What works in health care

One of the silliest talking points many on the left have is that Republicans and conservatives do not have a solution to replace Obamacare with. Ben Domenech explains why that is wrong here. 

Yesterday, Mark Perry wrote of another example of how price competition can lead to better outcomes at lower costs. Obamacare, it probably doesn't need to be said, goes in the opposite direction with its further reliance on third-party billing. Writing of a medical center in Oklahoma City, Perry explains how it works:

Unlike most other medical providers, the Surgery Center posts transparent pricing and offers deeply-discounted, payable-in-advance, cash-only medical procedures. The center does accept private insurance, but it does not accept Medicaid or Medicare — government regulations won’t allow them to post transparent prices online. If any competitor offers a lower price, the Surgery Center will match or beat it, so patients can be guaranteed of getting the lowest price possible. ... And it’s working — other hospitals, both locally and nationally, are being forced to compete with the center’s low-cost surgery fees — which are typically one-sixth to one-eighth less than what most other hospitals and clinics are charging for the same procedures. For example, the Oklahoma University Medical Center charges $23,934 for an ankle arthroscopy, while the procedure will cost only $3,740 at the Surgery Center of Oklahoma.

In other Obamacare-related news, Michael Cannon says the Fourth Circuit court dealt a "hidden blow" to the overhaul.

Are religious schools intolerant?

The Wall Street Journal opens their terrific piece:

On President Obama's recent visit to Ireland, he offered a surprising explanation of the enduring tensions there: "If towns remain divided—if Catholics have their schools and buildings, and Protestants have theirs—if we can't see ourselves in one another, if fear or resentment are allowed to harden, that encourages division. It discourages cooperation." Given his use of the word "we," it is hard to avoid the conclusion that this is also how the president views religious "schools and buildings" in the United States.

Of many Democrats' opposition to allowing parents to use school vouchers to place their kids in religious schools:

Perhaps the president and other Democrats oppose vouchers because they fear—as the president's remarks in Ireland suggest—that religious schooling undermines social cohesion. The belief that religious schools erode civic goals has a long history. In the mid-19th century, religious schools, Catholic schools in particular, were accused of reinforcing separate identities rather than shared American values. Much has changed in education since then, but a suspicion lingers in some quarters that church-operated schools breed intolerance.

The results:

I conducted two of those 21 studies, and others were produced by researchers at institutions including Harvard, Notre Dame and the University of Chicago. The studies varied in whether they looked at national or local samples of students and whether they examined secular, religious or all types of private schools. Of those studies, only one—focusing on the relatively small sector of non-Catholic religious schools—found that public-school students are more tolerant. Eleven studies, examining both secular and religious private schools, found that private-school students are significantly more likely to be tolerant, and nine found no difference.

Of course that shouldn't be a surprise. Ironically, those who think the religious are more likely to be intolerant are often themselves the actual intolerant ones.

A populist critique of Obamacare

Populism is a dirty word to many conservatives, but there is a difference between class warfare -- what many think of when they hear the word populism -- and attacking crony capitalism. The House GOP is going after Obamacare in the latter way. From National Journal:

The argument goes like this: By delaying last week a requirement that employers with a workforce of 50 or more offer their workers insurance, the White House gave a break to big business. But it isn’t granting a similar reprieve to ordinary Americans by postponing the law’s unpopular requirement that individuals obtain health insurance or face a fine. The approach, developed in the wake of the White House’s decision to delay implementing the employer mandate, is designed to force Democrats to take tough votes on the law that could be used against them in close 2014 elections. 

“The White House says it’s listening to the concerns of our nation’s businesses. But are they ignoring the voices of American families and taxpayers?” Rep. Kevin Brady, R-Texas, who chairs the House Ways and Means Health Subcommittee, asked at a Wednesday hearing. His remarks echo similar talking points from House Speaker John Boehner, R-Ohio, and House Majority Leader Eric Cantor, R-Va. 

It’s unusual rhetorical territory for Republicans, who are frequently criticized for favoring business interests over those of people, a common theme in the 2012 Obama campaign. It’s even a quick switch on health care; in the weeks leading up to the administration’s announcement about the employer mandate, congressional Republicans were attacking the provision as one that stifled business growth and hiring. 

But the fairness argument could be a winner in next year’s races, says Andrea Bozek, a spokeswoman for the National Republican Congressional Committee. “Any time a president is seen picking winners and losers is politically toxic,” she said.

