Health Insurance Reform

Mitt Romney may have a tough time raising enough money to be competitive in the general 2012 election.

His potential contributors are likely to decide that the GOP's 2012 presidential nomination is worthless. If they decide that Obama will be re-elected, they won't waste money on a Romney campaign.

The GOP nommination is almost worthless because Rick Santorum and Newt Gingrich have branded Republicans as social issues radicals and extremists, and Romney is almost as radical and extreme on those issues as Santorum and Gingrich.

Romney's big mistake, I think, has been his decision to defend the Catholic church leaders and the old white men who control other fundamentalists Christian denominations such as the Baptists and Evangelicals against President Obama's use of ObamaCare to dictate that all employers, including Catholic hospitals and universities, pay insurers to covere the cost of employes' contraceptives.

Instead of blasting Obama for mandating health benefits including contraceptives and sterilization for any employer or insurer, Romney, Santorum and Gingrich pandered to the church leaders. They all want the church leaders to support their campaigns. So they took the sides of the church leaders instead of defending all American workers against the use of ObamaCare to increase health premiums by mandating any benefits.

What Romney, Santorum and Gingrich showed is that they think federal and state mandated health benefits are just fine so long as they don't offend religious leaders. What workers want is not important to the candidates. They're not only Big Intrusive Government Republicans on social issues, they're also Big Intrusive Government Republicans on health insurance and health care issues.

The GOP's candidates have turned off conservatives who oppose mandated health benefits and individual mandates that everyone buy health insurance, but even more important, they've turned off Small Government Republicans, independents and women. The huge gender gap in the Michigan primary that favored Romney over Santorum shows how senstive women are to candidates who don't respect them or their rights. 

Look for Obama to win a big majority of women over Romney, assuming that he will be the GOP's candidate, as I do.

Mitt Romney introduced his economic reform plan today in USAToday. The 59 points follow:

Every Friday, Jennifer Rubin, the Right Turn blogger on the Washington Post web site, asks her readers a question. On Sundays, she picks one or two answers posted by commenters on her blog and comments on the thread that she started.

This week's question: "What does [Rick] Perry need to do to maintain his momentum and begin to minimize doubts about his electability?"

This morning she picked two answers. My post about my eight ideas for stimulating consumer spending and hiring was one of the two answers she picked out of a bunch of good comments that followed her question. That thread is here. My slightly edited and expanded version of my comment, which I posted on this blog, is here.

Rubin summarized the answers this way:

I was struck by two important assumptions running through the answers. First, unlike many in the right blogosphere, the readers did not dismiss criticisms of Perry out of hand or characterize them as creations of the liberal media. They want to put Perry through the paces, and they understand there are real concerns about his candidacy. Second, it is apparent that readers are sick of platitudes and one-liners; they want detailed proposals and an explanation as to how the candidate’s background equips him to deal with our current national challenges. If Right Turn readers are representative of the Republican primary electorate, the party is in very good hands. The primary process is a time for not only choosing, but probing and testing.

Over the last 35 years, there have been a lot of attempts to slow the growth in Medicare expenditures, which have continued to soar unabated because of poor policy making by both parties. 

Although the Budget Control Act of 2011 (S. 365) says the Joint Budget Committee that will try to agree on the next round of budget cuts won't be allowed to change Medicare's benefits, I think it should.

Here are some ideas for changing Medicare that would give consumers and providers strong financial incentives to increase access to care and higher quality care at lower costs per patient and per enrollee.

1. Means testing should be introduced to Medicare. 
2. Premiums should be upped 50% to 100% for the wealthiest beneficiaries, provided that they are allowed to buy non Medicare insurance in place of the lousy Medicare plan. That would take 5 million to 15 million of about 47 million beneficiaries out of Medicare and save billions, if not trillions.
3. The WSJ Health Blog reported on a study that estimated that defensive medicine costs $46 billion a year, or $460 billion over 10 years and growing. Tort reform is imperative.
4. Strip the pork and new public sector jobs built into ObamaCare from the budget and save close to $1 trillion.
5. Revamp Medicaid so that it serves the truly poor, and not every special interest group that votes Democrat. Save billions for the states and federal government.
6. Strip useless preventive care from Medicaid and Medicare and save more billions. Provide only the four preventive care services that actually save lives. Note that I've blogged on a Krauthammer column that reported that preventive services increase health care costs 162%. http://tiny.cc/k4hck
7. Stop using Medicare to subsidize over-staffed inner city and teaching hospitals and save more billions.
8. Reduce Medicare/Medicaid reimbursements for providers' payments to GE and its competitors for equipment maintenance contracts and save more billions.
9. Give consumers on Medicare and Medicaid strong financial incentives to buy reasonably-priced Medicare and Medicaid insurance plans and save more billions.
10. Stop all subsidies to people who want and buy Medicare Advantage plans and to the insurers who offer those plans and save more billions.
11. Spend more on fraud and abuse enforcement for M/M and save more billions.
12. Give workers stronger financial incentives to save for their health care expenditures after they reach 65 and save more billions.
13. Reimburse hospitals for only 50% of the health insurance premiums that they pay for employees. Many hospitals pay 100% of their workers' insurance premiums, which are soaring like everyone else's.

The Budget Control Act signed by President Obama today creates a Joint Committee of a dozen members of Congress. It's job is to cut the budget by Thanksgiving.

Everyone expects that the committee, which will be comprised of six members of the Senate and six members of the House with six from each party, will target Medicare, Medicaid and other health services for savings.

