Archive for category Health Care

Does Primary Care Actually Save Money?

One of the arguments for Obamacare has been the claim that increased access to primary care will result in long-term cost savings, but studies show conflicting results.  The theory in favor of this is that early detection will allow treatment in earlier stages.  The theory opposed to it is that keeping people alive costs money, as well.

Still, before we commit to a government takeover of health care, isn’t there a pretty simple experiment that we could run to find out?  If access to primary care really does save money in the long run, why aren’t insurance companies providing incentives to the insured to make more and better use of their PCPs?  There are some experiments in the works to incentivize doctors to be more accessible, and Anthem is even cutting them in on the presumed savings.

But the problem may be on the demand side as well – people just don’t like going to doctors, and not only because of the wait times.  Presumably the problem isn’t just putting off going to the doctor when you’re sick, it’s also putting off the routine physical or the annual checkup that could catch trouble early, before there are any symptoms at all.  So why not cut the co-pays?  Or why not mimic the safe-driver discounts and rebate an increasing portion of the co-pay for every year you go for your physical?  The latter would also help create the habit of going to the doctor regularly.

Insurance companies live and die on the sort of actuarial math that would let them detect any positive results from these experiments pretty quickly.  And if anyone is culturally geared not to fall for the fallacy of the seen and the unseen, it’s insurance companies.  (The fallacy states that people fall for redistributionist schemes because the beneficiaries are immediately identifiable, while the costs are distributed among the many.  In this case, presumably, the beneficiaries are largely unseen, while everyone sees the hit to the bottom line.)

So, is there are good reason that insurance companies don’t do this?  Is it just that they haven’t thought of it, or is there actual evidence that it doesn’t work?  Is anyone aware of any results from the Anthem experiment that show one way or the other?

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Everything Ends Up Subsidized Or Illegal

We are Orthodox Jews.

We keep kosher.

And as we all know, kosher meat is expensive.  A typical cut of kosher meat is something like twice the price of a comparable non-kosher cut.  Ground beef is at $2.49 a pound?  Kosher ground beef runs about $4.99 a pound.  I just check the price of ribeye.  Treif at $6.99, it’ll run you $14.89 a pound at the East Side Kosher Deli.  (They’re not necessarily gouging here in Denver; it’s that way everywhere.)

Now, Susie just got a mailer from the Colorado Democrats stating that Mitt Romney would “[take] away vital health services for women,” by, “[signing] laws allowing your employer and your insurance company to make your birth control decisions.”  Presumably, they mean he’d repeal the HHS Mandate requiring employers and insurers to pay for employees’, without co-pay.

They’re arguing that, now that such coverage is the law, going back to making someone pay for it themselves is the same thing as “restricting” it (their word), or allowing someone else decide whether or not you use it.

So what this means is that you, every one of you now reading this piece (unless you also keep kosher), are deliberately restricting Susie and me from our Constitutional right to keep kosher.  You are in fact making our food choices for us.  Unless, of course, you take out your checkbook right now and send Susie and me a check to cover the difference in cost between kosher and non-kosher meat.  And you wouldn’t want that on your conscience, would you?

This is the reductio ad absurdum of the liberal line that not having someone else pay for something legal that you want is the same thing as restricting it.  So ultimately, everything is either free or illegal.

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I Guess We Are the 1%

This afternoon’s mail brought a letter from UnitedHealthcare, my insurance company from a previous job.

“They never write you to say they’re giving you back money,” said Susie.


The Affordable (sic) Care Act requires UnitedHealthcare Insurance Company to rebate part of the premiums it received if it does not spend at least 80 percent of the premiums [it] receives on health care services…

In 2011, UnitedHealthcare Insurance Company spent only 79% of a total of $58,159,006,54 in premium dollars on health care and activities to improve health care quality. Since it missed the 80 percent target by 1% of premium is receives, [it] must rebate 1% of the total health insurance premiums paid by the employer and employees in your group health plan.

