An Axelrod to grind

I got an email from David Axelrod today. Since he asked me to forward it, I’m including the substantive portion below with my own comments included.

8 ways reform provides security and stability to those with or without coverage

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
   Whatever you feel about this, it dramatically increases costs. I know we abandoned any sense of treating health insurance as… insurance… a long time ago, but I’ll repeat: insurance simply cannot be profitable (or manageable if it can’t make use of actuarial analysis. Should we also demand that home insurance cover damages that were sustained before the policy was written?
2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
   This is absurd. All it does is increase premiums. No cost savings, no net benefit in health coverage, it’s shifting the accounting in an attempt to fool people.
3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
   See above. Another pointless accounting measure that increases premiums. There’s a significant downside to this kind of cost masking: forcing insurance to cover “preventive” care upfront and without co-pay will result in the insurance companies capping the number and kind of “preventive” visits that they’ll cover. This is back-door service rationing, nothing more.
4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
   In practice this means that insurance companies will be prohibited from capping the total amount of individual liability. Again, it’s an effort to force insurance to abandon actuarial analysis, which makes insurance impossible. Again, imagine an insurance company trying to assess the risk of insuring homes against fire when the potential financial exposure on each home is essentially unlimited? No fire insurance.
5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
   Again, an attempt to ignore actuarial evidence.
6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
   All of these attempts to end-run the actuarial tables only serve to make private insurance impossible. These are provisions that will destroy the private insurance market. That’s their purpose and aim, no other. The cost increases that would result from these provisions would be impossible to absorb.
7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
   Why not 86? Because young adults are the population that consumes the least amount of health care. They’re also the most likely to not have insurance. By extending family coverage to young adults, the premiums that would otherwise be lost are captured. Since there’s no attempt to mean-test any of these proposals, this acts simply as a yet another tax on the young to support the aging.
8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.
   I’m not sure how this differs from point 4, above. I’m not also sure how it’s legal. A contract that cannot be terminated is not a contract, it’s servitude.

8 common myths about health insurance reform

1. Reform will stop “rationing” – not increase it: It’s a myth that reform will mean a “government takeover” of health care or lead to “rationing.” To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
   The full frontal assault on actuarial analysis will require insurance companies to ration all the coverage that they’re forbidden to charge co-pays and deductibles on. For as long as they can manage to stay in business at all that is. But public insurance isn’t magically exempt from the laws of economics and nature, the only way to increase liability limits while abandoning actuarial analysis is to decrease coverage.
2. We can’t afford reform: It’s the status quo we can’t afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
   This is just a lie. Obama promised the same thing about the rest of his agenda. The result? $100 million in “waste cutting.” $100 million out of a $3 trillion budget. You simply cannot radically increase obligations and not radically increase costs. The government is notoriously–and necessarily–wildly less efficient than the private sector.
3. Reform would encourage “euthanasia”: It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
   This is correct. There is no euthanasia requirement, unless it’s euthanasia by prolonged exposure to crippling debt. But really, why put the “end of life” consultations in the section of the bill addressing cost reduction strategies?
4. Vets’ health care is safe and sound: It’s a myth that health insurance reform will affect veterans’ access to the care they get now. To the contrary, the President’s budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
   I haven’t seen any criticism of the proposals because of the negative effects it might have on the VA. I have seen a number of rather frightening reports of incompetence and cost overruns in the VA that belie the idea that the Feds have the competence to run a national health care system. I will also add that it’s indisputably our responsibility to provide veterans with health care. Got no beef with me on that score. I just wish the VA were better managed and provided better care.
5. Reform will benefit small business – not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
   Why not extend the tax benefits to individuals as well? Why not just make health costs deductible below the line? Add a means-tested credit for insurance premiums and maybe vouchers for preventive care and call it a job well done?
6. Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare “doughnut” hole to make prescription drugs more affordable for seniors.
   And it will make your teeth white, ease the pain of heartbreak, and give your car that fresh-from-the-dealer smell. If they won’t finance it with Medicare cuts, how the hell will they finance it?
7. You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
   Page 16 of the bill in the House committee contains a provision that makes individual health insurance illegal. Also, when your private insurers goes bust because they’ve made it illegal to price insurance (that’s the actuary’s job), your insurance will change.
8. No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts.  Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose.  Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.
   What??? The government will be in charge of the privacy of my health insurance payments?? WTF? The government in charge of privacy??

8 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill.
   First, these numbers aren’t accurate. Why aren’t these people on Medicaid? Don’t we already have a program for the uninsurable? Even if we accept this as a problem, shouldn’t we address this problem rather than devise a program to ensure that no one is privately insured?
   
2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job.  Americans pay more than ever for health insurance, but get less coverage.
   Get less coverage? Not true. That would be true if premiums had increased faster than payouts, but they haven’t. According to the National Coalition on Health Care, premiums rose 5% in 2008 while expenditures rose 6.9%. Yes, that means that with each passing year, Americans are getting more coverage for less premium.
   
3. Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care.
   So, they’re saying that women cost more to care for than men, and while we should pay close attention to that fact as a reason to support the administration’s proposals, we should ignore that fact when it comes to price actual care. Maybe we should be looking at ways that we could reduce the costs of chronic care for men and women?
   
4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities.
   But how is destroying the private insurance market supposed to help rural America? From John Goodman,

   Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income—with rich and well-connected citizens jumping the queue for treatment. Democratic political pressures (i.e., the need for votes) dictate the redistribution of health care dollars from the few to the many. In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments.

5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse.
   Systematically increasing premiums is not the way to help small businesses. Extend the tax deduction to individuals.
6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.
   So we should make personal tragedies political? Again, this argues for addressing concerns and problems with Medicare, but it provides no justification at all for assaulting everyone’s coverage. Medical costs can be extraordinary, to be sure. The way to decrease costs and increase availability is through competition, innovation, and wealth generation. The point isn’t that we don’t want Grandma and Granddad to pay $300,000 for medical care, it’s that we should want them to be able to pay it.
7. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people – one in every three Americans under the age of 65 – were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families.
   There’s a key point in these absurd numbers, “at some point.” If you changed jobs and were uninsured for a day, or if you adjusted coverage at your job and the old policy ended before the new policy began, you were “uninsured.” This is an especially weaselly lie as regulations dictate the manner and nature in which co-insurance policies are written, so if you change jobs, or substantially revise your primary insurance, you must–by law–be uninsured “at some point.” This is an abuse of statistics designed simply to scare people.
8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance – projections suggest that this number will rise to about 72 million in 2040 in the absence of reform.
   First, increased health care expenditures are a good thing. We don’t want to reduce our health care expenditures, we want to spend more on health care! The truly disturbing trend would be an annual reduction in health care expenditures, that would certainly mean that we’re getting less care, less innovation, and less health. Is everything hunky-dory and peachy-keen? No. But the reforms on the table are not improvements. Should we do something? Yes. But doing something doesn’t mean doing anything. We should do something, but we should do something smart. Extend the tax deduction. Let’s talk about means-tested health-care vouchers and tax credits. Let’s talk about catastrophic coverage and actuarial pools. Let’s talk sense.

rules

Ezra Klein has an unusually banal piece in the WaPo in which he presumes to demand that anyone who opposes the current healthc are reform bill, oppose it ways that he approves of. Specifically, he asks that if you use the CBO’s critical assessment you, “must do some combination of the following:”

a) Support, as the CBO says you should, the eradication of the tax exclusion that protects employer-based health-care insurance;

b) Support, as Lewin and Commonwealth say you should, a public insurance option that can bargain at Medicare’s rates;

c) Support, as the Office of Management and Budget and every health-care wonk in town says you should, one of the various policies floating around to give MedPAC authority to continually reform and modernize Medicare;

d) Support some form of aggressive cost-sharing that would make people extremely angry because it will save money by reducing their access to health-care services;

e) Support comparative effectiveness review that can judge not only the effectiveness but also the cost-effectiveness of various treatments, and give the federal government authority to use that data when deciding reimbursement rates.

