The CBO Report on Single Payer Isn’t the One We Deserve to See

On Wednesday, the Congressional Budget Office (CBO) released a 30-page report analyzing a single-payer health insurance plan. While the publication explained some policy considerations behind such a massive change to America’s health care market, it included precious few specifics about such a change—like what it would cost.

Sen. Bernie Sanders (I-VT), perhaps single payer’s biggest supporter, serves as the ranking member of the Senate Budget Committee. If he asked the budget scorekeepers to analyze his legislation in full to determine what it would cost, and how to go about paying for the spending, CBO would give it high-priority treatment.

But to the best of this observer’s knowledge, that hasn’t happened. Might that be because the senator does not want to know—or, more specifically, does not want the public to know—the dirty secrets behind his proposed health-care takeover?

Hypothetical Scenarios

The CBO report examined single payer as an academic policy exercise, running through various options for establishing and operating such a mechanism. In the span of roughly thirty pages, the report used the word “would” 245 times and “could” 209 times, outlining various hypothetical scenarios.

That said, CBO did highlight several potential implications of a single-payer system for both the demand and supply of care. For instance, “free” health care could lead to major increases in demand that the government system could not meet:

An expansion of insurance coverage under a single-payer system would increase the demand for care and put pressure on the available supply of care. People who are currently uninsured would receive coverage, and some people who are currently insured could receive additional benefits under the single-payer system, depending on its design. Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system, such as provider payment rates. If the number of providers was not sufficient to meet demand, patients might face increased wait times and reduced access to care.

The report noted that in the United Kingdom, a system of global budgets—a concept included in the House’s single-payer legislation—has led to massive strains on the health-care system. Because payments to hospitals have not kept up with inflation, hospitals have had to reduce the available supply of care, leading to annual “winter crises” within the National Health Service:

In England, the global budget is allocated to approximately 200 local organizations that are responsible for paying for health care. Since 2010, the global budget in England has grown by about 1 percent annually in real (inflation-adjusted) terms, compared with an average real growth of about 4 percent previously. The relatively slow growth in the global budget since 2010 has created severe financial strains on the health care system. Provider payment rates have been reduced, many providers have incurred financial deficits, and wait times for receiving care have increased.

While cutting payments to hospitals could cause pain in the short term, CBO noted that reducing reimbursement levels could also have consequences in the long term, dissuading people from taking up medicine to permanently reduce the capacity of America’s health-care market:

Changes in provider payment rates under the single-payer system could have longer-term effects on the supply of providers. If the average provider payment rate under a single-payer system was significantly lower than it currently is, fewer people might decide to enter the medical profession in the future. The number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities. That decline could lead to a shortage of providers, longer wait times, and changes in the quality of care, especially if patient demand increased substantially because many previously uninsured people received coverage and if previously insured people received more generous benefits.

That said, because the report did not analyze a specific legislative proposal, its proverbial “On the one hand, on the other hand” approach generates a distinctly muted tone.

Tax Increases Ahead

To give some perspective, the report spent a whopping two pages discussing “How Would a Single Payer System Be Financed?” (Seriously.) This raises the obvious question: If single-payer advocates think their bill would improve the lives of ordinary Americans, because the middle class would save so much money by not having to pay insurance premiums, wouldn’t they want the Congressional Budget Office to fully analyze how much money people would save?

During his Fox News town hall debate last month, Sanders claimed a large show of support from blue-collar residents of Bethlehem, Pennsylvania for single payer. The ostensible support might have something to do with Sanders’ claim during the town hall that “the overwhelming majority of people are going to end up paying less for health care because they’re not paying premiums, co-payments, and deductibles.”

Where have we heard that kind of rhetoric before? Oh yeah—I remember:

At least one analysis has already discounted the accuracy of Sanders’ claims about people paying less. In scrutinizing Sanders’ 2016 presidential campaign plan, Emory University economist Kenneth Thorpe concluded that the plan had a $10 trillion—yes, that’s $10 trillion—hole in its financing mechanism.