I’m always happy to get money back, and getting money back from an insurance company is particularly delicious.  But you know, it’s a little like finding out you won that game with Florida State three years ago because they committed a recruiting violation.

In all seriousness, what business is it of the government’s what G&A margin a private company has.  For some reason, 20% is exactly right, but forcing 0% borrowing on these clowns is a violation of every holy democratic republican principle since the Romans.

Of course, we’ll take the money, though.

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Adolescence Just Keeps Getting Longer

Two posts getting some attention today.  First, this from Derek Thompson at the Atlantic:

And then this, from Taylor Cotter over at the Huffington Post:

I suppose that I’m grateful that I can make all my car payments and start saving for retirement while most of my friends are living at home and working part-time jobs — but I often find myself lamenting the fact that I’m not living at home and not working a part-time job. From my perspective, these are just some of the life-changing, character-building experiences that I may never have.

Now, it’s easy to laugh at Taylor, and Lord knows, I have.  Oh, the struggles of not starving, not having to live at home.  The horrors of being able to go out for drinks and read a book from time to time.  The sheer insipidness of knowing that your rent is paid and there’s food on the table.  Really, who wants to live like that?

But at a more serious level, the fact that she seriously thinks that she’s missing out on something by not spending mandatory time in her parents’ basement or her old room, shows that that may slowly be turning into the norm.  It slows down adulthood, accumulation of both social and financial capital, and becomes harder and harder to reverse.  Subsidizing the trend by putting 25-year-olds with masters degrees on their parents’ health insurance only aggravates the problem.

As young Taylor shows, it can become a desirable thing to start off your life that way.  And when you think about it, why stop at 26?  Or 30?  Why not keep going all the way to early retirement.  (Retirement from what? If you have to ask, man, you just don’t get it.)  Well, the Greeks and the Spaniards show why.

Michael Barone likes to say that American has the worst 18-year-olds and the best 30-year-olds.  That’s because the time immediately after college toughens kids up, and teaches them what the real world is like.

God help us when 40 becomes the new 30.

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A New Form of Revenue

Just as physicists long ago realized that light is neither a particle nor a wave, the Democrats have now, evidently, discovered a form of revenue that is neither a penalty nor a tax:

President Obama:

David Axelrod.

Deputy Campaign Manager Stephanie Cutter:

Austan Goolsbee:

HHS Secretary Sebelius:

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A Loss Wrapped in a Tie Shrouded in a Defeat

References to yesterday’s 98th anniversary of the assassination of Archduke Franz Ferdinand may be overwrought, But contrary to those who see this as a win disguised as a loss inside of a tie wrapped in a stalemate, it was a loss.

Yes, the Court may have drawn some lines with regards to the elasticity of the Commerce Clause, but replacing the ever-elastic Commerce Clause with the taxing power isn’t necessarily a win.  Especially as conservatives have always held that property rights are a key underpinning of political rights.  There is nothing here that necessarily keeps Congress from doing what it pleases, as long as the penalties are collected by the IRS.  What happens then, if they add on an additional provision that, much like student debt, you can work off your sins against the state, but you can work it off more quickly in certain favored ways?

I’ve also heard it asserted that in the political climate, it will make it more difficult to pass large changes, since they’ll have to use the taxing power.  This seems overly-optimistic to me in at least three ways.  First, the ruling in no way begins to roll back nearly a century of mistaken Commerce Clause jurisprudence, and if anything has shown, it’s that the current boundaries of the Commerce Clause are plenty broad enough to contain all sorts of trouble.

Second, I doubt that further massive changes are on the agenda, anyway.  The gargantuan administrative state that this law is going to require, the tens of thousands of pages of regulations and rules and boxes to check off, will provide more than enough machinery for Change as they stand.

