Monthly Archives: February 2011

The Individual Mandate and Its Alternatives

Dr. Jonathan Oberlander is a nationally-known expert on the U.S. health care system and the politics of health reform. He also happens to be my academic adviser and the chair of my dissertation committee. Recently, he published an article in the New England Journal of Medicine that updates the current status of (read challenges to) health reform implementation–in particular the individual mandate. It’s quite good, and deserves your reading.

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Posted by on February 28, 2011 in Individual Mandate


A Modest Proposal

The Commonwealth Fund recently released the results of their ongoing Health Care Opinion Leaders Survey. The highlight was that 91% of those surveyed believe that the Affordable Care Act is a step in the right direction. Of course, there is variation in the response to more specific items. For example, 86% support the health insurance exchanges, 84% support the individual mandate, and 82% support the expansion of Medicaid. At the other end of the spectrum, 38% think that opening up the insurance market across state lines is a good idea, and 22% think health savings accounts would move us in the right direction.

Now, it could be that all of the health care opinion leaders are biased Obamosocialists. That would explain why they like it so much. Conversely, it could be because they are leaders in the industry of health care and health policy, and actually know what they are talking about. Of course, either one of these two scenarios could be true, and it would still sharply distinguish the group surveyed from the majority of the American public.

In our democracy, however, popularity wins, and the views of these “leaders” are not entirely popular. So, I’d like to offer a modest proposal for the people to consider.

You do not like the mandate for all individuals to purchase insurance. Therefore, we will eliminate that provision. However, you do like the ban on insurance companies denying coverage because of pre-existing conditions, so we’ll keep that in. You don’t like the sound of state-run insurance exchanges, which sounds too “governmenty,” but you do like competition, so we’ll hire a private firm to operate a website called “” where you name your own price for health care. William Shatner is already taken, so Levar Burton will be the spokesman for the new site. Lastly, you don’t like government involvement in your personal life, which includes health care. So, we’ll eliminate all aspects of that. There will be no more Medicaid program for the low income, no more Medicare program for the elderly or disabled, no more Veterans Administration, no more subsidizing of employer-sponsored insurance by making your premiums tax-exempt, and most certainly no laws mandating treatment of emergencies or active labor at the hospital if you aren’t insured.

Under the new proposal, government will save literally hundreds of billions of dollars annually. You will stop having certain taxes deducted from your paycheck, but you will also start having more of your paycheck taxed. You will have the right to decide whether or not to purchase coverage for yourself and your family. You will have the right to shop around for the best price for health care services. You will also have the responsibility to pay for any and all services you use. You will not have the right to receive health care services, even in case of emergency, unless you have insurance or the financial resources to pay the full cost of services up front.

You wanted so badly to be on your own, and now you will be. Will more people go bankrupt because of medical bills? Sure. Will the population of this country grow sicker? Without question. Will more people die under the proposed system? Absolutely. But it is the pinnacle of personal responsibility.


Posted by on February 25, 2011 in Uncategorized


Spending Wisely, Saving Foolishly

When the GOP took control of the House, the mantra became something like “We might not control the government yet, but we can sure throw a bagful of wrenches into the works.” The metaphorical wrenches are actually proposals to cut government spending in an effort to reduce the deficit. At least that’s how it’s being presented. And that’s not a bad idea. The annual deficit in this country has grown steadily, especially during this most recent economic downturn, leaving a mounting national debt in its wake. Something needs to happen.

Unfortunately, the idea of just cutting funding for government programs without considering the possibility of simultaneously raising taxes, is akin to the idea of trying to lose weight by eating less while sitting on the couch. It may or may not work, but even if it does work, you’ll not only be lighter than you were before, you’ll also be a lot weaker.We have to make smart choices about how we bring costs and revenues into alignment.

That starts with adherence to the facts. Speaker Boehner has been going around talking about the wasteful hiring practices of the Obama Administration, which he claims has added 200,000 jobs since the President took office. The problem is, he’s off by 143,000. Follow his math here and here. You’d think that our problems are real enough that he wouldn’t have to resort to such inflated statistics to convince us that action is warranted. Of course, he was probably betting on the majority of people hearing the statistic and never bothering to check its veracity–much like the Duke University student who, at a debate I moderated last week, cited Newt Gingrich’s bogus claim that the IRS would have to hire 16,000 additional agents to deal with the individual insurance mandate as a fact. When I asked for the source of the information, the student couldn’t find it. What a surprise.

I guess it just comes down to my not being a fan of making uninformed decisions. Especially when those decisions will affect potentially millions of people. Case in point: The GOP wants to significantly reduce funding for community health centers. I like community health centers. They are the subject of my dissertation here at Carolina, and I chose to focus on them because of what remarkable organizations they are. They provide care for those that fall through the cracks in our system, they do it well, and they do it for less money than most other health care providers. But they now find themselves on the chopping block for no good reason. You can get the details here. If, after reading, you want to voice support for health centers, you can visit this site. We need a government in Washington that spends wisely, yes. But that doesn’t necessitate that they save foolishly.

