It’s the Republicans Who Support Israel

Via Jeff Jacoby, the fact that Democrats don’t much like Israel, but Republicans remain staunch supporters.

There are exceptions, for course. Democratic office holders who live in places like New York (where there are a lot of Jewish voters) remain firmly behind the Jewish state (at least rhetorically).

First, the fact that Americans generally support Israel, and have much more sympathy for it than for the Palestinians.

(You may want to click on the image to see an enlarged version.)



Then the question becomes: what about the partisanship of the supporters and opponents. Here the data (from Gallup) is clear.



How do we interpret this? Quite simply. Liberals really don’t much like America (although they would never admit that, even to themselves).

Liberals pride themselves in always seeing that America’s enemies have a justified grievance. In seeing that it’s really our fault.

It follows from that that America’s friends aren’t particularly liked. Just look at Obama’s actions toward America’s allies.

Thus it follows that Israel, one of America’s strongest friends, is viewed with, at best, stand-offish reserve. It follows that the Palestinians, being anti-American, must have a good case.

The views of Democrats in the poll, of course, are what underlies Obama’s foreign policy.

Obama Flip-Flop on “Cadillac” Tax Plans

The Real Cost of ObamaCare: Your Freedoms

One of the fundamental problems with the health care “reform” proposals of liberal Democrats is that they have a hidden agenda. Fundamentally, the seek government control of the entire health care system -- even if it’s left under nominal priivate ownership.

From CNN, an analysis of what would really happen if Obama gets his way.

NEW YORK (Fortune) -- In promoting his health-care agenda, President Obama has repeatedly reassured Americans that they can keep their existing health plans -- and that the benefits and access they prize will be enhanced through reform.

A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy’s Health committee, contradict the President’s assurances. To be sure, it isn’t easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

If you prize choosing your own cardiologist or urologist under your company’s Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests -- you may be shocked to learn that you could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution.

In short, the Obama platform would mandate extremely full, expensive, and highly subsidized coverage -- including a lot of benefits people would never pay for with their own money -- but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can’t have. It’s a revolution, all right, but in the wrong direction.

Let’s explore the five freedoms that Americans would lose under Obamacare:

1. Freedom to choose what’s in your plan

The bills in both houses require that Americans purchase insurance through “qualified” plans offered by health-care “exchanges” that would be set up in each state. The rub is that the plans can’t really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Today, many states require these “standard benefits packages” -- and they’re a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure “children” until the age of 26. That’s just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn’t even know what’s in their plans and what they’re required to pay for, directly or indirectly, until after the bills become law.

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.

Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage. So if a 20-year-old who costs just $800 a year to insure is forced to pay $2,500, a 62-year-old who costs $7,500 would pay no more than $5,000.

Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that’s understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet. That’s hardly a formula for lower costs. It’s as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.

3. Freedom to choose high-deductible coverage

The bills threaten to eliminate the one part of the market truly driven by consumers spending their own money. That’s what makes a market, and health care needs more of it, not less.

Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. “The government could set extremely low deductibles that would eliminate HSAs,” says John Goodman of the National Center for Policy Analysis, a free-market research group. “And they could do it after the bills are passed.”

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It’s worth diving into the weeds -- the territory where most pundits and politicians don’t seem to have ventured.

The legislation divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don’t have real insurance. Those are the GEs (GE, Fortune 500) and Time Warners (TWX, Fortune 500) and most other big companies.

The House bill states that employees covered by ERISA plans are “grandfathered.” Under ERISA, the plans can do pretty much what they want -- they’re exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.

But read on.

The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the “qualified” policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we’ve already discussed. So for Americans in large corporations, “keeping your own plan” has a strict deadline. In five years, like it or not, you’ll get dumped into the exchange. As we’ll see, it could happen a lot earlier.

The outlook is worse for the second group. It encompasses employees who aren’t under ERISA but get actual insurance either on their own or through small businesses. After the legislation passes, all insurers that offer a wide range of plans to these employees will be forced to offer only “qualified” plans to new customers, via the exchanges.