But mostly, it’s not as though the individual mandate was ever sold as a tax in the first place.  Taxes may be toxic, but the Court ruled – probably correctly – that something doesn’t have to be expressly declared a tax in order to be valid under the taxing authority.  Even the silver lining here is double-edged: what can be repealed under reconciliation can be passed under reconciliation.  And repeated use of the phrase, “taxing power” has the ability to drain the word “tax” of its deserved fearsomeness.

In terms of this election, it’s certainly a net plus.  It will make Obama’s life miserable on the campaign trail, as he finds himself explaining that “it all depends on what the meaning of ‘tax'” is.  Those who have been calling for him to play against type an imitate Clinton probably didn’t have that part in mind.

It also means that it’s true, as Romney will now say, that “in order to get rid of Obamacare, you have to get rid of Obama.”  The Court essentially eliminated the severability clause between Obama’s presidency and this law.

But this election really is the game.  Not only would Obama’s re-election, or the retention of a Democrat Senate, ensure the eventual transformation of freeborn citizens into subjects, even a victory doesn’t guarantee victory.  The electoral wipeout of 2010, and its foreshocks (Scott Brown) and aftershocks (Keith Judd), have left the Democrats undeterred.  To believe that they won’t use every Senatorial procedural option available to them is probably to hope for too much.  Even the hoped-for lame duck period between November and January will be fraught with opportunities for administrative mischief.

If elections are to continue to have meaning, if indeed, they haven’t already been emptied of their power to reflect change in any but one direction, this one needs to count.


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Health Care, Religion, Government, and The Left – Part II

Last night, I posted some audio of lawyers at a loss for words at a panel discussion on religion and government.  This morning, I’d like to post another clip from the Q&A, one that I think is particularly revealing about the left’s attitude towards religious liberty.  The commenter is Ed Kahn, the lawyer for the Colorado Center on Law and Policy, and he’s discussing to what extent a hospital’s association with a religious body should matter.  Shorter answer: none.  But let him tell you himself.

(The audio quality here is markedly worse than the clip last night from Ms. Hart.  I think it’s a combination of Mr. Kahn’s voice and the fact that he was sitting farther away from the mike, but there’s a persistent hiss.  I ran it through the noise reduction algorithm, and while it got rid of most of the hiss, there’s a residue that makes it sound like he’s talking from the engine room of a starship, if the engine were powered by boilers, but I think it’s easier to hear than the raw sound.)

They can close shop on Saturday, but that doesn’t make them like a church or synagogue in my view.  And if they’re going to hold out their product or their service to the public, then they should not be able to mandate that their religious beliefs to which they subscribe, that the results of that belief should be visited on the people who are entitled to sign up for that service.

If there’s a market where comprehensive health care is available without restriction, and people understand that, then maybe it’s ok for somebody to say that we’re a Catholic health insurer and our hospital is going to be open six days a week, but our emergency room will be open on the Sabbath.  But in general, I think that if you’re providing a public service that is a necessity, especially, that it ought to be provided across the board, and the law ought to require it as a condition of licensing.

Some states do say to Catholic (unintelligible) hospitals, “You cannot restrict (unintelligible) abortion, you cannot restrict contraception services or tubal ligation,” and that, I think, is the better standard.  So I start there.  I think the concept that these organizations are health care, providing what’s a necessity, not simply a good like a candy store, overrides the ability to finesse what services they will or won’t provide, given an economic necessity or need, especially in monopoly situations.

There’s almost too much here to unpack, but let’s give it a try.  It embodies almost all the current liberal assumptions about having a right to other people’s work product, and the inconsequentiality of others’ religious beliefs, to the extent that they differ from your own.

The phrase that really popped out at me was this: “…people who are entitled to sign up for that service.”  Who talks this way, about people “signing up for a service?”  The Left, apparently.  Remember when Michael Moore rolled up to congressmen, asking them if they would be willing “sign their kids up to serve in Iraq,” as though it were a particularly violent venue for sleep-away camp.  Seventh-graders are “entitled to sign up for” band.  Adults purchase products and services with their own money.  Seventh-graders buy things, too, generally with their parents’ money, which leads them to feel entitled.