This is a slightly revised piece I'm posting on comments sections and on Facebook:

1. How would you like to have Obama cut your income by, say, raising your income taxes, forcing you to buy expensive health insurance mandated by ObamaCare, forcing you to buy expensive food and gasoline as a result of ethanol mandates and forcing you to pay for others’ preventive care even though they can afford to pay for it themselves?

Oh, you are having your disposable income cut. So you know how it feels.

But say you’re a hospital employee—a nurse, a receptionist, a technician, etc. And you’ve been taught guest relations skills so that you’ll help patients and be friendly. Your pay is cut. What happens to your attitude, your attention to details and how much you care about quality?

Cutting the pay of highly-trained, skilled health care workers will destroy much of the quality that we see in today’s health care institutions.

I’ve had to be in and out of hospitals a few times over my pretty long life, and I think that while care always was as good as the workers could make it, today’s care is exceptional. The people who have cared for me and mine have been friendly and attentive with minor exceptions.

2. I’ve covered the hospital industry since 1976 for Modern Healthcare, Health Care Strategic Managment and my blog. I’ve learned that hospital executives care about themselves first. They’re human.

Therefore, they care about their bottom lines second. Profits are important to both tax exempt and taxable companies. They care about physicians third, because the docs control them. Then they worry about their employees and patients in that order.

So hospital associations, which also care about themselves before they worry about their members, are most concerned about protecting their members’ bottom lines. They never suggest changes that cut government’s or private payers’ costs. This is why the AMA, AHA, CHA, etc. are looked at with such scorn and cynicism in Washington where everyone is looking out for number one—himself.

3. Medicare expenditures must be cut by reforming the system, not by cutting payments to doctors and health workers. While it’s impossible to motivate people, it’s very easy to demotivate them by threatening their incomes and their status.

4. Reform Medicare by adopting significant parts of Paul Ryan’s plan and modifying Medicare and Medicaid as much as politically feasible.

Give patients strong financial incentives to be smarter about using Medicare. And give physicians and institutions strong financial incentives to cut costs.

Let everyone make as much money as possible by increasing access and quality of care while cutting Medicare expenditures per enrollee and per patient.

Providers have no control over disease outbreaks nor demographics, which is why controlling the rate of growth in health care expenditures is so difficult.

If the Joint Committee focuses on problem solving instead of politics, it can take $1 trillion to $3T out of Medicare over 10 years.

I assume politics will cut the real savings to about zero.

What I want GOP candidates to promise:

On Thursday, Mitt Romney, a yet-to-be-announced presidential candidate, will try to get the RomneyCare Massachusetts health insurance disaster off his back. 

Romney experimented with health insurance markets in Massachusetts, and his stab at increasing access to health services while containing costs has failed big time. Health insurance is more expensive and health care is harder to get in Massachusetts under Romney care. And 100,000 still are uninsured.

RomneyCare's costly failures will dog Mitt Romney until he explains how it has gone wrong and how he would fix the politically distorted health care and health insurance markets. So far, he's called for repeal of ObamaCare, but he seems incapable of showing that he's learned from RomneyCare's mistakes. Sally Pipes, a leading analyst of health insurance and health care markets in Canada and the U.S., spells out the cost of RomneyCare for Forbes. http://tiny.cc/zqwti . Impact graphs:

A Florida Federal District Judge who today ruled ObamaCare (PL 111-148) is unconstitutional because it mandates that all Americans must buy government-approved health insurance also ruled that the law's provisions that force states to spend more on Medicaid is constitutional according to case law. The only thing that will save the states on the Medicaid issue is the judge's ruling that the unconstitutionality of the mandates makes the whole law unconstitutional. Links:  Decision on Florida v. DHHS. Scholars, politicians discuss the ruling here.

A "comprehensive list of tax hikes in ObamaCare" is here.

The Weekly Standard says this is the text of the two-page "Repealing the job-killing health care law act" that would repeal ObamaCare (Public Law 111-148).

The conservative Heritage Foundation is being delusional with its recommendations for reforming ObamaCare. Much of what it wants to do is politically impossible, and it avoids doing the hard work of digging out the line items of pork that could be defunded and repealed. AEI, another conservative think tank in Washington, however, offers a much more realistic appraisal of what has to be done with ObamaCare. Repealing ObamaCare and getting health care right, by Nina Owcharenko. Beyond Repeal and replace, by Thomas P. Miller. Republicans should be able to find $500 billion worth of pork to cut in ObamaCare, by Donald E. L. Johnson.

Like all "comprehensive" bills passed by the Democrats, ObamaCare and the failed stimulus law of 2009 are full of pork and wasteful spending. Republicans should have no trouble finding $500 billion worth of savings in ObamaCare, otherwise known as the Patient Protection and Affordable Care Act of 2009  (PL 111-148). Just scan the summary that I've linked to. You'll see lots of provisions that can be killed and defunded. Start by defunding the dozens of new bureaucracies and research projects funded by the bill. GOP plans to use purse strings to fight health law, by Robert Pear.

A little over a year ago, I spent several hours reading, summarizing and commenting on sections of the ObamaCare bill. I'm linking to those summaries and to articles and commentaries on the bill for anyone who wants to get a feel for the mess that Obama Democrats created and that Republicans will spend the next 20 years trying to fix, if not repeal it. I just spent more than an hour reviewing my summaries, and ObamaCare looks as bad now as it did before it was passed last spring. Most of the provisions reviewed are in the final bill, I think.—except for the controversial abortion provisions. Will anybody read the bill before they vote on repealing it?

Mike Fallon, M.D., Wednesday gave the one best talks on health care economics and policy that I've heard since 1976 when I started covering health care deform. He certainly showed that he knows more about health economics and policy than any Republican who's in the U.S. House of Representatives today. More with links after the jump: