In my previous post dealing with how universal health care will make Wisconsin a magnet for the nation\’s sick, I made a quick point that actually deserves more attention. As it turns out, people may not even need to move here to have Wisconsin taxpayers foot the bill for their health problems.

Under the \”Healthy Wisconsin\” bill, an individual is eligible for full benefits immediately if they are \”gainfully employed\” in the state. Once one person is \”gainfully employed\” (as defined by the Healthy Wisconsin plan\’s board), \”the person and the members of the person’s immediate family are eligible to participate in the plan.\”

But wait – while there\’s a catch. The bill requires an individual to live in the state for 12 months and have a \”substantial presence\” in Wisconsin (the time limit requirement would be legally questionable in court). However, once they\’re \”gainfully employed in this state,\” those requirements disappear. So what is \”gainfully employed\” in Wisconsin? If someone lives in Arkansas but owns businesses in Wisconsin, are they gainfully employed in this state? Is an independent contractor who lives in Colorado but contracts with Wisconsin business gainfully employed in Wisconsin? Apparently, the board would have to decide.

What is clear, however, is that once a single individual in a family is eligible, everyone in that person\’s immediate family is immediately eligible. And there are no residency requirements for family members. (I have verified this with legislative attorneys.)

As a result, a father of eight in Georgia could move to Wisconsin, get a job at a hot dog stand, and his wife and all of his children would immediately be eligible for taxpayer funded health care, paid for by Wisconsin residents. And the family wouldn\’t have to move an inch. For any family in America facing expensive care for a child afflicted with autism or multiple sclerosis, their prayers would be answered just by having one immediate family member qualify in Wisconsin.

Anyone who thinks this isn\’t incentive enough for people in South Carolina or Indiana to take advantage of this program are willfully deceiving themselves. As I previously mentioned, the health care crisis for people not already on Medicaid-based programs isn\’t a Wisconsin problem – it\’s a national problem. In fact, Wisconsin\’s MA program, Badgercare, even has a residency requirement tougher than Healthy Wisconsin.

As a result, it makes sense that the other 49 states would beg Wisconsin to enact the program – it would alleviate them of all the health care costs they\’re currently paying for their sickest individuals. Suddenly, Mississippi\’s budget would look a lot better when we\’re paying for their citizens\’ health care.

Interesting article this week in The Economist, where they point out that increased Medicare funding, in the form of President Bush\’s Medicare Part D program, might actually be harming seniors in the program.

While they concede that the program has been able to get seniors lower costs on prescription drugs, it has also faced damaging cost overruns that threaten to cut into other areas of Medicare spending.  Specifically, if the prescription drug plan continues to grow, reimbursement to doctors for treating elderly Medicare recipients may be cut.  As a result, many doctors would simply refuse to treat Medicare patients.  Others would treat them, but pass the costs on to non-Medicare patients to make up for the reduced payments.

The article concludes:

Doctors and hospitals already had a disincentive to take on Medicare patients, as cost-cutting laws enacted by Congress years ago were anyway hurting their margins. But in late December, Congress went further, and very nearly enacted a mandatory 10% cut in doctors\’ reimbursements for Medicare patients. In the end, doctors got a six-month reprieve; efforts are now under way in the Senate to extend that reprieve for a further two years. If such cuts go through, most doctors will think again about treating Medicare patients.

Mr Bush\’s Medicare reforms are popular today, but a backlash may be coming. Some private firms have been caught manipulating the elderly into signing up for inappropriate plans. Questions are being asked about why the public is subsidising the marketing expenses of pharmaceutical companies\’ expenses that the public sector does not incur. Those doubts will turn into howls if Part D puts the rest of Medicare under the scalpel.

John Edwards commercial running in Iowa:

Is this really what the health care debate has come down to?  We need to bankrupt the U.S. economy because members of Congress get health benefits?

Incidentally, as George Will points out, Edwards doesn’t have the authority to take anything from Congress, as their health care is statutorily granted.  But it’s nice to know Edwards’ plan is essentially to increase the number of uninsured in America.

Here\’s the \”Healthy Wisconsin\” Letter to the Editor of the Year, from a self-described Atheist who decides to lecture Christians on why God supports Senate Democrats:

If I were to label myself religiously, I\’d have to say I\’m an atheist. However, I think that the myths surrounding Jesus\’ life offer good lessons in how we should treat people, especially the ones about how he healed others even if they couldn\’t afford a copayment or weren\’t covered by his HMO.

