Why Pete Buttigieg’s Health Plan Might Be More Radical than Bernie Sanders’

During the most recent Democratic primary debate in New Hampshire, former South Bend Mayor Pete Buttigieg claimed that his health-care plan, unlike the single-payer proposal advocated by Vermont Sen. Bernie Sanders, would “not polarize the American people.” But contra the candidate’s claims, Buttigieg’s health plan advocates a policy—government price controls on the entire health-care sector—even more far-reaching than Sanders’s socialist approach.

Others have exposed how Buttigieg’s plan would force people to buy insurance costing thousands of dollars, whether they want it or not. But his proposal for government price controls across a $4 trillion health-care sector represents the most radical idea yet—because, unlike Sanders’s plan, individuals appear to have no way to opt out.

National Price Controls

Buttigieg’s plan, released in September, would “prohibit health care providers from pricing irresponsibly by capping their out-of-network rates at twice what Medicare pays.” (Upon entering the race for the Democratic presidential nomination last November, New York Mayor Michael Bloomberg also adopted this rate-capping provision in his health plan.) Buttigieg admits that, by capping out-of-network rates, his proposal would give insurers leverage to demand lower prices for in-network care, creating a de facto system of national price controls for the entire health-care sector.

Imposing price controls on nearly 20 percent of the American economy, and linking those price controls to Medicare rates, would have substantial distortionary impacts. For starters, Medicare often does not reimburse medical providers at a rate to recover their costs. The Medicare Payment Advisory Commission estimated last March that hospitals would incur a -11 percent margin on their Medicare patients in 2019.

Moreover, because Medicare payment rates reflect the cost of treating the over-65 population—not many Medicare beneficiaries need maternity care, for instance—even supporters of capping rates have questioned the wisdom of linking such caps to Medicare levels.

More broadly, a national system of price controls could create health-care shortages. Facing reductions in pay, doctors could decide to retire early, and aspiring physicians could avoid the profession entirely. With the United States already facing a shortage of up to 121,900 physicians between now and 2032, Buttigieg’s price controls would reduce the physician supply still further.

Pathway to Single Payer—With No Exit

Despite the contrast he attempts to draw with Sanders’s plan, Buttigieg’s price controls would likely lead to a fully government-run system. Buttigieg admits a desire for his plan to provide a “glide path” to single-payer; its price controls provide an easy mechanism for such a transition.

By reducing the payments that private health insurers can offer doctors and hospitals, Buttigieg would slowly sabotage individuals’ existing coverage, throwing all Americans into a government-run health system. Indeed, his price caps provide an easy mechanism to force more and more individuals off their private coverage. While Buttigieg says he wants to cap payments at double Medicare rates, he could lower that cap over time. Of course, capping private health-care reimbursements at less than Medicare rates would all-but-guarantee private health insurance would cease to exist, because few doctors would agree to accept it.

Patients facing long waits for care would have no way to get around queues created by Buttigieg’s socialistic price controls. Sanders’s single-payer legislation allows physicians and patients to contract privately by paying cash for health-care services. But Buttigieg’s plan does not envision a mechanism for Americans to opt out of his price control regime. If Medicare pays $50 for a service, a patient could not pay a physician more than $100 for that service—no matter how experienced or qualified the physician, and no matter how desperate the patient.

The questionable constitutionality of Buttigieg’s plan belies its purportedly moderate nature. On the one hand, he would compel all individuals to pay for health insurance—whether they want it or not, and whether they use it or not. On the other, he would prohibit individuals from engaging in private transactions with their own doctors and hospitals if the amounts of those transactions exceed federally defined limits.

Differences in tone notwithstanding, Sanders and Buttigieg represent two halves of the same general approach to health care, expanding a technocratic leviathan that will attempt to micromanage nearly one-fifth of the economy from Washington. Doctors and patients, take note.

This post was originally published at The Federalist.

Is Elizabeth Warren Trying to Use a “Goldilocks” Strategy to Win the Democratic Nomination?

In blessing the presidential candidacy of Sen. Elizabeth Warren (D-MA), former Housing and Urban Development Secretary and recent presidential dropout Julian Castro used an interesting rationale to explain his endorsement: “More than any other candidate in this race…Elizabeth Warren is the candidate who can unite the entire Democratic Party.”

That premise may well explain the strategy behind her campaign, to win the Democratic nomination as the “Goldilocks” candidate—not too hot, and not too cold.

The strategy wouldn’t make Warren a political moderate, by any stretch. No nominee who has endorsed a conversion to a single-payer system of socialized medicine would fall into that category. But making Warren the candidate most acceptable (or least unacceptable) to moderates and leftists alike does mean that, the longer the nomination fight plays out, the stronger her chances might get.

Contested Convention Ahead?