The statement provides a case study of the inevitable intersection between social issues and economic ones.  The Left feels entitled to sign other people up to do things for them, without realizing that at a minimum, there’s an opportunity cost.  Grant the dubious proposition that All Hospitals Are Created Equal, that you can require anything calling itself a hospital to provide a menu of services at all times, in all places.  They still can’t pay for the staff, facilities, and equipment to be perpetually on-call for every conceivable service or procedure.  They will have to make choices.  And since they are the ones providing the services, their own priorities and values will and ought to guide those choices.

That’s really the only fair way to decide.

If Charles Bronson were still around, he might reprise his scene from The Magnificent Seven where he throws the Mexican child over his knee and whacks him a couple of times for ingratitude, reminding him that his parents don’t do everything for him because they have to.  (Hey, you want to be treated like a child?)  Nobody makes the church or churches run these hospitals in the first place, except themselves from their own religious conviction.  If that same religious conviction prevents them from providing other services, Planned Parenthood should just see that as a market opportunity.

Of course, the same law that enables the HHS Mandate also makes it virtually impossible to open new, specialized, physician-owned hospitals, thus providing further justification for commandeering existing facilities.


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The Sound of Silence

This evening, I attended a panel discussion at one of the local synagogues on the topic of religion and government.  It was sponsored by the very liberal National Council of Jewish Women, and featured four attorneys: Melissa Hart, Assoc. Prof. of Law and Director of the Byron White Center for the Study of Constitutional Law at CU, Ed Kahn, Special Counsel for the Colorado Center on Law and Policy, Dan F. Lynch, Attorney, Teacher and Author, and Rebecca T. Wallace, Staff Attorney, ACLU of Colorado.  (In case you’re wondering whether Mr. Lynch was there for balance, I can assure you he was not; his primary concern seemed to be the imminent threat of Christian Zionists manipulating our government into starting WWIII to hasten the Apocalypse, or something like that.)

The panel was somewhat interesting, as these things go.  The audience was mostly liberal, and the panelists were never really challenged.  Most of what they said would be pretty unremarkable to anyone familiar with the leftist cant about religion in the public schools, public square, and private hospitals.

Until the last question, submitted by yours truly.  It’s a question that was inspired by a Spengler column a couple of months back, at the height of the HHS Mandate controversy, and let me hasten to assure you that except for cropping out Mr Kahn’s basically non-responsive answer at the end, and bumping up the volume, I have not edited this clip at all:

The silence – finally ended by Mr. Kahn wishing aloud that someone else would take the question – is 9 seconds long. 

Nine seconds long.

That’s roughly an eternity, when you have four lawyers on a panel.  There is no charitable interpretation of this silence, the only explanation being that they simply hadn’t considered the question before.  (Ms. Hart’s answer, that kosher slaughter is central to the Jewish religion, at least relieves us of the fear that they don’t really care about kashrut; like most Conservative or Reform Jews, they’re happy to have it around, even if they don’t practice.)

Ms. Hart’s response, that she has “faith” that the legal system would never do such a thing will be of slight comfort to conservatives who’ve seen the courts do many previously unthinkable things in the last half-century, but I will admit that I was only partially successful in hiding a wry smirk.

Like so many who inhabit the lefty echo chamber for a living, the panelists simply fail to consider that the results of their activism might one day be turned against something they care about, and have no good answers when their assumptions are challenged in a constructive, rather than confrontational, way.

Maybe they should have just stayed silent.

UPDATE: I’ve filtered out some of the noise from the sound clip, and attached the following transcript:

Moderator:  OK, I have maybe a technical question.  Assuming the HHS Mandate – and if you answer this question you can tell us what that is – is allowed to stand, suppose that a government office were to decide that kosher slaughter violated the relevant animal cruelty statues.  How would you persuade them, or persuade the judge, to continue to permit kosher slaughter?

