Will Single-Payer Health Care Help Ruin the Planet?

To promote his single-payer health care legislation, Democratic presidential candidate Bernie Sanders recently sent an interesting tweet: “Average cost of childbirth in the United States: $32,000. Average cost of childbirth with Medicare for All: $0.” However, the left’s general position on population growth’s effect on the climate make one wonder why Sanders and his single-payer supporters want to facilitate additional births, whether in the United States or overseas.

As one might expect, Sanders’ tweet contained several oversimplifications and mis-statements. First, his “Medicare for All” bill would actually abolish the Medicare program. Second, the 2013 report to which Sanders referred studied the charges medical providers submitted, not just for childbirth, but for all prenatal and postpartum care. While doctors and hospitals charged patients an average of $32,063 for this year’s worth of care before and after a vaginal childbirth, insurers paid far less ($18,329)—and consumers paid only $2,244 out-of-pocket.

Not one week before Sanders sent his tweet, he addressed the topic of population growth at a CNN climate forum. A member of the audience said that “human population growth has more than doubled in the past 50 years. The planet cannot sustain this growth.” In talking about “the need to curb population growth,” she asked Sanders if he would “be courageous enough to discuss this issue and make it a key feature of a plan to address climate change?” Sanders responded in the affirmative, then proceeded to highlight the need for abortion and contraception, both in the United States and overseas.

In his CNN appearance, Sanders echoed statements by other leftist leaders. In February, Rep. Alexandria Ocasio-Cortez (D-NY) asked what she considered “a legitimate question: Is it okay to still have children,” given that “there’s a scientific consensus that the lives of children are going to be very difficult?”

Following Ocasio-Cortez’ comments, Vox highlighted “a growing discussion about the ethics of having children,” due to the “a genuine concern of many young prospective parents today” about the effects of climate change. It included some questions that prospective parents have asked themselves about having children, including “how much time do I have to make a decision” to see if carbon emissions decline rapidly, and “what kinds of signals would I be sending” by making an environmental statement to eschew parenthood.

Leftists like Sanders and Ocasio-Cortez, and forums like Vox, have given voice to millennials seeking to avoid procreation, whether to hypothetically save the planet, avoid a dystopian future for their potential offspring, or a combination of the two. But few outlets on the left have reconciled their belief in the need to slow population growth to save the planet with their support for a single-payer system that—according to Sanders’ own statements—would encourage population growth by making it financially easier for parents to have children.

The conservative case against Sanders’ proposal encompasses the taxes, regulations, and government control necessary to create a single-payer health system. But liberals who claim to have a single-minded focus on the climate crisis should oppose single payer as well, due to the ecological effects that would logically follow.

This post was originally published at The Federalist.

Rant by Congressional Spouse Illustrates the Problem Facing American Health Care

Last week, the wife of Rep. Joe Cunningham (D-S.C.) went on a self-described “rant on social media” about her health coverage.

Amanda Cunningham’s comments echo claims by Democratic lawmakers like Reps. Alexandria Ocasio-Cortez (D-N.Y.) and Rep. Cindy Axne (D-Iowa) about the problems with their health coverage. For many members of Congress that comes via Obamacare-compliant policies sold on health insurance exchanges.

The comments raise one obvious question: If Democrats don’t like Obamacare plans for themselves, then why did they force all Americans to buy this insurance under penalty of taxation? But beyond demonstrating the bipartisan dissatisfaction with Obamacare, Amanda Cunningham’s story illustrates the larger problems plaguing the American health care system.

Mental Health Parity

In her Instagram post, Cunningham complained that under her Blue Cross Blue Shield policy, “all of my mental health therapy sessions are denied, in addition to all of our marriage counseling sessions.” She continued: “It’s just mind-blowing to me that these basic well-known needs, that mental health is health care, are still being denied, that we’re still fighting for these absolutely basic things—it’s unbelievable to me.”

Cunningham didn’t go into many specifics about her case, but on one level, her argument sounds compelling. The opioid crisis has shone a brighter spotlight on the people who need treatment to cover mental illness or substance use disorders. Congress passed mental health parity legislation (as part of the TARP bill, of all things) in 2008, and Section 1311(j) of Obamacare extended these provisions to exchange plans.