In the past several weeks, multiple stories have analyzed the possibility of a prolonged contest for the Democratic nomination. In the fourth quarter of 2019, four candidates—Vermont Sen. Bernie Sanders, former South Bend Mayor Pete Buttigieg, former Vice President Joe Biden, and Warren—raised more than $20 million, suggesting they will have ample resources to compete in primaries throughout the spring. The nomination fight also features two billionaires who have the ability to self-fund their campaigns, Tom Steyer and former New York City Mayor Mike Bloomberg.

Couple the field of well-financed candidates with the Democratic Party’s proportional allocation method, in which any candidate exceeding 15 percent of the vote in a state receives a share of that state’s delegates, and you have the recipe for a prolonged campaign of attrition. In this year’s “bizarro world” scenario, each of the half dozen candidates has the means to continue competing in primaries, and because many (if not most) will amass delegates along the way, they will have every incentive to do so.

It seems premature to make definitive judgments on the complexion of the campaign weeks before the first ballots get cast. But Democrats may convene in Milwaukee this July without a single candidate controlling the majority of delegates necessary to win the presidential nomination.

Least Common Denominator Candidate

If Democrats do end up with a contested convention, it seems unlikely to result in an outcome in which a previously undeclared candidate emerges from the shadows to win the nomination. Given the acrimony throughout the 2016 campaign, when Sanders’ supporters (rightly) protested at a process rigged against their candidate, the idea that a “white horse” candidate such as Michelle Obama, Oprah Winfrey, or someone similar could win the nomination without having entered a single primary seems far-fetched, not least because of the outrage that would ensue.

So a contested convention would feature the candidates currently declared, and only the candidates currently declared, battling for the nomination. At that point, it likely would become less a contest of persuasion—which candidate can I most enthusiastically support?—than an attempt to cobble together a coalition of delegates that focuses on a different test: Which candidate offends the least?

Of the four candidates leading the polls, Warren appears to win this test, by a fairly wide margin. Consider the negatives against the other candidates:

  • Biden’s age (77) has raised questions throughout the campaign about his physical stamina and mental acuity. Even after he reversed himself (under pressure) on taxpayer funding of abortion, Biden’s history of positions on issues—from his support for the 2005 bankruptcy bill, to his vote for the Iraq War, to his support for the 1994 crime bill, to his treatment of Anita Hill—remain to the right of the party, drawing scorn from leftists as a moderate supported by corporate interests.
  • Like Biden, Sanders’ age (78) remains an issue, particularly given his heart attack in October. While many on the left believe he has strong appeal to working-class voters, particularly in the Rust Belt, who have deserted the party, establishment types worry that a self-proclaimed socialist will prove unelectable in November.
  • Buttigieg has age concerns as well because of his relative youth (he turns 38 this month). He has little political experience outside South Bend, won his last mayoral election with a total of 8,515 votes, and lost his only statewide campaign by a nearly 25-percentage point margin. And his experience working at McKinsey has become fodder for attacks by the far-left, who love to hate the candidate they call “Wall Street Pete.”

By contrast, Warren has comparatively few obvious drawbacks. While a septuagenarian, her age (70) makes her several years younger than Biden and Sanders, and younger than President Trump. She has endorsed a host of far-left policies, but insists she remains a capitalist to her bones. And in a field that has shrunk to become dominated by white men, a Warren nomination would provide Democrats an identity politics card.

For all these reasons, Warren remains the top second choice of voters in most polls, even as her standing as voters’ first choice has shrunk. It makes her well-placed to serve as the compromise candidate should Democrats face a contested convention, which by definition would involve at least some delegates choosing their second-favorite candidate as the nominee.

The two biggest strikes against her appear largely self-inflicted: The controversy over her ancestry (exacerbated by her DNA test), and her evasions on health care. While Trump would bring the latter up often—indeed, has already done so—it seems unlikely any opponent would make it an issue during a fight for the Democratic nomination. (At least he or she would not do so publicly.)

As for health care, she evaded questions about how to pay for single payer for months, and finally released a funding plan in early November, only to say two weeks later she wouldn’t push for single payer until the third year of her term. This bobbing and weaving coincided with a pullback in her polling numbers. But to take the longer view, it syncs up well with a larger “Goldilocks” political strategy.

Her eventual position, in which she pledged to enact a robust “public option” immediately, followed by a push for single payer later, drew little love from either moderates (who don’t like talk of single payer at all) or leftists (who want to enact single payer immediately, as Sanders has promised). But it represents the kind of clunky political compromise could easily envision a party’s platform committee drafting. That makes it entirely consistent with an attempt to position Warren in ways that offend the fewest number of Democrats—a helpful strategy in the event of a contested convention.

Obama Wild Card?

One other figure could loom large over a prolonged nomination fight: Barack Obama. Two reports in recent weeks suggest first that Obama doubts Biden’s connection with voters, and second that Obama has talked up Warren’s candidacy behind closed doors. While one must caveat the articles with two of the biggest weasel words in politics—“If accurate”—these reports suggest that, should the nomination fight become prolonged, the last Democratic president may weigh in on behalf of the Massachusetts senator. While such a development might not decide the nomination, it could go a long way in doing so.