Filling that hole with tax increases meant that 71 percent of households would pay more under single payer than under the status quo, because taxes would have to go up by an average of 20 percentage points. Worse yet, 85 percent of Medicaid households—that is, people with the lowest incomes—would pay more, because a single-payer system would have to rely on regressive payroll taxes, which hit the poor hardest, to fund socialized medicine.

Put Up or Shut Up, Bernie

If Sanders really wants to prove the accuracy of his statement at the Fox News town hall, he should 1) ask CBO to score his bill, 2) release specific tax increases to pay for the spending in the bill, and 3) ask CBO to analyze the number of households that would pay more, and pay less, under the bill and all its funding mechanisms.

That said, I’m not holding my breath. A full, public, and honest accounting of single payer, and how to pay for it, would expose the game of three-card monty that underpins Sanders’ rhetoric. But conservatives should keep pushing for Sanders to request that score from CBO—better yet, they should request it themselves.

This post was originally published at The Federalist.

Gov. Jindal Op-Ed: Your Health Care: Obama’s $18,000 Broken Promise

How would you feel if someone promised to give you a car, and then reneged on that pledge?  That’s how all Americans should feel when it comes to Obamacare — because Barack Obama’s failed and discredited campaign promise to lower health insurance premiums has cost the average American family an amount equal to the price of many new cars.

During his 2008 campaign, one of then-Senator Obama’s most audacious promises was that his health plan would reduce premiums by $2,500 for the average family.  His repeatedly made his pledge on videotape; you can view those promises here.  But health insurance premiums have continued to rise — not just despite Obamacare, but in many cases because of the law’s new regulations and mandates.

A new analysis by the think-tank America Next, where I serve as honorary chairman, quantifies the massive scope of the broken promise.  Compared to 2008 — the year President Obama was elected — Americans have faced a cumulative $6,388 per individual, and $18,610 per family, in higher costs because President Obama’s health plan has failed to achieve its promised premium reductions.  Overall, that amounts to $1.2 trillion in higher premium costs due to Obamacare’s failure to deliver.

The administration has put forth all sorts of excuses about why its law hasn’t met the expectations the president himself set. One of them is that the law’s major provisions only took effect in January, so Obamacare needs more time to achieve savings.

But, in July 2008, Jason Furman—then the Obama campaign’s economic policy director, and now the Chairman of President Obama’s Council of Economic Advisors—told the New York Times that “we think we could get to $2,500 in savings by the end of the first term, or be very close to it.”

The fact that Democrats delayed full Obamacare implementation until 2014 to hide the legislation’s true cost shouldn’t absolve President Obama for failing to deliver on his promise one whit.

The administration also now claims that Obamacare is working, because premiums are “only” rising by 6 or 8 percent per year.  But that’s not what then-candidate Obama himself promised in 2008; he spoke frequently of “cutting,” “reducing,” and “lowering” premium costs.  Whether premiums go up by 1 percent or 101 percent, any increase represents a promise broken.

In August 2012, Politifact nicely summed up Obamacare’s discredited premium pledge: “An author of the $2,500 figure has disavowed its use as it relates to premiums alone.  An independent health care analyst projects that premiums will go up for the typical family.  The federal agency implementing [Obamacare] did not provide evidence that premiums will go down for the typical family.  We rate this a Promise Broken.”

Even as Obamacare has failed to deliver, there is a better way.  The America Next health plan can provide the relief from rising costs that Americans need and deserve.  Rather than focusing on a massive expansion and restructuring of the health care system, the America Next plan focuses like a laser beam on reducing health costs. The plan creates incentives for states to reform their insurance markets, thereby reducing plan premiums. It also includes other reforms with a proven track record of lowering costs, including tax equity between employer-based and individually-purchased insurance plans, lawsuit reforms, and new incentives for Health Savings Accounts.