Other People’s Money

On the other hand, consider that members of Congress receive a salary of $174,000 annually—more than most Americans (myself included). Consider also that unlike all other Americans purchasing coverage on Obamacare exchanges (myself included), Cunningham, other members of Congress, and their staff receive (likely illegal) subsidies offsetting much of the cost of their health insurance premiums.

More importantly, consider that each coverage requirement on insurers—whether to cover a certain type of treatment (e.g., mental health, in-vitro fertilization, etc.) or treatments provided by a certain type of provider (e.g., marriage counselor, podiatrist, etc.)—raise the price of health insurance each month. Collectively, the thousands of mandates imposed nationwide increase premiums by hundreds of dollars per year.

They also send a paternalistic message to Americans: The policy-makers who impose these coverage requirements would rather individuals go uninsured, because their premiums have become unaffordable, than purchase a plan without the covered benefit or treatment in question.

She didn’t say it outright, but in her “rant,” Cunningham wanted to raise premiums on other Americans—most of whom earn far less than her family—so she would receive “free” therapy. Viewed from this perspective, her objections seem somewhat self-serving from a family in the upper tier of the income spectrum.

Therein lies the problem of American health care: Everyone wants to spend everyone else’s money rather than their own. Everyone wants “their” treatments—in this case, Cunningham’s counseling sessions—covered, even if others pay more. And if their chosen therapies are covered by insurance, with little to no cost-sharing, patients will consume more health care, because they believe they are spending their insurer’s money rather than their own.

Obamacare Made It Worse

The 2010 health care law didn’t cause this problem. However, as the Congressional Budget Office (CBO) noted in its November 2009 analysis of the legislation’s premium impacts, the federal benefit requirements included in the measure raised insurance rates significantly:

Because of the greater actuarial value and broader scope of benefits that would be covered by new nongroup policies sold under the legislation, the average premium per person for those policies would be an estimated 27 percent to 30 percent higher than the average premium for nongroup policies under current law (with other factors held constant). The increase in actuarial value would push the average premium per person about 18 percent to 21 percent above its level under current law, before the increase in enrollees’ use of medical care resulting from lower cost sharing is considered; that induced increase, along with the greater scope of benefits, would account for the remainder of the overall difference.

In CBO’s view, the law required people to buy richer insurance policies, and those richer policies encouraged people to consume more health care, both of which led to a rise in premiums. Unfortunately, that rise in premiums over the past several years has led millions of individuals who do not qualify for insurance subsidies (unlike Amanda Cunningham) to drop their coverage.

Get the Incentives Right

Sooner or later, our country will run out of other people’s money to spend on health care. Despite her impassioned plea, only a movement away from the solutions Cunningham advocated for can prevent that day from coming sooner rather than later.

This post was originally published at The Federalist.

Ten Ways Congress Can Apply the Green New Deal to Itself

Last week, Sen. Ed Markey (D-MA) and Rep. Alexandria Ocasio-Cortez (D-NY) introduced their long-anticipated “Green New Deal” legislation. Observers across the political spectrum derided both the legislation, and a summary document associated with same, as an example of big government overreach with goals that neither can nor should be achieved within a ten-year period.

However, if they wish to persist in their socialistic delusions, members of Congress who believe in the Green New Deal should first apply it to themselves. Hence the following list of proposals that GND supporters should insist Congress take, to put Ocasio-Cortez’s vision into practice.

1. Ban Meat in Congressional Cafeterias

The House and Senate cafeterias can even rely upon the ghost of Clara Peller to promote this new GND “innovation”!

2. Free Arugula

The GND resolution talks about government’s role to “build a more sustainable food system that ensures universal access to healthy food.” To help solve this problem, Congress must make sure that never again should someone like Barack Obama have to complain that Whole Foods is “charging a lot of money” for arugula. Instead, congressional cafeterias can provide arugula free of charge!

3. End Taxpayer-Funded Plane Travel

4. Turn Off the A/C

To promote the zero-emissions agenda, Congress should cease using its highly polluting air conditioning systems. Sure, Sen. Harry Reid (D-NV) didn’t like smelling sweaty tourists in the summertime, but he retired from Congress three years ago!

5. Shut Off the Lights

While they turn off the air conditioning, Congress should also turn out the lights in the Capitol to become emissions free. Better yet, lawmakers could decide to “hold Congress outside” on the National Mall during good weather. After all, it’s not like anyone ever tried to attack Congress in session or anything.