After Warren’s fumbling on health care this fall, some had begun to write off her candidacy. Indeed, this author said she had “Swift-boated” herself, by turning her supposed strength as a policy wonk into her biggest weakness. Paradoxically, however, while Warren’s machinations cost her in the polls over the short term (and would harm her in a general election campaign), they could help her to win the Democratic nomination.

This post was originally published in The Federalist.

Three Ways Pete Buttigieg Is No Moderate

In recent weeks, former South Bend Mayor Pete Buttigieg has enjoyed a boomlet in polls for the Democratic presidential nomination, helped in no small part by fawning press coverage. Politico and others have examined the candidate and his supposedly “moderate” message.

Rhetoric aside, however, the substance of Buttigieg’s policy plans seem anything but moderate. On multiple issues, Pete has embraced positions far to the left of anything Hillary Clinton dared endorse in her campaign four years ago, and which seem “moderate” only in comparison to the socialist delusions of candidates like Sen. Bernie Sanders (I-Vt.).

1. Big Tax Increases on the Middle Class

As I first noted last month, Buttigieg has supported at least one, and quite possibly several, tax increases on the middle class. His retirement security plan included one explicit tax increase on working families, endorsing legislation that would raise payroll taxes as part of a new regime of paid family leave.

The retirement white paper, released just before Thanksgiving, implicitly endorsed a second tax increase on the middle class as well. The plan proposed a new entitlement program, Long-Term Care for America, designed to replace the CLASS Act included in Obamacare, but which Congress repealed prior to its implementation due to solvency concerns. Buttigieg’s paper didn’t say how it would pay for the new spending created by the program, but other studies cited by the campaign did: They proposed another increase in the payroll tax, which would also fall on middle-class families.

I wrote about Buttigieg’s tax plans in the Wall Street Journal last month. Yet following that article, no one from the Buttigieg campaign bothered to refute, smack down, or otherwise correct my assertion that their candidate wants to tax middle-class families.

The deafening silence from the Buttigieg campaign regarding my op-ed suggests the candidate does indeed want to raise taxes on the middle class—he just hopes that no one will notice that fact. It seems like an ironic bit of silence, given that Buttigieg attacked Sen. Elizabeth Warren (D-MA) for being “extremely evasive” on the issue of middle-class tax increases last fall.

2. ‘Insurance, Whether You Want It or Not’

Buttigieg likes to advertise his health care plan as “Medicare for All Who Want It,” but as several stories over the holiday revealed, it comes with an intrusive twist. While his plan says that “individuals could opt out of public coverage,” they could do so only “if they choose to enroll in another insurance plan.”

In other words, Buttigieg would compel people to buy insurance—whether they want to or not, enforcing this revived individual mandate through the tax code. On April 15, individuals who didn’t enroll in health insurance the previous year would get a bill for coverage, which could total $5,000 or more, whether they wanted that coverage or not, and whether they knew they had that coverage or not.

It’s far from clear that this new “mandate on steroids” would pass constitutional muster. In 2012, the Supreme Court under Chief Justice Roberts blessed Obamacare’s mandate as a tax in part because “for most Americans the amount due will be far less than the price of insurance…It may often be a reasonable financial decision to make the payment rather than purchase insurance.”

Roberts justified Obamacare’s mandate as a tax because it gave the public a genuine choice: Buy insurance, or pay the IRS a tax. Buttigieg’s plan would give the public a Hobson’s choice: Buy insurance, or have insurance bought for you. It represents a significant increase in federal powers—one courts could (and should) strike down.

3. ‘Glide Path’ to Socialized Medicine

Notwithstanding his use of a strengthened individual mandate, Buttigieg ultimately wants to end up with a single-payer system of socialized medicine. He has made no bones about his objective, claiming that his health-care plan would provide a “glide path” to socialism.

As with most of the 2020 Democratic candidates who haven’t endorsed single payer explicitly, Buttigieg’s plan contains several characteristics designed to promote the growth of government-run health care. For instance, he would automatically enroll millions of individuals into the government-run health plan. (He claims Americans could opt out of the government plan, but if he wants the system to end in single payer, how easy would he make it for them to do so?) And he has proposed capping the amount that both private and public insurers can pay physicians and hospitals for health treatments, another way to funnel Americans into the government-run system.

Buttigieg’s plan would create the architecture to create a government-run system of socialized medicine. He just would build that edifice slightly more slowly than Sanders would. It represents but one of the big-government dreams of a candidate who, despite soothing rhetoric, has little in the way of policies to justify the term “moderate.”

This post was originally published at The Federalist.

The Left’s Health Care Vision a Prescription for Brute Government Force

Even as Democrats inveigh against President Trump for his alleged norm-shattering and contempt for the rule of law, their health care plans show a growing embrace of authoritarianism. For instance, Rep. Adam Schiff (D-CA) recently dubbed the President’s July 25 call with Ukrainian President Volodymyr Zelensky “a classic mafia-like shakedown.” He knows of which he speaks, because the Democratic agenda on health care now includes threats to destroy any entities failing to comply with government-dictated price controls.

