Fighting Universal Health Care

Coverage of yesterday's press conference on the concerns about "Cover All Kids" - the Governor's proposed universal health care coverage for children in the Morning Call.

Also from Capitolwire (Subscription). I particularly love this quote from Rendell's office: “It doesn’t matter if [Rep. Rohrer] thinks it needs to be studied," said Kate Philips, Rendell's spokeswoman. "His leadership signed a commitment.” In other words, since 8 legislative leaders wrote a letter that they would draft legislation (not guarantee passage), then Rep. Rohrer and the other 245 General Assembly member's opinions and votes count for nothing. Is Rendell proposing we shrink the size of the general assembly to 8?

HARRISBURG (Oct. 17) - Pennsylvania lawmakers will vote on the expansion of the state’s subsidized health insurance program for children in the coming days, but some lawmakers, policy groups and private insurance providers are questioning the wisdom of the decision.

On Monday, Rep. Sam Rohrer, R-Berks, discussed the issue in a news conference at the state Capitol with representatives of the Commonwealth Foundation, a Harrisburg-based conservative think tank, and the Pennsylvania Association of Health Underwriters. He urged “members of the General Assembly to hold off on the ‘Cover All Kids’ initiative until more research is done about the impact on private sector insurance.”
...
Despite concerns expressed by Rohrer and some of his Republican colleagues in the House of Representatives, the Rendell administration’s position is clear: Lawmakers made a promise they must now honor. “It doesn’t matter if [Rep. Rohrer] thinks it needs to be studied," said Kate Philips, Rendell's spokeswoman. "His leadership signed a commitment.”

Philips said Rohrer should have asked for this study months ago when Rendell proposed the idea and before Republican leadership worked out a deal with Rendell. In a letter to the governor, Republican and Democratic leaders of both the House and Senate wrote they would “work with [Gov. Rendell] to statutorily craft the language necessary to amend [the] CHIP program to expand the qualifying income levels, maximize federal resources and provide children’s health insurance for families who otherwise could not afford to purchase this vital coverage for their children.”
Philips said Rohrer’s call for an impact study is “not a legitimate reason” to prevent children from getting health insurance coverage. “It’s disgraceful at best,” she added.
...
Matthew J. Brouillette, president of the Commonwealth Foundation, said private health insurance providers could reduce their insurance offerings in the state if forced to compete with taxpayer-subsidized public sector insurance programs, thereby creating more uninsured people.
Brouillette also warned that expanding the CHIP program could create a budgetary problem for the state due to potentially incorrect assumptions by the Rendell administration about program use and costs in the coming years.
...

Jesus: Roman Empire Should Provide Universal Health Care

Remember the passage in the Bible where Jesus called upon the Roman Empire to provide universal, government-run health insurance? Well, Governor Rendell says it is there:

Rendell criticized politicians who talk about "morals" and "family values," yet refuse to support his plan for covering the uninsured.

If they care about what's right morally, Rendell shouted, they should heed the Bible's advice to "heal the sick" or stop claiming to support such values.

New taxes to provide government-run health care does not equate to "healing the sick". To paraphrase Ronald Reagan, "The size of the state budget is not an appropriate measure of social conscience or charitable concern."

If Governor Rendell wants to be truly charitable why won't he support ending laws that prevent people from buying lower-cost insurance from other states.

What about repealing mandates which drive up the cost of insurance and makes it too expensive for many familes?

Is it charitable to tax individuals for the cost of their health insurance? If, as we think it is not, then the Governor should support equalizing the tax code for those who buy insurance.

Instead, the Governor proposes a 3% payroll tax on businesses that "don't provide health insurance" (yet to be defined) to employees. As anyone can tell you, a payroll tax is essentially the same as a wage tax (or a pay cut) - meaning that employees who don't get insurance from their employer will get a 3% salary cut. Is this charitable?

How about creating a tax credit for charitable contributions to HSAs for low income families?

As Governor Rendell's plan essentially expands Medicaid, shouldn't we be talking about the negative effects of Medicaid, include the low quality care provided to Medicaid recipients.

What about considering the long waiting lists for medical care in countries with socialized medicine. Is moving us toward that model to be considered charitable?

Governor Rendell obviously confuses health "insurance" with health care, and confuses government spending with altruism.

Here are some other policy changes to free the market to reduce the uninsured and to help reduce the cost for those already insured. Jesus, Moses, and Muhammad would support that, wouldn't they? Of course the insurance companies and the unions backing Rendell's plan might not.

Is RendellCare good medicine?

Three articles in the NE PA Business Journal on Governor Rendell's health care proposals, all featuring the Commonwealth Foundation's Rick Dreyfuss.

Is Gov. Rendell's 'Prescription for Pennsylvania' Good Medicine?:
Dreyfuss: "I just question whether more government investment in the health-care system ultimately leads to a more competitive marketplace. I don't see a lot of evidence where it does"

Rx for Affordability:
Dreyfuss: "I don't see the plan reducing the cost of health care and I see it increasing the cost of government. It's not the direction I think we should be going."

Does the proposed 3% tax on employers violate ERISA?:
Dreyfuss: "What ERISA said is that employers are not required to provide any specific employee benefit level and, as such, they remain free to amend or modify or even to choose whether to offer these programs at all," says Dreyfuss.

According to Dreyfuss, the governor's CAP program mirrors the Maryland law except it targets all employers and sets a 3 percent threshold instead of 8 percent.

"So if you take at a given that this provision of the Rendell health-care proposal is somewhere between problematic and illegal, that puts to risk the revenue stream that is anticipated to come out of this," says Dreyfuss.

RendellCare lobbyists push socialist pricing

The lobbyists charged with pushing RendellCare InsurePANow has fired off another missive advocating more of Rendell's health care agenda. They tout a bill that they proclaim will "make insurance companies work for you". Huh?

The legislation they are lobbying for imposes a modified "community rating" on all insurance providers. Community rating means that insurance companies can't charge different rates for different individuals. While this sounds good on the surface, what it means is that younger, healthier workers would pay higher premiums, while the old and sick may pay less.

In addition, insurance companies wouldn't be able to charge smokers more (which seems odd given the anti-smoking campaign of RendellCare), nor would they be able to offer discounts for "healthy behavior" - i.e. wellness or fitness programs.

Community ratings drive up the number of uninsured, and discourage younger, healthier customers from buying health insurance (even when health insurance is mandated, as in Massachusetts). Read more about community rating in the ALEC/CAHI State Legislator's Guide to Health Care.

The RendellCare lobbyists claim that community rating would "help small businesses" and protect us from the big bad insurance companies. But small businesses oppose community rating, and many insurance companies favor it (including many of the big carriers), as they simply shift their cost to some people more while charging others less.

Instead, here are some actual reforms that reduce the cost of health care for everyone - insured and uninsured, employer-provided and individual purchasers, young and old, sick and healthy, smokers and the physically fit.

(Note: I don't think I signed up for the InsurePANow email list, but I did sign up for the Rendell re-election list to follow campaign events, and I assume that InsurePANow got both the email list and Rendell's campaign manager in a package deal)

Lawmaker's bills to counter Rendell health package

Chambersburg Public Opinion on Sen. Folmer's Healthy Pennsylvania proposal.

Governor Rendell has indicated he might, maybe, support this plan

"The governor's interest is in health care reform, whether it's his plan or someone else's. As long as it's a good one, we'll support it," [Rendell Spokesman] Ardo said.

That remains to be be seen. I don't know why Governor Rendell wouldn't support any of the Healthy PA reforms, if his goal is to "heal the sick". But, Given Rendell is on a bus tour to promote his "Cover all Pennsylvania" proposal, which represents the opposite approach, philisophically, to free market health care, call me skeptical.

We’re No. 2 … in loss of employer health insurance

Cross-posted on Capitol Domes
 
It should come as no surprise that universal health care proponents are spinning a report from an organization that supports universal health care to suggest that we need -- guess what -- universal health care.


Or, they say, we should at least adopt Gov. Rendell's halfway measures now stalled in Harrisburg.
Aside from not having enough taxpayer money to pay for such schemes, no one is asking the important question: Why are we No. 2?