Because of this, I am befuddled about why church-going Republican senators are opposed to universal health care in the form of the Healthy Wisconsin plan. I think it\’s just good old moral values to want every pregnant woman, regardless of income or residency, to have the best care possible for herself and her baby. Or for every person who needs a life-saving medical procedure to have access to it. Thank God it\’s not me!

Now before you fall victim to the venomous propaganda they are putting out against this plan, make sure you do your own research. And search your heart as well as your head. Why shouldn\’t we all have equal access to health care? It sounds like the Christian thing to do.

TERRY MEINEN

Altoona

Of course, supporters of Healthy Wisconsin have announced they are willing to drop the program in exchange for $1 billion in new taxes in spending.  Somewhere, Baby Jesus is crying.

Actually, given the Senate Democrats\’ insistence that they are going to continue to push the abominable Healthy Wisconsin plan later in this legislative session, I thought of a relevant Biblical passage.  From 2 Peter 2:22:

\”But that word of the true proverb has happened to them: The dog has turned back to his own vomit; and, The washed sow to her rolling in mud.\”

Concerned that their doctors-in-training were working too many marathon shifts, many states have limited the number of hours their residents can work.  The thinking was that long shifts often affected patient care, leading residents to make mistakes in their treatments.

A new study in the Journal of the American Medical Association actually shows no correlation between hours worked and the quality of care given to  Medicaid patients.  They conclude that \”implementation of duty hours limitations was not associated with any significant change in risk-adjusted mortality among Medicare patients.\”

David Leonhardt has written a fantastic article in the New York Times that addresses the contention that government-run universal health care somehow \”saves\” money. Although Leonhart is open to the idea of cost savings in some circumstances, he says:

The theory goes like this: By practicing preventive medicine, doctors can keep many people from getting sick in the first place. Those who do end up with a chronic illness will be closely tracked so that fewer of them develop complications. These steps will result in less illness, which in turn will require less health care. With the savings, the country can then lower its medical bills or provide health insurance for the 40-odd million people who lack it – or maybe even both.

[…]

No one really knows whether preventive medicine will save money in the long run, let alone free up the billions of dollars a year needed to help pay for universal health insurance. In fact, studies have shown that preventive care – be it cancer screening, smoking cessation or plain old checkups – usually ends up costing money. It makes people healthier, but it\’s not free.

\”It\’s a nice thing to think, and it seems like it should be true, but I don\’t know of any evidence that preventive care actually saves money,\” said Jonathan Gruber, an M.I.T. economist who helped design the universal-coverage plan in Massachusetts.

This is a tough idea to swallow because better health really does seem as if it should lead to lower medical bills. Indeed, if it were somehow possible to wave a wand and turn people into thin nonsmokers who remembered to take their statins, this country\’s health care expenses would fall.

[…]

Jay Bhattacharya, a doctor and economist at Stanford\’s School of Medicine, estimates that to prevent one new case of diabetes, an antiobesity program must treat five people -not cheaply, he says. Along the same lines, Mr. Gruber found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care – in the form of doctors visits and drugs. Louise Russell, an economist at Rutgers, points out that programs that focus on at-risk patients cost the least, but even they are rarely free.

The idea that savings can be realized with a government takeover of health care is a central component of the \”Healthy Wisconsin\” plan currently before the Legislature.  The notion that somehow all these cost savings are going to materialize once government takes over health care is far-fetched, as they rely on people fundamentally changing their behavior to reduce hospital visits in the future.  In fact, providing government health care for everyone may have the exact opposite effect, since individuals may begin to over-utilize the system for minor health problems.

In the United Kingdom, the National Health Service has dropped Alzheimer\’s medication from the list of drugs covered by their universal health care system, citing the high cost of providing the drugs.  In a recent court ruling, the High Court found the move to be legal, citing the diminished benefits of Alzheimer\’s drugs in later stages of the disease.

In essence, it was up to the courts to make a determination of how effective the drugs were – and not health professionals.  Some very interesting points are made in the comments section of this Scottish news account of the court ruling.  Among them:

My wife\’s mother here in Madrid has been using Aricept for about 3 years now to treat Alzheimer\’s, and we have certainly seen a massive improvement since she started using it. It is free for all pensioners over 65 in Spain, although those under 65 have to pay 40% of the cost.

I find it perplexing that the UK constantly appears to lag behind countries such as Spain in so many health related issues like this.

This may sound familiar:

This is the same NHS that wastes huge amount of money to offer free treatment to immigrant and asylum seekers as well as paying for translation costs and bankrolling a lot of useless manager.