The latest evidence comes from Colorado, where several government agencies recently submitted a draft report regarding the creation of a “state option” for health insurance. The plan would not create a state-run health insurer; instead, it would see agencies dragooning private sector firms to comply with government diktats.

The plan would “require insurance carriers that offer plans in a major market,” whether individual, small group, or large group, “to offer the state option as well.” In these state-mandated plans insurers must offer, carriers would have to abide by stricter controls on their administrative costs, in the form of medical loss ratio requirements, than those dictated by Obamacare.

For medical providers, the Colorado plan would use “payment benchmarks” to cap reimbursement amounts for doctors and hospitals. And if hospitals decline to accept these government-imposed price controls, the report ominously says that “the state may implement measures to ensure health systems participate.”

In comments to reporters, Colorado officials made clear their intent to coerce providers into this price-controlled system. Insurance Commissioner Michael Conway admitted that “If our hospital systems don’t participate, this won’t work….We can’t allow that to happen.” The head of Colorado’s Department of Health Care Policy and Financing, Kim Bimestefer, said that “if we feel that the hospitals are not going to participate, we will require their participation.”

State officials did not elaborate on the mechanisms they would use to compel participation in the state option. But they could attempt to require hospitals and insurers to participate in the new plan to maintain their license to operate in Colorado—a likely unconstitutional condition of licensure.

In threatening this level of coercion—agree to price controls, or we’ll shut down your business—Colorado Gov. Jared Polis imitated his fellow Democrat, House Speaker Nancy Pelosi. Pelosi’s proposed drug pricing bill, up for a vote in the House as soon as next month, would impose excise taxes of up to 95 percent of a drug’s sale price if companies refuse to “negotiate” with the federal government.

In its analysis of Pelosi’s legislation, the Congressional Budget Office (CBO) noted that, because drug makers could not deduct the 95 percent excise tax for income tax purposes, “the combination of income taxes and excise taxes on the sales could cause the drug manufacturer to lose money if the drug was sold in the United States.” Perhaps unsurprisingly, CBO concluded that the excise tax would not generate “any significant increase in revenues,” as “manufacturers would either participate in the negotiating process”—because they have no effective alternative—“or pull a particular drug out of the U.S. market entirely.”

CBO also noted, in a classic bit of understatement, that Pelosi’s bill “could result in litigation,” for threatening losses on any company that dares defy the government’s offer of “negotiation.” But the left seems uninterested in abiding by limits on government power—or the consistency of its own arguments. As I noted this spring, other proposed legislation in Congress would abolish the private health care market. Less than one decade after forcing all Americans to buy a product for the first time ever, in the form of Obamacare’s insurance mandate, liberals now want to prohibit all Americans from purchasing care directly from their doctors.

These recent proposals continue a virulent strain of authoritarianism that has permeated progressivism’s entire history. Franklin Roosevelt threatened to invoke emergency powers during his first inaugural address, and Rahm Emanuel infamously said during the Great Recession that “you never want a serious crisis to go to waste.” Make no mistake: The health care system needs patient-centered reform. But the true crisis comes from the progressives who would utilize blunt government force to seize control of one-fifth of the nation’s economy.

This post was originally published at The Daily Wire.

Medicare for Pets IS as Crazy as You Think

Recently, business writer David Lazarus penned a column in the Los Angeles Times called “Medicare for Pets—It’s Not as Crazy as You Think.” The column argued for a “Peticare for all” program (I’m not making that up—that’s really what he called it) of mandatory insurance for pets.

Unfortunately for Lazarus, the idea is as exactly as crazy as one might think: Both an impractical and unwise use of government resources. But the fact that he would propose such a concept—and that a major newspaper would devote column inches to the idea—shows how people now expect government to solve their every waking problem.

Why It Wouldn’t Work

California law requires that all dogs over the age of 4 months be vaccinated against rabies and licensed through the local animal care agency. Many cities and counties, including Los Angeles, also require that cats be vaccinated for rabies and licensed. How about if we insure dogs and cats as part of the licensing process?

The proposal raises several obvious problems. First, confining the proposal to cats and dogs could prompt outrage from owners of non-feline, non-canine breeds, like the 9.4 million reptiles kept as pets. The most recent national pet owners’ survey reveals Americans keep more fish as pets (139.3 million) than cats (94.2 million) or dogs (89.7 million). Of course, including more species, particularly exotic ones, could make “Peticare” tougher and costlier to implement.

Pet Licensing Ineffective, So Why Would This Work?

More importantly, Lazarus didn’t mention it—perhaps he didn’t even bother to check—but a simple Google search reveals that, legal requirements notwithstanding, a large percentage of pets remain unlicensed. A 1998 House of Commons Library paper notes that Britain abolished its licensure requirement in 1987, because the license “was held by only around half of dog owners.”