That’s probably because these same folks were the ones pushing for many of the policy changes enacted during the Rendell years that likely have forced employers to drop health insurance for their employees in the first place.

Maybe the 2004 income-tax increase of nearly 10 percent on small businesses meant businesses have had billions less in capital they could have spent on health insurance.

Or maybe it was the minimum-wage hike of nearly 40 percent pushed through in 2006 that reduced capital being spent on health insurance for employees.

Or perhaps government programs are crowding out private coverage, as studies indicate that up to 60 percent of enrollees in expanded government health care programs (Medicaid, SCHIP, AdultBasic, etc.) were those who recently dropped private coverage.

Or perhaps government mandates that drive up the cost of insurance, such as the recently enacted autism mandate, make it too costly for businesses to afford.

But instead of asking why, we’re simply told once again, “Government is the solution” to the problem it has helped create.

At the Commonwealth Foundation, we also see a need to reform our health care system, but we have better ideas on how to approach the problem.

What reforms would you like to see?

Governors health care plan assailed

Alison Hawkes in The Herald Standard on business groups responses to Governor Rendell's universal healthcare plan.

[Rendell healthcare spokeswoman] Kelchner said she can't understand why business trade associations are not on board. Businesses that don't provide health care coverage are raising health care costs for businesses that do. "That piece I don't understand," she said. "We're trying to help everyone in the long run."

To paraphrase V: It's not about what you are trying to do, it is about what you are doing.

Hopefully this will help her understand the problem with RendellCare:
State can't fix health insurance problems it created
Higher Taxes Won’t Cure Cancer
RendellCare Treats the Symptom Rather than the Cause
RomneyCare is greatly exceeding expected costs

And here are some ideas about what we should be doing instead:
Alternatives to RendellCare
Eliminating government mandates would lower cost of health insurance
How to Cure the Health Insurance Crisis

Further Reading:
The Cure: How Capitalism Can Save American Health Care
Healthy Competition: What's Holding Back Health Care and How to Free It

PA Health Survey Results

The PA Department of Health released results on a survey of health (Behavioral Risk Factor Surveillance System). What does this tell us?

Their main finding was:

30 percent of adults [in PA] (ages 18-64) making less than $15,000 annually and 25 percent of adults (ages 18-64) with less than a high school education had no health insurance, compared to only 3 percent of adults making more than $75,000 annually and only 6 percent of adults (ages 18-64) with a college degree;

From which the Secretary of Health (note: appointed by Rendell) concludes:

This type of information supports the need for health care reform, including Governor Rendell’s ‘Cover All Pennsylvanians’ initiative to make affordable basic health insurance available to everyone in the state

FALSE! This finding completely undermines the push for RendellCare, which seeks to expand government run and subsidized health coverage to higher income families. But this survey find that it is very low income families - who are already eligible for Medicaid - that are unisured. Why? Probably because Medicaid sucks.

This survey also finds that:

70 percent of men and 54 percent of women were overweight, but only 55 percent of overweight men were trying to lose weight, compared to 75 percent of overweight women.

I have come to the conclusion that this is simply because the federal definition of "overweight" is just wrong. For instance, for a man of my height (5' 10") "normal" weight is 128 to 173, "overweight" is 174-208, and "obese" is 209 and above.

Based on this definition, I am obese. So is Steeler's running back Willie Parker. I always thought his nickname was "Fast Willie Parker" not "Fat Willie Parker".

Did Governor Rendell fix Medical Malpractice?

Not to impugn John Graham's post on StateHouseCall, saying "Gov. Rendell Has One Health Reform Half Right," but we think Pennsylvania gets less than a thumbs up on medical malpractice reform (See Evening Bulletin article, "Critics Dispute Rendell's Assertion Malpractice Crisis Has Come To End") .

Governor Rendell continues to oppose several tort reforms proposed by PA House Republicans and supported by the state NFIB, the PA Chamber, and the Politically Active Physicians Association, and his massive "Prescription for Pennsylvania" (aka RendellCare) makes no mention of tort reform.