Analysis by independent, non-partisan experts confirm the plan’s effectiveness.  When considering proposals similar to those in the America Next plan, the Congressional Budget Office concluded in 2009 that they would lower small business health insurance premiums by 7 to 10 percent, and reduce individual health insurance premiums by 5 to 8 percent.  Compared to the premium increases projected under Obamacare, the reforms in the America Next plan could provide thousands of dollars in real relief for families struggling from high insurance premiums.

The America Next report confirms that the average American family has paid a price equal to the sum of many new cars because Obamacare has failed to meet the president’s commitments. And, as with any balky automobile, it’s time for the American people to trade in this Obamacare lemon, and replace it with something that works. Coupled with Obamacare’s full repeal, the America Next health plan can provide what the American people need—real relief from skyrocketing health costs.

This post was originally published at Fox News.

Gov. Jindal Op-Ed: Yes, We Can Still Repeal Obamacare

According to those in the elite salons of Washington, Obamacare cannot be repealed. The conventional wisdom on the cocktail circuit contends that once you mandate health insurance for millions, you cannot unmandate it.  This theoretical belief has become accepted in Washington as a dogmatic article of faith.  And the Obamacrats and most of the press believe that repeating this mantra often enough will make it so.

Of course, many Beltway insiders claim that Obamacare cannot be repealed because they wish to preserve the financial windfalls the law has brought them.

From the Big Pharma CEO bragging about the “rock-solid deal” benefitting his industry, to the health insurers who have a captive audience of Americans now required to purchase their products, to the lobbyists seeking preferential treatment in regulations, Obamacare has become big business to the K Street crowd.  No wonder so many view repeal of the law as fantastical—it would take away their gravy train.

But even many conservative “thinkers” in Washington have given in to Obamacare fatalism.  They may not say so in public, but they fully believe that talk of the law’s repeal exists only in the land of unsophisticated rubes.

The country that won two world wars and put a man on the moon cannot, it is believed, repeal a disastrous public policy. Says who? Why not?

I know a little bit about health care policy, having spent most of my adult life analyzing and implementing policy changes on the state and federal levels.  And based on my decades of experience, the idea that Obamacare cannot be repealed defies both logic and real world justification, on multiple levels.

First, the fact that the federal government has by force of law and under pain of taxation forced millions to sign up does not constitute “success” or “progress.”  In fact, I bet the administration could have raised their enrollment totals even higher if friendly IRS agents had paid personal visits to all Americans “encouraging” them to enroll.

The real “progress” thus far from Obamacare? Health care premiums have gone up, health care costs continue to escalate, and millions of consumers are losing their plans and finding that they may not be able to see their doctors any longer.

Let’s remember, too, that Obamacare was sold on a series of deceptions – if you like your plan you can keep your plan, you can keep your doctor, and premiums will decrease on average $2,500 per year.

To pass Obamacare in the first place, the American people were sold a bill of goods that would make even P.T. Barnum blush.

In one sense, the smart guys are correct. Conservatives do need to articulate alternatives to Obamacare—because the American people need relief from premiums that continue to skyrocket.

The plan I endorsed last month would do just that—focus like a laser beam on reducing costs. The Congressional Budget Office previously analyzed many of the policies included in our plan, and concluded they could reduce premiums by thousands of dollars compared to Obamacare’s surging costs.

Many families struggling with rising premiums and co-payments might believe that they will never see relief. But the notion that we can’t slow the growth of health spending is just as fanciful as the idea that Obamacare cannot be repealed.  The only reason we can’t accomplish both objectives is political will—because Washington needs a Beltway-sized reality check.

Fortunately, there’s a big country out there. We don’t care what they think in Washington, and we are not willing to quit on the idea of America.

This post was originally published at Fox News.

Gov. Jindal Op-Ed: Real Health Care Reform: Give States the Tools, and Let Them Do the Job

They’re practically the first words out of one’s mouth the second a Washington reporter hears about a new health reform proposal: “How many people does your plan cover?”

The basic premise of the America Next health plan I’m endorsing today is simple: “I believe the problem is not that folks are trying to avoid getting health care. The problem is they can’t afford it.”

In short, I agree with Barack Obama.