More recent surveys in the United States indicate a similar rate of non-compliance with pet licensure laws. For instance, as of 2014, “98.8 percent of pets living in Richmond,” Virginia’s capital, were unlicensed, even though city code requires dog and cat owners to pay $10 annually for a license. The nearby counties of Henrico and Chesterfield, which require licenses for dogs but not cats, fared little better, with compliance rates of only about 50 percent and 34 percent, respectively.

Britain’s Kennel Club opposes a renewal of that country’s dog licensing laws, because “it is the responsible dog owner who will end up paying a further tax on dog ownership, whilst the irresponsible will continue to flout the law.” Adding an insurance requirement to go with the licensing fee would only compound the incentives for individuals to disobey—and compound the financial punishment inflicted on those law-abiding individuals who comply.

Lazarus’ concept of linking pet insurance to licensure would only work if government officials created a massive (and expensive!) bureaucracy to enforce those requirements. One can easily see how this “nanny state” proposal would cause all sorts of ramifications—neighborhood disputes escalating as someone reports “uninsured” pets to the authorities, for instance. Libertarians have already outlined good reasons to forgo pet licensure, with this proposal to add an insurance requirement merely the latest.

Big Government Has Gone to the Dogs

Apart from the fact that the “Peticare” proposal wouldn’t work, the fact that some people might take it seriously speaks to the desire for government to solve all their problems. Lazarus began his article by telling the story of a woman whose dog could well need a hip replacement, but whose pet insurance policy won’t cover the treatment because it’s a pre-existing condition. The owner asked Lazarus, “If you’re going to have loopholes for pre-existing conditions, why offer insurance at all?”

The question has a simple answer—albeit one the owner likely does not want to hear. If a health condition pre-exists the issuance of the policy, then by definition covering it doesn’t constitute insurance. Insurance consists of protection against an event that could occur in the future but that has not occurred yet. The problem occurs when individuals want “insurance” for conditions they (or in this case, their pets) have already developed.

And that’s the problem: People who want, or worse yet expect, government—meaning someone else—to solve their problems, and give them something for “free.” Lazarus’ “Peticare” represents a more absurd manifestation of that desire, but by no means the only one.

After all, if people didn’t expect something for nothing from the federal government, future generations wouldn’t face the prospect of paying off nearly $23 trillion in debt for things other people got and they won’t.

This post was originally published at The Federalist.

In Fourth Dem Debate, Warren Maintains Her Health Care Evasion

On Tuesday, Sen. Sherrod Brown—a notable leftist who has said he supports a single-payer health care system in theory—said in a CNN story that “it’s a terrible mistake if the Democratic nominee would publicly support ‘Medicare for All.’” On Tuesday evening, two of the party’s leading contenders for that nomination, Sens. Bernie Sanders and Elizabeth Warren, redoubled their commitment to such a policy, with Warren drawing fire from all sides about her lack of detail surrounding the issue.

As she had in previous debates, Warren refused to get into specifics about how she would pay for the single-payer plan that Sanders has introduced as legislation, and which Warren has endorsed. Sanders has previously admitted that taxes on the middle class would go up under his plan.

Warren would not admit that taxes on the middle class would go up under single payer. She claimed that costs for the middle class would go down on net under her plan, and that she would not sign any legislation that raised costs on the middle class.

However, even this supposed promise raised additional questions:

  1. Who qualifies as middle class in Warren’s estimation? A family making under $50,000, a family making under $250,000, or somewhere in between?
  2. Does Warren’s promise mean that no middle-class families will see their costs go up on net? If so, that seems like an impossibly high bar to clear, as virtually every major law creates both winners and losers. Even though the left tries to turn the federal government into another version of “Oprah’s Finest Things”—“You get a car! You get a car! You get a car!”—it rarely works out that way in practice.
  3. In September 2008, Barack Obama made a “firm pledge” that he would not raise taxes on families making under $250,000 per year—“not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” That promise lasted for less than a month of his administration. On February 4, 2009, two weeks after taking office, Obama signed a children’s health insurance reauthorization that included a large increase in tobacco taxes—taxes that hit working class families hardest. Given how quickly Obama did an about-face on his campaign promise, why should the American people take Warren’s word any more seriously than they did Obama’s “firm pledge?”

South Bend Mayor Pete Buttigieg also chimed in on the funding discussion. He had previously characterized Warren as “extremely evasive” on the issue during the last debate, and released ads prior to this debate questioning Warren’s and Sanders’ proposals to prohibit private health insurance. During the CNN debate, he pressed both issues, noting (as this commentator has) that Warren has “a plan for everything, except this.” With that, Warren derided Pete’s plan as “Medicare for all who can afford it.”

It seems particularly noteworthy that Warren wants to enact a major expansion of the federal government’s role—the largest expansion of government’s role ever, in both its financial scope and massive reach into every American’s life—yet cannot find a sufficient justification to admit the middle class will pay even a little bit more in taxes to fund this socialist utopia. The former speaks volumes about the left’s ultimate objective—full, unfettered power over the economy—and the latter speaks to the deception they are using to obtain it.