(First, National Journal misses the mark on a couple of points. Most Republicans, and certaintly those elected since 2010, are not pro-business but pro-free enterprise. And the employer mandate would stifle business growth and hiring. House Republicans did not change their tune on that but rather the way the administration circumented Congress to delay it and the unfairness in granting businesses with large lobbying budgets a reprieve but not every American citizen.)

But I think this is exactly the right approach for the GOP. Acting and being seen as the party of markets and free enterprise -- ecschwing both big business and big government -- is not only the right policy but good politics as well. President Obama is no opponent of big business; he has worked with them on health care, on the auto bailouts, on financial regulation.

While I would prefer getting rid of Obamacare in one fell swoop, there is no chance of that until January 2017 at the earliest. Death by a thousand cuts -- or a few big ones -- is the way to go. And pushing the fact that this White House thinks that individual Americans should have to be forced to buy health insurance while businesses are exempt is a big cut.

And in other news, Nancy Pelosi is really, really confused.

Jail time for exercising religious freedom

Another case illustrating the need for religious liberty protections in those states that allow gay marriages or civil unions.

The owners of a Colorado bakery could face up to a year in prison for refusing to make a cake for a gay couple. Dave Mullins, 28, and Daniel Craig, 33, filed a discrimination complaint against Jack Phillips, one of the owners of Masterpiece Cakeshop, for denying them a cake for their Massachusetts wedding.

And to show the difference between the two parties:

Republican lawmakers in Colorado have pushed the addition of religious protection for businesses to the civil union law, but Democrats argue that such a provision would merely be a cover for discrimination.

"Why The White House Is Panicking About ObamaCare"

John Goodman has a great piece for Forbes.com, explaining why the administration has been searching high and low -- "Actors. Actresses. NFL football players. Baseball players. Librarians. Mayors. City councilmen. Members of AARP." -- to try to encourage people to sign up for Obamacare.

He points out that only a quarter of those currently eligible for Medicaid sign up. Goodman posits -- correctly, I think -- that the reason that is the case is the outcomes are the same for those on Medicaid and the uninsured. (A study from Oregon released in May concluded the same.)

James Capretta testified in front of the House and Ways Committee about the employer mandate delay. He concluded: "Therefore, this committee should seriously consider legislation that couples delays in the employer and individual mandates with a simultaneous delay in the entire exchange roll-out." The Weekly Standard has his full testimony here.

In other news: "Today, U.S. Senator Tom Coburn and U.S. Representative Charles Boustany -- both practicing physicians -- sent HHS Secretary Kathleen Sebelius a letter asking serious questions about 'ongoing significant weaknesses in HHS’ financial management' outlined in HHS's FY2012 financial audit."

And another article from the mainstream media pointing out the recent troubles with implementation have been predicted by those in charge for months now.

"We will root out the waste and fraud and abuse"

Michael Cannon of the Cato Institute looks at how President Obama has changed his tune on getting rid of the waste in health care.

Vehemently opposed to it in 2009 and 2010, the President often said waste and fraud could only be ended by passing Obamacare. (Of course, at the time, the question was: why not just end the fraud and abuse right now?)

Now, to help implement the overhaul, fraud and waste are not such urgent concerns, and there will not be any verification of eligibility for subsidies.

"Barack Obama used to oppose health care fraud—up until the moment that opposing fraud conflicted with his goal of preserving ObamaCare," writes Cannon. "And why not? It’s just other people’s money."

Heritage looks at other cases of the administration not following the legislation as it was written, including HHS spending $150 million on an unauthorized program.

“President Romney is openly defying the laws of the United States"

During the campaign, Mitt Romney pledged to grant each state a waiver from Obamacare on day one of his Presidency. I panned the idea, as I didn't believe he would have the authority. Liberals agreed.

But whereas I think neither Romney nor President Obama has the authority to ignore the laws passed by Congress, almost every liberal believes Obama can do what they said Romney couldn't.

Enter Phil Kerpen, who writes what a news story would have looked like had Romney been elected and went about ignoring parts of the law he didn't like. It's worth reading the entire thing, but here's an excerpt:

Under pressure from large corporations, the Treasury Department quietly announced the provisions of the law requiring employers to provide health insurance coverage will not be enforced. The law contains no language granting Treasury discretion for such a move and has a clear effective date of January 1, 2014. Nonetheless, Treasury official Mark Mazur announced in a blog post that penalties for employers who fail to meet the law’s requirements will simply not be enforced in 2014.

Guy Benson: "Surprise: White House Has Known Obamacare Implementation Would Collapse For Months."