Well, as it happens, I support a… except that I’d prefer to see the tax break extended to private individuals rather than eradicated. We should make all health care expenses, out-of-pocket expenses as well as insurance premiums, tax-deductible below the line.

Option b is a vile, nasty solution that will drive up costs, reduce the quality of care, and force private insurance out of business. Option c is…. oh, whatever. This is emblematic of how crippled the current health care debate is.  Whenever anyone uses the line, “every wonk in town says you should,” without any justification, it means that he’s  either a complete idiot, an insufferable gasbag, or in this case, both.

Option e, is of course, the idea that the federal government could decide that some treatments regardless of their efficacy, aren’t worth supporting and will not be covered. It’s essentially giving the government the power to decide that your life isn’t worth quite as much as you might think it is.

Option d also stinks, but is of course, the essence of the current bills (and of option b). Aggressive cost-sharing is all that the government can do, “a public insurance option that can bargain at Medicare’s rates” is the very definition of aggressive cost-sharing. Klein claims he doesn’t support d, but he does support both b and e, which is exactly the same as supporting option d.

What Klein is saying is that if you oppose the current bill, you’re just opposed to increasing taxes and reducing the quality of care.

No time to think

The administration is pushing both houses of Congress hard to pass health care bills before the August recess.  Reports are that the administration wants this badly enough to push it through on a purely partisan basis. Whether enough Democrats would be willing to entirely own the consequences of such woeful legislation remains to be seen. They certainly wouldn’t have gotten the stimulus packages through without significant Republican cover, and the Republicans may have learned their lesson (sometimes, even idiot dogs can learn new tricks).

But why the rush? Why is it SO darned urgent to push 1,000 pages of legislation through Congress RIGHT NOW? Well, the rush is on because the administration sees its approval ratings slipping (no surprise) and they don’t imagine that they’ll be able to strong arm as many Blue Dog Democrats in the fall as they might be able to right now. Plus, if they waited, well then someone might actually read the legislation. (Well, probably not any of the legislators… let’s not get silly.)

Instead of saving the federal government from fiscal catastrophe, the health reform measures being drafted by congressional Democrats would increase rather than reduce public spending on health care, potentially worsening an already bleak budget outlook, the director of the nonpartisan Congressional Budget Office said this morning.

Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose “the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.”

“On the contrary,” Elmendorf said, “the legislation significantly expands the federal responsibility for health-care costs.” — Washington Post

Well… duh.

So let’s see here, we’ve got increased health-care costs, higher taxes, and we’re going to limit access to care, reduce Medicare coverage for the elderly and, oh yeah, make private individual health insurance illegal. Sounds like business as usual.

more newspeak

From the WSJ,

Last September Sen. Barack Obama promised that under his health-care proposal “you’ll be able to get the same kind of coverage that members of Congress give themselves.” On Monday, President Obama repeated that promise in a speech to the American Medical Association. It’s not true. …

Members of Congress “enjoy the widest selection of health plans in the country,” according to the U.S. Office of Personnel Management. They “can choose from among consumer-driven and high deductible plans that offer catastrophic risk protection with higher deductibles, health saving/reimbursable accounts and lower premiums, or fee-for-service (FFS) plans, and their preferred provider organizations (PPO), or health maintenance organizations (HMO).” These choices would be nice for all of us, but they’re not in the offing. Instead, if you don’t enroll in a “qualified” health plan and submit proof of enrollment to the federal government, you’ll be tracked down and fined (sections 3101 and 6055).

For a health plan to count as “qualified,” it has to meet all the restrictions listed in the legislation and whatever criteria the Secretary of Health and Human Services imposes after the bill becomes law. You may think you’re in a “qualified” plan, but the language suggests that only plans with managed-care controls such as the “medical home” will meet the definition (sections 3101 and 2707).