The employees who got their coverage before the law goes into effect can keep their plans, but once again, there’s a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it’s likely that millions of employees will lose their plans in 12 months.

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we’ve seen, that will soon be most Americans -- must get their care through something called “medical home.” Medical home is similar to an HMO. You’re assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America’s health-care cost explosion.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they’re healthy and switching to fee-for-service when they become seriously ill. “That would kill fee-for-service in a hurry,” says Goodman.

In reality, the flexible, employer-based plans that now dominate the landscape, and that Americans so cherish, could disappear far faster than the 5 year “grace period” that’s barely being discussed.

Companies would have the option of paying an 8% payroll tax into a fund that pays for coverage for Americans who aren’t covered by their employers. It won’t happen right away -- large companies must wait a couple of years before they opt out. But it will happen, since it’s likely that the tax will rise a lot more slowly than corporate health-care costs, especially since they’ll be lobbying Washington to keep the tax under control in the righteous name of job creation.

The best solution is to move to a let-freedom-ring regime of high deductibles, no community rating, no standard benefits, and cross-state shopping for bargains (another market-based reform that’s strictly taboo in the bills). I’ll propose my own solution in another piece soon on Fortune.com. For now, we suffer with a flawed health-care system, but we still have our Five Freedoms. Call them the Five Endangered Freedoms.

Health Care Debate Tonight

Unaffordable or Unavoidable:
A Forum on Health Care Reform

A town hall forum featuring:
Dr. Susan Giaimo
Panelist: Visiting Assistant Professor of Political Science
Dr. John McAdams
Panelist: Associate Professor of Political Science
Dr. Robert Kraig
Panelist: Executive Director, Citizen Action of Wisconsin
State Rep. Leah Vukmir
Panelist: Representative for Wisconsin’s 14th Assembly District

Wednesday, November 11, 6 p.m. in
Marquette Hall, Room 200
Here is the flyer for the event.

This ought to be pretty good, especially since we are talking about legislation that could radically change a sixth of the U.S. economy, and affect the quality of health care that Americans get for the rest of their lives.

ObamaCare: Demagoguing the Insurance Companies

From Jeff Jacoby in the Boston Globe:

TWO THINGS supporters of a government-run “public option” for health insurance know for sure. One is that private health insurers are raking in obscenely high profits. The other is that only a government rival can force them to compete on price.

In a clever new commercial featuring Heather Graham as an agile sprinter named “Public Option,” the left-wing pressure group MoveOn combines both themes, describing insurance companies as “lazy” and “bloated from the profits of raising our health care costs sky-high.” Why, it asks, should anyone resist the competition a public option would generate? After all, “competition is as American as apple pie.” In a less amusing print ad a few weeks ago, MoveOn charged that “insurance companies are willing to let the bodies pile up, as long as their profits are safe.”

President Obama also attacks health insurers as avaricious profiteers.

“The insurance industry is making this last-ditch effort to stop reform,” he declared on Oct. 16, “even as costs continue to rise and our health-care dollars continue to be poured into their profits (and) bonuses.” When he addressed Congress in September, Obama insisted that only a public option will “keep insurance companies honest.” On the White House Blog, ObamaCare opponents are accused of “fighting to protect insurance industry profits.”

Indeed, there is no shortage of voices characterizing health insurers as greedy villains. Earlier this year, House Speaker Nancy Pelosi praised her party for highlighting “the immoral profits being made by the insurance industry.” On CNN last week, Ohio Senator Sherrod Brown demanded a public option “so the insurance industry can’t continue to game the system and discriminate” against women and the disabled — tactics insurers have used to “quadruple their profits in the last five years.” If quadrupled profits don’t seem rapacious enough, the union-backed Health Care for American Now! ups the ante, claiming, according to the AFL-CIO’s news blog, that “during the past five years, health insurance company profits have soared by 1,000 percent.”

Outbidding them all is Senate Majority Leader Harry Reid. Health insurance companies “are so anti-competitive,” he said last month, “because they make more money than any other business in America today.”

