Grading PolitiFact: Barbara Boxer and Medicare overhead

To assess the truth for a numbers claim, the biggest factor is the underlying message.
--PolitiFact editor Bill Adair

The issue:

(clipped from PolitiFact.com)

The fact checkers:

Louis Jacobson:  writer, researcher,
Bill Adair:  editor

Analysis:

I favor an examination of context no less for liberals than for conservatives (transcript mine; source video below):

BOXER:
And this is something people should never forget:  You know, Newt Gingrich said, 15 years ago, let Medicare wither on the vine.  Bob Dole, when--I went back into the 60s when Medicare was put into place--said something like it's socialism and it's horrible and it's the worst thing in the world.  And the fact of the matter is, it works.  There's a 1.5 to 2 percent overhead in Medicare.  The insurance companies have a 20 to 30 percent overhead.  What are these boys doing on the other side.

The video version:




I would identify four propositions in Boxer's statement.

1)  Medicare carries an overhead of 1.5 to 2 percent.
2)  Private insurance companies carry an overhead of 20 to 30 percent.
3)  Medicare is at least 10 times (20 divided by 2) more efficient than private insurance in terms of overhead.
4)  Medicare operates more efficiently than private insurance (the underlying message).

This time, PolitiFact is not blind to the underlying message:

Boxer’s comment cuts to the core of whether a government-run program like Medicare has advantages over one in which private insurers take a primary role.

The term "advantages" might easily turn out a weasel-word.  Boxer asserts better efficiency, using as her representative example the claim that overhead is at least 10 times greater for private insurance.  If correct, Boxer's assertion would constitute an important evidence of Medicare's overall greater efficiency.  Individual advantages one way or another carry modest importance except where one model has an overall advantage over the other.

Weighing the evidence?

Shooting magic blanks

Our favorite St. Petersburg Times commie columnist*, Robyn "Blumñata" Blumner is at it again, celebrating anniversary after anniversary of the perfect marriage between economic cluelessness and leftist ideology.

Perhaps that's redundant.

Anyhow, Blumñata's latest column blasts Republicans for supposedly presenting tort reform as a magic bullet for controlling the increase in health care costs before offering her own solution based on little more than a rhetorical "Abracadabra!"

On Republican magic bullets:

While everyone agrees that spiraling Medicaid costs are a problem that need addressing, Republican politicians would have you believe that tort reform is the magic bullet to cost containment, winning them plaudits and contributions from the medical community.

According to my recollection, Republicans advanced tort reform as a conspicuously missing piece of Democratic Party health care reform proposals.  Blumner apparently thought it unnecessary to provide any example of the type of advocacy with which she charges Republicans.

But at least she comes through with a stellar example when it comes to her own magical thinking:

While defensive medicine — where doctors order tests and procedures as a hedge against malpractice suits — undoubtedly adds unnecessary costs, it is not the main driver. That dishonor goes to one overarching factor: bad jobs — something Republicans don't want to talk about.

Blumner's claim is sheer lunacy, unless by "bad jobs" she literally means jobs that result in making it more likely that workers will require expensive medical care.  The only thing a bad job does is make health care, at whatever price it carries, less affordable.

This is an important distinction progressives like Blumner seem to handle with difficulty.  Suppose we had available a spinal replacement surgery, but it came a cost of $2 trillion per procedure.  In Blumner's world, spinal replacement surgery represents a terrible thing because it's just one more way that health care is unaffordable.  And such prices help necessitate universal coverage where "the rich" share the costs of expensive procedures.  That way, rich folks like Bill Gates can be forced to help underwrite spinal replacement surgery for dozens of people who can't even afford basic health insurance.

Of course, we don't have spinal replacement surgery at any cost--yet.  But the hypothetical procedure illustrates the primary driver of increased medical costs:  medical innovation.

If the only medical care we had was plaster casts, pain killers and 19th century surgical procedures then medical costs would be very low today.  It's not that hard to saw off a leg.  Medical costs increase rapidly because the technology to accomplish more medical treatment is increasing rapidly.  And even when a new advance is relatively inexpensive, such as treatment for erectile dysfunction, overall medical costs increase because people expect such treatments to make up part of their medical care.  That's why even Viagra was covered for a time under Medicare.

The cost (price) of treating erectile dysfunction went down.  The amount of money spent (cost) of treating erectile dysfunction went up.  It's a classic supply-and-demand curve.

And then there's the cost of health insurance as contrasted to the price of health care.  As above, if health insurance covered plaster casts, pain killers and 19th century surgical procedures then health insurance would be extremely affordable--no doubt a small fraction of what it costs today given coverage of everything from cancer treatment to substance abuse treatment.  But government regulators tell insurance companies what they have to cover.  And because so many expensive health procedures exist, the cost of covering the risk of providing those procedures grows right along with it.  The consumer foots the bill where the state mandates increases in the cost of shared risk.

