Nearly an A-?

We noted yesterday that Obama awarded himself a “solid B+” for his performance to date. His approval rating is at minus 19, and falling, this week. He was plus 8 as recently as August, at which time the public considered his performance wasn’t worth even a C: How the Public Graded Obama

Handling of the Economy = C-
Handling of Health Care = D
Handling of Foreign Affairs = C

As for the grade the public gave President Obama himself? C-.

He’s down 27 points since that publicly awarded C-.

The man thinks he’s improved to B+ since then? Do we have to add delusional to narcissistic? Note: Should you object to the term “delusional,” remember he told Oprah he deserves an A- if Pelosi & Reid succeed in crippling the American health care system – where he scored a D just 4 months ago.

I don’t think that “grade” means what he thinks it means.

Clunker

Congressman Mike Rogers wants me to know he is opposed to the Pelosi health care bill. More power to him. I applaud his opposition to it. Here’s what the Congressman sent me today:

I write to update you on recent developments in the health care reform debate in Washington, D.C. I appreciate the opportunity to contact you.

As you may know, House Democrat leaders recently introduced another massive health reform bill. This legislation (H.R. 3962) clocks in at 2,000 pages, $1.2 trillion in new spending, and over $400 billion in cuts to Medicare services for seniors. The bill also includes over $700 billion in new tax increases, clearly violating President Obama’s pledge to not raise taxes on middle-class families. I wanted to share with you a list of the tax increases found in H.R. 3962:

Small business surtax (Sec. 551, p. 336)- $460.5 billion
Employer mandate tax (Secs. 511-512, p. 308)- $135 billion
Individual mandate tax (Sec. 501, p. 296)- $33 billion
Medical device tax (Sec. 552, p. 339)- $20 billion
Annual cap on tax-free FSAs (Sec. 532, p. 325)- $13.3 billion
New taxes on HSAs (Sec. 531, p. 324 and Sec. 533, p. 326)- $6.3 billion
Tax on health insurance policies (Sec. 1802, p. 1162)- $2 billion
Other tax hikes on U.S. job creators (Secs. 553-562)- $56.4 billion
Other “revenue raising” provisions- $3 billion

TOTAL TAX INCREASES $729.5 BILLION

To read more about the Democrat health legislation, please visit my website at mikerogers.house.gov and click on “Health Reform Update.”

Rest assured, I will continue to oppose plans to raise taxes and put the federal government in charge of America’s health care. Instead, I will continue to work on bipartisan solutions that will enact real health reform – lowering costs, expanding access and improving care for all American families.

Again, I appreciate the opportunity to contact you. You can also follow my efforts on YouTube (RepMikeRogers) and Facebook (Mike J. Rogers). Should you have any questions or concerns, please do not hesitate to call on me.

Sincerely,

Mike Rogers
Member of Congress

Well and good. However, opposition to the health care fiasco is pretty easy. Opposition to the cash-for-clunkers program, on the other hand, was impossible for Congressman Rogers. He wrote me earlier extolling the virtues of that program. So, here is my response to today’s email:

Dear Congressman Rogers,

Thank you for your steadfast opposition to the Democrat plan to nationalize the health care industry, raising health care costs and taxes, and reducing the quality and availibility of health care. The principles of small government and a commitment to liberty are clear in your position on this.

I wish I could have written “your principled position.” I could not, however, because of an earlier email wherein you took credit for the cash-for-clunkers program. What difference is there in principle between health care takeover dollars the money dumped into cash-for-clunkers?

Your eager support for cash-for-clunkers has two unfortunate consequences. 1) It makes you seem like a Jack Murtha, but lacking the gravitas to obtain really district-focused pork and, 2) it makes your opposition to spending and taxation on health care seem shallow, partisan and cynical.

Principles, Congressman, principles. There is no difference between cash-for-clunkers and health care spending except for the number of dollars.

Michigan Democrats propose health care tax surcharge

You can’t imagine this stuff, much less make it up.