To such overheated agitprop, the only useful response is a cold shower of facts, and the Associated Press supplied a timely one last week. For all the impassioned talk about obscene profits and bodies piling up, AP’s Calvin Woodward reported, “health insurance profit margins typically run about 6 percent” of revenues, a return “that’s anemic compared with other forms of insurance and a broad array of industries.”

87 cents out of every premium dollar pays for medical services, according to a PriceWaterhouseCoopers study for America’s Health Insurance Plans. Insurance company profits account for just 3 cents.

On the Fortune 500 list of top industries, health insurance companies ranked 35th in profitability in 2008; their overall profit margin was a mere 2.2 percent. They lagged far behind such industries as pharmaceuticals (which showed a profit margin of 19.3 percent), railroads (12.6 percent), and mining (11.5 percent). Among health insurers, the best performer last year was HealthSpring, which had a profit of 5.4 percent. “That’s a less profitable margin,” AP noted, “that was achieved by the makers of Tupperware, Clorox bleach, and Molson and Coors beers.”

For the most recent quarter of 2009, health-insurance plans earned profits of only 3.3 percent, ranking them 86th on the expanded Yahoo! Finance list of US industries. The application-software industry, by contrast, is pulling in profits of nearly 22 percent. Why aren’t MoveOn and the Democrats demanding a “public option” to compete with Microsoft and Adobe and drive down their “immoral” profits?

There are certainly industries doing worse than health insurance — airlines and newspapers, for example — but the notion that health insurers “make more money than any other business in America today” is preposterous. Advocates of a public option may find it tactically expedient to paint insurers as insatiable predators, swollen with ill-gotten profits. The reality is otherwise.

Still, the critics do have one thing right: More competition would bring down health-care premiums. But the way to increase competition is not by adding a government-run health plan to the 1,300 private firms already providing Americans with health insurance. After all, there’s no public option for auto insurance and life insurance, yet they’re sold in a highly competitive national market. There is no reason health insurance can’t be sold the same way.

Let’s be clear on this: the pro-Obama Care liberals, when they attack the insurance companies, are no different from the late and unlamented Senator Joe McCarthy in their willingness to demonize any group that stands in the way of their agenda.

And their tactic dates back to the demagogues of Ancient Greece, who would demonize the groups they wanted to oppress — typically the wealthy whose property they wanted to seize. They are, in other words, not merely misguided. They are sleazy.

The Future of U.S. Health Care (If the Liberals Get Their Way)

Further news on an issue we have blogged on before.

From The Times:

AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

Well that’s reassuring. Just how often is it “possible” in a system starved for resources.

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered.

Of course, even 3% is a large number of people who are literally being starved and dehydrated to death.

But nobody knows how many would have recovered had they never been placed on the plan to begin with.

Even if “the education and training” is in place, no assessments from even well-trained people can be perfect, and the inevitable effect will be to kill patients who could recover and live a year or two or five years of meaningful life.

And, under any system of socialized medicine, budgetary constraints will bias the assessments toward the option that releases scarce resources for other uses, that is, which lets people die.

The phrase “death panels” just can’t be avoided here.

Government Run Health Care and Killing Patients

From National Review Online:

Compare America’s system with Canada’s and Great Britain’s. The latter are single-payer, universal health-care programs in which medical treatment is free at the point of service (Yay!), although citizens eventually pay for it through higher taxes (Boo!).

According to Organization for Economic Cooperation and Development data, there were 26.6 MRI machines in the U.S. per million people in 2004. In Canada, there were 4.9 such devices, while Britain enjoyed 5. For every 100,000 Americans, 2006 saw 436.8 receive angioplasties. Among Canadians, that figure was 135.9, while only 93.2 Britons per 100,000 got that cardiac procedure.

Maybe that’s why, among American men, heart-attack deaths in 2004 stood at 53.8 per 100,000. In Canada, 58.3 men per 100,000 died of cardiac arrest, while coronaries buried 69.5 of every 100,000 British males.

The fatality rate for breast cancer, according to the National Center for Policy Analysis and Lancet Oncology, is 25 percent in the U.S., 28 percent in Canada, and 46 percent in Great Britain.