[9 seconds of silence]

Mr. Kahn: I hope someone else will take this.

Moderator: Now we see which of them has studied the Talmud.

Ms. Hart: So, one of the things that gets harder when politics gets stranger, as it is right now, but one of the things that I say to all of my first-year Civil Procedure students is that I have a very deep faith in law.  I believe that to practice law and to love law, as I do – civil law – you have to have a great deal of faith in law and in the (unintelligible) practice in law, including the courts.

HHS is Health and Human Services, and I assume the question is referring to the provision – to the question about the abortion and contraception provision.

I – (2 second pause)  have faith that no court would find that a state could outlaw rules of kosher under animal cruelty provisions, that the centrality of the kosher rules to the Jewish faith, and the lack of any kind of question of that is so clear, that even a law that seemed to be neutral, and animal cruelty law, would not pass (unintelligible) as a way of forbidding the laws of kosher.  I don’t believe that because of any precedent that tells me that that’s definitely true.  I believe that because I have faith in the courts not to go to that extreme.

If if you’re looking for precedent and the arguments you would make from precedent, I would go back to the law that I talked about briefly in the beginning, the Lukumi Babalu Aye case, that actually was the state’s, the community’s ban on animal sacrifice was an animal cruelty provision.  And the courts were willing to look behind it and say there are other ways to prevent cruelty to animals than this kind of prohibition.  So I think that courts have addressed animal cruelty provisions in the context of religious laws before – this is a quite different kind of religious law – and have found that they’re able to separate these things out and should separate these things out and I believe that they will continue to do that.


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Inverting the State/Civil Society Relationship

That to compel a man to furnish contributions of money for the propagation of opinions which he disbelieves and abhors, is sinful and tyrannical. – Thomas Jefferson, Virginia Status for Religious Freedom

You can quote Jefferson like scripture.  But this is one of the three acts he had put on his tombstone, so I’d wager that he would stand by it, if pressed.

The President’s attempt to force Catholic hospitals to provide services forbidden by their religious beliefs have been roundly – and rightly – attacked as an assault on religious freedom of conscience.  Over-fond of the non-establishment clause, many on the left have forgotten the free exercise clause.

But combine this power grab with an earlier money grab, and a darker pattern emerges.  Remember, early in his administration, Obama floated a proposal to limit the tax-deductability of charitable contributions for high-earners.  (This proposal has recently been revived at the state level in Maryland.)  After all, the government needs the money.  Needs the money more than any private charitable organization needs it.

The safety net has always been sold – an accepted – as programs of last resort, intended for those for whom private organizations would not or could not care.  But by taking money away from charitable organizations for itself, Obama is reversing that equation.  To him, these services should be provided first by the government, and then civil society can fill in whatever it can with whatever the government decides to let it keep.  Moreover, it can’t even really decide what services to provide in accordance with the dictates of it conscience, but needs to provide what the government requires or permits it to.

When viewed as a package, the HHS regulations and the proposed tax law changes constitute less an attack on religion per se, and more an assault on the primacy of civil society.  Not content with filling in the gaps, the government has moved from that to competition with private charities, and any competition involving the government is inherently unequal.  This is exactly the sort of thing he has in mind for a second term, when he’ll be testing and often exceeding the limits of executive authority to enact his agenda, with or without Congress.

No wonder he doesn’t care if the Senate ever passes another budget.

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Justice Kagan, You Got Some Splainin’ To Do

As we know, Elena Kagan was the Obama Administration’s Solicitor General at the time that Obamacare was being drafted, and its legal defenses were being constructed.  As a result, some Republicans have called on Justice Kagan to recuse herself from cases involving Obamacare when they come before the Court.