If Blumner has any clue about any of this then her expertise in hiding it for the purpose of her columns cannot be questioned.


* I don't know that Blumner's a communist.  People in the comments section at the Times like to call her that, and I like alliteration ("commie columnist").  She likes organized labor and big government.  She calls herself an atheist.  So if she's not a communist then at least she has a thing or two in common. The description is not intended to identify her as a communist, however.  It is intended as alliterative hyperbole.



Hat tip to JD for pointing out the mess I had made of the third paragraph.  A redundancy has been removed and the phrasing changed slightly to meet my exceedingly high standards of something-or-other.

"The President's Proposal" on health care

The White House has unveiled President Obama's health care plan.

Is it about messaging or content?  I suspect the former:

The proposal will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy:

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.

It's far from clear how a tax cut makes health care more affordable in terms of costs.  If my taxes are cut entirely then I am better able to afford a $50,000 Mercedes-Benz, but the cost of the vehicle doesn't change.  The reduction of premiums sounds like let another promise of getting something for nothing--either that or the traditional liberal approach of having "the rich" subsidize those who are "priced out of coverage today."

• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have. 

I smell a big, unspoken caveat in that one:  You get the same choices as Congress but not necessarily the ability to pay for all those glorious choices.

• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.

Market competition keeps premiums down.  I imagine that insurance company abuses and denial of care help keep premiums down, so it will be interesting to see how the White House reconciles those contrary aims in this single bullet point.

• It will end discrimination against Americans with pre-existing conditions.

The ending discrimination thing must play well with focus groups.  But adjusting risk according to pre-existing conditions is an ultra-basic feature of risk management in the health care insurance business.  Risk management of that sort is what helps keep premiums low for the majority.  A few weeks ago, I heard a caller to a radio show propose a similar arrangement for life insurance as a method of stimulating the economy.  Insurance companies would no longer be able to deny life insurance policies to people just because they happen to be dead.  It is an important analogy despite its inherent silliness.

• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

This point sounds like the measures the CBO received with great skepticism.  The government has a poor record on cutting government spending and reining in waste, fraud and abuse.

The bullet point summary is singularly unimpressive.  I look forward to seeing more detailed analysis and perhaps a CBO analysis of the president's proposal.  It seems that either tax increases play a large part in the plan, or else the final bullet point represents the type of government control of health care services that Sarah Palin characterized as a "death panel."

E. J. Dionne tries to reconcile numbers in health care bill

Bear in mind that the CBO figures showing a net deficit reduction for our most recent version of the health care bill include the caveat that the Medicare savings may not materialize.  Dionne was answering a question posed to him on the Hugh Hewitt Show, and I rely on Hewitt's transcript:

"Well, some of it, what they’re talking about is moving away from fee for service medicine. And they’re talking about a lot of different ways of charging people for medicine that encourage activities by doctors that deliver care more efficiently. The truth is we are shifting money that’s paid into the health care system one way, and paying it back into the health care system another way. And so I am persuaded that you are not going to see seniors, once this thing actually takes effect in 2014, or 2013, if they back it up a little bit, I don’t think you are going to see seniors wildly unhappy. And I think you’re going to see a lot of seniors very happy as they close the donut hole on the prescription drug benefit. So again, I think some of the polling among seniors against the bill reflects the fact that this generation of seniors is very Republican compared to the earlier, the earlier New Deal generation of seniors. So I think that when you’re talking politically, a lot of seniors are going to say the bill is bad, and they’re going to vote Republican. But guess what? Seniors voted for John McCain over Barack Obama. I think that politically, what’s going to be interesting is the behavior probably 10-15% of seniors who are persuadable by your side of this or by the other side of this."

One comment from Dionne reminds me of a criticism I read some days ago.  That critic charged the bill with budgetary sleight of hand for counting Medicare savings as part of the overall savings, if I remember correctly, in spite of the fact that the money is spent regardless.  Dionne seems to play up that bug as a feature.  But how can seniors have any assurance that the saved monies will go toward care for the Medicare population?  I detect no such assurance.

The later satisfaction Dionne expects comes, I believe, from the satisfaction folks usually have with a service they do not use, combined with the satisfaction of at least a few who actually use the service.

Hewitt has a good number of transcripts dealing with the health care issue, many featuring the words of those who favor the legislation.

NHS: No, we will not approve use of an effective liver cancer drug

More on the compassion of the single-payer system of health insurance:

A drug that can prolong the lives of patients with advanced liver cancer has been rejected for use in the NHS in England, Wales and Northern Ireland.

Quality care for all. Wait a minute! You there! Not you.

The market does it better, in concert with personal human caring.

Universal health care all about compassion?

I often see the argument that the universal, single-payer plan is all about compassion. So it was almost refreshing to see an editorial from the St. Petersburg Times that stepped far away from that position.