Among those diagnosed with prostate cancer, 19 percent die of the disease in America. In Canada, 25 percent of such patients succumb to this disease. And in Great Britain — an Anglophone NATO member and America’s closest ally — prostate cancer kills 57 percent of those who contract it. That is triple the American fatality rate.

The Senate Finance Committee should sink Obama-Baucuscare and instead craft a patient-friendly, pro-market, limited-government approach to health-care reform. Perhaps some senators cannot fathom the Hippocratic Oath’s key insight: First, do no harm. If that’s Greek to them, here it is in language they understand: First, don’t kill your voters.

Unfortunately, a fair number of politicians are in thrall of an ideology that favors government, and a fair number of others don’t much mind hurting people if they can’t be blamed for it.

Health Insurance as Though Economics Matters

Two more examples of how market competition drives down prices are stand-alone imaging centers and dialysis centers. It’s clear that sane health-care reform would involve high coinsurance, deductables and out of pocket maximums, combined with medical savings accounts.

But that doesn’t serve the political interests of certain people.

Obama’s Arrogant, Partisan Health Care Speech

From Reason, a fairly long post, in which we found the following particularly cogent:

As the reform supporter and professional skeptic Mickey Kaus noted before the speech, “Obama doesn’t need to get ‘Republicans on board.’ He doesn’t need to get Blue Dog Democrats on board. He needs to get voters on board.” And if there’s any tactic less effective at wooing skeptics than number-fudging insincerity, it’s number-fudging insincerity coupled with attacks on the veracity, motivation, and worldview of the skeptics themselves.

Again last night, Obama invoked the boogeyman of “special interests” who “lie” in order “to keep things exactly the way they are,” despite the fact that the special interests in this case are lining up to support the president, and that the critics of his plan tend to bemoan, not defend, the status quo. Opponents of his plan, he said, were “ideological”; Ted Kennedy’s support for health care reform, meanwhile, “was born not of some rigid ideology, but of his own experience.” Obama said his door was “always open” to those bringing “a serious set of proposals,” and he slammed that door shut on any attempts to break the almost universally unloved link between employment and insurance. He yearned to “replace acrimony with civility,” then got Democrats stomping on their feet with attacks against the Iraq War and “tax breaks for the wealthy.” The center of the debate, as always, was wherever he chose to stand.

And above all else, Obama chose to shadowbox against the more extreme claims of the Sarah Palins of the world, rather than engage the most serious of the skeptics’ arguments. No, the administration doesn’t “plan to set up panels of bureaucrats with the power to kill off senior citizens,” but what about the possibility of government cost-cutters frowning upon expensive hip replacement surgeries for the chronically old? No, the proposal doesn’t amount to a complete “government takeover” of health care, but it does continue to expand the government’s role (and, promises aside, expenses) in ways that make a deficit-whiplashed nation nervous. No, “no one would be forced to choose” a public option, but what about the argument that incentives would eventually push Americans from private insurance to the public plan?

Obama’s problem is simple: he has a hidden agenda. He wants a complete government takeover of health care. He wants health care rationed, as it is under systems of socialized medicine. He wants taxpayer money to pay for abortions. He wants illegal immigrants covered. He doesn’t mind if the deficit is drive up even higher.

But the public wants none of those things. Thus Obama simply has to lie.

When the Health Care You Get Depends on How Well You Lobby

White House Enemies List

This has gotten a lot of play in the media.

It’s the now-famous White House web page asking that Americans report any e-mail that says anything “fishy” about Obama’s attempt to impose government-run health.

We just sent them an e-mail, to flag@whitehouse.gov, as follows:

Please add me to your enemies list.

I’m a blogger who has blogged about how Obama wants government run health care.

You can’t make the video clips that show Obama saying he favors “single payer” go away.

John

I would suggest that an excellent form of protest would be for everybody who doesn’t like this Nixonian tactic to send a similar e-mail.

Of course, what one tells the White House would be different for each person, such as “I attended a town hall meeting and booed when the Congressman said that nobody wants government-run health care,” or “I sent a link to a video about how bad health care in Canada is to a friend.”

“Public Option:” Trojan Horse for Socialized Medicine