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Republicans are understandably nervous about polling data showing considerable opposition to the Ryan plan’s Medicare proposal – particularly since they just voted for a budget resolution in the House of Representatives that includes such a reform.

Their unease is warranted. GOPers almost surely will be subjected to a scorched-earth campaign in 2012, featuring lots of demagoguery about  Medicare “privatization,” mixed in with shrill rhetoric about big insurance companies and “tax cuts for the rich.”

I don’t particularly care about the GOP’s electoral prospects, but I do want to save my nation from fiscal collapse, so that means I don’t want entitlement reform to become radioactive.

So what can be done to counter the predictable onslaught against Ryan’s Medicare proposal?

First and foremost, reformers should borrow some advice about counter-attacks from President Obama. He said during the 2008 campaign that if opponents “bring a knife to the fight, we bring a gun,” and a high-ranking White House aide in 2009 urged supporters to “punch back twice as hard” when dealing with attacks against government-run healthcare.

While reformers obviously should avoid the unseemly rhetoric associated with the current Administration, they should copy the aggressive approach. Timidity is a recipe for defeat.

For instance, do not allow the left to compare the Ryan proposal to the status quo of unlimited handouts. That system is bankrupt and even the Obama Administration acknowledges that something dramatic needs to happen to control costs.

Indeed, the best strategy for reformers may be to compare the Ryan plan to Obama’s scheme for a beefed-up “Independent Payment Advisory Board.” Sounds wonky and technical, but IPAB is the bureaucratic entity that will be in charge of imposing price controls that lead to the rationing of health care for the elderly.

In other words, the real issue is who will be in charge of the pool of dollars that will be used to provide healthcare for the elderly. Ryan’s plan would let seniors choose a health plan that best suits their needs and provide a big subsidy to finance that policy. Obama’s plan, by contrast, will keep seniors in a government-run system and let a bunch of unelected bureaucrats decide what kind of care they should receive.

Moreover, reformers should fight fire with fire. If the left is allowed to use “privatization” to describe Ryan’s plan (notwithstanding massive government involvement and subsidies), then reformers should refer to IPAB as a “death panel.”

My colleague Michael Cannon is a one-man truth squad on these issues, and he already has explained that there was a lot of merit in Sarah Palin’s accusation that Obamacare would create something akin to a death panel, and he has documented the various ways that government-run healthcare will lead to rationing.

To conclude, here are excerpts from two excellent columns that recently have been published on Obama’s IPAB scheme.

Rich Lowry of National Review writes.

Why does Obama need specifics when he has the Independent Payment Advisory Board, or IPAB? If spending on health care is the biggest driver of government spending, then IPAB is Obama’s most important deficit-reduction initiative. …Obama…implicitly acknowledges that [Medicare] is broken and bankrupting us. Otherwise, he wouldn’t be proposing a cap on Medicare’s growth that is at least as stringent as anything New Gingrich proposed in the 1990s… Under Obamacare, IPAB is to hit a target for Medicare’s growth that significantly squeezes the program beginning in 2014 (in his budget speech, Obama said he wants to ratchet down the cap even further). …In the fact sheet released in conjunction with his budget speech, the White House says he wants to give IPAB “additional tools” and “additional enforcement mechanisms such as an automatic sequester.” …IPAB won’t make the notoriously inefficient Medicare program any more efficient. Through arbitrary reductions on payments to providers, it will simply reduce the supply of care. …Medicare’s chief actuary warned that Obamacare will drive providers out of the program. If you love Medicaid, you’ll adore the new IPAB version of Medicare. It will be the experts’ gift to America’s seniors.

The Wall Street Journal’s superb editorial page also has a good analysis.