The editorial, titled "Science, not emotion," discussed the new mammogram schedule recommended by the U.S. Preventive Services Task Force. The facts of the matter illustrate how preventive care is not always cost effective care. Women under 50 years of age were getting rather little bang for their mammogram bucks.

The transition to the bitter pill at the end was a bit rough:

The United States spends roughly 16 percent of its gross domestic product on health care — far more than many other developed countries. Britain long ago adopted a less stringent standard: Begin mammograms at 50 and have them every three years. The task force didn't go that far, and its recommendations deserve thorough vetting by the broader medical community. And women in their 40s should always have the option to finance mammograms either out of pocket or through optional insurance coverage.

But a basic tenet of our health care system must include a willingness to base medical standards on science, not emotion. That is the only chance the country has for making health care more available and affordable for all.

Note: "(W)omen in their 40s should always have the option to finance mammograms either out of pocket or through optional insurance coverage."

Um--what about the "right" to health care?

No?

The editors don't quite get it. A government-controlled system is highly likely to decrease availability of mammograms. Take Canada, for example:

In early 2008, women in southeast New Brunswick who wanted a routine mammogram had to wait more than a year to get an appointment. That has changed since the first of two digital mammogram units have been added to the Moncton Hospital.

Rachelle Gaudet, the manager of diagnostic imaging services for Regional Health Authority B, said women now have to wait about 32 weeks to get a routine screening.

Granted, waiting for a year or so provides women more time to save money to pay for the mammogram. But they'll pay more because of scarcity, and they'll have to wait.

The last paragraph from the editorial serves as the paper's admission that single-payer health care is not thoroughly compassionate. If it was, we could base the decisions on emotion instead of science. Or at least science plus economics. We have the science to provide early mammograms. It is economics that ultimately discourages providing them early and often.

Now I'll start hoping that the Times will admit that the single-payer system would discourage medical innovation.

Grading PolitiFact: Paul Krugman and a mere $1.8 trillion

In which Paul Krugman benefits from PolitiFact's penchant for tunnel vision.



Fact-checking the fact checkers

The issue:





The fact checkers:

Angie Drobnic Holan: writer, researcher
Bill Adair: editor


Analysis:

Time and time again, PolitiFact waffles between addressing the literal truth of a statement and the underlying argument that the statement would supposedly help support. This fact check involving the capable economist/left-wing hack op-ed writer for the New York Times, Paul Krugman, again manifests the problem of finding nothing wrong with the literal truth of a statement while effectively ignoring the underlying argument. That, in fact, was the same pattern Drobnic used in another PolitiFact item I evaluated.

In this case, PolitiFact concerns itself over whether the Bush tax cuts cost the federal government $1.8 billion in revenue. Krugman compares that figure with the proposed cost of a universal health plan, in particular the Kennedy plan recently evaluated by the Congressional Budget Office.

As with that other item, Drobnic offers a number of clues that she perceives an underlying argument. The "Truth-O-Meter" blurb reproduced above notes that Krugman is comparing the cost of the health care reform bill to the "cost" to the government of the Bush tax cuts. I use quotation marks for the second use of "cost" simply because the tax cuts represented decreased income while the former represents an outlay.

But the comparison all by itself means nothing. Who cares whether one is less expensive than the other minus other considerations? Krugman is clear about those other considerations, but Drobnic never picks up on it for purposes of her analysis even though she quotes the relevant passage:

"I'm not that worried about the issue of costs," Krugman wrote. "Yes, the Congressional Budget Office's preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."
(bold emphasis added)

There was a time--not that long ago--that Paul Krugman was concerned about that type of cost. Back when the federal deficit was much smaller than it is now:

"[The 2003 tax cut] was wildly irresponsible, third-world irresponsible, banana-republic irresponsible," said Krugman. "We can't afford any of it."

The tax cut came despite indication that the United States would be facing a "catastrophic" deficit, about $550 billion next year.

(The Daily of the University of Washington)

For comparison, the federal budget deficit will reach an estimated $1.1 trillion for 2009. Deficits under President Bush never exceeded $500 billion despite Krugman's claims, though it is fair to pin a substantial portion of the 2009 deficit to the TARP program that both Bush and Obama supported.

So, even though Krugman regarded the $500 billion deficit as "catastrophic" back in 2003 and flatly stated that the U.S. "can't afford" the second round of Bush tax cuts, somehow we can afford to spend about that much if the budget deficit doubles from its "catastropic" levels to an even higher percentage of the GDP.

Will Drobnic take note of any of this? No such luck:

We wanted to know if Krugman was right that the initial cost estimates for health care legislation by the Congressional Budget Office were less than "the $1.8 trillion cost of the Bush tax cuts."

