Thursday, March 31, 2011

That Government Takeover Thing

[Cross posted from Doctors for America Blog.]

As many of us in DFA know, one of the more fevered arguments against the PPACA, both before and after its passage, was the cri de guerre, "It's a government takeover of health care!"

This argument left me often fumbling for an answer. I know enough about international health care, and enough about our true homegrown versions of government health care (the VA, TriCare, the Indian health Service) to know that PPACA ain't it. Not even close. Trying to explain the difference among single payer systems and true government runs systems and private but universal systems, did not cut the mustard (or get through the neural programming, George Lakoff would say). "Obamacare" was a government takeover, and I was just a dupe if I couldn't see it.

Apparently, the answer was in plain sight, and I just was not aware of it. While researching another topic, Google took me to an interesting, but very public place that I had overlooked before. It is on the web site from over a year ago, and billed as "Courtesy of the Senate Republican Policy Committee":  159 Ways the Senate Bill Is a Government Takeover of Health Care

As you scroll through the list, you might get the feeling that every single line in the bill represents a fundamental alteration in health care as we know it, changing our current "system" into some form of crypto-socialist mockery of the free market system we're all so pleased with. I guess a conservative minded person might indeed scroll through all of these initiatives and gasp in horror, but as I read through it, it seems like a very good list for us to trot out and show all of the good stuff actually in the bill!

The idea that various projects and initiatives to promote administrative simplification on insurance claims, to promote quality of care in the Medicaid program, to promote Patient Centered Medical Homes,  grants to support physicians and others entering primary care and geriatrics, to develop quality measures, to figure out how to align payment incentives to promote the best patient care, and on and on, that these somehow represent a sinister plot requires epic, delusional almost, paranoia.

One of our kids' favorite books growing up was "A House is a House For Me." It was a delightful exploration of how, when looked at with the appropriate viewpoint, everything was a house: a sock for a foot, a shell for a hermit crab, or a tree for a monkey.

So, in the minds of the GOP Senate Republican Policy Committee, any law or regulation or initiative, can be a "government takeover." This is not new, of course, Ronald Reagan famously opposed Medicare as the clear path to Soviet style communism, and the John Birchers, now resurgent, thought former Supreme Allied Commander and then President of the United States Dwight Eisenhower was a Soviet agent. The difference now is that this is mainstream political rhetoric, even articles of faith, in many circles.

So, in our new book, "A Regulation is a Government Takeover To Me!" we will explore how there are really no legitimate functions of government, Constitution notwithstanding. Protecting air and water safety is a government takeover of drinking and beathing,  food safety rules are takeovers of eating, and promoting homework and hard work in school is a takeover of parenting. See how that works? Although, I understand that all limitations of birth control and sex education are intrinsically appropriate uses of government.

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Wednesday, March 16, 2011

What Would Jefferson Do?...Dissent Magazine

Dissent Magazine - What Would Jefferson Do? How Limited Government Got Turned Upside Down

Surveying the wreckage of the Great Depression,
Roosevelt simply told his followers that “the average man once more confronts the problem that faced the Minute Man,” because “[a] small group had concentrated into their own hands an almost complete control over other people’s property, other people’s money, other people’s labor—other people’s lives.”

Roosevelt’s analysis of “economic tyranny” shared a critical assumption with Thomas Jefferson and James Madison and other important founders of our country: that limited government is not an end itself, but the instrument of a particular vision of society, an egalitarian vision. It was a social vision in which extremes of wealth and poverty did not exist, and a relatively equal distribution of productive property secured independence and freedom for the whole citizenry.

As historian James L. Huston writes, it was against the “political economy of aristocracy,” government organized by and for a small, wealthy elite, that supporters of the American revolution embraced the “egalitarian promise of the negative state.” The ideal, simply, was a system that restricted the legal and political power of the wealthy, in order to prevent them from combining against independent smallholders and those without property. Limited government, in other words, was a “populist” ideal, a doctrine of the many versus the few. As a group of North Carolina democrats petitioned in 1776, when “fixing the fundamental principles of Government,” the goal should be to “oppose everything that leans to aristocracy or power in the hands of the rich and chief men exercised to the oppression of the poor.”
Clearly, for Jefferson and Madison (as for Taylor), the republican social objective of securing a relatively equal distribution of productive property was paramount in their thinking about what government should or should not do.
OK, just go read it already!...........................

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Saturday, March 5, 2011

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health:

 "Record surpluses amassed by not-for-profit Blue Cross and Blue Shield plans during the first nine months of 2010 could be used to price products more aggressively next year. And that could put pressure on competitors to hold down their rates or risk losing market share, according to one equities analyst. But other industry observers tell HPW that Blues plans are more likely to hold onto their surpluses due to increased regulatory scrutiny over rate hikes and the unknown financial impact of the health reform law."

I mainly put this here to remind me of the Medical Loss Ratio implications of PPACA, specifically the minimum requirements coming into effect this year. The fact that NOT FOR PROFITS don't meet these standards voluntarily, eagerly and easily tells you almost all you need to know about our broken system, but go to the link and scroll down and see the MASSIVE financial reserves these guys are amassing.

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Thursday, March 3, 2011

In Norway, Start-ups Say Ja to Socialism

In Norway, Start-ups Say Ja to Socialism

At one point, I asked Wiggo Dalmo why he was still working so hard to expand his company: Why not just have a nice life—especially given that the authorities would take a hefty chunk of whatever additional money he made? "For me personally, building something to change the world is the kick," he says. "The worst thing to me is people who chose the easiest path. We should use our wonderful years to do something on this earth."

When I got back to the United States, I had a beer with Bjørn Holte, the CEO of bMenu, whom I'd first met in Oslo. It was early November—days after the congressional elections—and Holte had just arrived in New York City, where he is opening a new office. We talked about the commercial real estate market, the amazing cultural diversity in a city that has twice as many people as his entire country, and the current debate in the United States about the role of government. Holte was fascinated by this last topic, particularly the angry opposition to President Obama's health care reform package. "It makes me laugh," he says. "Americans don't understand that you can't have a functioning economy if people aren't healthy."

Holte's American subsidiary pays annual health care premiums that make his head spin—more than $23,000 per employee for a family plan—and that make the cost of employing a software developer in the United States substantially higher than it is in Norway, even after taxes. (For a full breakdown, see "Making Payroll.") Holte is no pinko—he finds many aspects of Norwegian socialism problematic, particularly regulations about hiring and firing—but when he looks at the costs and benefits of taxes in each country, he sees no contest. Norway is worth the cost.

This issue of Inc. ended up in my mailbox instead of my subscribing neighbor's. Divine providence, clearly.

You will be shocked, I know, that there are hard working people who are not Americans and that there are other health systems that don't hobble businesses.

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JustLists' 30 Significant Medical Achievements and Their Country of Origin

30 Significant Medical Achievements and Their Country of Origin :

"Much debate occurs today about whether a country’s chosen health system impedes or encourages discovery and invention in the medical field. The fact is… innovation occurs wherever fertile and creative minds are trying to address real human need. Here is a list of a few significant discoveries/inventions:"

This is just too good a list not to share! Have fun showing it to your friends and frenemies!

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