Now this, from the Daily Caller:

Newly released documents reveal Supreme Court Justice Elena Kagan was more involved with President Obama’s health-care law than she disclosed previously. The documents likely will lead to a revival of questions about whether the Kagan should recuse herself from future cases.

In an email dated Jan. 8, 2010, then-Deputy Solicitor General Neal Katyal sent an email to Senior Counsel Brian Hauck and Deputy Attorney General Thomas Perrelli that indicates Kagan played a key role in coming up with a legal defense.

“Brian, Elena would definitely like OSG [Office of Solicitor General] to be involved in this set of issues … we will bring Elena as needed.”

In an email on March 21, 2010, Katyal urged Kagan to attend a health-care litigation meeting on defending the law. “I think you should go, no?” wrote Katyal. “I will, regardless, but feel like this is litigation of singular importance.”

This isn’t open-and-shut, of course.  The first email says that Elena wanted OSG, not herself, to be involved.  But Katyal’s response isn’t to name the deputy that Kagan wants to go in her stead, it’s to name Kagan herself.

Later, indeed 10 weeks later, Katyal is telling Kagan he thinks she should be at another meeting to craft legal strategy.  There are two ways to read this.  The first is that 10 weeks later, it’s not clear to Katyal that Kagan – his boss – wants nothing to do with this bill.  The other is that the tenor of the email is slightly pleading, making the case for the importance of the legislation.  Would Katyal need to do that if Kagan had been involved before, or perhaps the SG was busy enough that, like all subordinates, is struggling to get on his boss’s calendar.

Either way, the House Judiciary Committee should immediately subpeona any and all OSG emails concerning Obamacare, and get a court order barring the OSG or Main Justice from destroying any of them.

I’ve always personally felt that this was a matter of the appearance of impropriety as much as anything else.   While I really couldn’t imagine any Solicitor General being cut out of discussions on any administration’s signature pieces of legislation, in the absence of an actual paper trail, we’d have to take Kagan’s word for it that even if her office was involved, she was kept out of the loop.

In fact, in an article I saw several months ago (I can’t find it online now, but I’m pretty sure it was the Washington Post), a major media outlet reported that careful steps were taken to keep Kagan out of the loop on Obamacare, even before she was nominated for the Court, indeed, even before she was being discussed as a nominee.  This can only be because all parties concerned knew what was going to happen.  And indeed, at the time, Republican senators did raise the issue:

Two challenges have been levied at the law by attorneys general in Florida and Virginia. Kagan has said she would recuse herself if she had participated in reviewing a draft of a position on the law or had participated in discussions to formulate the government’s position on the legislation.

Then there’s this exchange, from Kagan’s confirmation hearings.  Most of the interrogation on the health care matter looked at Kagan’s opinions on the Commerce Clause.  But right at the end, this:

COBURN: Thank you. And my — I have two final questions. One, was there at any time — and I’m not asking what you expressed or anything else — was there at any time you were asked in your present position to express an opinion on the merits of the health care bill?

KAGAN: There was not.

That contention now appears to be seriously in doubt.

The Democrats have also engaged in a strategy not so much to politicize the Court as to recognize that the Court’s legitimacy is as much political as it is legal.  The left has, for some time, been launching frankly pathetic attacks on the right of Justices Thomas and Scalia to hear the Obamacare cases, mostly centered on the fact that Thomas and his wife hold opinions.  But if they can muddy the waters enough, they can get one of two acceptable outcomes: either both Kagan and Thomas recuse themselves, or neither does.  It’s sort of the legal version of the hockey tactic of bringing in your enforcer to start a fight with the other team’s star, in hopes that they both get thrown out.  That this sort of warfare will ultimately degrade the Court is of little consequence to those on the left, seeking a pre-determined outcome.

I’d very much want to reserve judgment on Kagan herself until we see the rest of the emails, both the ones that Daily Caller has, and the ones that they should have, but don’t.  At the moment, however, Kagan should, without doubt, recuse herself.

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