Great. The Obama plan is designed to “cut costs” by requiring doctors to “manage” care in accordance with govt. directives. Payments will be made to a subscriber’s primary care physician (PCP) based on how effectively the physician has followed federal treatment guidelines. That means that if your PCP orders a test that isn’t on the formulary for your preliminary diagnosis, or if he prescribes an individualized course of treatment that deviates from the standard directive–as set by the Secretary of Health and Human Services–then he’ll be financially penalized. That’s right. Under Obama’s plan, your doctor will be financially penalized for treating you and financially rewarded for limiting treatment.

If you don’t sign up for a plan that limits your care, you’ll be fined.

But what about Congress and Federal employees? Surely since this is the “kind of coverage that members of Congress give themselves” we should expect the formulary to be expansive, forgiving and inclusive? Ha.

“[Obama's Plan] specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116).”

So, when the President says that you’ll be able to get the “kind of coverage that members of Congress give themselves” what he means is that that you won’t be able to get that kind of coverage.

It gets better.

What he said,

So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. . . .

If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange. . . .

You can keep your existing coverage, if it exists and isn’t forced under by government subsidized monopoly care, and if it does last, you can keep it and be fined for keeping it. How generous! Not only will Obama let you keep your existing health insurance, he’ll fine you for the privilege.

According to the AP, the White House has already backtracked some of these “promises,”

White House officials suggest the president’s rhetoric shouldn’t be taken literally: What Obama really means is that government isn’t about to barge in and force people to change insurance.

Well, they won’t barge in; they’ll be quiet.

Earlier this week, a preliminary analysis by Congressional Budget Office estimated that 10 million people would have to seek new insurance under a Democratic plan that a Senate committee is working on, because their employers would no longer offer coverage. Those workers and their families would shop for a plan through new insurance purchasing pools called exchanges. About 160 million to 170 million people now get employer coverage.

So, if you like your health insurance, and it matches what they want you to have, and you don’t get your insurance through your employer, then sure, yeah, you can keep it. But they’ll still fine you.

From Jim Lindgren at Volokh.com,

In other words, if you believed something closer to the opposite of what Obama promised, that would be closer to the truth. When Obama said he “will keep this promise”:

If you like your doctor, you will be able to keep your doctor. Period.

he actually meant:

If you like your doctor, many of you will NOT be able to keep your doctor. Period.

And when Obama said he “will keep this promise”:

If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.

Obama really meant:

If you like your health care plan, many – perhaps most – of you will NOT be able to keep your health care plan. Period. Someone – perhaps your employer – may take it away. It all depends on how things work out.

Feeling ill

From Kieth Hennessey: (emphasis added)