So Drobnic seems willing to let the underlying argument escape scrutiny in favor of double-checking the comparison of the initial CBO estimate to the estimated loss of revenue from the Bush tax cuts.

In the course of that meaningless exercise, Drobic at least pays attention to the respective durations of the tax cuts and the health care reform bill. However, she appears to overlook at least one critical point in comparing the two: The CBO estimate offers no apparent attempt to calculate the cost of financing health care reform through deficit spending. As Drobnic notes, the think-tank estimate that best supports Krugman explicitly applied that factor to the Bush tax cuts:

The left-leaning Center on Budget and Policy Priorities agrees with Krugman. The center's 2009 report on the Bush tax cuts states:

"The 2001 and 2003 tax cuts added about $1.7 trillion to deficits between 2001 and 2008. Because they (were) financed by borrowing — which increases the national debt — this figure includes the extra interest costs resulting from that additional debt. This figure also includes the cost of 'patching' the Alternative Minimum Tax to keep the tax from hitting millions of upper-middle-class households, a problem the tax cuts helped cause. Over the next decade (2009-2018), making the tax cuts permanent would cost $4.4 trillion, assuming that the tax cuts remain deficit-financed."

So even the wrong analysis was performed badly.

In addition, the initial CBO report explicitly stated that it had not taken into account several factors likely to increase the costs of the bill. As a result, it should have been obvious that in the end it did not really matter to Krugman what the reform bill would cost. If the CBO had estimated the costs at $2.2 trillion instead of $1 trillion we should expect Krugman to say that the costs don't really bother him since we can supposedly clearly afford it. Even though that runs directly counter to what he was claiming in 2003.

Mr. Krugman can take comfort in the knowledge that PolitiFact has not found him out as the inconsistent political hack that he is. PolitiFact rates Krugman "Mostly True" since it is "probably" true that the CBO's initial cost estimate for the Kennedy health care reform bill was less than the estimated revenue cost of the Bush tax cuts.

After reading many studies on the cost of the Bush tax cuts, it seems to us that Krugman is in the ballpark with his $1.8 trillion estimate. But we believe there are a couple of important caveats to his comparison. First, his wording implies that CBO's much-discussed estimate is for universal coverage, but it's not. Also, he doesn't offer a time frame for the Bush tax cuts, so we can't be sure he is comparing the same number of years. Finally, the health care plan is still very much in flux, and the CBO estimate is based on an early and incomplete bill. So we find Krugman's claim Mostly True.

Can we afford it like Krugman said? Or can we not afford it like Krugman said?


The grades:

Angie Drobnic Holan: F
Bill Adair: F

Ignoring the interesting part of Krugman's statement was the equivalent of intentionally offering softball questions to an interview subject.


Afterword:

Drobnic's piece had a hilarious little interlude where Kenneth Thorpe declared the relatively easy affordability of a universal health plan:

There's one other implicit assumption in Krugman's statement. He writes, "But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts." We know the CBO report scored the first draft at $1 trillion, but we also know that CBO determined the draft was not a "universal" plan — only about a third of the uninsured would be covered. But would a truly "universal" bill still come in under $1.8 trillion?

"Absolutely," said Kenneth Thorpe, a health care expert at Emory University. He said draft version of the bill could be modified to expand coverage to everyone and trim costs, and he thinks the total cost of that would likely be just over $1 trillion. He said the Senate Finance Committee is working on a new plan, though it has not been released to the public.

"I think that you can provide universal health care coverage for all 46 million of the uninsured for just over $1 trillion," he said.

I cannot disagree with Thorpe. All 46 million could be insured for just over $1 trillion. Would they get great care? Probably not. Would the result tend to decrease quality of care for the system overall and progressively degrade the system? Very probably. Can we afford it? Pay attention to Paul Krugman, circa 2003.

The common thread in the push for health care reform is the issue of controlling costs. Third party payment is a dependable disaster in terms of controlling costs. That remains about as true for private insurance as for government insurance. Private insurers use a number of methods to control their risk, including the refusal to cover preexisting conditions. Unless the government does the same thing, it will have two primary methods of controlling costs:

1) Capping/dropping the pay of health care workers
2) Rationing services

Be careful what you wish for, single-payer advocates.

The truth about the truth about health care (Updated)

Robyn "Blumñata" Blumner is back at it again this week with another nonsensical foray into editorial journalism.

Not that Blumñata has been on vacation since the last time I dissected one of her granfalloonian offerings. She finally wrote something focused enough to warrant a relatively focused reply. Much of her work this year consists of laundry list attacks on either the Bush administration or conservatives in general.

This week she puts her abysmal knowledge of economics on display as she writes in favor of single-payer health care.

Universal health care is a benefit that a large majority of Americans say they want. It would grant Americans some semblance of the kind of peace-of-mind that Canadians and Western Europeans enjoy. We wouldn't have to worry that a job loss would also put our family's health coverage at risk. And on and on.