On the eve of a government shutdown, Michigan Democrats are proposing a 4% tax on health care – not on Doctors, not on insurance companies – on your cost of health care. Oh, and those people Barack Obama is complaining about who are a burden on the system because they don’t buy health insurance even though they could? And those people who truly can’t afford health care but receive it anyway? Add their 4% to your taxes, too. And have a plan for finding a new Doctor when yours moves out of state.

GOP blasts Democrats’ proposed health care tax surcharge
Tax on doctors will make medical treatment more expensive, push deficit on backs of patients, health care

House Republicans today blasted a proposal by Democrat lawmakers to tax health care in order to help balance the state budget.

House Bill 5386, which is currently in the tax policy committee, levies a 4 percent tax on physicians’ gross receipts. Democrat House Speaker Andy Dillon was quoted in a recent news article saying the state would be crazy not to do it.

“It is astounding to me that right now when we are in the middle of a national discussion about lowering the high cost of health care, Michigan Democrats are actually pushing for a new tax on doctors that will make medical treatment more expensive,” said House Republican Leader Kevin Elsenheimer, of Kewadin. “Doctors are going to have to pass these costs onto their patients, making the cost of health care go up.”

If approved, the tax would raise health care costs in Michigan by nearly half a billion dollars annually.

“House Republicans proposed a plan to balance the budget without raising taxes months ago – and our plan didn’t reduce Medicaid reimbursements by any more than what the governor recommended,” said state Rep. Matt Lori, of Constantine. “There is absolutely no way we are going to support the Democrat plan to tax health care just because lawmakers waited until the last minute and now are under the gun to finish the budget by Oct. 1.”

Elsenheimer also said he was concerned the plan could negatively affect Michigan’s growing health care industry:

“Two years ago lawmakers rammed the poorly thought out business tax surcharge through the Legislature at the 11th hour, and we’ve only seen unemployment go up since. Now we’re about to repeat that mistake by adding a new tax surcharge on health care. It makes me wonder, who’s next? Who’s left to tax?”

Elsenheimer also noted that the Speaker has recently indicated that House Democrats will vote Tuesday on raising taxes.

#####

____________________________
Phyllis Browne
Communications Manager
Michigan House of Representatives
(517) 373-1690 office
(269) 806-4936 cell

The question that comes to my mind is what’s the real objective? What do they want in exchange for dropping this? Some other tax that won’t get them thrown out of office, I’m sure.

Let them pass it. Write down their names.

The View from Dromore

Recently, I was visited by an old friend from Dromore, Ontario, Canada. During his visit I had occasion to see my doctor because of an infection on my left ankle that was not responding to home treatment. Because it resulted from a quite minor scrape, I expected it to heal in a few days. A month later it was getting worse, so I called my Doc around 11AM Wednesday and was given an appointment at 10AM Thursday. I had a followup a week later, and he was quite pleased with the progress of the treatment (antibiotics and hydrogen peroxide soaks).

Following is the impression this made on my visitor:

Duane,

During my recent visit to Michigan, I was totally shocked by your ability to get a doctor’s appointment on short notice. If the American health care system is “broken”, I didn’t see it. It may be expensive, but it would appear to work the way most people would want it to work. It doesn’t matter what your problem was (not immediately life-threatening – apparently easily resolvable with antibiotics), what struck me was the speed with which you got a doctor’s appointment. I think you said you called on Wednesday and had an appointment on Thursday – unheard of in Canada in my experience. You also lost very little time from work. The appointment was at 10:00 and you were probably back at your desk by 10:30. It would appear that when you make an appointment for 10:00, the doctor actually sees you at 10:00. Interesting concept.

It made me reflect upon what would have happened to me in a similar situation under the Canadian government-run single-payer system.

First off, I have a “family” doctor and have had for over 30 years. That immediately puts me in a rather unique position. Neither he, nor any of the other doctors in my area are accepting new patients unless a current patient dies or moves away – the wait-list is years long. My doctor, who used to have his own office, is now part of a government-mandated Local Healthcare Integrated Network (LHIN) – i.e. a clinic, composed of local docs and supported by a number of nurses and nurse practitioners (a relatively new breed – registered nurses who have taken additional training and are allowed to do certain things normally done only by doctors) as well as a common administrative staff.