1. The Kennedy-Dodd bill would create an individual mandate requiring you to buy a “qualified” health insurance plan, as defined by the government.  If you don’t have “qualified” health insurance for a given month, you will pay a new Federal tax.  Incredibly, the amount and structure of this new tax is left to the discretion of the Secretaries of Treasury and Health and Human Services (HHS), whose only guidance is “to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).”  The new Medical Advisory Council (see #3D) could exempt classes of people from this new tax.  To avoid this tax, you would have to report your health insurance information for each month of the prior year to the Secretary of HHS, along with “any such other information as the Secretary may prescribe.”
2. The bill would also create an employer mandate.  Employers would have to offer insurance to their employees.  Employers would have to pay at least a certain percentage (TBD) of the premium, and at least a certain dollar amount (TBD).  Any employer that did not would pay a new tax.  Again, the amount and structure of the tax is left to the discretion of the Secretaries of Treasury and HHS. Small employers (TBD) would be exempt.
3. In the Kennedy-Dodd bill, the government would define a qualified plan:
   1. All health insurance would be required to have guaranteed issue and renewal, modified community rating, no exclusions for pre-existing conditions, no lifetime or annual limits on benefits, and family policies would have to cover “children” up to age 26.
   2. A qualified plan would have to meet one of three levels of standardized cost-sharing defined by the government, “gold, silver, and bronze.”  Details TBD.
   3. Plans would be required to cover a list of preventive services approved by the Federal government.
   4. A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.”  The MAC would have to include items and services in at least the following categories:  ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.
   5. The MAC would also define what “affordable and available coverage” is for different income levels, affecting who has to pay the tax if they don’t buy health insurance.  The MAC’s rules would go into effect unless Congress passed a joint resolution (under a fast-track process) to turn them off.
4. Health insurance plans could not charge higher premiums for risky behaviors:  “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.
5. Guaranteed issue and renewal combined with modified community rating would dramatically increase premiums for the overwhelming majority of those Americans who now have private health insurance.  New Jersey is the best example of health insurance mandates gone wild.  In the name of protecting their citizens, premiums are extremely high to cover the cross-subsidization of those who are uninsurable.
6. The bill would expand Medicaid to cover everyone up to 150% of poverty, with the Federal government paying all incremental costs (no State share).  This means adding childless adults with income below 150% of the poverty line.
7. People from 150% of poverty up to 500% (!!) would get their health insurance subsidized (on a sliding scale).  If this were in effect in 2009, a family of four with income of $110,000 would get a small subsidy.  The bill does not indicate the source of funds to finance these subsidies.
8. People in high cost areas (e.g., New York City, Boston, South Florida, Chicago, Los Angeles) would get much bigger subsidies than those in low cost areas (e.g., much of the rest of the country, especially in rural areas). The subsidies are calculated as a percentage of the “reference premium,” which is determined based on the cost of plans sold in that particular geographic area
9. There would be a “public plan option” of health insurance offered by the federal government.  In this new government health plan, the federal government would pay health care providers Medicare rates + 10%.  The +10% is clearly intended to attract short-term legislative support from medical providers.  I hope they are not so naive that they think that differential would last.
10. Group health plans with 250 or fewer members would be prohibited from self-insuring. ERISA would only be for big businesses.
11. States would have to set up “gateways” (health insurance exchanges) to market only qualified health insurance plans.  If they don’t, the Feds will set up a gateway for them.
12. Health insurance plans in existence before the law would not have to meet the new insurance standards.  This creates a weird bifurcated system and means you would (probably) be subject to a different set of rules when you change jobs.
13. The bill does not specify what spending will be cut or what taxes will be raised to pay for the increased spending.  That is presumably for the Finance Committee to determine, since it’s their jurisdiction.
14. The bill defines an “eligible individual” as “a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”
15. The bill would create a new pot of money for state gateways to pay “navigators” to educate people about the new bill, distribute information about health plans, and help people enroll.  Navigators receiving federal funds “may include … unions, …”

——————————

There’s some really nasty stuff in there. It’s crucially important to remember that the economics of public chopice dictate that these kinds of programs are subject to quick capture by parties with long-term vested interest (health insurers). The mandatory minimum coverage terms that come associated with this plan will quickly become exhaustive lists of coverage. The number of “essential health benefits” will erode as quickly as “inessential health benefits” will fade from private coverage.

The net effect of these lists and requirements will be shortages and queues. This bears repeating because supporters will insist, despite all evidence to contrary, that some how, some way, by some miracle of hope, the laws of economics won’t apply to subsidized health care. But they will. And when you reduce the cost of a scarce good to zero (through subsidy) and constrain supply of that same good (through price controls and increased regulation) the result is a shortage of that good.

The most appalling on the list (it’s hard to pick) may be that plans will not be allowed to adjust rates for risky behavior.

Part of the reasoning behind that little bit of genius (just wait until the queue for liver transplants gets jumped by some congressman’s drug-addled, meth-freak of a nephew), is that I imagine the plan will rely on increased sin-taxes for financial support.

I eagerly await the chorus of denunciation from the Democrats in Congress who will surely decry the delegation of such enormous power to the Executive branch. Right? They were exorcised about the over-reaching Bush White House and will surely stand up to what amounts to granting the White House total control over a significant portion of the federal tax-rate, right?