This post was originally published at The Federalist.

Hospital’s “Egregiously Unethical” Behavior Illustrates Problems of Government-Run Health Care

Why would a hospital keep a brain-damaged patient on life support in a vegetative state for months, without so much as talking with the patient’s relatives to ascertain the family’s wishes for their loved one? Because government regulations encouraged them to do just that.

ProPublica recently profiled a pattern of troubling cases at Newark Beth Israel hospital. In several cases, physicians admitted they kept patients alive to bolster their statistics in government databases, and prevent a potential closure of the hospital’s transplant unit. The sorry tale shows but some of the perverse consequences of government-run health care—a system that the left wants to force on all Americans.

Brain-Damaged Patient Artificially Kept Alive

After suffering from congestive heart failure for years, Young, a Navy veteran and former truck driver with three children, had received a heart transplant on Sept. 21, 2018. He didn’t wake up after the operation and had been in a vegetative state ever since.

Machines whirred in his room, pumping air into his lungs. Nutrients and fluids dripped from a tube into his stomach. Young had always been fastidious, but now his hair and toenails had grown long. A nurse suctioned mucus from his throat several times a day to keep him from choking, according to employees familiar with his care. His medical record would note: ‘He follows no commands. He looks very encephalopathic’—brain damaged.

On one day this April, physicians at Newark Beth Israel discussed what to do about their brain damaged, and severely injured, patient. When asked about Young, the head of the hospital’s transplant team, Mark Zucker, had a blunt response: “Need to keep him alive ‘til June 30 at a minimum.”

Zucker went on, instructing hospital staff not to raise the option of palliative care—that is, a less aggressive treatment course focused more on alleviating pain—until the one-year anniversary of Young’s transplant in September.

“It’s not as if they’re asking for this and we’re saying no, we cannot do this,” another physician said, according to a recording of the meeting. “We haven’t refused anything they’ve asked,” Zucker agreed in talking of the family’s wishes. “We just haven’t raised withdrawing” intensive treatment.

Unethical Behavior to Meet Government Targets

Beginning in 2007, as ProPublica notes, the federal Centers for Medicare and Medicaid Services (CMS) set quality standards for organ transplants:

Under those rules, the one-year survival rate has been ‘the magic number,’ according to Laura Aguiar, principal of consulting firm Transplant Solutions. If a program’s survival rate fell too far under its expected rate, which was calculated by a CMS algorithm, the agency could launch an audit. If the audit uncovered serious problems, CMS could pull a program’s Medicare certification, meaning that the federal health care insurer would stop reimbursing for transplants.

A hospital losing its Medicare certification could lead to the end of its transplant program, as many private insurers will only pay for procedures performed at Medicare-certified hospitals. With heart transplant survival rates already below the national averages, Newark Beth Israel feared the potential consequences of an audit if its numbers fell any further.

As a result, the hospital’s doctors decided to keep patients like Young alive to prop up its federal rankings. They took those actions without consulting Young’s family, and even though they believed Young would “never wake up or recover function.”

Hid Information from Relatives

Despite the damage to Young’s brain during the procedure, doctors never initiated a conversation with the family about options for care, such as hospice, given his poor prognosis for recovery. They failed to inform Andrea Young that her brother had contracted a dangerous drug-resistant fungal infection. During this time, Andrea also struggled to ensure the hospital staff provided basic grooming; she recounted that it took four months—four months—for staff to trim her brother’s toenails.

All the while, doctors knew they were violating their ethical duty to Darryl Young, by failing to obtain informed consent for his care. But they felt that Young and his family needed to “take one for the team”—incur more pain and heartache so the hospital could meet government targets. As transplant director Mark Zucker explained in a meeting:

This is a very, very unethical, immoral but unfortunately very practical situation, because the reality here is that you haven’t saved anybody if your program gets shut down….This guy unfortunately became the seventh potential death in a very bad year, alright, and that puts us into a very difficult spot.

Sadly, Darryl Young does not represent the only instance where Newark Beth Israel purposefully tried to boost their targets to meet government standards. ProPublica uncovered other instances where patients were kept alive, or their hospital discharge delayed, until one year after surgery. Notes in another patient’s files indicate that “he will remain hospitalized…to hit his one year anniversary.”

Government-Run Care Betrays the Vulnerable

Poor examples of government-run health care abound. As I recently noted, the United States suffers from an antiquated kidney care system—with a much smaller percentage of patients receiving at-home dialysis than a country like Guatemala—because Medicare has covered most patients with kidney disease since 1973, and the government-run program has failed to innovate since then. In the Newark Beth Israel case, an arbitrary target imposed by a government agency more than a decade ago led to patients being kept alive simply to meet that target.

Patients like Darryl Young deserve better than the care Newark Beth Israel provided to him. They also deserve better than the government-run health care that the left wants to impose on all Americans.

This post was originally published at The Federalist.