The Independent Payment Advisory Board was created in the ObamaCare statute, and the President will appoint its experts in 2012 to six-year terms. …Starting in 2014, the board is charged with holding Medicare spending to certain limits, which at first is a measure of inflation. After 2018, the threshold is the nominal per capita growth of the economy plus one percentage point. Last week Mr. Obama said he wants to lower that to GDP plus half a percentage point.  Mr. Ryan has been lambasted for linking his “premium support” Medicare subsidies to inflation, not the rate of health cost growth. But if that’s as unrealistic as the liberal wise men claim, then Mr. Obama’s goals are even more so. …Since the board is not allowed by law to restrict treatments, ask seniors to pay more, or raise taxes or the retirement age, it can mean only one thing: arbitrarily paying less for the services seniors receive, via fiat pricing. …Now Mr. Obama wants to give the board the additional power of automatic sequester to enforce its dictates, meaning that it would have the legal authority to prevent Congress from appropriating tax dollars. In other words, Congress would be stripped of any real legislative role in favor of an unaccountable body of experts. …the board will decide “what works” and apply it through regulation to all of American medicine. …As a practical matter, the more likely outcome is the political rationing of care for the elderly, as now occurs in Britain… Messrs. Ryan and Obama agree that Medicare spending must decline, and significantly. The difference is that Mr. Ryan would let seniors decide which private Medicare-financed insurance policies to buy based on their own needs, while Mr. Obama wants Americans to accept the commands of 15 political appointees who will never stand for election.

Even though I play senior softball, I’m not a senior citizen by Medicare standards. But when I reach that age, I know what I’ll decide if my choice is “privatization” or a “death panel.”

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The left already is wailing about the Medicare and Medicaid reforms in Congressman Paul Ryan’s budget. They don’t have any solutions of their own for these bankrupt programs, but they hope to scare voters in the short run and don’t seem to care about the nation in the long run.

But, as Margaret Thatcher famously warned, the problem with socialism is that sooner or later you run out of other people’s money. With that in mind, it’s quite appropriate to cite a story about another needless death resulting from the inefficient U.K. government-run health care system.

But what makes this story so remarkable is that the person who died was part of the upper-level bureaucracy. When folks relatively high in the pecking order start suffering from needless death and wind up having their surgeries delayed four times, you know it’s just a matter of time before the system collapses.

A former NHS director died after waiting for nine months for an operation – at her own hospital. Margaret Hutchon, a former mayor, had been waiting since last June for a follow-up stomach operation at Broomfield Hospital in Chelmsford, Essex. But her appointments to go under the knife were cancelled four times and she barely regained consciousness after finally having surgery. Her devastated husband, Jim, is now demanding answers from Mid Essex Hospital Services NHS Trust – the organisation where his wife had served as a non-executive member of the board of directors.

Keep in mind that this is America’s future if we don’t reform entitlements. That’s what the leftist critics of Ryan’s plan aren’t telling you.

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This won’t surprise anyone with a pulse, but Obama, Reid, Pelosi, et al, were disingenuous about the costs of Obamacare. The Congressional Budget Office has released revised numbers and government-run healthcare will cost 8.6 percent more than what was projected in last year’s forecast. This doubtlessly is just the first of many “re-estimates” that will occur, with each one showing the program to be far more costly than initially projected.

This obviously shows the mendacity of Democrat politicians, but let’s also make sure that CBO takes a lot of the blame. The bureaucrats deliberately low-balled expenditure estimates to please their political masters. If Republicans had any brains, they would fire all of them.

Here’s a brief blurb from the Wall Street Journal’s editorial on the topic.

CBO says the entitlement’s health insurance subsidies will cost $1.13 trillion between 2012 and 2021, not $1.04 trillion, the prior estimate. This 8.6% jump is the result of revised assumptions, the so-called technical factors in CBO’s budget model. The bill’s total cost now stands at $1.445 trillion, according to another recent CBO estimate. Remember that all of these are fictitious numbers that reflect Congressional gaming of CBO conventions to make it seem as if ObamaCare “saves” money. But now, even under these conventions, CBO is conceding that it significantly underestimated the bill’s cost. If the propeller heads decide to add a few more trillion dollars in new spending, they might get somewhat closer to the bill’s true cost.

And because I like to brag when I get something right (to be fair, everyone knew the CBO numbers were dishonest and wrong, so I wasn’t exactly making a brilliant observation), I invite people to re-watch my video explaining how the politicians and their minions were lying to us.

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I’ve commented before about the sub-par government-run healthcare system in the United Kingdom, including patients dying of malnutrition, patients suffering needless pain and discomfort, and patients dying from poor care (additional examples at this link).

I’ve even commented on the NHS wasting money on politically correct nonsense while letting patient care deteriorate.