Of course, Barack Obama circa January 2008—when he uttered those words in opposition to a health insurance mandate — represents a far cry from the Barack Obama who signed Obamacare into law in March 2010.

The president backtracked on nearly every single promise he made: on an individual mandate, keeping your plan, cutting premiums by $2,500 per year, and even on taxing health benefits — all in the name of achieving the left’s utopia of “universal coverage.” And in return, America has been left with shredded promises, cancelled insurance plans, and a major-league case of buyer’s remorse.

So no, I won’t endorse a plan that sees tens of millions of Americans forced to buy health insurance under pain of taxation.

I won’t endorse a plan that sees millions of other Americans forced out of the insurance they like, simply because it doesn’t meet some Washington bureaucrat’s standards. And I won’t endorse a plan that sees Americans extended the promise of insurance, only to find out that the “coverage” provided doesn’t guarantee they’ll receive the care they need.

We already have all that — it’s called Obamacare, and it needs to be fully repealed, because it’s the problem.

Here’s the solution.

First, we need to focus like a laser beam on the health care issue Americans care most about: rising costs. 

The plan I’m endorsing includes an innovative $100 billion grant program that incentivizes our “laboratories of democracy”—the states—to come up with insurance reforms and other solutions that can stem the rising tide of health costs. States’ eligibility for the grants would be tied to their ability to lower insurance premiums for their citizens.

We include other reforms in our plan too — tax equity between employer and individually-purchased health plans, lawsuit reform, wellness incentives, and new incentives for Health Savings Accounts.

These reforms have proven track records of success — and analysis from top economists to back them up.

In fact, the Congressional Budget Office, analyzing a similar state-based approach in 2009, concluded that the kinds of ideas included in our plan would lower premiums on the individual health insurance market by $5,000 per year when compared to current projections. That, and not Obamacare “rate shock,” is true change America can believe in.

Second, we need to protect the safety net for the most vulnerable. As someone whose mother arrived on these shores pregnant with me, I’m well aware of the plight of Americans with pre-existing conditions. I was one — from birth.

My son Shaan’s desperate fight for survival from a childhood heart defect reinforced my belief in making sure those with major illnesses don’t get left out in the cold. But we didn’t need to give up all the good things in the system to fix the bad. Extending coverage to Americans with pre-existing conditions didn’t require throwing millions of Americans off their current plans, or turning the IRS into the health insurance police.

Here’s a better solution. Our plan’s state grant program requires states applying for grants to guarantee access for individuals with pre-existing conditions. A state could guarantee access through a high-risk pool, through reinsurance, or through some other mechanism. But our plan ensures that the most vulnerable won’t fall through the cracks, and provides $100 billion in resources that states can use to subsidize that coverage.

Third, we should make insurance more portable, to enhance personal choice. Rather than taking away choices by regulatory fiat, we should give Americans more insurance options, so they can purchase plans they will own, hold, and keep. But if people like their existing plan, they won’t have to worry about it getting taken away by some government bureaucrat saying it doesn’t comply with a new mandate.

As someone who studied public policy in college, and worked in health policy all my adult life, I know Obamacare is bad policy.

The law may have been sold as a solution to the problem of pre-existing conditions. But it solidifies government — through taxes, mandates, regulations, and your friendly bureaucrats at the IRS — as a pre-existing condition in our health care system, and in the lives of all Americans.

That’s not reform.

As a governor, I know states can do better. We need solutions, but not Washington-centric bureaucracy disguised as “reform”—we’ve done that already, and it hasn’t worked.

By contrast, conservative governors throughout the country have implemented successful health reforms — from the Hoosier State’s Healthy Indiana Plan, to Rhode Island’s innovative Medicaid waiver, to the Bayou Health program we’ve created right here in Louisiana. These reforms have lowered costs — in some cases dramatically — improved the quality of care, and received widespread public support.

But in many states, including Louisiana, we would go further with our reforms, if only Washington bureaucrats would get out of the way. At the risk of echoing Churchill, that’s the better way forward on health care — give states the tools, and let them do the job.