A large majority of Americans want universal health care? A pity that Blumner failed to name her source. Here is one, from 2003, that calls her claim into question.

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.
(ABCNews.com)

Focusing simply on the first sentence, one would think that universal health care appeals greatly to Americans. But the four in 10 mentioned subsequently is not a majority, and doctor shortages and waiting lists are quite likely with universal health care.

At least we can say that Americans like the idea of pie-in-the-sky health care. Who could be against that minus the problems?

But even Blumñata admits there are problems:

But expanding health coverage to everyone is going to mean higher taxes in some form as well as other sacrifices, such as enforceable cost controls on the medical establishment and some practical limits on patient medical services. Expensive medical procedures that don't demonstrably work or have about the same outcomes as cheaper methods are going to have to be eliminated from coverage. Drugs too will have to prove their efficacy. Welcome to the age of generics.

Higher taxes is a huge drawback to universal health coverage. This represents a core inconsistency with both President Obama's domestic policy and Blumñata's thinking.

Think about it. Mr. Obama is selling health care reform as an economic salve. But that is ridiculous. Sure, decreased spending on health care decreases the percentage of GDP spent on health care--but it also decreases the GDP, particularly where the expenses return workers to their jobs faster.

***
Interruption via update: To make myself clear, decreased spending on health care decreases the GDP generally, while the rapid return of workers to their jobs shrinks the percentage of GDP spent on health care as a percentage of GDP generally.

I apologize for the poor job I did expressing that idea.
***

But back to her list of admitted problems.

• cost controls
  
• limits on patient medical services
  

To be sure, Blumñata offers only one example in support of these euphemistic-sounding drawbacks. Expensive treatments that do not work well would be eliminated as options, she says, and where two treatments offer about the same benefit the more expensive of the two would be sidelined.

It is neither that simple nor that benign.

Cost controls will very probably include restrictions on your choice of doctors as well as limitations on seeing a specialist. They will probably include (perhaps only when the money starts to run out) assessments on the quality of life a patient expects following treatment. They will include rationing of services, which will grow gradually more pronounced as the wealth of medical resources produced by our past systems turns obsolete. As for Blumner's example of reduced availability of medications, doctors often have clinical reasons for choosing a more expensive medication. Patients do not always respond the same way to medicine, and some medicines do not work well in conjunction with other therapies.

The benign-sounding push toward efficiency is, by analogy, an initiative that removes tools from the doctor's toolbox, and, instead of your doctor, the government will decide which tools belong in there.

Knowing there will be costs and how much Americans hate the thought that lunch may not be free, opponents to health care reform have already launched a "Harry and Louise" style scare campaign. A group called Conservatives for Patients' Rights expects to spend up to $20 million on television ads that feature patients and doctors in Canada and Britain complaining about long waits for surgery or how they couldn't get needed medications under their national health care.

Sometimes the truth hurts, which is probably why single-payer proponents like Blumñata want to poo-poo the real problems with the idea by labeling it as a "scare campaign." The poll above shows how support for universal health care shrinks based on the existence of its traditional drawbacks. Conservatives who want to publicize those drawbacks are simply trying to scare people. Or something:

It is designed to make you want to desperately cling to the status quo.

I doubt it, for the admitted problems with the current system stem largely from government involvement, including the ramifications for malpractice within the framework of the U.S. legal system. Other problems stem from attaching health care to employment--a problem presidential candidate John McCain had hoped to address with his health care reform plan--and the third party payment system as represented by private insurance, Medicare and Medicaid.

As for the supposed desperation:

PRINCETON, NJ -- Despite ever-increasing healthcare costs and widespread dissatisfaction with the U.S. healthcare system, a majority of Americans remain satisfied with what they pay for their own healthcare, the quality of the healthcare they receive, and their healthcare coverage.
(gallup.com)

What, Blumñata never told you that? Most of you are supposed to be desperate! Now get with the socialist pogrom! Er, I mean program.

Of course, President Barack Obama isn't suggesting that we adopt a single-payer system like these other countries have — which is too bad in my view.

Obama has said that he prefers the single-payer plan. But he also clearly realizes that an immediate switch to a single-payer plan is a high political risk. His plan immerses the medical system frog in a pot of tepid water and starts heating it gradually from the bottom. Before you know it, you're cooked.

Reality: Obama Has Consistently Said That If We Were Starting From Scratch, He Would Support A Single Payer System, But Now We Need To Build On The System We Have
(barackobama.com)

No doubt that prospect makes Blumñata impatient.

People in the United States seem to like our own single-payer government-run program: Medicare.

Sure they do. So long as they aren't thinking about the incredible waste in the Medicare system along with the fact that it already consumes over 16 percent of federal spending (Social Security included). National defense takes up about 19 percent.

clipped from www.factcheck.org

The Medicare budget just keeps expanding, and the baby boomers will push its expenses to even more amazing heights. Sorry if that sounds scary, but it is reality. There is one way to avoid the problem: Cut and/or ration services. The only part of his plan for Medicare that Obama will currently admit, so far as I'm aware, is the part that expands the government's share of medical costs and raises taxes to pay for it. Is that fiscal responsibility? Seriously?

Back to Blumñata:

And as to the poor Canadians who can't get decent medical care? A 2008 Harris poll of how the citizens of 10 developed countries feel about their health care system found the United States dead last, with fully a third of Americans saying our system needs to be completely rebuilt. Meanwhile, Canada's system was third-highest in popularity.

Hmm. Blumñata left out the poll's conclusion to the effect that all the nations surveyed had majorities calling for health care reform.

Regardless of what system a country has it falls far short of satisfying public expectations. Most systems always seem to be in a crisis or near crisis.
(harrisinteractive.com)

It is true that the U.S. system ranks last among the nations surveyed in terms of native popularity. But there could be innumerable reasons for that other than quality of care, including the existence of a pervasive negative message from the national press.

Blumñata again:

But the folks coordinating the ads don't let the facts stand in their way.

They'll face a stiff challenge in ignoring more facts than our own Blumñata. Rather than start in on how those folks play with the facts, she engages in four paragraph's worth of personal attacks against Rick Scott of Conservatives for Patients' Rights. Supposedly it is relevant that the hospital group Scott once headed, HCA, was found guilty of various wrongs even if Scott himself was charged with nothing and convicted of nothing.

Too cute.

After apparently exhausting her supply of facts misrepresented by Scott (without ever starting on it), Blumñata runs off to attack the strategy she says Republicans will use to oppose Obamacare:

Republicans in Congress are positioning themselves in this camp too. They're working from a 28-page attack plan by GOP strategist Frank Luntz, an expert on phrasing political positions for maximum advantage. The plan lays out ways to defeat Obama's health care reforms by painting Democrats as wanting "to put Washington politicians in charge of your health care."

The charge is absurd since Obama's intention is to leave current health insurers in place while offering a government plan as an alternative. But there may be real trouble in holding congressional support together when the new costs and sacrifices necessitated by a $120 billion universal health care plan start coming clear.

Somehow, Blumñata has worked in an editorial position with a newspaper for over 15 years without apparently realizing that Congress controls the expenditures of the government. Along with not realizing that government insurance automatically carries a competitive advantage over private insurance. Know of any private insurance companies that can levy general taxes in order to support their bottom line?

How long did it take for Florida's state-sponsored homeowner's insurance entity to its current status as Florida's #1 homeowner's insurance company?

The Florida Legislature created Citizens Property Insurance Corp. in 2002 when it merged two existing state-backed insurance pools, the Florida Residential Property and Casualty Joint Underwriting Association and the Florida Windstorm Underwriting Association. Commonly called Citizens, it is now Florida's largest home insurer. As of November 2007, Citizens insured more than 1.4 million homes, condos and businesses in Florida.
(SunSentinel.com)

FYI, the Florida Residential Property and Casualty Joint Underwriting Association was established way back in 1992. The Florida Windstorm Underwriting Association is comparatively ancient, kicking off in 1970 to cover properties in the Florida Keys. In any event, they demonstrate the tendency of government entities to grow. A big part of that growth stems, in this case, from the state insurers exemption from leverage rules applied to private insurers.

So, yes, the plan set forth by Obama does increase the government's role in health care and that role is likely to incrementally increase, leading to exactly the types of problems characteristic of single-payer programs--unless the political pressure brought by groups such as Scott's prevent it.

And for Blumñata it isn't just the supposed misrepresentations by Scott, it is the method they supposedly intend to employ.

She quotes a portion of the Frank Luntz "attack plan," but where is the rest of the so-called "attack plan"? I have been unable to find a copy of it online. If it is so bad, then why not publicize the whole thing? Why quote tiny portions from the 28 pages without any surrounding context?

Maybe that's the only way to keep Luntz from misleading people? Keep the people from accessing the information?

Bottom line, Obama's health care reform as part of an economic stimulus is a dangerous fantasy. And the resulting health care system will surely deliver a lower quality of care even if it satisfies people who believe they would have to pay for their own care otherwise. Speaking of free lunch.

Grading PolitiFact: Obama health plan fines small businesses?

This PolitiFact outfit simply astounds me.

People who should be serious journalists get into a fact-checking game--a good gig for journalists on the surface--and then proudly announce that they will boldly grade the truth of political claims with a needle graphic.

The resulting grades are about as dependable as figuring the truth via Ouija board.

The latest example: The McCain claim that Obama's health care plan will fine small businesses.

At the second presidential debate in Nashville, John McCain attacked Barack Obama's health care plan.

