Category Archives: Health Care

6 Pages of Legislation, 1,000 Pages of Regulation

HHS is about to issue over 1,000 pages of new regulations stemming from last year’s health care bill. That’s not a huge surprise, considering the bill is about 2,000 pages long.

But these regulations all come from a 6-page section covering accountable care organizations, or ACOs.

According to Politico, John Gorman, who runs a health care consulting firm, “expects a 1,000-page rule to come out on Thursday, March 31—because he doesn’t think HHS will want to deal with releasing the regulations on April Fool’s Day.”

Understanding the Health Care System

One of the worst parts of the current health care system is its sheer complexity. Because most of the payments are made by third parties, the paperwork burden is enormous. Co-pays, deductibles, ever-shifting networks, and so on. Unfortunately, that complexity is about to get a lot worse because of this year’s health care bill. Check out this flow chart of what the health care system will look like once Obamacare is implemented:

You can also download a PDF version of the chart that allows you to zoom in more closely. It’s worth taking a few minutes to look at all the agencies and bureaucracies in greater detail.

This chart was released by Rep. Kevin Brady, a partisan Republican. But whatever your politics, you should be wary of any scheme as grandiose as Obamacare. This represents a re-ordering of one sixth of the American economy.And not only is the government tasked with making this flow chart flow smoothly. It is also tasked with fighting two land wars in Asia. With delivering the mail. With developing new energy technologies. With overhauling the nation’s entire financial system. No organization can do all those things and do them well. Doesn’t matter how talented and well-meaning the people behind it are. It is beyond the limits of anyone’s ability to plan.

As Dan Mitchell points out, real health care reform would have just two parties to most transactions: buyer and seller.

There are two other things I’d like to see. One is that health insurance should not be linked to your job. Under both the current system and Obamacare, if you lose your job, you lose your insurance at exactly the time you need it most. This can be done by treating employer-provided insurance exactly the same as individual insurance in the tax code. Employer-provided insurance is currently given special treatment.

Real reform would also fundamentally change the way we use health insurance. The purpose of insurance is to insure against unexpected risks. Your annual physical does not fit that description. Having insurers pay for routine, expected expenses is like using your auto insurance to pay for a tank of gas and a car wash. No wonder premiums are so high. Health insurance isn’t really insurance. It’s pre-paying for your health care. And it also has one whopper of a principal-agent problem that explains a large portion of why health costs are so shockingly high.

Regulatory Problem, Regulatory Solution?

A dying patient in the UK’s NHS made the news after nurses refused to bring him a glass of water, despite his repeated begging. He died soon after of pneumonia. It really is a terrible story.

Had that poor soul lived in Arizona, he might not have had that problem. In that fine state, it is against the law to refuse someone a glass of water if you have any to spare.

As the U.S. slowly but surely hands its health care sector over to government, and NHS horror stories repeat themselves on this side of the Atlantic, this may become a more pressing issue than one would expect.

Four Ways to Spend Money on Health Care

As the House gets ready to pass the health care bill today, I’m reminded of one of the first lessons in economics I ever learned. Milton Friedman put it best:

There are four ways in which you can spend money. You can spend your own money on yourself. When you do that, why then you really watch out what you’re doing, and you try to get the most for your money. Then you can spend your own money on somebody else. For example, I buy a birthday present for someone. Well, then I’m not so careful about the content of the present, but I’m very careful about the cost. Then, I can spend somebody else’s money on myself. And if I spend somebody else’s money on myself, then I’m sure going to have a good lunch! Finally, I can spend somebody else’s money on somebody else. And if I spend somebody else’s money on somebody else, I’m not concerned about how much it is, and I’m not concerned about what I get. And that’s government. And that’s close to 40% of our national income.

The biggest problem with health care today is that patients only pay 12 percent of costs out of pocket.  As far as each individual is concerned, it’s basically on sale for 88 percent off! No wonder we spend so much on health care.

Today’s bill consists almost entirely of spending other peoples’ money on other people. If it becomes law, that 12 percent figure will fall even further. This is no way to keep costs under control. However noble Congress’ intentions may be, its bill will not work as advertised. Human nature won’t allow it.

How Do These People Avoid Cognitive Dissonance?

Supporters of the health care bill spend a lot of time attacking health insurance companies.

The health care bill, by the way, would legally require people to give a lot of money to those same insurance companies. A lot of money. It would be the largest corporate gift Washington has ever given out — as much as $1.5 trillion over ten years by one estimate.

Health insurers’ loudest detractors are actually their best friends, and they don’t even seem to realize it. Apparently, regulatory capture is not always a conscious process.

Regulation of the Day 125: Salt

Having eliminated all crime from New York’s streets, ended homelessness, rebuilt Ground Zero, and fixed the state’s ailing public schools, New York’s state legislature has set its sights on how much salt you eat.

New York City Mayor Michael Bloomberg already has a plan to reduce NYC residents’ salt intake by 25 percent over five years. But State Assemblyman Felix Ortiz (D-Brooklyn) thinks that doesn’t go nearly far enough. It only covers New York City, for starters. The rest of the state’s salt intake would remain perilously unregulated under the Bloomberg plan.

That’s why Mr. Ortiz has introduced statewide legislation that would “make it illegal for restaurants to use salt in the preparation of food. Period.

A $1,000 fine would accompany each violation.

Tom Colicchio, who owns a restaurant and has appeared on the television show Top Chef, is livid. He told the New York Daily News that “New York City is considered the restaurant capital of the world. If they banned salt, nobody would come here anymore… Anybody who wants to taste food with no salt, go to a hospital and taste that.”

He’s right; the salt ban does offend culinary decency. But there’s another angle that’s at least as important: personal responsibility.
If I want to pile on the salt, as Mayor Bloomberg famously does, that’s my right. But I also need to be liable for the consequences. If chronic salt over-consumption gives me high blood pressure and heart trouble, that’s my fault. I should pay the cost.

But that’s not how the current health care system works. We suffer from the 12-cent problem: on average, people only pay 12 cents for every dollar of health care they consume. Roughly 50 cents are picked up by the government, and insurers cover the rest.
That means people have less incentive to watch what they eat than under a more honest system. Why not rack up huge health care bills? Everyone else is paying for me. Health care on sale! 88 percent off!

Freedom cannot exist without responsibility. Decades of government encroachments in health care have taken away a lot of our responsibility for health care decisions. So it makes some sense that Mr. Ortiz would finish the job by taking away peoples’ freedom to eat what they want.

A better solution would be to have both freedom and responsibility, instead of neither. Ban the salt ban. Give people more control over their health care dollars. Let us be free. Let us be responsible. We’re all adults here. Treat us as such, Mr. Ortiz.

The Hayekian Approach to Health Care

George Will has a good column today. He does a wonderful job contrasting Hayek’s philosophy of humility before complexity with the early 20th-century progressive mindset of planning and scientistic design. The framework applies surprisingly well to today’s health care debate, with President Obama playing the role of Woodrow Wilson. Very thought-provoking.

Regulation of the Day 123: Donating Blood

If you’re gay, you can’t donate blood. It’s illegal. The ban was put in place in 1983, during the early days of the HIV/AIDS scare. It may have made some sense in those days, when HIV testing was less than trustworthy. But it sure doesn’t now, with modern screening technology.

Obviously, keeping HIV-positive blood out of circulation is a wise policy goal. But most gay people don’t have HIV/AIDS. Rather than screening donors for sexual preference, they should be screened for blood-borne diseases. Straight people already are. And it works quite well. Current policies are keeping healthy, willing donors out of the system.

The outdated ban could soon be coming to an end. Sen. John Kerry and 15 of his colleagues, usually more prone to passing regulations than repealing them, are urging the FDA to repeal this one. You can read their letter here.

The one disconcerting thing about the letter is that every single one of the signees is Democratic. Not one Republican joined in. That could be because Sen. Kerry and the others deliberately excluded them for political reasons. But the GOP is famously behind the curve on gay rights issues. So maybe Republicans were asked, and said no. I don’t know.

Republicans should send their own letter supporting Sen. Kerry’s position. Enlarging the pool of eligible blood donors is an unabashed good. It’s a classic gay rights issue. It’s also a health issue. Blood would be more readily available for patients who need it. Economists would add that increasing the supply of blood will lower its price – a good thing in this age of rapidly rising health care costs.

State of the Union Live-Blog

Meant to post this earlier. Here’s last night’s live-blog of the State of the Union:

8:46 Welcome to CEI’s live-blog of the 2010 State of the Union address. President Obama will be touching on all kinds of issues tonight. And I’ll have something to say about them all. But I’ll be paying special attention to what he has to say about regulation and spending. Keep refreshing this post every few minutes for fresh commentary.

8:54 Important people are filing in. Pundits are bloviating. Welcome to Washington.

8:58 Here comes the cabinet.

9:00 Peter Orszag and Christina Romer are there. Romer has done some excellent research on the Great Depression, by the way. Any monetarists out there would find much to like about what she has to say about monetary policy vs. fiscal policy.

9:06 The President enters. Much applause.

9:06 While waiting for the applause to die down, I’ll add that Romer thinks that monetary policy is what drives business cycles. Fiscal policy, such as stimulus spending, has little effect. I largely agree.

9:10 Speaker Pelosi introduces the President. Much applause. Many “thank yous.”

9:11 It begins.

9:11 He refers to the Constitution. Heh.

9:12 American exceptionalism. Neocons cheering somewhere, no doubt.

9:13 He inherited a bad situation. True enough. We must act? Not so much. The recession is largely a creation of over-active monetary and regulatory policy. Not a lack of policy.

9:14 First reference to “the children.”

9:15 He has said both “hope” and “change” already. Campaign 2012 has begun.

9:17 First standing ovation.

9:18 A government that matches our decency? Public choice theory is unknown on Capitol Hill, apparently.

9:18 He hates the bailout. Good! Why did he go through with it, then?

9:18 It was necessary. Unemployment would have doubled. Hyperbole. Now banks know they can continue taking stupid risks and get bailed out for it.

9:19 touts his fee on big banks that received bailouts.

9:20 20 tax cuts. Net tax cuts. While spending goes through the moon. Tax cuts are great, but spending cuts are more important. A tax cut now is a tax increase later if spending isn’t cut to match. An increase. Not a decrease. An increase.

9:22 Many jobs created. Touting the stimulus. Which takes money out of the economy, wastes some of it on bureaucracy, then puts it back into the economy. First instance of the broken window fallacy.

9:23 Anecdotes, people helped by stimulus spending. He sees what is seen. But not what is unseen. Those jobs, and that money, came from somewhere else. Each job created is one lost elsewhere.

9:25 Jobs, jobs, jobs. Bryan Caplan’s make-work bias lives.

9:25 Business creates jobs. Government can help. But only by taking money from somewhere else, and hurting businesses elsewhere. No net effect.

9:26 $30 billion transfer from “Wall Street” to “small businesses.”

9:27 small business tax credit. Eliminate capital gains tax on small businesses. Nice, but tax code simplification would be better. Lobbyists will be all over this one.

9:28 Infrastructure!

9:28 Rail! It’s the 19th century all over again.

9:29 Clean energy. Higher energy bills for all!

9:29 Keep jobs in America! Efficiency be damned! USA! USA! USA!

9:30 Jobs bill, ASAP. But full employment requires…

9:31 still waiting…

9:32 still waiting… the virtues of China’s economy…

9:33 financial reform! For starters. But don’t punish banks. Prevent recklessness. Good. Prevent dumb risks. House has already passed some reform. But lobbyists are all over.

9:34 And they will be as long as Washington is doling out money.

9:34 Plank 2: Innovation and science. More clean energy. More nuclear power. More offshore oil. More biofuels and clean coal. Comprehensive clean energy bil. Cap-and-trade light?

9:36 Consensus on global warming. Jeers from the crowd. Acknowledges doubts, touts clean energy again.

9:37 Plank 3 – trade. More exports! Double them in 5 years = 2 million jobs. National export initiative. Trade, of course, has almost zero effect on the number of jobs. It only affects the kinds of jobs. Also take measures to decrease imports. Renegotiate Doha. Is this a new protectionism?

9:40 4th plank – education. Only reward success. Not failure. Nice. Of course, that would mean less federal involvement in education, not more. Washington has no idea how to educate kids hundreds or thousands of miles away.

9:41 End taxpayer subsidy to banks for college loans. Substitute a tax credit and increase Pell grants. Forgive student loans after 20 years. Why bother paying back, then? This will bode well for future deficits.

9:43 Social Security fix – lend more to homeowners. Yeesh.

9:43 Health care!

9:44 Acknowledges unpopularity.

9:44 Anecdotes!

9:45 Blames insurance industry for regulatory failures. Emphasis on preventive care; no empirical research is cited for obvious reasons.

9:46 We can save money by spending money.

9:46 Reduce deficit by $1 trillion over 20 years. Last year and this year alone will incur nearly $3 trillion in deficits.

9:47 Temperatures cooling? Oh wait, he’s talking about health care.

9:48 Open to other proposals. Not bloody likely.

9:48 Pass a health care bill, any health care bill.

9:49 Spending.

9:50 Blames Bush for the deficit. Rightly so! Where’s he going with this, though?

9:51 Adding debt was the right thing to do. No mention of “the children” who will ultimately pay for it.

9:51 freeze certain types of discretionary spending for three years. This excludes most spending.

9:52. Save $20 billion this year. Or less than one percent of total spending.

9:53 Bi-partisan fiscal commission. Not exactly the Gramm Commission. Good idea, but beware the execution. Wayne Crews and I have done some research on this.

9:54 Pay-Go budget keeps spending in line. The data say otherwise.

9:54 Oh, the freeze won’t take effect until next year. The crowd laughs.

9:55 Says Bush cut regulations. Actually, he passed more than 30,000. See CEI’s Ten Thousand Commandments study for the exact numbers.

9;56 Deficit of trust in Washington, not just dollars. There’s a reason for that, you know. Two of them are the Republican and Democratic parties.

9:57 Excluded lobbyists from policymaking jobs. That isn’t actually true.

9:58 Doesn’t like the Citizens United decision. Or the First Amendment, for that matter. Wants a new campaign finance regulation bill. Presumably so it can be struck down on First Amendment grounds like the last ones.

9:59 I’m liking what he has to say on earmarks. Good luck to you, sir.

10:00 “can’t wage a perpetual campaign.” Tell that to Organizing for America.

10:01 Partisan politics get in the way of doing things. He’s right. And that’s exactly why I like gridlock.

10:02 Hey Republicans, no filibusters, please.

10:03 Will be talking more to the other side of the aisle.

10:03 National security!

10:04 Hope again. I haven’t been keeping track, but that’s at least 3.

10:05 Start getting out of Afghanistan in mid-2011. Good!

10:06 Out of Iraq by August. Good! Foreign aid to Iraq. Bad for Iraq!

10:07 Pork for veterans. Taking a page right out of the Gracchi playbook.

10:08 Nuclear deproliferation. I applaud the sentiment, but prohibition doesn’t work. Good luck to you, sir.

10:11 Would love to hear what Bill Easterly has to say about all the government-to-government transfer programs he’s touting.

10:12 Haiti. I completely agree with the ends. But the effectiveness of the means needs to be questioned.

10:13 Hate crimes. Thought crimes?

10:14 Let gays in the military. Nice! About bloody time.

10:14 Immigration. He has a positive view of immigration. Let’s hope that means much-needed liberalization. The more immigrants, the better. Those who are illegal, make them legal. It is the right thing to do. Obama says this is bi-partisan. I wish he was right.

10:16 Decries cynicism. There’s a reason for all that, you know.

10:19 Anecdote!

10:19 Another anecdote!

10:19 A third!

10:20 A fourth!

10:20 “I don’t quit!” Reminds me of Brett Favre’s advice to a startled referee: take two weeks off, then quit.”

10:21 End of speech.

10:26 Here comes Bob McDonnell’s Republican response. Get ready to be disappointed!

10:30 Thank yous and much applause.

10:31 Jobs. Jobs for all! Good end. The means?

10:31 So far, indistinguishable from Obama.

10:32 Calls for less taxation, regulation, etc. Quotes Jefferson. Says government is trying to do too much. Now he sounds different.

10:33 Likes Obama’s spending freeze. Says it’s small. Not often one hears a politician calls a spending non-increase anything other than draconian.

10:34 Likes bipartisanship. I like gridlock. Boo!

10:34 Likes the Shadegg health insurance reform. And medical malpractice reform. No specifics, though.

10:35 Energy. More of everything! Why isn;t anyone saying, “let the market decide?” Why must government, no matter the party, pick winners and losers?

10:36 Government energy policy can create jobs. Oh, wait, that costs money and jobs from elsewhere. Broken window fallacy again.

10:37 Education. Likes merit pay and school choice. Nothing about reducing federal involvement in this state and local issue.

10:38 Wars abroad. Daughter served abroad. Laudable. But nothing to do with the merits of nation-building.

10:39 Doesn’t like giving due process to the underwear bomber. Well, he’s probably guilty. Let’s find that out for sure and then punish him accordingly, then! What’s to be gained from denying due process?

10:40 I’m liking his rhetoric about taxes, spending, and regulation. But I’ll believe it when I see it. Which is probably never.

10:41 Haiti. Less than a paragraph.

10:42 Big role for government in creating opportunity.

10:43 One more call for bipartisanship, and a big sop to the Religious Right. An utterly conventional speech. If you thought liberals and conservatives have fundamental philosophical differences, think again. Two sides of the same coin.

10:44 That’s all for tonight. CEI scholars will have more in-depth analysis for you tomorrow. Thanks for reading!

Health Insurance and Campaign Contributions


Congressional Democrats are thinking of revoking the health insurance industry’s antitrust exemption; some insurers have spent as much as $20,000,000 opposing the current legislation.

Of course, insurers also gave $20,175,303 to President Obama’s 2008 campaign, roughly triple what McCain netted.

On one hand, this might look like the dog biting the hand that feeds. But really, it isn’t.

If the health care legislation passes, there is a good chance that every American would be required to purchase health insurance.

Suppose that happens. $40 million and change plus some antitrust troubles is a really small price to pay for a legal guarantee of vastly increased business, forever, plus looking like you didn’t want the favor.

As my friend Jeremy Lott is so quick to remind, it’s a wonder that politicians can be bought off so cheaply, given what they could charge for their services.

It is just as surprising that insurers would spend $20 million opposing legislation that would yield many times that in profit. As economist Bruce Yandle notes, “industry support of regulation is not rare at all; indeed, it is the norm. And in the United States it is as American as apple pie.”