Separating Fact from Fiction on Trump’s Health Care Proclamation for Immigrants

On Friday, President Trump issued a proclamation requiring certain immigrants entering the country either to purchase health insurance, or demonstrate they can pay their medical bills. The order prompted no small amount of hysteria from the left over the weekend.

If you’re puzzled by this development, you might not be the only one. After all, don’t liberals want everyone to have health insurance? They have spent significant time and effort attacking President Trump for a (slight) increase in the number of uninsured people while he’s been president.

What the Proclamation Says

The proclamation itself, which will take effect on November 3 (30 days from Friday), limits “the entry into the United States as immigrants of aliens who will financially burden” the American health care system. It requires aliens applying for immigrant visas to become “covered by approved health insurance…within 30 days” of entry, or “possess…the financial resources to pay for reasonably foreseeable medical costs.”

The proclamation includes numerous different acceptable forms of health insurance: employer plans (including association health plans and COBRA coverage), catastrophic plans, short-term limited duration insurance, coverage through Tricare or Medicare, or visitor health coverage lasting a minimum of 364 days. The list of acceptable forms of insurance does not, however, include subsidized Obamacare exchange plans, or Medicaid coverage for individuals over age 18—likely because these options involve federal taxpayer subsidies.

What the Proclamation Doesn’t Say

It shouldn’t need stating outright, but contrary to claims that the proclamation constitutes a “racist attack on a community who deserves health care,” the order says not a word about a specific race, or national or ethnic group. It also exempts “any alien holding a valid immigrant visa issued before the effective date of this proclamation,” meaning the requirement will apply prospectively and not retrospectively.

Liberal reporters claimed that “the move effectively creates a health insurance mandate for immigrants,” after Republicans eliminated Obamacare’s individual mandate penalty. But this charge too ignores the fact that the proclamation—unlike Obamacare—includes an exception for those who “possess…the financial resources to pay for reasonably foreseeable medical costs.” (The proclamation does not define this term, meaning that the administration will presumably go through a rulemaking process to do so.)

The Real Story

Liberals’ hysteria over the issue demonstrates a massive shift leftward in recent years. Consider that in 1993, Hillary Clinton testified before Congress that she opposed extending benefits to “illegal aliens,” because it would encourage additional migration to the United States:

We do not think the comprehensive health care benefits should be extended to those who are undocumented workers and illegal aliens. We do not want to do anything to encourage more illegal immigration into this country. We know now that too many people come in for medical care, as it is. We certainly don’t want them having the same benefits that American citizens are entitled to have.

Even in 2009, Barack Obama felt the need to claim that his health plan wouldn’t cover those in the country illegally (even if the claim didn’t stand up to scrutiny). The fact that Democrats have now gone far beyond Obama’s position, and have attacked President Trump for ensuring foreign citizens will not burden our health care system—a position liberals claim to support for Americans—speaks to the party’s full-on embrace of both socialism and open borders.

This post was originally published at The Federalist.

How the Impeachment Frenzy Could Block Bad Health Care Policies

House Democrats’ headlong rush to impeach President Trump will have many implications for American politics and the presidential election. On policy, it could have a salutary effect for conservatives, by precluding the enactment of harmful policies that would push our health care system in the wrong direction.

Congress should of course do something about our health care system, particularly the millions of individuals priced out of insurance by Obamacare, also known as the Unaffordable Care Act. But in recent weeks, it appears that Republicans have fallen into the typical definition of bipartisanship—when conservatives agree to do liberal things. As a result, if the controversy over impeachment leads to a legislative stalemate over health care, it will at least prevent Congress from making our current flawed system any worse.

Renewed Impeachment Push

The emerging controversy over Trump’s interactions with Ukraine, and whether those actions constituted an impeachable offense, resulted in analyses of whether and how the impeachment push will affect the legislative agenda on multiple issues, including health care.

Multiple Republicans suggested impeachment could bring Congress’ other work to a halt, whether by consuming the time and energy of members of Congress and staff, poisoning the proverbial well for negotiations and compromise, or a combination of the two. Consider the following quotes from Republicans in a Wednesday story:

  • House Ways and Means Committee Ranking Member Kevin Brady (R-Texas): “Impeachment makes a toxic environment more toxic.”
  • Former House Freedom Caucus Chairman Mark Meadows (R-N.C.): “There is more oxygen on impeachment than there is on legislation….My Democratic colleagues have put everything on hold to try to make sure that this President is not the one that signs any proposed bills.”
  • President Trump: Nancy Pelosi has “been taken over by the radical left. Unfortunately, she’s no longer the Speaker of the House.”
  • The White House: Democrats have “destroyed any chances of legislative progress” with their focus on impeachment.

Ultimately, whether any major legislation passes in this environment, whether on health care or other issues, will depend on two factors. First, will President Trump want to strike legislative bargains with House Democrats at the same time the latter are working to impeach and remove him from office? On that front, color me skeptical, at best.

Second, at a time when Trump will need Republicans to support him in an impeachment fight, will he aggressively push policies that many of them oppose?