Obama's plan calls for "mandates and fines for small businesses," McCain said.

"If you're a small business person and you don't insure your employees, Senator Obama will fine you — will fine you. That's remarkable," McCain said.

That's the issue.

But we find that when you dig into the nitty gritty of Obama's plan, that's not the case.

And there's the judgment.

The judgment is based on two factors. First, PolitiFact fact-checker Angie Drobnic Holan notes that Obama's plan exempts small businesses of unspecified size. And that is a fair criticism, since McCain's statement could easily be taken to refer to all small businesses. So at best McCain's statement is partially true based on this factor.

The PolitiFact entry notes that Obama does not specify the size of a small business that would qualify for the exemption. And apparently that does not trouble Ms. Drobnic in the least when it comes to judging McCain.

It is possible to get an estimate out of the Obama camp, however. Why PolitiFact doesn't share this is beyond me, unless they don't want readers to know about it.

"The number would almost certainly be higher than ten employees," Furman added when asked if a recent non-partisan study by the Urban-Brookings Tax Policy Center was correct in assuming that Obama would exempt "small businesses" with fewer than 10 employees from the pay-or-play system.
(ABC News blog)

Eleven? Twelve? Thirteen? "Furman" is Jason Furman, Obama's director of economic policy.

If the number might be 10 or lower, then it could be that small businesses will have to pay into a pool if they do not provide insurance to their employees. And that brings us to the second factor that results in the goofy PolitiFact rating:

McCain calls this a "fine," but being required to contribute to a pool is not the same as paying a penalty for some wrongdoing.

Actually, being required to contribute to a pool can be the same as paying a penalty for some wrongdoing. Any distinction probably requires hair-splitting.

a sum of money imposed as a penalty for an offense or dereliction: a parking fine.
(Dictionary.com)

a sum of money paid to settle a matter; esp., a sum required to be paid as punishment or penalty for an offense.
(Webster's New World College Dictionary, Fourth Edition)

Under Obama's plan, isn't Obama implicitly declaring businesses that do not provide insurance "derelict"? Is the government not requiring the business to pay in order to "settle a matter" like providing insurance to an employee?

Angie Drobnic Holan's analysis requires a specialized understanding of the term "fine" and as such amounts to a fallacy of equivocation. But combining the fallacy with the unspecified small business exception, PolitiFact gives us the following:

So even by a generous definition, Obama does not fine "small businesses." Indeed, they are not even subject to the mandate. We rate McCain's claim False.

It simply doesn't follow that a "generous definition" gets Obama off the hook for fining small businesses. On the contrary, a "generous definition" of "fine" puts Obama squarely on the hook. Likewise a "generous definition" of "small business" puts Obama squarely on the hook.

Without at least a ballpark definition of "small business" from the Obama campaign it is irresponsible to rate McCain false for finding small businesses vulnerable to a fee imposed for not insuring workers. The narrow and unjustified redefinition of "fine," to McCain's disadvantage, is even more egregious.

PolitiFact rates an "F" on this one.


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Just a small addendum.

Angie Drobnic Holan's distinction between a "fine" and a requirement that businesses pay into a pool if they fail to provide insurance reminds me of past experience. I rented from a landlord who imposed a "non-refundable deposit."

Can anybody tell me the difference between a "non-refundable deposit" and a fee?

Blumner expands her realm of credibility, albeit in an unhealthy way

I'll have to grant Robyn Blumner, that pinata of the St. Petersburg Times, an area of expertise.

After all the cherry-picking she did for this week's editorial, I'll have to take her very seriously the next time she writes about the plight of agricultural workers.

The topic this week, along with the customary swipe at Bush and/or Republicans, is health care.

Rudy Giuliani has been called "Bush with brains" by those who fear that the former New York City mayor shares a penchant for unbridled executive power. But the Republican presidential primary front-runner seems to have a screw loose when it comes to campaigning. His attack on Hillary Clinton's health care proposal with the bugaboo of European-style "socialized" medicine is not only full of factual holes but it will surely bite him in the butt if he makes it to the general election.
(St. Petersburg Times)

Cherry-pick No. 1: "(F)ull of factual holes" but Blumner will only mention one, regarding Giulianni's imprecise use of cancer statistics earlier in the campaign.

Cherry-pick No. 2:

Polls regularly show that Americans are disgusted with the current state of affairs. In a 2007 CBS News/New York Times poll, nine in 10 respondents said that the U.S. health care system needs fundamental changes and two-thirds said it was up to the federal government to guarantee that all Americans have health care coverage.

In the paragraph just preceding the one above, Blumner assures the reader that the voters "won't be fooled again" regarding Sen. Clinton's health care magic. Not many will bother looking up the poll Blumner cited, unfortunately.

