Is there a happier day of the bi-week than HWR Day? Not for us health wonks. Here is this round of health policy blogging, complete with first-time hosting jitters.
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New Mexico: Land of Dependence
Found on a New Mexico state web site…
![Media Name: nm_hsd.jpg](/sites/cato.org/files/styles/pubs_2x/public/download-remote-images/www.cato.org/172395922072/nm_hsd.jpg?itok=GWwPw8v1)
My father-in-law runs the Santa Fe chapter of Habitat for Humanity, a voluntary charity that measures success in terms of how many people it helps to achieve financial independence. Odd that the state government appears to take pride in doing the opposite.
The Free Lunch Project may have found its new home. Crescit eundo, indeed.
What Is Health Insurance?
Over at the Health Affairs Blog, Mark Smith, president of the California HealthCare Foundation, offers the following assessment of that which we call “health insurance”:
When you ask people why they want health insurance, they will give you one of four answers.… (1) “What if I’m hit by a bus?”; (2) “I need to be covered for my preventive services”; (3) “I can’t afford to go to the doctor, or to get my medicine”; and (4) “I’ve got a chronic disease, for which I can’t afford to pay over time.” …
Please note: Only the first of those is insurance, in the sense in which anyone would understand that term — that is to say, protection of financial assets against the rare, unpredictable, catastrophic event …
Some component of what we call health insurance is that “what if I’m hit by a bus” concept. But the difficulty, we think, in trying to find a method of coverage which is acceptable to the various constituencies who are involved in health insurance … is that this thing we call health insurance is actually four different market items put together in one financial instrument which is increasingly unaffordable.…
To the extent that insurers and providers both see the problem of the uninsured as a revenue problem — which is to say, there are all these people out there who aren’t part of our system, and we need to find a way to buy them into our system at more or less our system’s price, at more or less our system’s configuration, and more or less maintain the incomes of everybody in our system — that is a very different question from how can we make the underlying asset more affordable.…
My point, therefore, is not [we] shouldn’t continue with the quest for expanded insurance coverage but that in so doing, we try to understand what it is we mean by insurance in the first place, and the extent to which combining these functions in one financial package creates a package which is simultaneously attractive for some people and unattractive for others. And in a voluntary market you create this mismatch, because for instance, how many people would pay money to protect their assets if they don’t have assets to protect? Most of the uninsured are low income; most low-income people don’t have huge amounts of assets to protect. They know that the hospital won’t come after them in quite the same way as the department store will, even for the same bill, and so asking them to pay money every week or every month, to protect assets that they don’t have, in case of an experience which will probably not occur to them, strikes us as not a very likely way to expand coverage among that population.
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Why There’s No Cure for the Common Cold
Phil Windley points us to the reason.
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Hoosier Tax-and-Spender
Editor’s note: This post was written on October 30, following a briefing by Indiana officials on Gov. Daniels’ proposed health care reforms. It was posted briefly, then pulled when those officials asked ex post that the details be kept confidential until announced by the governor. That happened today.
Indiana Republican Mitch Daniels received a grade of ‘D’ in Cato’s most recent governors report card, which grades the 50 governors on their record of cutting taxes and spending. I’ve just returned from a briefing on a new health care proposal that Gov. Daniels has put together, and it doesn’t seem that he wants to improve his grade.
The Daniels proposal would:
- Increase cigarette taxes by 25 cents per pack,
- Use those funds to “pull down” additional federal Medicaid dollars (federal matching funds allow Indiana to almost triple their money), and then
- Offer new government subsidies to every able-bodied adult under 200 percent of poverty.
In addition, it would have the state fund a health savings account (HSA) for each enrollee, and if an enrollee receives the recommended preventive care and does not touch their HSA funds (preventive care is 100 percent covered), at the end of the year an enrollee could withdraw $600 from their HSA to spend, say, on a color TV. If he instead leaves that taxpayer subsidy in his HSA, he gets to roll it over and let it grow. I’ve argued in a number of places that HSAs are not the solution to Medicaid, in part because they would resurrect within that program the same dependence problems that we tried so hard to kill in AFDC.
Gov. Daniels is not proposing an entitlement, and participants would have to pay for a portion of their premium. But those and other provisions (e.g., the income cutoff, the mandated benefits package, etc.) would be subject to revision on their way through the state house and by subsequent governors and legislators. Pretty soon, it would be an entitlement, the participants’ contribution would be smaller, the HSA cash subsidies would be greater, the income cutoff would be increased, and the benefits package expanded. How can I be so sure? Because Indiana can do all these things and the feds will pick up two-thirds of the tab. And heck, if this is a Republican proposal, where is the opposition going to come from?