So, let us assume that I had a relatively minor problem similar to yours. What would my options be under the Canadian system?

There are four: 1) Ignore the problem, cross your fingers and hope it goes away on its own – an option I have taken in many cases; 2) Ask for an appointment with “my” doctor – and be prepared to wait a couple of months (not that dissimilar to option 1); 3) Ask for an appointment with any doctor at the clinic and be prepared to wait for a couple of weeks; and 4) Go to the emergency at the local hospital and bring a copy of Tolstoy’s War and Peace with you as you are likely to be able to get most of the way through it while you sit in the crowded waiting room for several hours.

At the emergency, there is a one-in-six (we have six local docs) chance that I will actually see my own doctor because they are mandated to supply emergency room service on a rotating basis (I am in a rural area – this may not be true in an urban area).

In defense of the system, the common administrative staff and records at the clinic means that any doctor has complete access to my medical history. How much time they may have to review that information before seeing me is open to question. Nonetheless, it seems mildly efficient.

Also in defense of the system, if I was exhibiting symptoms of a truly serious nature (arriving at the emergency carrying a severed limb, bleeding from the ears, chest pains, etc.), I would move to the express line and would probably be seen fairly quickly.

The vagaries of our Canadian system means that I normally take option 1 (ignore the problem) or option 4 (go to the emergency). Options 2 and 3 are not really viable options.

Having said all that, no matter what my situation may be, I only need to present a health card, not a credit card. It’s “free” in the sense that I’ve already paid for it through my taxes. I will never be bankrupted or even majorly affected in financial terms by my health situation.

Again, I was impressed by your ability to get quick medical attention from your own doctor. If Americans want to experience my situation, go ahead, but I’m not sure you’ll be all that happy with the resulting process.

Rationing of services and extended wait-times are the real prices you will pay for a government-run system. Cheaper? – probably (although I question the government’s (either yours or mine) ability to run anything either efficiently or effectively). Better? – you decide.

As to the expense, it was paid for by insurance and, having given my insurance particulars many years ago, I did not need to present any card. This does not mean that I like the idea of employer-based health care, or that I had not been paying (tax exempt) premiums. Still, the visit was simple and easy, including scheduling the followup appointment.

Finally, it turns out that options 1 through 3, above, would have been pretty bad choices. The Doc explained that if the infection spread to my Achilles tendon I would have been in for significant difficulty and the insurance company in for significantly greater expense.

Would you buy a used plan from this man?

President Obama is considering making a speech prior to September 15th, the most recent deadline he set for the Senate to agree on a bipartisan health care “reform” bill. According to top presidential adviser David Axelrod, the speech would be “more prescriptive” about Obama’s redefinition of health care. I’m sure it will mention his good friend, Senator Kennedy. It shouldn’t, but it will.

What the President should do is resolve the profound differences in his own positions by clearly stating whether he favors a single payer universal care system now, or in the future. He could categorically reject any special interests, including his own deal with big Pharma. He could ask why tort reform has not been on the agenda. He could admit he was overwrought by his own rhetoric of fierce urgency: That demanding such fundamental change in so short a time with so little scrutiny was… yes, delusional. He could apologize for his mistakes. He’s done it often enough on behalf of the whole country, so why not?

The President’s original, urgent deadline for remaking 1/6th of the economy via a 1,000 page bill he outsourced to Nancy Pelosi and that nobody had time to read, much less consider, was “before the August recess.” He felt no need to be prescriptive, or even forthcoming, then. So, NOW he’s going to explain what should have been in the bill he didn’t understand himself, but wanted forced through in July?