6. Evict Congress from Its Offices

Both the resolution and background document discuss “upgrading all existing buildings” to promote the zero-emissions agenda. Congress should start by throwing itself out of its own offices for some eco-friendly upgrades. Instead of ornate offices with high ceilings, floor-to-ceiling windows, and huge desks, Congress can place some trailers out back for members’ offices. You know, in the congressional parking lots that staff will no longer need—because they’ll be banned from driving cars to work.

7. Unionize Congressional Staff

8. Welfare for Those ‘Unwilling to Work’

The background document talks of guaranteeing “economic security for all who are unable or unwilling to work.” Members of Congress should ensure that their staff aren’t harassed by an obligation to do actual work, and are instead permitted to do whatever they feel like.

9. Vote to Move the Capitol

The resolution talks of “obtaining the free, prior, and informed consent of indigenous peoples for all decisions that affect indigenous peoples.” In theory, this language might refer to Native Americans such as Sen. Elizabeth Warren (D-MA). But what about the individuals indigenous to Washington, DC? Did Congress ever ask them whether they want to maintain the Capitol here? Congress should ballot the citizens of Washington to seek their consent for its continued presence. And if District citizens object, then lawmakers have an easy solution:

10. Congress Can Go to Hell

The resolution calls for “repairing historic oppression of…depopulated rural communities,” and what better way to repair such oppression by moving the entire Capitol to one of them! An ideal location: Hell, California, approximately 200 miles east of Los Angeles, in the middle of the Mojave Desert. (Another possible alternative: Hell, Michigan.)

Lest any of the above satire leave the wrong impression, this conservative does believe in conserving the environment. But when some members of Congress put forward unrealistic proposals that have no chance of happening, and use very real concerns about climate change to shoehorn in every liberal and socialist agenda item of the last century and this, they not only beclown themselves, they do the same to their cause.

Environmentalism deserves more than the socialist crazies behind the Green New Deal.

This post was originally published at The Federalist.

Congress Prepares to Pass Another Huge Bill No One Has Read. Again.

Stop me if you’ve heard this one before: Congress rams through a massive piece of legislation costing hundreds of billions of dollars without bothering to read it. Meet Congress under a Democratic majority—same as under the old majority.

Late Wednesday evening, congressional leaders still had not publicly released their omnibus appropriations legislation, and were not planning to do so until near midnight—hardly an auspicious time to embark on reading a bill exceeding 1,000 pages.

Those predictions ended up largely on the mark. The bill as introduced amounted to “only” 1,169 pages. But House leaders didn’t post the final version online until 1:20 a.m. on Thursday—the same day as the intended vote.

As Yogi Berra might say, when it comes to Congress’s bipartisan willingness to ram through massive bills, “It’s déjà vu all over again.”

Pelosi Breaks Her Promise

Of all things, Politico reported that one of the major holdups preventing an earlier public release included provisions having nothing to do with government spending—or, for that matter, border security:

“Congressional leaders are still haggling over an extension of the landmark Violence Against Women Act—one of the final hold-ups in a funding deal to avert a shutdown on Friday….One dispute centers on a Democratic push to add protections for transgender people, which the GOP is resisting; meanwhile, Republicans want more time to negotiate a broader deal, according to lawmakers and aides.”

Democrats in the House of Representatives promised that this time would be different. In a summary of their rules package for the 116th Congress—one which they released fewer than six weeks ago, remember—they pledged the following:

“ALLOW TIME TO READ THE BILL Require major bill text to be available for 72 hours before the bill can proceed to the House Floor for a vote. The current House rule only requires slightly more than 24 hours of availability.”

(Emphasis in the original.)

Their rules package did change the prior House rule, which had previously called for a three-calendar-day “reading period”—meaning that a bill promulgated at 11:59 p.m. on Monday could be voted on at 12:01 a.m. Wednesday, barely 24 hours after its release—to allow a full 72 hours for review.

And particularly in this case, Democrats find giving people time to read the bill inconvenient. Even though government funds won’t expire until Friday at midnight—and Congress could always extend that funding temporarily, to allow for more time to review the bill—both chambers want to vote on Thursday. Because heaven forbid Congress 1) do actual work on a Friday and 2) delay their “recess” (read: vacation) and their overseas trips during same. (Democratic leaders claimed their members have been “sufficiently briefed”—because it’s very easy to “brief” someone on most, let alone all, of the contents of a 1,200 page bill.)

