Democrats Raid Medicare to Pay for Obamacare (Again!)

As Ronald Reagan would say, “There they go again.” A decade after Democrats raided Medicare by more than half a trillion dollars to fund Obamacare, House Speaker Nancy Pelosi (D-Calif.) and her Democratic colleagues recently introduced new Obamacare legislation that would raid Medicare by nearly another half-trillion dollars.

Sadly, the House plans to vote on this legislative package before the Independence Day holiday. Lowering spending in one unsustainable entitlement to fund another represents the height of fiscal irresponsibility. For Democrats, however, it looks like par for the course.

Obamacare on Steroids

Democrats have titled their bill the Obamacare “enhancement” act — and for good reason, because it would effectively put the law on quite the figurative steroids. The bill would stymie recent efforts by the Trump administration to offer more insurance options to consumers, such as short-term, limited-duration insurance and association health plans.

Instead, it would make skyrocketing premiums “affordable” by dedicating more taxpayer dollars towards Obamacare exchange subsidies, while also directing $10 billion per year to insurance companies via a new — and permanent — federal bailout fund.

The legislation would also balloon Obamacare’s Medicaid expansion to able-bodied Americans. It would require states to keep individuals on the rolls for 12 months, allowing affluent individuals to remain in this “low-income” program. The income cap on coverage for children would also be eliminated, permitting states to cover children of millionaires while receiving federal dollars for doing so if they choose.

At a time evidence already suggests significant waste and fraud takes place among individuals receiving Medicaid coverage, the Pelosi legislation would add to the ever-increasing budget woes of numerous states by forcing them to keep ineligible individuals on the rolls.

Socialist-Style Price Controls

How would Democrats fund all this new spending? From Medicare.

The Obamacare “enhancement” legislation includes drug pricing provisions that the House of Representatives passed last December. The provisions would require drug companies to “negotiate” prices with the Department of Health and Human Services (HHS),  which would effectively dictate prices to drug companies based on benchmarks laid out in the bill. Companies that do not “negotiate” would face excise taxes that could cause the manufacturer to lose money on every drug it sells in the United States.

The Congressional Budget Office confirmed back in December that these “negotiation” provisions would lead to the development of fewer drugs, as companies invest less in research and development. The CBO also said, however, that the blunt price controls would reduce Medicare and Medicaid spending. So Democrats used these price controls to fund their recent Obamacare expansion bill.

Raiding Medicare (Again)

According to CBO, the vast majority of the savings from drug pricing — a total of $448.2 billion over ten years, to be exact — used to fund the Obamacare bill comes from Medicare. That the Democrats are effectively raiding Medicare to expand entitlements for younger Americans makes the Obamacare “enhancement” legislation all the more odious and irresponsible, though, at this point, we really shouldn’t be surprised.

We’ve seen this act before. Indeed, the Obama administration spent years trying to justify the raid on Medicare. Kathleen Sebelius, then the HHS secretary, testified before Congress that provisions in the law would “both” extend Medicare’s solvency and pay for Obamacare. This is a position that defies both logic as well as common sense.

As it stands, Medicare has already become functionally insolvent. The year before Obamacare’s passage, the program’s trustees projected the Hospital Insurance Trust Fund would run out of money to pay all its bills in 2017 — three years ago. The Obamacare double-counting gimmicks that Sebelius testified about may appear to have extended the program’s solvency, but if only on paper. But the true cost of these things cannot remain hidden forever. According to current projections, even the funds from these phony solutions will run out by 2026.

Doing the Wrong Thing About Medicare’s Insolvency

Yet what would Pelosi and House Democrats do about Medicare’s looming insolvency? Not just nothing — worse than nothing. Rather than using the savings from their socialistic price controls to make Medicare solvent, they would take that money and throw it at health insurers to prop up Obamacare. As shocking as it may seem to some, this behavior echoes Pelosi’s 2011 interview with CNBC, when she bragged about how Democrats “took half a trillion dollars out of Medicare” to pay for Obamacare.