While supporters of Wisconsin\’s proposed government-run health care system continue to speculate as to how the program will work, they forget that similar programs already exist.  And they have the same problems we will inevitably see in Wisconsin. \”Healthy Wisconsin\” is a mystery to which we already know the answer – it\’s just a matter of who is willing to listen.

Sick of expensive medications and visits to the doctor?  Upset that the state hasn’t done enough to provide you with the health care you so richly deserve? The New England Journal of Medicine may have found the answer:

 They discovered Oscar the Cat, who apparently has the power to tell when people are going to die.  From a news account:

According to the author of a study in the New England Journal of Medicine, the two-year-old cat has been observed to be correct in 25 cases so far.

Staff now alert the families of residents when he sits down next to their ailing loved one.

“He doesn’t make many mistakes. He seems to understand when patients are about to die,” David Dosa, a professor at Brown University who carried out the research, told the Associated Press news agency.

So instead of going to the doctor, we can just have Oscar pay you a visit.  If he’s willing to go into your house, it’s time to start finalizing funeral arrangements.

Seriously, though – has anyone considered that Oscar might actually be killing these people?  It seems pretty coincidental that people he cuddles up to end up dying.  Someone needs to look into possible organized crime involvement here.

This isn’t unprecedented – it follows some research that suggested some dogs may be able to smell cancer, among other things.  I’m skeptical, however, because my dog seemed to find cancer in the rear ends of every other dog he ever encountered.

I imagine we’d have to put together a pretty lucrative package to lure Oscar to Wisconsin.  No word on whether any local hospitals offer domestic cat benefits.

Sick of expensive medications and visits to the doctor?  Upset that the state hasn\’t done enough to provide you with the health care you so richly deserve? The New England Journal of Medicine may have found the answer:

 They discovered Oscar the Cat, who apparently has the power to tell when people are going to die.  From a news account:

According to the author of a study in the New England Journal of Medicine, the two-year-old cat has been observed to be correct in 25 cases so far.

Staff now alert the families of residents when he sits down next to their ailing loved one.

\”He doesn\’t make many mistakes. He seems to understand when patients are about to die,\” David Dosa, a professor at Brown University who carried out the research, told the Associated Press news agency.

So instead of going to the doctor, we can just have Oscar pay you a visit.  If he\’s willing to go into your house, it\’s time to start finalizing funeral arrangements.

Seriously, though – has anyone considered that Oscar might actually be killing these people?  It seems pretty coincidental that people he cuddles up to end up dying.  Someone needs to look into possible organized crime involvement here.

This isn\’t unprecedented – it follows some research that suggested some dogs may be able to smell cancer, among other things.  I\’m skeptical, however, because my dog seemed to find cancer in the rear ends of every other dog he ever encountered.

I imagine we\’d have to put together a pretty lucrative package to lure Oscar to Wisconsin.  No word on whether any local hospitals offer domestic cat benefits.

Over the weekend, the state media scrambled around to try to piece together details of the universal health plan being offered by Wisconsin Senate Democrats in the state budget.  This article from the Wisconsin State Journal on Sunday caught my eye as being particularly interesting.

While there are parts of the article that I would accuse of being too favorable to the universal health care plan (like, the first six paragraphs, for instance), I do actually have some sympathy for how difficult it is to cover your typical \”liberal versus conservative\” types of topics.  As a general rule, people who benefit from new government programs are pretty easy to track down.  On the other hand, the people who pay for such a program, and therefore would be in strident opposition, are the taxpayers – who are spread out and largely disinterested.

For instance, let\’s say the Senate was proposing a new $2 million program to benefit the Wisconsin Society of People with No Lips.  When the bill is up on the floor, all the State Journal has to do is call someone with no lips to tell them (as best as they can, at least) how great the bill is.  The downside, of course, to passing the bill is that you couldn\’t tell if it really made the lipless people all that happy – since they\’d be smiling anyway.  Although they wouldn\’t look quite as surprised as the Wisconsin Society of People With No Eyelids when their bill passed.

On the other hand, it would be harder to track down people who are anti-lipless and think the free market could better serve their needs.  First, the cost of the program would be minimal when spread throughout all taxpayers, so nobody really gets all that upset.  The problem is, when you stack program upon program upon program like that – each with a supposed \”minimal\” effect on taxpayers – you end up as the 8th highest taxed state in the nation, as Wisconsin is now.