In other words, the new House Democratic majority has spent barely one month in office, and we’re already back to Speaker Nancy Pelosi (D-CA), circa 2010: “We have to pass the bill so that you can find out what is in it.”

Garbage In, Garbage Out

After last year’s omnibus fiasco, I wrote that members of Congress only had themselves to blame for the awful process leading to that 2,232 page bill:

“As the old saying goes, the true test of a principle comes not when that principle proves convenient, but when it proves inconvenient. Only when Members find themselves willing to take tough votes—and to abide by the outcome of those votes, even if it results in policy outcomes they disfavor—will the process become more open and transparent.”

This post was originally published at The Federalist.

Ocasio-Cortez Wants Congress to Stop Pretending to Pay for Its Spending

Get used to reading more storylines like this over the next two years: The left hand doesn’t know what the far-left hand is doing.

On Wednesday, incoming House Speaker Nancy Pelosi (D-CA) faced a potential revolt from within her own party. Rep.-elect Alexandria Ocasio-Cortez (D-NY) and several progressive allies threatened to vote against the rules package governing congressional procedures on the first day of the new Congress Thursday, because of proposed changes they believe would threaten their ability to pass single-payer health care.

What’s Going On?

Ocasio-Cortez and her allies object to Pelosi’s attempt to reinstate Pay-as-You-Go (PAYGO) rules for the new 116th Congress. Put simply, those rules would require that any legislation the House considers not increase the deficit over five- and ten-year periods. In short, this policy would mean that any bill proposing new mandatory spending or revenue reductions must pay for those changes via offsetting tax increases and/or spending cuts—hence the name.

Under Republican control, the House had a policy requiring spending increases—but not tax cuts—to be paid for. Pelosi would overturn that policy and apply PAYGO to both the spending and the revenue side of the ledger.

Progressives object to Pelosi’s attempt to constrain government spending, whether in the form of additional fiscal “stimulus” or a single-payer health system.

However, Pelosi’s spokesman countered with a statement indicating that the progressives’ move “is a vote to let Mick Mulvaney make across-the-board cuts.” Mulvaney heads the Office of Management and Budget, which would implement any sequester under statutory PAYGO.

Regardless of what the new House decides regarding its own procedures for considering bills, Pay-as-You-Go remains on the federal statute books. Democrats re-enacted it in 2010, just prior to Obamacare’s passage. If legislation Congress passed  violates those statutory PAYGO requirements (as opposed to any internal House rules), it will trigger mandatory spending reductions via the sequester—the “across-the-board cuts” to which Pelosi’s spokesman referred.

To Pay for Spending—Or Not?

Progressives think reinstituting PAYGO would impose fiscal constraints hindering their ability to pass massive new spending legislation. However, the reality does not match the rhetoric from Ocasio-Cortez and others. Consider, for instance, just some of the ways a Democratic Congress “paid for” the more than $1.8 trillion in new spending on Obamacare:

  • A CLASS Act that even some Democrats called “a Ponzi scheme of the first order, the kind of thing Bernie Madoff would have been proud of,” and which never went into effect because the Obama administration could not implement it in a fiscally sustainable manner;
  • Double counting the Medicare savings in the legislation as “both” improving the solvency of Medicare and paying for the new spending in Obamacare;
  • Payment reductions that the non-partisan Medicare actuary considers extremely unlikely to be sustainable, and which could cause more than half of hospitals and nursing homes to become unprofitable within a generation;
  • Tax increases that Congress has repeatedly delayed, and which could end up never going into effect.

A Bipartisan Spending Addiction

An external observer weighing the Part D and Obamacare examples would find it difficult to determine the less dishonest approach to fiscal policy. It reinforces that America’s representatives have a bipartisan addiction to more government spending, and a virtually complete unwillingness to make tough choices now, instead bequeathing massive (and growing) amounts of debt to the next generation.

In that sense, Ocasio-Cortez and her fellow progressives should feel right at home in the new Congress. Republicans may criticize her for proposing new spending, but the difference between her and most GOP members represents one of degree rather than of kind. Therein lies the problem: In continuing to spend with reckless abandon, Congress is merely debating how quickly to sink our country’s fiscal ship.

This post was originally published at The Federalist.

Ocasio-Cortez Suddenly Realizes She Doesn’t Like Paying Obamacare’s Pre-Existing Condition Tax

On Saturday evening, incoming U.S. representative and self-proclaimed “democratic socialist” Alexandria Ocasio-Cortez took to Twitter to compare her prior health coverage to the new health insurance options available to her as a member of Congress.