Controversial Agenda in Congress

In July, the Senate Finance Committee approved drug pricing legislation over the concerns of many Republicans. A majority of Republicans voted against the Finance Committee bill, believing (correctly) that its provisions limiting price increases for pharmaceuticals amounted to price controls, which would have a harmful impact on innovation.

Since that time, House Speaker Nancy Pelosi (D-Calif.) has taken ideas from Senate Finance Committee Chairman Chuck Grassley (R-Iowa), and the Trump administration, and put them on steroids. The drug pricing legislation she recently introduced as H.R. 3 would force drug companies into a “negotiation” with defined price limits, confiscating virtually all their revenues if they do not submit to these government-imposed price controls.

Likewise, Congress’ action on “surprise” billing appears ominous. While Washington should allow states to come up with their own solutions to this issue, some Republicans want Congress to intervene.

Save Us from ‘Socialism-Lite’

If Congress’ legislative agenda grinds to a halt over a combination of the impeachment food fight and the impending 2020 presidential campaign, it would mean that lawmakers at least did not make the health care system worse via a series of socialist-style price controls.

The American people do deserve better than the failed status quo. They need the enactment of a conservative health care agenda that will help lower the skyrocketing cost of health care.

But if Republicans have failed to embrace such an agenda, as by and large they have, at least they can stop doing any more damage through new policies that will push us further in the direction of government-run health care. Thankfully, Pelosi’s newfound embrace of a march towards impeachment may slow the march towards socialized medicine—at least for the time being.

This post was originally published at The Federalist.

Meet the Radical Technocrat Helping Democrats Sell Single-Payer

If anyone had doubts about the radical nature of Democrats’ health care agenda, they needn’t look further than the second name on the witness list for this Wednesday’s House Ways and Means Committee hearing on single-payer health care: Donald Berwick of the Institute for Healthcare Improvement.

If that name sounds familiar, it should. In summer 2010, right after Obamacare’s passage, President Obama gave Berwick a controversial recess appointment to head the Centers for Medicare and Medicaid Services (CMS). Democrats refused to consider Berwick’s nomination despite controlling 59 votes in the Senate at the time, and he had to resign as CMS administrator at the end of his recess appointment in late 2011.

Berwick’s History of Radical Writings

Even a cursory review of Berwick’s writings explains why Obama’s only option was to push him through with a recess appointment, and why Democrats refused to give Berwick so much as a nomination hearing. As someone who read just about everything he wrote until his nomination—thousands of pages of journal articles, books, and speeches—I know the radical nature of Berwick’s thinking all too well. He believes passionately in a society ruled by a technocratic elite, thinking that a core group of government planners can run the country’s health care system better than individual doctors and patients.

Here is what this doctor believes in, in his own words:

  • Socialized Medicine: “Cynics beware: I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country.”
  • Control by Elites: “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
  • Wealth Redistribution: “Any health care funding plan that is just, equitable, civilized, and humane must—must—redistribute wealth from the richer among us to the poorer and less fortunate.”
  • Shutting Medical Facilities: “Reduce the total supply of high-technology medical and surgical care and consolidate high-technology services into regional and community-wide centers … Most metropolitan areas in the United States should reduce the number of centers engaging in cardiac surgery, high-risk obstetrics, neonatal intensive care, organ transplantation, tertiary cancer care, high-level trauma care, and high-technology imaging.”
  • End of Life Care: “Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been available for centuries.”
  • Cost-Effectiveness Rationing of Care: “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”
  • Doctors Putting “The System” over their Patients: “Doctors and other clinicians should be advocates for patients or the populations they service but should refrain from manipulating the system to obtain benefits for them to the substantial disadvantage of others.”
  • Standardized “Cookbook Medicine”: “I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”

For those who want a fuller picture of Berwick’s views, in 2010-11 I compiled a nearly 30-page dossier featuring excerpts of his beliefs, based on my comprehensive review of his prior writings and speeches. That document is now available online here, and below.

Where’s the Political Accountability?

Some of Berwick’s greatest admiration is saved for Britain’s National Health Service on the grounds that it was ultimately politically accountable to patients. For instance, Berwick said his “rationing with our eyes open” quote was “distorted,” claiming that

Someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.

When running for governor of Massachusetts in 2013, Berwick claimed he “regrets listening to White House orders to avoid reaching out to congressional Republicans.” But that doesn’t absolve the fact that Berwick went to great lengths to avoid the political accountability he previously claimed to embrace.

It also doesn’t answer the significant questions about why Obama waited until after Obamacare’s enactment to nominate Berwick—deliberately keeping the public in the dark about the radical nature of the person he wanted to administer vast swathes of the law.

Thankfully, however, Wednesday’s hearing provides a case of “better late than never.” Republicans will finally get a chance to ask Berwick about the extreme views expressed in his writings. They will also be able to raise questions about why Democrats decided to give him an official platform to talk about single payer (and who knows what else).

This post was originally published at The Federalist.