This post was originally published at Fox News.

Obamacare’s Terrible, Horrible, No Good, Very Bad Week

It’s now been seven days since Obamacare’s exchanges officially launched. In reality, however, the “launch” has more closely resembled a blooper reel of rocket failures than a smooth takeoff. Here is but a sampling of the problems, failures, and glitches that have turned the exchanges into a comedy of errors:

TUESDAY

  • Some state exchanges delay their opening to address technical problems; Maryland’s exchange postpones its launch by four hours.
  • When the federally run exchanges in 36 states open, they are immediately overwhelmed by massive volume and technical errors. One MSNBC reporter spends more than half an hour trying in vain to establish an account and compare insurance options.
  • Reuters reports that in total, 47 state exchange websites “turned up frequent error messages.”

WEDNESDAY

  • The Los Angeles Times reports that California’s state exchange vastly overstated its first-day web traffic. Instead of receiving 5 million hits, the exchange actually received 645,000 visitors.
  • The Washington Examiner notes that new co-operative health insurance programs funded by billions of Obamacare dollars featured “sites [that] were difficult to navigate and provided little understandable insurance information on topics like eligibility, costs, and benefits.”

THURSDAY

  • The Washington Post’s Sarah Kliff writes a story, illustrated with a picture of a unicorn, asking whether anyone has actually purchased health insurance on from the federally run exchange—or whether these individuals are just “mythical creature[s].”
  • An Arizona television station profiles a leukemia survivor who “just got a letter from his insurance carrier saying as of January 1, he would be dropped from coverage because of new regulations under Obamacare. His doctor at the Mayo Clinic may be gone as well.”

FRIDAY

  • Liberal blogger Ezra Klein admits that the Administration “did a terrible disservice by building a website that, four days into launch, is still unusable for most Americans.”
  • CNBC reports that “as few as 1 in 100 applications on the federal exchange contains enough information to enroll the applicant in a plan.”
  • One of the few individuals claiming to have enrolled in a federally run insurance exchange admits that “he has not in fact enrolled in a health-care plan.”
  • The Department of Health and Human Services (HHS) announces it will take major portions of its website offline over the weekend for repairs and major upgrades.

SATURDAY

  • Reuters interviews IT experts who believe the exchange contains major design flaws: “so much traffic was going back and forth between [exchange] users’ computers and the server hosting the government website, it was as if the system was attacking itself.”
  • The San Jose Mercury News profiles people suffering premium increases due to Obamacare—including one whose premiums may increase by nearly $10,000 for his family of four.

SUNDAY

  • Treasury Secretary Jack Lew refuses to tell Fox News’s Chris Wallace how many people have, or have not, enrolled in coverage.
  • The Charlotte Observer profiles one Charlotte family, whose premiums could rise from $228 per month to $1,208 per month—a 430 percent increase—because their current health insurance does not meet Obamacare’s standards.
  • The Wall Street Journal quotes technology consultants as saying that the federal exchange site “appeared to be built on a sloppy software foundation,” and that “basic Web-efficiency techniques weren’t used…clog[ging] the website’s plumbing.”

MONDAY

  • Politico finds many individuals are resorting to paper applications for coverage, due to the continued problems with online exchanges.
  • The New York Post reports that navigators were entirely unprepared for the launch of Obamacare’s exchanges last week; many staffers working for purported navigators seemed unaware the program existed.
  • HHS announces it is taking the exchange website offline again for more repairs.

Given this track record, some may find the words of Saturday’s Reuters piece prescient: “Five outside technology experts interviewed by Reuters…say they believe flaws in system architecture, not traffic alone, contributed to the problems” with the exchanges.

That quote is an apt metaphor for the entire law itself. Just as the exchanges’ problems stem from fundamental “flaws in system architecture,” so do these “glitches” prove that the entire law is unworkable—not just parts of the measure. It’s why Congress should act now to save America from this unpopular, unfair, and unworkable law.