It shouldn’t shock most observers to realize that Congress gave itself a better deal than it gave most ordinary citizens. But Ocasio-Cortez’ complaints about the lack of affordability of health insurance demonstrate the way liberals who claim to support Obamacare’s pre-existing condition “protections”—and have forcibly raised others’ premiums to pay for those “protections”—don’t want to pay those higher premiums themselves.

She’s Paying the Pre-Existing Condition Tax

I wrote in August about my own (junk) Obamacare insurance. This year, I have paid nearly $300 monthly—a total of $3,479—for an Obamacare-compliant policy with a $6,200 deductible. Between my premiums and deductible, I will face paying nearly the first $10,000 in medical costs out-of-pocket myself.

Of course, as a fairly healthy 30-something, I don’t have $10,000 in medical costs in most years. In fact, this year I won’t come anywhere near to hitting my $6,200 deductible (presuming I don’t get hit by a bus in the next four weeks).

As I noted in August, my nearly $3,500 premium doesn’t just fund my health care—or, more accurately, the off-chance that I will incur catastrophic expenses such that I will meet my deductible, and my insurance policy will actually subsidize some of my coverage. Rather, much of that $3,500 “is designed to fund someone else’s medical condition. That difference between an actuarially fair premium and the $3,500 premium my insurer charged me amounts to a ‘pre-existing conditions tax.’”

Millions of People Can’t Afford Coverage

Because I work for myself, I don’t get an employer subsidy to pay the pre-existing condition tax. (I can, however, write off my premiums from my federal income taxes.) Ocasio-Cortez’s tweet referred to her coverage “as a waitress,” but didn’t specify where she purchased that coverage, nor whether she received an employer subsidy for that coverage.

However, a majority of retail firms, and the majority of the smallest firms (3-9 workers), do not offer coverage to their workers. Firms are also much less likely (only 22 percent) to offer insurance to their part-time workers. It therefore seems likely, although not certain, that Ocasio-Cortez did not receive an employer subsidy, and purchased Obamacare coverage on her own. In that case she would have had to pay the pre-existing condition tax out of her own pocket.

That pre-existing condition tax represented the largest driver of premium increases due to Obamacare, according to a March paper published by the Heritage Foundation. Just from 2013 (the last year before Obamacare) through 2017, premiums more than doubled. Within the last year (from the first quarter of 2017 through the first quarter of 2018) roughly 2.6 million people who purchased Obamacare-compliant plans without a subsidy dropped their coverage, likely because they cannot afford the higher costs.

Lawmakers Get an (Illegal) Subsidy to Avoid That Tax

Unsurprisingly, however, members of Congress don’t have to pay the pre-existing condition tax on their own. They made sure of that. Following Obamacare’s passage, congressional leaders lobbied feverishly to preserve their subsidized health coverage, even demanding a meeting with the president of the United States to discuss the matter.

Senators and representatives do have to purchase their health insurance from the Obamacare exchanges. But the Office of Personnel Management (OPM) issued a rule allowing members of Congress and their staffs to receive an employer subsidy for that coverage. That makes Congress and their staff the only people who can receive an employer subsidy through the exchange.

Numerous analyses have found that the OPM rule violates the text of Obamacare itself. Sen. Ron Johnson (R-WI) even sued to overturn the rule, but a court dismissed the suit on the grounds that he lacked standing to bring the case.

Liberals’ Motto: ‘Obamacare for Thee—But Not for Me’

Take, for instance, the head of California’s exchange, Peter Lee. He makes a salary of $436,800 per year, yet he won’t buy the health insurance plans he sells. Why? Because he doesn’t want to pay Obamacare’s pre-existing condition tax unless someone (i.e., the state of California) pays him to do so via an employer subsidy.

Ocasio-Cortez’ proposed “solution”—fully taxpayer-paid health care—is in search of a problem. As socialists are wont to do, Ocasio-Cortez sees a problem caused by government—in this case, skyrocketing premiums due to the pre-existing condition tax—and thinks the answer lies in…more government.

As the old saying goes, when you’re in a hole, stop digging. If Ocasio-Cortez really wants to get serious, instead of complaining about the pre-existing condition tax, she should work to repeal it, and replace it with better alternatives.

This post was originally published at The Federalist.