In 2005, Governor Rendell vetoed the "Fair Share Act", which would have amended joint and several liability so that no defendant could be held responsible for a great share of damages awarded than their share of liability. He had supported this reform in his 2002 campaign.

Governor Rendell touts the reduced payments from MCare as part of the reason why the Med-Mal "crisis" is over. This ignores the fact that MCare was created in 2002 as a "temporary solution" to the Med-Mal insurance costs- but has been extended year after year as no real solution has been enacted (in fact, we argue that the MCare fund serves to stave off any real solution).

Pennsylvania continues to have among the highest costs for medical malpractice insurance, and studies indicate that doctors continue to leave Pennsylvania for other states.

On the other hand, Govenor Rendell has said he is open to "other ideas", including a proposal by State Sen. Mike Folmer - which includes many of the free-market reforms championed by the Commonwealth Foundation and other members of the Health Care Freedom Coalition.

We'll be generous and give Gov. Rendell credit for being "25% right".

Government Health Care Kills

Pennsylvania Governor Ed Rendell is calling on the Pennsylvania Senate leadership to break their pledge not to hold a lame duck session. Among Rendell's rhetorical arguments is that "nearly two people a day die in Pennsylvania because of a lack of health insurance."

The Commonwealth Foundation's response, tongue-in-cheek, is that 10 Pennsylvanians die every day because of government involvement in health care.

Of course, no one really dies because they lack insurance or because they enroll in Medicaid, but the point (besides exposing Rendell's demagoguery) is that government health insurance—which Governor Rendell sees as the solution—is worse than the disease.

Instead, we should look to options that allow more individuals to enroll in private coverage.

Gov. Rendell Calls the Kettle Black

The Sun-Gazette has a recent article on the Pennsylvania state budget titled "Rendell lashes out at Senate plan".  It didn't sound like something that would surprise me - but it did, because of the reasons Rendell is criticizing the Senate budget plan.

Just to recap, here are some of the basics of the Senate plan, and Rendell's budget, which he promises to cut by an additional $400 million.  What does Rendell critique in the Senate budget?

1) He says it isn't balanced - "It's out of whack from $750 million to $1 billion" and needs either more revenue or more cuts.  But here is the problem: Rendell proposes spending (after his new cuts) $1.3 billion more than the Senate, his proposed tax increases amount to less than $500 million.  In other words, by Rendell's own math, his budget is out of whack by $1.55 to $1.8 billion. 

2) He blasts privatizing the state liquor stores - this isn't part of the Senate budget, but has been touted as a possible revenue option.  Rendell decries using one-time revenue sources, "You don't do stuff like that," he said. "Those are gimmicks."

Hmm...

One time revenue sources used in Gov. Rendell budget for this year and next:

• Federal Stimulus: $3.5 billion
• Rainy Day Fund: $625 million
• Health Care Provider Retention Account: $350 million
• Legislative Surplus: $175 million 
• Marcellus Shale Lease Revenues: $174 million
• Prior Year Lapses (money unspent in 2007-08): $91 million

Hey kettle, this is the pot, you're black.

Public Health Insurance is Not Sustainable

Fraser Institute study reports that "health insurance costs are growing faster than our ability to pay." While this may sound like a report that would support Governor Rendell's "Cover all Pennsylvanians" plan, I should mention this is a report on Canadian health coverage. The style of government run health insurance Governor Rendell is proposing is failing in Canada.

The Fraser Institute recommends that Canada expand private sector competition in health insurance and allowing individual patients to pay for health care of all kinds - ideas Pennsylvania policymakers should learn from.

RendellCare!

AP story on Rendell's health care proposals, including universal health care ("Cover All Pennsylvanians"). For more details, go to the Governor's Health Care Reform site.

FYI, several months ago, a young soothsayer predicted that the Governor's "Cover All Kids" proposal would be "the first step toward a universal, government monopoly of health coverage for all residents, not just children."

Look for more on our take of the Governor's proposals in the coming days.