This post was originally published at The Daily Signal.

Sen. DeMint Op-Ed: We Must Stop Obamacare Before It Becomes Hazardous to Our Health

New York’s famous 42nd Street will offer natives and visitors a new sight later this week: a mammoth, six-story billboard with a striking message: “Warning—Obamacare may be hazardous to your health.”

It’s part of The Heritage Foundation’s continuing public education campaign to inform the American people about the dangerous side-effects of this unfair, unaffordable and unworkable law, and how it can be stopped.

How will Obamacare—a 2,700-page law passed by a single vote over bipartisan opposition— harm Americans’ health?

Well, here are five of its worst side effects.

First, many Americans will lose their current health coverage. That’s what’s happening to Rod Coons and Florence Peace, a married couple in Indianapolis. Rod and Florence like their current plan.

“I’d prefer to stay with our current plan because it meets our needs,” Rod says.

Unfortunately, their current coverage fails to meet new requirements imposed under Obamacare by federal bureaucrats. At the end of this year, that plan will no longer be available to Rod and Florence. They’ll have to find another, Obamacare-sanctioned plan that may restrict their access to certain treatments or force them to buy coverages they neither want nor need.

Second, many Americans will lose access to physicians they trust. The Wall Street Journal recently highlighted the case of John Nowak, who faces a dilemma when he chooses an insurance plan on Obamacare’s Exchanges this fall. He “will be able to pick a [revised, Obamacare-compliant] plan from his current insurer—or go for one that includes his primary-care doctor.”

To save costs, many plans on Obamacare’s Exchanges are limiting physician networks. So if John chooses to keep his current insurance carrier, he may not be able to keep his current doctor. At minimum, he will pay a lot more to see that physician out-of-network.

Third, Obamacare places bureaucrats between doctors and patients. The law imposes new penalties on doctors who do “not satisfactorily submit data” that meet Washington bureaucrats’ standards.

It also creates a panel of unelected, unaccountable bureaucrats empowered to make rulings that reduce Medicare spending.

Little wonder that nearly three in five physicians responding to a recent Deloitte survey think the practice of medicine is in jeopardy.

Fourth, Obamacare dumps millions of patients onto Medicaid—a health program so bad that not even Medicaid patients call it “real insurance.” An analyst for the liberal Consumers Union once admitted that a Medicaid card is but a “hunting license”—“a chance to go try and find a doctor” that actually accepts Medicaid patients.

Moreover, several studies have shown that people enrolled in Medicaid often have worse medical outcomes than those with no health insurance at all.

Expanding a broken Medicaid program is just giving millions of Americans a cruel and empty promise—an insurance card with limited access to real health care.

Fifth, Obamacare’s reductions in Medicare spending could undermine the health system for millions of seniors.

According to the non-partisan Medicare actuary, the law’s arbitrary spending reductions could cause 15% of hospitals to become unprofitable by 2019, and as many as 40% of hospitals to become unprofitable in the long term. These hospitals could face the choice between shutting out seniors or shutting their doors for good.

Either outcome is unacceptable.

Obamacare is not just bad for Americans’ physical health—it’s bad for America’s fiscal health as well. If Congress does not act, on January 1, 2014, Washington will tap a gusher of new federal spending on Obamacare.

Over the next decade, the cost of the law’s new entitlements will soar more than fivefold, from $48 billion in 2014 to $250 billion in 2023.

That will create a lot of pain in taxpayers’ wallets.

For all these reasons and more, Congress must act, and act now, to stop Obamacare before it takes root.

This fall, Congress will have an opportunity to use its “power of the purse” to block Obamacare from going forward.

I recently traveled across the country on a town hall tour sponsored by our sister organization, Heritage Action for America.

I met many Americans concerned about the impact of Obamacare on their health care, who want the law stopped immediately.

There are things we can and should do to improve America’s health care system and reduce costs, but first we must stop Obamacare before it starts.

The law is a dangerous prescription for America, and its side effects will damage our collective health.

This post was originally published at Fox News.