Thursday, August 23, 2007


The State Children’s Health Insurance Program--so called though it is enrolling adults—is due to expire the end of September. The law was amended by the House of Representatives on August 1 and by the Senate August 2. The more stringent House bill withdraws the federal subsidy from private insurance companies offering plans to elderly Medicare beneficiaries. Originally SCHIP was to be reauthorized every ten years. The House bill has made it a permanent entitlement.

The House bill passed narrowly by 224-204, defying a veto-threat from the President, who sees SCHIP as too expensive and too much like socialized medicine.

The Senate bill was passed by 68-31. All the “no” votes were Republican. Eighteen Republicans joined two Independents to vote with the Democrats for the bill.

Both Democrat and Republican observers agree that SCHIP is on track for HillaryCare, to reach the same final outcome as HillaryCare but incrementally, one person, one group, at a time. SCHIP was designated for low-income families who did not qualify for Medicaid and could not afford private insurance. Initially, a family of four could earn as much as $40,000 and still qualify, but the threshold has been raised to $82,500.

This “Kids First” proposal is a precursor to a universal system. The amended House bill gives states a bonus for enrolling more people. The Senate bill would stop payments for adults who don’t have children.

How is it to be financed? From the federal subsidy given to the elderly. The current federal appropriation to states is not enough to enable the states to maintain their current programs.

Private insurers of the elderly living in rural areas have been receiving a federal subsidy to help elderly who, unlike urbanites, did not have private Medicare plans, to have a choice. Insurers say private insurance plans would disappear from many parts of the country if this provision were to remain in the House bill. The House bill cuts $50 billion over five years to private insurers that operate in Medicare Advantage D, a managed-care alternative to the federal health program. Federal welfare is pushing out private health insurance.

The direction in which this health-care insurance is headed is “universal,” frequently involving a single-payer, as under the Soviet Socialist system for food. Soviet central planners did not have much control over the supply so they controlled the demand, by rationing it. The same system fairly describes the universal health-care in England and Canada . The cost is high: premature death and productivity-decline. Productivity is lost when sick workers have to wait for medical attention.

The wait is long. Moira Ryan’s case is illustrative. She needed a hip replacement. She was prepared to wait 21 months to get free surgery, but when her turn came, the British bureaucracy turned her down because her body-mass index exceeded 35. She took out a bank loan and flew to Malta where she got her hip surgery for $14,000. Outsourcing for health care may become an alternative to long waits and to unaffordability, for in an American case, elderly parents, both in need of constant care, have been outsourced by their son to India.

How long do patients have to wait before they get to the general physician who assigns them to the hip-surgery queue? Canadians wait 40 weeks for orthopedic surgery, 35 weeks for plastic surgery, 27 weeks for ophthalmology, 12 weeks for internal medicine, 31 weeks for neurosurgery, 35 weeks for plastic surgery. Canadian medical orthodoxy has finally been punctured. One province is allowing private spending for private health care. Other provinces are considering it. Ignoring the unsatisfactory health-care solution in Canada and England , in the U.S. there appears to be growing support for it.

In California and Massachusetts , everybody is now required to have health insurance. Massachusetts employers who don’t provide employee health insurance must pay a modest $275 annually per employee. In California , the Governor’s $14 billion universal plan requires employers who do not provide employee insurance to pay 4% of their payroll. Universal coverage has the support of the AARP. “If we can get comprehensive reform in California ” said AARP’s chief executive, “it could be the dynamite that breaks the national log-jam.”

Republicans who see universal medicine as a form of socialism have a different approach. They want a consumer-based free market to replace the employer-based system, which is seen as faltering. They would put 300 million people in charge of their own care at zero extra cost through Health Saving Accounts (HSAs) and tort-liability reform.

Cost is a big concern. A survey finds that 82 percent of respondents are dissatisfied with the cost, which some say will be ruinous. Advocates of universal health care show no interest in reducing cost, counting on government to raise taxes to supply the funds.

A big saving would be possible with Health Savings Accounts. The President lobbied hard for it, but the opposition did not support it, arguing (erroneously but successfully) that it would privatize Social Security. Dr. David Gratzer, a member of the Manhattan Institute who has had experience in the U.S. and Canada and has published a book, The Cure, How Capitalism Can Save American Health Care, says that health savings accounts (HSAs) are the best vehicle for expanding health coverage to the widest possible group of people, while also stimulating the American economy in the most efficient way.”

Besides HSAs, answering the call presently, 400 convenience-care clinics have sprung up. They are open after hours and on weekends and when doctors’ offices are closed and hospital emergency rooms are filled to overflowing. They are often located near pharmacies. They (nurses) treat ordinary illnesses. No appointment is needed. The American Medical Association disapproves of them.

By Natalie Sirkin


Bob said...

I have relatives in Canada, they come to the USA for major health care. I have relatives in England, they use private doctors for immediate health care.
They both think we are nuts for looking to a National Health Care System.


Anonymous said...

It is interesting that the costs of procedures which are paid for out-of-pocket like cosmetic surgery and lasik benefit from a competitive market. Over the last few years availability is way up and prices are way down.

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