Now we have another distasteful example showing why it is a big mistake to put bureaucrats in charge of health care. This BBC story is a sobering look at America’s future with a government-run healthcare system.

The NHS is failing to treat elderly patients in England with care, dignity and respect, an official report says. The Health Service Ombudsman came to the conclusion after carrying out an in-depth review of 10 cases. The ombudsman, which deals with serious complaints against the NHS, said the patients – aged over 65 – suffered unnecessary pain, neglect and distress. Charities said the findings were “sickening”, while the government admitted improvement was needed. …Several themes became clear from the ombudsman’s analysis. Half the people featured did not consume adequate food or water during their time in hospital. Some were left in soiled or dirty clothes. …In another case, a cancer patient wanted to be discharged to die at home. When his daughter arrived to collect him, she found him sitting behind a closed curtain in distress. He had been left for several hours in pain and desperate to go to the toilet. He was unable to ask for help because he was so dehydrated that he could not speak or swallow.



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I refuse to allow myself to get too excited about the chances of Obamacare ultimately being declared unconstitutional, but I’m definitely semi-psyched that this horrid law has been declared void by another federal judge. Here’s what the Washington Examiner has to say.

The full text of the decision from Federal Judge Roger Vinson is not available yet, but according to reporters who’ve seen the decision, he’s ruled the entire Patient Protection and Affordable Care Act unconstitutional. The ruling favors of the 26 state attorney generals challenging the law. The judge ruled the individual mandate that requires all Americans to purchase health insurance invalid and, according to the decision, “because the individual mandate is unconstitutional and not severable, the entire Act must be declared void.”

By the way, my skepticism has nothing to do with the legal merits. I have no doubt that our Founding Fathers would be horrified by much of what happens in Washington, and there is no doubt in my mind that Obamacare is wildly inconsistent with the original intent of the Constitution.

But the courts have done such a lousy job of protecting economic liberty ever since the 1930s and 1940s that I’m afraid some appeals court will give Obamacare a free pass.

But, at least for today, let’s celebrate.

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A former  Cato colleague, Will Wilkinson, made one of the most astute and powerful observations I have ever read when he wrote that, “…the more power the government has to pick winners and losers, the more power rich people will have relative to poor people.”I thought about this statement when I read a column today by muckraking journalist Tim Carney, who discusses how former Republican Senator Bill Frist is advising his fellow GOPers to surrender and give up the fight against Obamacare. But, as Tim warns, Frist is not an impartial observer. He is getting rich (or richer, to be more accurate) by helping special interests line their pockets by taking advantage of the government’s added power over the health care sector.

If you’re a Republican, and you don’t want the media to pry into your financial conflicts of interest, there used to be a simple method: support Democratic big-government policies. The latest Republican to try this rule is Bill Frist. …as I wrote in my column last year:

Frist is a partner in a private investment firm that bets on health care companies — and on regulation…. So Frist gets rich by helping pick the health care companies that will get rich. Now he’s backing Obamacare — and winning praise for it.

Look at some of the language on Cressey & Co’s webpage. “The Cressey & Company strategy applies unique insights and experience to produce extraordinary results” [emphasis added]. What “unique insights” do you think Frist provides? Another page on the site gives us a hint: “With deep expertise in the healthcare reimbursement and regulatory environments, the Cressey & Company team has invested in almost every for-profit niche of healthcare.” Stein noted Frist’s conflicts of interest, but don’t expect the rest of the media to be as thorough — after all, last year, Frist got a free pass as did health-care lobbyist Bob Dole. Sharing the stage with Frist was Tom Daschle, a K Street consultant for many health-care companies. The venue: The Bipartisan Policy Center. That’s a clue — if you hear the word “bipartisan,” there’s a good chance everyone on the marquee is getting paid.

Tim’s work on these issues is first rate, and you should follow what he writes – but only if you have a strong stomach and low blood pressure. Why? Because if you follow his work, you will understand that the worst forms of redistribution in Washington are the ones that 1) take place behind closed doors, and 2) transfer money from ordinary people to the rich and powerful.

This is the essential point of my video linking big government to corruption, though I wasn’t as succinctly eloquent of Will Wilkinson or as exhaustively detailed as Tim Carney.

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I try to visit the Drudge Report  once a day because he has a knack for finding quirky stories. One of his recent gems is a report from the UK-based Sun about an obese man who is suing the government’s healthcare system because he got close to 1200 pounds (assuming I’m right about a “stone” being 17 lbs) before getting weight-loss surgery. [CORRECTION: A “stone” is 14 lbs, so he was close to 1000 lbs]

Man mountain Paul Mason plans to sue the NHS – claiming they ignored his plight as he rocketed towards 70 stone. …Paul said: “I want to set a precedent so no one else has to get to the same size….” At his heaviest Paul was eating 20,000 calories a day – ten times what a normal, healthy man should consume – and the cost of caring for him is thought to have hit £1million in 15 years. …He finally had the £30,000 operation last spring but before it could take place floors at St Richard’s Hospital in Chichester, West Sussex, had to be reinforced at a cost of £5,000 to take his weight.

I’m not a fan of Britain’s wretched health system, but my immediate instinct is to take the side of the NHS and make some snarky comment about personal responsibility. Perhaps, for instance, we should ask Mr. Mason whether a government official was holding a gun to his head and forcing him to eat an average of 20,000 calories every day?

But that’s too easy. So I got to thinking about the public policy issues involved, particularly in the context of second-best solutions. In other words, if I’m not allowed to assume an ideal policy such as the dismantling of the National Health Service and restoration of a genuine free market, how would I deal with the issues raised in this story? There are two difficult questions we have to decide.

The first quiz deals with how to spend taxpayer money, combined with a bit of moral hazard analysis. Which option would you pick?

A. The NHS should have given him the operation right away to save money for the taxpayers in the long run. The operation cost nearly $50,000, but he was already costing taxpayers (I assume) $100,000 every year. Sounds like a smart investment that will pay for itself in just a few years.

or:

B. The NHS should not have given him the operation at all because that is akin to forcing taxpayers to subsidize personal irresponsibility.Moreover, it sends a signal to others that it will be marginally less costly to engage in similar self-destructive behavior. Last but not least, taxpayers probably will still pay through the nose to subsidize Mr. Mason’s annual expenses.

Our other quiz is about Mr. Mason’s lawsuit. As noted above, part of me thinks this case has no merit, but the article notes that it took five years before the NHS got him in the operating room after an initial surgery was canceled. In other words, it appears the lawsuit is happening because of the incompetence and waiting lines of a government healthcare system, so the real issue is the remedy. Which option would you pick?

A. Mr. Mason should win the lawsuit, both to compensate him for the government’s presumed incompetence and to punish the NHS for being so inefficient.

or:

B. Mr. Mason ate his way into trouble, so doesn’t deserve to win his lawsuit. Regarding the NHS, it is horribly inefficient, but any court-imposed damages would just get passed on to taxpayers, so there’s no possible upside.

So how do I answer these questions, assuming the Sun reported all the relevant facts and did so correctly?

For the first question, I reluctantly pick A. I’m guessing that the surgery will somewhat reduce the long-run burden that Mr. Mason is imposing on taxpayers. I realize there’s a genuine moral hazard issue, and that decisions like this make is marginally easier for other people to become morbidly obese (and thus impose costs on taxpayers), but my gut instinct is that surgery is still the best choice from a cost-benefit perspective. Finally, even though I’m not overflowing with sympathy for Mr. Mason, I’m a sucker for happy endings and maybe this will turn his life around.

For the second question, I do realize that governments should not be immune from lawsuits. And I say that even though it galls me that taxpayers pay for any damages awarded, either directly or because tax dollars are used to purchase insurance policies (it would be much better if successful lawsuits meant that damage awards were financed by cuts to agency budgets and/or reduction in bureaucrat pay, but I’m only allowed second-best solutions here). Nonetheless, I still pick B, and I make that choice with a decent degree of confidence. My decision is based two factors. First, I don’t want taxpayers to pay even more just because the government is incompetent. In many cases, that might not matter, but now we come to the second key factor, which is that Mr. Mason’s problems are self-inflicted.

To be sure, a court might be bound by the law rather than what’s right and therefore rule differently, but we already know from a previous blog post that I’m not similarly constrained.

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