The numbers she cites are accurate, albeit the wisdom of the mob isn't necessarily the best guide to public policy (I'll point Blumner to the approval for the Iraq War in 2003 if she looks askance). On the other hand, she's not telling the whole story.

Won't be fooled into thinking Hillarycare isn't the greatest thing since Social Security (we'll leave aside the fact that the younger generation correctly doubts that it will benefit from Social Security)?

CONFIDENCE IN HANDLING HEALTH CARE
(Among registered voters)
Clinton Edwards Obama
Confident 36% 22% 25%
Uneasy 51 50 44
Don’t Know 13 28 31
(CBSnews poll, page 2)

With only 51% of registered voters polled "uneasy" about Sen. Clinton's health care initiative, how could people possibly be fooled this time? Perhaps Blumner hopes that by hiding part of the truth she can bring that embarrassing number down a bit.

Blumner's key statistic, the high public approval for a federal guarantee of health insurance, had a caveat in the original poll. Not the sort of thing a Blumner would wish to share with the public.

But only about half as many Americans – less than one in three - think the government can do a better job than private insurance companies at actually providing medical coverage. Many are not sure how government would fare in this role.

WOULD GOVERNMENT DO BETTER OR WORSE AT PROVIDING COVERAGE THAN PRIVATE COMPANIES?

Government better 30% Government worse 44 Don't know 23
(CBSnews poll, page 4)

A subsequent comment by Blumner nearly resulted in my eyes rolling violently enough to fly out of their orbits.

If the next president does nothing else but add this country to the pantheon of advanced nations that provide universal coverage, it will be a successful tenure -one that will be remembered fondly by generations to come, like that of FDR for Social Security and LBJ for Medicare.

The "advanced nations" that provide universal coverage are putting their citizens on waiting lists and admitting that the system is allowing people to die as a result.

So it is acutely awkward for his successor, Gordon Brown, that, 10 years on, his government is scrambling to fend off accusations of crisis in the NHS following a damning report about hospital infections that critics say is symptomatic of a wider malaise in British healthcare.
(Christian Science Monitor)

When you look at consumer satisfaction in Canada, it's as low as consumer satisfaction in the United States, which is extraordinary, given how high it was in Canada ten years ago.
(PBS, commentary by Sharon Glied, PhD)

Germany proposes radical plans to tackle financial crisis in health care
(British Medical Journal)

In short, these "advanced" countries are creating huge problems for themselves with their national health care plans. The problem, economically is the third-party payor problem, and it also wreaks its havoc with the privatized fraction of the U.S. system (the dirty little secret of American health care is that government regulation is causing many of the problems already). But Blumner won't want her sheeple to know any of that.

Yes, Roosevelt and LBJ were fawned over by the three generations who received the benefit of their ponzi schemes. The later generations will have ample reason to curse them, assuming the government will permit dissent at that point.

Roosevelt saddled the nation with a pyramid scheme that was never designed to abide a trend toward a graying and retired population. LBJ made it even worse.

But back to Blumner, for she has yet to exhaust her stupidity. This next line sums up the thrust of the rest of her editorial.

But guaranteed health care will not only serve to relieve the anxieties of tens of millions of American families, it will also be a shot of adrenaline to our economy.

This claim of Blumner's, by rights, should be entirely laughable. Has nationalized health care stimulated the economies of those nations who follow that path? Made them noticeably more efficient? If it has, then Europe's relatively weak economies seem even more pathetic.

Blumner's focus on the link between employment and health insurance seems curious, given that President Bush proposed portable insurance back in 2006.

• Leveling the playing field by making the same tax relief available to individuals and employers. Americans who purchase HSA-qualified insurance policies on their own should have the same tax advantages as people who obtain insurance through their employer.
• Eliminating all taxes on out-of-pocket spending through HSAs. Americans with HSAs should be able to pay for all of their care tax-free.
• Making health insurance portable. Americans should be able to own the insurance policy that goes along with their HSA, and keep it when they change or lose their jobs without worrying about paying higher premiums if they become sick.
• Strengthening the buying power of America’s small businesses. Small businesses should have the same access to price efficiencies as large businesses when purchasing health insurance.
• Passing medical liability reform. Limit costly and frivolous lawsuits that waste scarce resources, increase health care costs, and drive doctors out of business.
• Improving adoption of health information technology. Electronic health records that reduce costs and improve the efficiency and effectiveness of medical treatment should be widely used.
• Empowering consumers through information. All Americans should be able to obtain easy-to-understand information about the price and quality of the health care they receive from their medical provider and insurance carrier.
• Providing affordable coverage for vulnerable Americans. Americans with low incomes and persistently high medical expenses should receive additional assistance.
• Promoting prevention, wellness, and fitness. The President encourages all Americans to lead a healthy lifestyle to prevent disease and improve their overall quality of life.

(whitehouse.gov)

I guess Blumner missed it.

*****