Furthermore, plans to \”help\” specific groups are much easier to explain to people than market forces.  Conservatives argue that on health care, we\’re not really operating in a free market with all of the state mandates on health plans and other government regulations.  If doctors and health plans had transparency in pricing, had to compete for patients, and had the flexibility to offer more specialized care, then health care costs would come down.  But try to explain this to someone who thinks their health care bills are too high, and you\’ll get a glazed stare.

So reporters find someone who wants free health care (look to your left, then to your right – there\’s a 90% chance both of those people fit the bill).  Then, as a counterpoint, they need someone who understands market economics.  I imagine the exchange goes something like this:

Q:  \”Do you want free health care?\”

A: \”Yes!\”

Q:  \”Do you want your employer to provide you with a tax-free health savings account, which would allow you to choose your health care services, which would make health care more subject to the forces of market competition, which would eventually hold down the price of going to the doctor?\”

A:  \”Can I have a sandwich?\”

The immediate constituency for government funds will always be more politically active than any loose arrangement of taxpayers who may dislike paying high taxes.  Sure, there are business groups that oppose higher taxes, but at a high-scale public hearing, those groups are going to be outnumbered 10 to 1.

In the case of this health care plan, the people who want free health care are easy to find.  The 8,100 minimum wage workers who are expected to lose their jobs (according to the Lewin Actuarial Analysis) are harder to track down, since none of them know if they\’d be the ones on the chopping block – they\’ll only know after it is too late.  The 53% of Wisconsin residents who are going to end up paying more for health care than they do now are probably equally as difficult to find – because everything is up in the air at this point.

In the end, it may end up that all this health care plan accomplished was to give Democrats a bargaining chip in the budget process.  There\’s very little chance that it will pass, and its hurried introduction and sham public hearing are evidence that it\’s not a serious proposal.  In that case, Senate Democrats may have ended up giving false hope to their people who really need cheaper health care.  And that would be a cruel irony.

A few days ago, I discussed some of the pros and cons of Massachusetts\’ law requiring residents to purchase health care.  Apparently the final piece of the puzzle has been finalized – the subsidy system is \”poised\” to become law.  From the New York Times:

State officials said that under the plan, they expected that all but about 65,000 of the 328,000 adults who are currently uninsured would be able to get affordable coverage.

The proposal sets a sliding scale of affordability standards in which, for example, a single person earning $40,001 a year would be expected to pay no more than 9 percent of income, or about $300 a month, for health insurance; a single person earning $25,000 a year would be expected to pay a much smaller percentage, about 3.3 percent of income, or $70 a month.

File this in the \”con\” column.  If you think government can determine, with surgical-like precision, subsidy amounts, percentage of income and eligibility for all citizens, then I want some of what you\’re drinking.  There\’s just no way.

In fact, as the Boston Globe reports, the new plan exempts 20% of the uninsured from the mandate, in order to avoid a backlash.  Of course, it is advocates for the poor that are pushing for more exemptions, even though it is the poorest people that the new plan is supposed to help the most.

Who knew your newspaper was making you fat? A press release from the Wisconsin Medical Society (and I had to check a couple times to make sure the date wasn\’t April 1st):

Recipe for Obesity?

Madison (April 11, 2007) – Research finds calorie-dense dessert recipes printed in major newspapers across the country may be contributing to obesity in large cities. The study, by researchers from Marshfield Clinic Research Foundation and UW Stevens Point, is published inthe latest issue of the Wisconsin Medical Journal (Volume 106, No. 2).

\”The average total caloric content of dessert recipes was significantly associated with the percent obese in the metropolitan cities,” reports the study, regarding recipes that were published the last week of August 2000. The researchers studied 64 entre\’ and 38 dessert recipes published in major newspapers serving cities with populations of 400,000 or more.

While these data cannot be interpreted as causal, they are intriguing and suggest that newspapers may play a greater role in promoting or preventing obesity than previously recognized, the researchers report.

Where to even start with this.

So in order to have better health in the inner cities, we need a lot less newspaper reading?  Reading newspapers is why your kids are tubby?  Maybe we need a \”sin tax\” on newspapers for making us fat, similar to proposals for higher taxes on soda and candy.

At least the release admits the study can\’t prove the relationship between recipes and fatties is causal.  But there isn\’t a causal relationship between number of Maple trees in Wisconsin and fat people either, and you don\’t see anyone putting out a release suggesting a link. Furthermore, what do you think the percentage of people in the inner city that make desserts found in a newspaper article are?