As I told the Gov. Daniels’ loyal foot soldiers, someone needs to shove this proposal in a drawer. There is nothing worth saving.
Where do Republicans keep coming up with these tax-and-spend health care ideas? The party needs a health care revival, particularly when it comes to Medicaid.
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Born-Alive
Last week the British Nuffield Council on Bioethics published a report including step-by-step recommendations regarding the proper care of premature infants. The Council recommended that infants born earlier than 22 weeks of gestation not be resuscitated and that infants between 22 and 23 weeks of gestation only receive intensive care if their parents request such care and the infant’s doctors agree.
There has been a flurry of commentaries in U.S. papers and blogs about the Nuffield Council’s recommendations, but not a single one that I have seen mentions the fact that in the U.S., it would be illegal to follow the Council’s recommendations. In 2002 President Bush signed into law the federal Born-Alive Infant Protection Act and in 2005 DHHS Secretary Mike Leavitt stated “[w]e aggressively enforce federal laws that protect born-alive infants. We issued clear guidance that withholding medical care from an infant born alive may constitute a violation of the federal Emergency Medical Treatment and Labor Act and the Medicare Conditions of Participation.”
It is nevertheless worth considering what the Nuffield Council has said to help put the Born-Alive Infant protection Act into perspective. The Council’s report makes it clear that there is no realistic chance that a baby born under 22 weeks of gestation will survive and that infants born between 22 and 23 weeks have only a 1% chance of survival. Furthermore, those few that do survive at 22–23 weeks are highly likely to suffer from severe handicaps. (None of this information is limited to Britain. U.S. statistics confirm these conclusions). The Born-Alive Infant Protection Act requires health care professionals to try to save such babies. They must tape them down, stick them with needles and tubes, and resuscitate them – essentially, they are required to torture such babies until they die. As a mother of four children and a Christian, I would want to hold and rock my little infant as it dies. I wouldn’t want its precious few hours of life to be filled with pain and fear and never a mother’s warm embrace or soft voice. It is a very cruel world indeed if the drafters of the Born-Alive Infant Protection Act knew they were going to require health care professionals to torture dying infants and deny parents the only realistic succor they have to offer – the physical affection that would tell such infants that, while their stay on earth is short, they are nevertheless loved.
My Afternoon with Milton & Rose
I had the fortune to work for the Republican leadership of the U.S. Senate from 1999 to 2003. I got to run around on the Senate floor, act important, give senators advice, and watch them routinely reject that advice. It was great fun.
The highlight of my tenure as a Senate staffer was easily the the afternoon that I shuttled Milton and Rose Friedman from their hotel to the Senate and back again.
It was May 9, 2002, the day that Milton was honored both at the White House and at the Cato Institute’s 25th anniversary gala for his lifetime of service to the cause of human freedom. When I learned he would be in D.C., I opportunistically arranged a meeting between him and half a dozen senators so that Milton could share his ideas about health care.
Some cute memories stand out. I had to ask my two passengers to buckle up. When we arrived at the Senate, Milton and Rose — each standing about 5′2″ tall — practically got stuck when they tried to step through the metal detector at the same time. I tried not to laugh as an enormous Capitol policeman repeatedly patted down the diminutive, apologetic, and 90-year-old Nobel laureate to find whatever deadly weapon Milton was trying to smuggle into the Capitol.
After Milton and the senators discussed health care, Sen. Don Nickles (R‑OK) brought up the farm bill that the Senate had just passed. He and Milton had a lengthy exchange wherein Milton denounced the bill as a throwback to Soviet-style economic planning. On our way back to the hotel, I explained that Sen. Nickles had raised the issue to needle another senator, who sat right next to Milton at the meeting, had voted for the farm bill, and who uncomfortably stared at his hands throughout the entire exchange. Milton was unconcerned about the senator’s discomfort, asking only, “Why did he vote for that??”
That day in 2002 was the only face time I got with Milton and Rose. (Another highlight of my career came in 2005, when Milton wrote a blurb for a book that I co-authored.) Nevertheless, ever since he passed on Thursday, I can’t help feeling that I lost a great friend. Just another one of his gifts, I suppose.
Rest in peace.