Why are we supposed to care now what Obama thinks about health care? He would have been overjoyed if the entire health care system had been remade in the image of Nancy Pelosi’s ideals in July. He would have been quite satisfied if no one had ever read the legislation. In fact, he would have preferred it. So we’re supposed to believe he cares what’s in a future bill? He was willing to hang us out to dry 2 months ago, what’s changed except he’s had some blowback?

Surgery panels

Thousands of surgeries may be cut in Metro Vancouver due to government underfunding, leaked paper

VANCOUVER — Vancouver patients needing neurosurgery, treatment for vascular diseases and other medically necessary procedures can expect to wait longer for care, NDP health critic Adrian Dix said Monday.

Dix said a Vancouver Coastal Health Authority document shows it is considering chopping more than 6,000 surgeries in an effort to make up for a dramatic budgetary shortfall that could reach $200 million.

RTWT

H/T National Center Blog

Message from the President of the Canadian Medical Association

How Canadians run their health care system is a concern to Americans only to the extent that some American supporters of nationalized medical care have pointed to Canada’s “single payer/universal coverage” system as a model. Those of us who think health care reform requires more individual control and less government intervention therefore naturally look for lessons from Canada’s experiment. President Obama, though he favors a SP/UC system, does not want to acknowledge we can learn something by looking north. He has said Canada’s model is not appropriate for the US. He does not say what details of Canada’s system are inappropriate for us. Because there are necessarily broad similarities to his own preferences, he does not want to talk about it. It’s to remain “mystery meat” until served.

Like Obama, Canadians can be very defensive about discussing health care, and resent foreigners who do not recognize the superiority of Canada’s health care system. Many Canadians routinely deny there are any problems with their system. Several have left comments on this blog claiming I don’t understand the Canadian system despite; a) I lived there for 22 years and, b) 95% of the criticisms documented here are from Canadian sources. Some examples:

Lessons from Canada???

Canada: health care rationing review

Canada: health care wait times

Canadians criticize Canadian health care wait times

Canadian analysis

The point is recently reinforced by the new President of the Canadian Medical Association:

The incoming president of the Canadian Medical Association says this country’s health-care system is sick and doctors need to develop a plan to cure it.

…”We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” [Dr. Anne Doig, see also this interview] said in an interview with The Canadian Press.

…The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet,

…His thoughts on the issue are already clear. Ouellet has been saying since his return that “a health-care revolution has passed us by,” that it’s possible to make wait lists disappear while maintaining universal coverage and “that competition should be welcomed, not feared.”

In other words, Ouellet believes there could be a role for private health-care delivery within the public system.

…”(Canadians) have to understand that the system that we have right now – if it keeps on going without change – is not sustainable,” said Doig.

Politically, Ouellet can’t come right out and say there must be a larger role for private health-care – he dare not risk comparison to the US system. South of the border, however, there are lessons from which Canada could benefit. The most important is our thriving private care option, a safety valve for Canadians when their system fails them: Canadians visit U.S. to get care

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.

…Canada’s U.S. backup care “speaks volumes to why we don’t need government to take over health care,” Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. “Their system doesn’t work if they have to send us their patients.”

But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit “are a terrific way to manage capacity” given Canada’s smaller health care budget.

“This is efficient,” he said. “At least in Canada, you don’t worry about going broke to pay for health care. You do here.”

Dr. Reinhardt apparently thinks that even if the US starts rationing health care it will still provide Canadians with a safety valve. His praise of Canada’s efficiency depends on the status quo. That some services simply are not available to Canadians in a timely fashion would look less like prudent fiscal management if people were actually dying due to unavailability of care. Providing such care is a political decision forced by proximity to a market where the care is quickly available. If Canada refused to pay for such treatment and Canadians were dying every day from its lack, what politician would be safe? Refusal to pay would be possible only if the US health care system did not exist.

In Canada, you don’t have to worry about going broke, but without access to US care, you do need to worry about suffering and even dying while waiting for treatment. This is not an argument that US health care does not need reform – it does – but moving in Canada’s direction is the wrong way to go about it for BOTH countries.