Six Inconvenient Truths About Obamacare.

Yuval Levin wrote of how Republicans should proceed.

"Servile and Licentious Tenancy"

In a break from Obamacare, I was struck by a blog post on acton.org highlighting Alexis de Tocqueville's writing on those who waver "between servitude and license."

There are some nations in Europe whose inhabitants think of themselves in a sense as colonists, indifferent to the fate of the place they live in. The greatest changes occur in their country without their cooperation. They are not even aware of precisely what has taken place. They suspect it; they have heard of the event by chance. More than that, they are unconcerned with the fortunes of their village, the safety of their streets, the fate of their church and its vestry. They think that such things have nothing to do with them, that they belong to a powerful stranger called “the government.”

Having been around people like that, those words really struck me. Empty existences, adults happy as long as they have a place to get drunk at on Friday or Saturday (or both) and whatever they consider entertainment. (Not a slam at those who enjoy video games, silly movies or shows, or who like going out on the town, as I enjoy all those. But when that is all you have in your life, and it consumes all your time, and you like it that way...)

No sense of a greater purpose -- whether religious or simply trying to pass off a better country to your kids. A total lack of awareness of anything besides who is on Us Weekly. I'm not looking for everyone to know the ins-and-outs of NAFTA, but let's try to know a little about how we are being governed and who our representatives are.

Another quote, long a favorite of mine, comes to mind:

Contemplate the mangled bodies of your countrymen, and then say "what should be the reward of such sacrifices?" Bid us and our posterity bow the knee, supplicate the friendship and plough, and sow, and reap, to glut the avarice of the men who have let loose on us the dogs of war to riot in our blood and hunt us from the face of the earth? If ye love wealth better than liberty, the tranquility of servitude than the animated contest of freedom — go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains sit lightly upon you, and may posterity forget that you were our countrymen!

The beer guy said that one.

Positive news for Obamacare (just joking)

Headline from WaPo: "I wish we had one more year:" States are struggling to launch Obamacare on time

From that article:

At a monthly board meeting of Connecticut’s health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won’t be completely ready on time. “It is highly complex, it’s unprecedented and it’s not going to be smooth,” Kevin Counihan, chief executive of the state’s exchange, Access Health CT, told the group. That’s why Connecticut — like other states across the country — has lowered the bar, doing what it can in the time it has left before the health-care law’s major programs are launched Oct. 1. Although the states are promising to provide new marketplaces for individuals to compare and buy health insurance plans, the Web portals will be a bare-bones version of what was initially envisioned.

Oregon us implementing this law that is at the breaking-edge of technology and innovation the same way my grandma keeps track of tuna casserole recipes:

How will brokers keep track of potentially thousands of customers in the interim? Cover Oregon’s executive director, Rocky King, suggested that they might use “index cards.”

The Wall Street Journal: "Blows to Health-Care Law Pile Up, Cutting Its Sweep."

From that piece, referencing the latest news surrounding the implementation: "You've got three body blows toward expansion of coverage," said Paul Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of Deloitte LLP. "It's three punches in a row."

A Congressman from my state: "Much like Humpty Dumpty, Obamacare had a great fall and all of King Obama's bureaucrats cannot put it back together again," said Rep. Tim Huelskamp (R., Kan.).

Elsewhere, Michael Cannon of Cato shoots down the idea that the administration can legally delay the employer mandate.

Philip Klein writes on the opening this presents the GOP.

George Will rips the "never mind Presidency" we've seen lately.

Heritage details the "Dirty Dozen Implementation Failures."

When $100 million is the same as $1 million

The New York Times breathlessly reports that a group funded in part by the dastardly Koch Brothers is spending $1 million on an anti-Obamacare ad campaign.

Meanwhile, Enroll America -- staffed with former Obama White House officials -- is trying to raise $100 million to promote the implementation of the bill. In order to do that, they are hitting up executives in the health care industry -- many of whom stand to gain from the law -- to pitch in.

The exact way HHS Secretary Kathleen Sebelius asked for donations is up for some controversy. She called up companies her and her agency have regulatory authority over in order to -- her words -- "suggest the entities look at the organization [Enroll America]."

Guy Benson: "She 'voluntarily decided not to make fundraising appeals' to companies over which she wields enormous power -- but she did, er, phone them up and 'urge' them to support the cause? How exactly does that work?"

That kind of cozying up of big business and bigger government doesn't have the Times worried, but two private citizens  -- with no stake in the health care industry that I'm aware of -- spending a tiny fraction in comparison is huge news.