The Obamacare “enhancement” demonstrates how Pelosi and her fellow Democrats don’t care about fiscal responsibility or protecting America’s seniors. Instead, they view Medicare just as they did in 2010: A slush fund to raid on a whim as part of their effort to expand government-run health care at any cost.

This post was originally published at The Federalist.

How Government-Run Health Care Worsened the Coronavirus Crisis

Leftist politicians have spent a great amount of time over the past two months attacking President Trump for his handling of the coronavirus crisis. But instead of reflexively criticizing the administration, those liberals might want to examine how the left’s dream of government-run health care has exacerbated the crisis within the United States.

One of the major causes of the dearth of testing over the past several months: Low payments from Medicare, which led to low payment rates from private insurance plans. It may come as a shock to people like Rep. Alexandria Ocasio-Cortez (D-NY), but guess what labs did when low payments meant they suffered a financial loss for every coronavirus patient tested? They performed fewer tests.

Low Reimbursements Equals Fewer Tests

A recent expose in USA Today highlighted how Medicare “lowballed payments” to labs for coronavirus tests, leading those labs to restrict the number of tests they performed. An executive at one lab, Aaron Domenico, told the paper that “I’m an American first, and if I could do it for cost, I’d be happy to do it for the people at cost.” But Medicare initially reimbursed laboratories only $51 for a coronavirus test, much less than Domenico’s costs of $67 per test.

Paying $51 for a diagnostic test sounds like a lot, but Medicare gives laboratories nearly twice that amount, or approximately $96, to test for the flu. And government bureaucrats setting unrealistically low prices meant that private insurers followed Medicare’s lead. Little wonder that the head of the National Independent Laboratory Association said “a number of labs are holding back” on performing additional tests “because they didn’t want to lose money.”

Thankfully, on April 14 Medicare raised its reimbursement for a coronavirus test from $51 to $100. Unsurprisingly, the number of tests performed daily has roughly doubled since that point. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said she “recognized that there may have been some issues with reimbursement” discouraging labs from performing coronavirus tests.

Bureaucrats Can’t Micromanage Health Care

Therein lies one of the major problems with government-run health care: The notion that federal bureaucrats can determine the correct price for every prescription drug, laboratory test, physician service, or hospital procedure across the country. Donald Berwick, a former CMS administrator who helped develop Sen. Elizabeth Warren’s single-payer proposal, once said, “I want to see that in the city of San Diego or Seattle there are exactly as many MRI units as needed when operating at full capacity. Not less and not more.”

Berwick’s comments suggest that the federal government can determine the “right” amount of MRI units in each city, and use policy levers to achieve that “correct” outcome. But the coronavirus testing fiasco demonstrates how federal bureaucrats often do a poor job of trying to micromanage health care from Washington. Paying doctors and laboratories too much will encourage over-consumption of care, while paying too little discourages providers from even offering the service.

Low Payments Lead to Job Losses, Too

The problems with coronavirus testing also preview the left’s efforts to expand government-run health care. For instance, Joe Biden’s campaign platform calls for a government-run health plan that “will reduce costs for patients by negotiating lower prices from hospitals and other health care providers.”

But all these proposals—whether they would abolish private insurance outright, as Warren and Sen. Bernie Sanders support, or offer a government-run “option,” as in Biden’s platform—would have the government “negotiate” prices by forcing doctors, nurses, and hospitals to accept less money. By lowering payment levels, those plans would lead to massive job losses—as many as 1.5 million jobs in hospitals alone under a transition to single-payer, according to one estimate in the prestigious Journal of the American Medical Association.

The pay cuts and furloughs affecting many front-line health workers—the health-care sector lost 1.4 million jobs during the month of April—provide a preview of the future. Instead of suffering temporary revenue declines due to the coronavirus pandemic, hospitals and medical practices would face permanent reductions in revenue from lower-paying government programs.

Worse yet, care will suffer when people cannot access the care they need at the paltry prices government programs will pay. While the left lays the coronavirus testing flaws at the feet of President Trump, they should look instead at the government-run programs they support as a major source of the problem. Voters being asked to endorse the movement towards socialism in November should take note as well.

This post was originally published at The Federalist.

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.