Health care is rationed in Canada; no reasonable observer can dispute it, and despite President Obama’s assurances to the contrary, choice will be ever more restricted in the US if “the public option,” shows up in any health care bill here: Fighting false health care claims, Obama repeats one of his own

Related:

American view
Wall Street Journal:
We Don’t Spend Enough on Health Care

Mr. Obama has said that “the cost of health care has weighed down our economy.” No one thinks the 20% of our GDP that’s attributable to manufacturing is weighing down the economy, because it’s intuitively clear that one person’s expenditure on widgets is another person’s income. But the same is true of the health-care industry. The $2.4 trillion Americans spend each year for health care doesn’t go up in smoke. It’s paid to other Americans.

…The U.S. health-care economy should be viewed not as a burden but as an engine of growth. Medical and orthopedic equipment exports increased by 65.1% from 2004 through 2008. Pharmaceutical exports were up 74.6%. The unprecedented advances expected to come out of American stem cell, nanotechnology and human genome research—which other countries’ constricted health sectors cannot support—will send these already impressive figures skyward.

A study by Deloitte LLP has found that more than 400,000 non-U.S. residents obtained medical care in the U.S. in 2008, and it forecasts an annual increase of 3%. Some 3.5% of inpatient procedures at U.S. hospitals were performed on international patients, many of them escaping from Canada’s supposedly superior health system.

“Inbound medical tourism,” Deloitte stated, “is primarily driven by the search for high-quality care without extensive waiting periods. Foreign patients are willing to pay more for care within the United States if these two factors play a large role.” The deficiencies of the foreign health-care systems the Obama administration wishes to emulate can be counted on to generate ever-increasing revenues for U.S. providers and employment for Americans.

Canadian view
London Free Press
:
Problems in health care won’t be fixed just by cash

Many jurisdictions are still woefully short of family doctors and the country need another 16,000 nurses. Canadians still rely on their own personal finances, or company benefit programs, to pay for their pharmaceuticals. Emergency rooms remain clogged. Patients are still waiting agonizing weeks for diagnostic scans to learn if they have cancer. Rural and northern communities are concerned about their access to services. We still lack an efficient electronic health records system.

Yet we continually spend more. According to Statistics Canada, the federal government, provinces and territories will spend a combined $121 billion on health care this year, an increase of 28% since 2005.

If anything, it shows the old solution of throwing money at a problem is incredibly ineffective in our health-care system. All of the benefits of state-run, publicly-financed health care are offset by an onerous, bureaucratic, bloated and expensive system.

What is needed is true systemic change that will ensure every dollar invested in health care benefits patients.

It’s inexcusable that patients have to wait to find out if they have a potentially fatal disease. It’s mind-boggling that people can wait more than a year to have life-altering surgeries like hip replacements.

Indeed. And that’s with a US safety valve in place. If the US moves toward a government run health care system it will be terrible news for us and a death sentence for some seriously ill Canadians.

Canadian counterpoint

A Canadian’s thoughts on US/Canada cultural norms related to health-care. RTWT.

Kathy Shaidle: Obamacare critics: win the debate by changing one word

“Rationing” is supposed to evoke the horror of utilitarianism, but frankly, millions of ordinary Americans are already de facto utilitarians and don’t see that as a bad thing. As long as they aren’t the ones experiencing the utilitarianism.


…OK then Kathy, “Waiting in line.”
;)

Obamacare roundup

As you reflect on the Federal Government’s prowess in running the billion dollar Clunk for Cashers deal, ruminate on how well they are likely to do running what the CBO says will be a multi-trillion dollar health care system.

You do also already have the evidence of Medicare to instruct you.

These are all worth reading…

Here’s a Second Opinion
The Hoover Institution
Scott W. Atlas

Reformers’ Claims Just Don’t Add Up
Investor’s Business Daily
Editorial

Some Inconvenient Truths About Medicare and the New ‘Public Plan’
RealClearPolitics
Regina Herzlinger and Robert Book

Socialized health care is not the answer
Morgan Hill Times
Judy Berkman

A Liberty Issue

National Review
Mark Steyn