Let\’s hope Wisconsin\’s doctors are using a little better logic in treating patients than their journal is using diagnosing the cause of obesity in urban centers. Next up for the Wisconsin Medical Journal: \”Study suggests link between portly grandmothers and deliciousness of apple pies.\”

Yesterday, former governor Tommy Thompson announced in Milwaukee that he will be running for president. Apparently, there\’s no truth to the rumor that he will be picking Sanjaya Malakar as his running mate. In his speech, he discussed his plan for health care:

Thompson devoted part of his speech to health care, stressing preventive medicine and using information technology to cut costs. He talked in general terms about using the public and private sector to \”require health insurance for all\” in a way that avoids a \”heavy-handed mandate.\”

Apparently he prefers a \”softer\” mandate that requires everyone to buy health care. Maybe when you get your new mandated health care bill, it can be in the shape of a heart. When he signs the new law, he can put a teddy bear sticker on it.

All kidding aside, Thompson appears to be talking about a health care framework similar to what Governor (now presidential candidate) Mitt Romney signed in Massachusetts in 2006. The law requires all Massachusetts citizens to purchase health care by July of 2007, increases subsidies for the poor and uninsured, and assesses a fee to businesses that do not offer health insurance to their workers. The law creates a new state department called the Connector that is responsible for helping people find \”affordable\” health care.

When Romney signed the bill, it made national news, and began a discussion among conservatives about the merits of the program. The Conservative Heritage Foundation lauded the bill, as it provided near-universal coverage while maintaining the ability of health care providers to work in the private marketplace. They recently wrote an update on what they perceive to be the successes of the new law. WPRI columnist Ben Artz also recently expressed an open mind to the idea.

When the uninsured get sick, they go to the emergency room for care. Naturally, emergency room care is an expensive way to treat illnesses – and the cost of that care is passed on to other health care consumers or taxpayers. Massachusetts actually had a framework that allowed hospitals to bill the state for emergency room care for the uninsured (called \”uncompensated care\”). The state would then reimburse the hospital for their emergency room costs for treating the uninsured. In many states, the costs for uncompensated care are merely absorbed by the hospitals and the costs are passed on to other hospital customers.

Under Romney\’s plan, there wouldn\’t be any need for the state to pay for uncompensated care (since everyone would be insured), so it freed up nearly $500 million for the state to spend on subsidies to pay for health care for people under 300% of the federal poverty line.

The end result of Romney\’s law is that people above 300% of the poverty line would be forced to pay for their own health care, rather than having the cost of care being shifted to them. People who don\’t purchase health care for themselves are punished by not being able to take the individual deduction on their state income taxes.

Other groups, such as the Cato Institute, see Romney\’s law as overbearing government intrusion. An excellent criticism of the program by Michael Tanner of Cato can be found here.

Tanner points out that government mandates eliminate consumer choice and could damage the quality of health care individuals receive (the Canadian Supreme Court once said that \”access to a waiting list is not access to health care\”). He points out that the uninsured tend to be people between the ages of 18 and 24 who often choose not to heave health care because they\’re healthy and looking for a job that will provide benefits, and that uncompensated care only accounted for about 3% of health care spending in Massachusetts. Both those facts, according to Tanner, point to a lack of need to overhaul the entire system.

Furthermore, Tanner points out that Massachusetts chose not to repeal any of the current health insurance mandates that keep the cost of insurance artifically high (for my take on mandates, see my last TV appearance). While Romney wanted everyone to have health insurance, it is unclear how dedicated he was to making it \”affordable\” by not addressing many of these mandates.

Tanner also addresses the comparison of the health care mandate to the requirement some states have that all their citizens purchase auto insurance. He notes that in some cases, the rates of the insured are actually lower in states that require insurance than in states that do not. He said a similar situation could exist with a health care mandate.

If Thompson goes down the road of pushing for mandatory health care, it\’s unclear how his plan would differ from Romney\’s. And since Romney is actually running for president (and said this would be his signature issue), it will be interesting to see how Thompson distinguishes himself from a governor who has actually signed such a framework into law.

UPDATE: A reader e-mailed me to make another point argued by supporters of a univeral mandate: Generally, since the uninsured are young and healthy, it leaves an older and more fragile population left to pay for health care – which currently makes it more expensive for everyone. Requiring all the healthier people to take part in the health care pool should lower health premiums for everyone, as it spreads the risk out among a broader range of people. Or so the argument goes.

There\’s still that little issue about it being a government mandate, however.