Everyone calls for reform - Except Rendell

Following the bonusgate indictments, there have been many more calls for action to clean up Pennsylvania state government, some from familiar voices, some from new members of the choir

• Sens. Scarnati and Pileggi call for the House Democrats to act on legislation the senate already passed (more on the Cerberus of the General Assembly).
• Reps. King and Galloway will start pushing for a Constitutional Convention (details). Democracy Rising lists other Constitutional Convention bills.
• Sen. Jeff Piccola calls for a special session on integrity, and will begin circulating petitions if the Governor refuses to call one. The Commonwealth Foundation will join Sen. Piccola, along with several others, as a press conference today at 2, as we joined in the call for one months ago).

It seems the only person who doesn't get it is Governor Rendell, who (through a spokesman) announced he won't call a special session, because it just isn't that important. Corruption in government isn't worth his time or effort? Really?

Gov Rendell cites energy and health care as more important but does he believe improving the integrity of government would 1) take too much time or 2) reduce his ability to pass legislation through corrupt schemes?

If it's a matter of time, here is a radical idea: make legislators return to Harrisburg before Sept. 15 (when the next session day is schedule) and make them work in October, instead of campaigning. Isn't good government more important than a few days at the beach? More important than kissing babies?

Oh, and for those who speculate Rendell is just pushing his energy, transportation, and health care agenda to win an Obama cabinet post or the VP slot on the ticket - let me point out (to Governor Rendell as well) that Obama is running on "cleaning up government" and "Change." Having the Governor of (arguably) the most corrupt state in the union, and one who refused to do anything about it, on the ticket might not play so well.

"Stupid Hicks" Oppose Big Government

I wasn't going to post anything on Barack Obama's comments about people "clinging" to guns and religion, until Philadelphia Daily News columnist John Baer offered his Obama can do no wrong defense.

Baer contends that:

1. He (Baer) is a small town guy at heart, because he enjoys the music of John Mellencamp, and wasn't offended by Obama's comments (I won't debate him on that).
2. Many people are frustrated with government - particularly the pay, benefits, abuses of power, etc (I concur).
3. People often express their frustration by illogical policy stances (I don't disagree).
4. Issues like the "defense of marriage amendment", gun rights, abortion, and religious freedom are meaningless.
5. Anyone who doesn't support Obama's agenda is naive. (Obviously, I take issue with the latter two points.)

Essentially Baer - like Governor Rendell when he declared "Jesus would support my health care plan" - is calling on "small town folk" to stop being Conservative, to support gay marriage, abortion, gun control (though it is Philadelphia Democrats who seem "bitter" and "cling" to guns as an issue), and above all, fixing health care.

Of course, when Baer says "fixing" health care, he means support RendellCare (or Obama/Hillary's plan). He, and others, argue that the debate is between "fixing health care" and not. He pretends the debate over how to fix health care does not exist, or that Rendell/Obamacare might make things.

Though I think those of us "bitter" and frustrated with government have a better plan.

Rendell pushes health plan

Lancaster Intelligencer Journal article on RendellCare. After quoting my commentary on Rendell's misdiagnosis of the problem, the article then quotes Rendell saying: "'It’s important for the Legislature to suck it up and say no' to special-interest lobbyists, Rendell said."

Which special-interest lobbyists does Rendell want to say no to? At his press conference announcing RendellCare, he appeared with union leaders (Bill George of the AFL-CIO specifically), health insurance companies, and healthcare providers. He has also claimed that business leaders love his plan. So which "special interest" is left out? Oh yeah, he forgot the "special interest" known as the taxpayers.

Healthcare For PA Families

House Republicans unveiled the outlines of a alternative health care reform plan, which they are calling the "Real Prescription for Pennsylvania" (their website name, Healthcare For PA Families, is a better name for marketing).

While the concept of their plan is good - consumer driven reform, giving choice to consumers, freeing the market, reducing the cost of health insurance and care, and avoiding more government programs - the details are limited. Some of their best reform ideas include: Requiring insurers to offer basic health policies ("Allowing" would be a better solution than "requiring" in my view, though I don't think insurers would choose not to offer a basic plan); liability reform, and supporting Health Savings Accounts.

Only two pieces of legislation currently exist; one reintroduces the Fair Share Act - which would limit the liabilities due in a lawsuit to the percentage of fault of a defendant - which Governor Rendell vetoed last year (after supporting as a candidate in 2002).