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Posted by on February 22, 2011 in Uncategorized


Be Mine Health Wonk

Valentine’s Day was on Monday, and in honor of that holiday / excuse to overspend on candy and flowers, there is a Valentine’s edition of the Health Wonk Review hosted by Louise and Jay Norris of the Colorado Long Term Care Insider. I’m not featured in it, but you should certainly read it anyway!

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Posted by on February 17, 2011 in Health Wonk Review


Who Needs Government Anyway?

The answer to the question that is the title to today’s post is a lot of us. The thing is, most of us just fail to realize it. If you haven’t seen this  yet, brace yourself. Cornell political scientist Suzanne Mettler recently published a study that, among other things, includes a table showing the percentage of program beneficiaries who report that they “have not used a government social program.”  Yes, that’s right. These are people who actually get government benefits of some sort, and yet claim that they have never received government benefits of any kind.

You can see their responses here.

You wouldn’t expect numbers like that to be very high. I mean, if I conducted a poll just outside of the food court at the mall and asked people who passed by “Have you ever eaten at the food court at this mall?” You’d expect that most people would know the answer–especially the ones who had just finished a meal there. What these figures suggest is that many people don’t know just how much government does for them, which is interesting when considered in the context of how many people are hopping aboard the anti-government bandwagon.

Those people probably hate the idea of what they consider lazy good-for-nothings sitting around and spending all of the taxpayers’ hard-earned money on food stamps, public housing, welfare, and Medicaid. I know people who espouse that view. I eat with them regularly during the holidays.What I also know is that those same people are likely saving for a child’s college education with a 529 plan, took advantage of federal student loans, claimed a tax credit for educational expenses, get a Social Security check every month, or have most of their health care paid for by Medicare. In fact, I myself have taken advantage of three of those government programs.

The thing is, for some reason, those very important, very beneficial government programs somehow aren’t framed as government programs in the minds of many who use them. There is some serious cognitive dissonance going on here. There has to be. That’s the only way that these people can survive what I imagine would otherwise be a crushing amount of hypocritical guilt. So they tell themselves a story about how they are different, how they aren’t like “those” people, never realizing that they, too, are the recipients of government assistance. Soon, health reform will be added to the list. Maybe Jonathan Gruber’s graphic novel will enlighten them on this one.


Posted by on February 15, 2011 in Uncategorized


The Commerce Clause and Legal Challenges to Health Reform

My friend, Mark Hall, the Fred D. & Elizabeth L. Turnage Professor of Law at Wake Forest University School of Law, has written a very thorough critique of the commerce clause as it relates to legal challenges to health reform. The great thing about what he has written is that it considers both sides of the issue in great detail. You don’t find that kind of balance very often. Click here to read it.


Hypocrisy Is So Much Fun to Point Out In Others

There is no use in re-inventing the wheel. Therefore, I am merely pointing the way towards a very remarkable piece by Jonathan Cohn. The take-home message is simple: If the individual mandate at the center of the Affordable Care Act is unconstitutional, then so is the idea of privatizing Social Security. (You’ll have to read Cohn to find out why.) The fact that the GOP is generally in favor of one and opposed to the other, however, means that they’re wrong about one of them. At the risk of sounding like a broken record, the Supreme Court will tell us which one it is.

“Not so fast!” interject my conservative friends (yes, I have some) “The Democrats are also in favor of one and opposed to the other. They’re just as hypocritical as the Republicans!” Ah, but you see, only the first part of that sentence is true. The Democrats have never claimed that privatizing Social Security was unconstitutional, they just asserted that it was bad policy. Thus, their different positions on the issues aren’t fundamentally at odds with each other. Think about it.

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Posted by on February 4, 2011 in Uncategorized


No Such Thing As a Free Lunch you don’t read the things Harold Pollack writes, I feel sorry for you. He has a real knack for making common-sense arguments and explaining complex things in a matter-of-fact way. Recently, he explained just exactly why it is wrong to suggest that emergency rooms are our universal coverage system in the U.S. Basically, people think that if push comes to shove anyone can go into an ER and get “free” care. This is the result of what happens when people explain the law known as EMTALA via that old childhood game of telephone. The requirement to assess and stabilize everyone who walks through the doors of an ER slowly morphed into the notion that if you can’t pay, ER care is free. That’s actually about as true as saying that if you don’t have wings, gravity will give you a pass and keep you from falling out of the sky. But, as you can see, I let my sarcasm get the best of me far too easily, which is why you should read Harold’s piece about the myth of “free” care.

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Posted by on February 2, 2011 in Uncategorized

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