, to what extent does Giuliani favor the market? One thing that struck me about your post was that it quoted at length Giuliani’s remarks but only gave a few sentences to his actual proposal. I’ve been at this business a little too long to put a lot of stock in a candidate’s rhetoric. It is policy where the rubber meets the road.

Suffice at this point to say that it is his policy proposal that I find disappointing. The changes he wants to make in the tax code and the FDA are excellent, no doubt. But beyond that, I don’t see much to get excited about.

Why am I not excited? Well, you’ll have to wait a few days for my piece in the American Spectator on that.

AMERICA is at a crossroads when it comes to healthcare.

All Americans want to increase the quality, affordability, and portability of healthcare. The 2008 election presents a decisive debate on how to reach this goal.

The Democratic candidates for president believe in a government-mandated model that looks for inspiration to the socialized medical systems of Europe, Canada, and Cuba.

Most Republicans believe in expanding individual choice and decision-making. I believe we can reduce costs and improve the quality of care by increasing competition. We can do it through tax cuts, not tax hikes. We can do it by empowering patients and their doctors, not government bureaucrats. Instead of being more like Europe, we need to be more like America.

More:

[T]he healthcare system is being dragged down by decades of government-imposed mandates, wasteful bureaucracy, and massive distortions in the US tax code that punish self-employed and low-income workers. Since 2000, Americans have seen their health insurance costs nearly double. Frivolous lawsuits have led to defensive medicine and doctors leaving the profession. More than 45 million Americans are without health insurance.

Hogberg? Catron? Browning? The above comments weren’t made by any of us bloggers here at freemarketcure.com. Actually, the author is the former mayor of New York, Republican candidate Rudy Giuliani.

His comments, which appeared yesterday in the Boston Globe, are concise, intelligent, and, yes, free market.

Earlier this week, as has been widely reported, Mayor Giuliani announced his principles for health care reform. First and foremost: tax fairness for the millions not covered by employer-sponsored insurance. He outlined other ideas: Cutting drug prices by reforming the FDA, reigning in trial lawyers, encouraging states to drop costly regulations (esp. mandates), reforming Medicaid by using welfare reform as a template.

Sure it’s early. And we need to see the details before drawing firm conclusions on RudyCare. But what we’ve seen is quite promising. And, yes, I’ll confess my bias. But even the Wall Street Journal had kind things to say – and that editorial board tends to be hard to please.

With that in mind, I’m a bit disappointed with David Hogberg’s earlier posting. I almost always agree with you, David. And, when I don’t, it’s usually because I’m wrong.

But in this case, I think you may have been too harsh. Don’t you think there is something compelling about a candidate who sees this as a contest between socialism and market reforms – and favors the latter?

As if to confirm a widespread suspicion that the establishment media coordinate closely with the Democratic National Committee, America’s “news” organizations are speaking with one voice on the health care strategy outlined by Rudolph Giuliani.

The party line, it would appear, is that Rudy’s strategy should be dismissed because it is similar to that which President Bush outlined in January and is, therefore, not a serious plan. The word went out from the DNC as follows: 

Democratic National Committee spokeswoman Karen Finney said, “the Giuliani-Bush health care plan has already been rejected by the American people.

It wasn’t long before the party line was being parroted by most of the major “news” organizations. The Washington Post, for example, produced this: 

Health-care experts said the plan resembles a proposal from President Bush in his State of the Union speech this year. 

Newsday was also in strict compliance with the approved DNC talking points on Rudycare: 

The Myrmidons at the Los Angeles Times also chimed in with its version of the party line. 

The idea is very similar to one President Bush has pushed — to absolutely no avail in Congress. 

Even Jonathan Cohn at TNR, usually not so transparently partisan, obediently repeated the official propaganda: 

Giuliani’s general approach to reform-which, from the looks of it, is closely modeled on an idea President Bush proposed in January of this year. 

Ironically, Mark Santora at the NYT failed to read the memo. Predictably, he has been taken to task by the usual suspects for his failure to parrot the proper talking points. I predict that he will soon be delivering pizzas for a living.

The consistency (and rapidity) with which the media have repeated DNC talking points on his health care strategy suggests that they are worried about “Hizzoner.” They are evidently looking forward to a new Clinton era, and apparently have no intention of providing honest reporting on anything he proposes.

One thing that might prevent universal, government-run health insurance from coming to America is the price.

Back in April, the Connecticut State Legislature dropped plans to implement a single-payer system when the state Office of Fiscal Analysis estimated that the cost would be $12 billion to $18 billion a year. $18 billion was about the amount Connecticut spent on its entire state budget. (For a look at what it would cost to do single-payer nationwide based on Connecticut numbers, go here.) Even as liberal as Connecticut is, politicians there wouldn’t dare saddle voters with a doubling of the tax burden.

And if they aren’t going to do it in Connecticut, what are the chances they are going to do it in Wisconsin? From the WSJ:

Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is “free” health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker….

The last line of defense against this plan are the Republicans who run the Wisconsin House. So far they’ve been unified and they recently voted the Senate plan down. Democrats are now planning to take their ideas to the voters in legislative races next year, and that’s a debate Wisconsinites should look forward to. At least Wisconsin Democrats are admitting how much it will cost Americans to pay for government-run health care. Would that Washington Democrats were as forthright.

If Wisconsin Democrats really want to run on a platform of a doubling of the state tax burden, then they are insane.

Michael Franc of the Heritage Foundation points out that the SCHIP legislation now being debated in Congress bears an uncanny resemblance to a fallback strategy outlined by Hillary Clinton’s ill-fated health care task force:

“Under this approach,” the task force authors explained, “health care reform is phased in by population [group],” beginning with “the most vulnerable of our citizens — children.” Kids First, they admitted, “is really a precursor to the new [universal] system” under which states would receive “broad flexibility in its design so that it can be easily folded into … future program structures.”

Sound familiar? It should. This is precisely what is being proposed in the SCHIP reauthorization bills now being debated in Congress:

Following the script outlined in the task force memo, liberal lawmakers now want to expand SCHIP to “new populations” by increasing eligibility for this welfare-style benefit to children (including “slackers” up to age 24) in households with incomes as high as 400% of the federal poverty level.

So, anyone under the impression that the resounding defeat of Hillarycare in 1994 marked the end of Mrs. Clinton’s efforts to foist government-run health care on the country should think again.

Hillary and her accomplices are determined that you WILL take your socialized medicine, and SCHIP is their latest effort to accomplish that goal.