The second, HB 121 would offer tax credits to small businesses for contributions to employee's Health Savings Accounts - the tax credit would be 25% of the contribution to individual HSAs and 50% to family HSAs. While this is a good way to encourage HSA use and decrease the cost of health coverage for employers, I consider it a lower priority. It does little to tranform the system, and insists on employer provided HSAs, which are already tax-free expenditures.

Some additional ways to promote HSA use would be:

• List Billing - this would allow employers to contribute to their employee's individually purchased HSA, without having a company plan. This was part of Missouri's recent health care reform.
• HSA Charitable Tax Credits - similar in design to the Educational Improvement Tax Credit, this could allow tax-free donations to charities providing partial support for HSAs to low income families.
• HSAs as a plan option for state workers and legislators, and for Medicaid recipients.
  

Rendell Declares Autism Mandate a Failure

In 2008, the Pennsylvania General Assembly passed, and Gov. Rendell signed, a new mandate that private insurers would have to cover autism services. At the time, we said the new mandate would drive up insurance premiums, should be offered as an optional rider, and suggested vouchers for autistic children instead.

Gov. Rendell, however, suggested the mandate would actually save taxpayers, saying in his signing statement,

"By requiring private health insurers to shoulder their fair share of the cost of treatment, we’re taking steps to address the gap in the private insurance market and reduce reliance on government programs as the primary source of services and funding.” [emphasis added].

But now Rendell is saying we have to increase, not reduce state spending on autism services. He blasts the Senate Republicans for proposing to spend "only" $14.8 million on the line-item. In reality, the Senate budget would spend $19.1 million - using federal stimulus funds to supplement state funds - but don't expect Gov. Rendell to give the straight facts.

That total actual represents about the same as 2008-09 spending (after Rendell's freeze, which reduced the autism line item by $3.7 million, and later revision to the actual spending), and a whopping $9.2 million increase (92%) over 2007-08, when Rendell signed the autism mandate.

I guess it is pretty fair to say that if a 92% increase in autism spending in two years isn't enough, then we have not "reduced reliance on government programs"

Renewed push on health care planned

The Patriot News reports that Governor Rendell will continue to push his health care tax.

Meanwhile, other state legislatures are taking up free-market health care reform (often to fight off proposals for socialized medicine), including California, Missouri, and now Wisconsin. Unfortunately there has yet to be any serious alternative to RendellCare presented, other than a House Republican Working Group plan to expand HSAs, which we offered some suggestions for.

For more ideas check out the Health Care Freedom Coalition's Affordable Health Care Agenda, the Heartland Institute's Ten Principles of Health Care Policy, and our PolicyPoints on Health Care Reform.

Is "Fair Share Tax" dead?

Times Tribune article suggests there is no support in the General Assembly for a payroll tax on businesses to pay for "Cover All Pennsylvanians". The administration suggested (as they have on other issues) they are open to alternatives- so long as the alternatives involve getting more money from taxpayers to pay for their plans.

In an interview, Rosemarie B. Greco, the director of the Gov.'s Office of Health Care Reform, said the administration was willing to discuss other funding sources with legislative leaders if necessary, but would not say what those possibilities might be.

"If in fact the fair-share assessment is something that ... would not even stand up for a vote, then I'm sure the governor would want to sit and talk with the leadership about what would the alternative be," Greco said after she testified before the Senate panel.

If the only discussion is about alternative funding sources, Pennsylvania taxpayers and residents have already lost. What we need is free-market alternatives to socialized medicine. Here are some starting points from the Commonwealth Foundation and others:

Free-Market Health Care Reforms
Universal Healthcare's Dirty Little Secrets
State can't fix health insurance problems it created
Governor Rendell’s Healthcare Misdiagnosis
Treating the Symptom Rather than the Cause
For Health Care Woes, a Capitalism Prescription
Eliminating government mandates would lower cost of health insurance

Books:

The Cure: How Capitalism Can Save American Health Care
Healthy Competition: What's Holding Back Health Care and How to Free It