America's Civics Teacher

The end of America? Healthcare is but one issue

2012-03-08T12:35:00.000-08:00

In a way I felt badly for my listeners. They had to confront some very hard facts about our great country that go far beyond, but include the provision of and payment for healthcare.

The United States is in trouble – deep and serious trouble. This is what I said to the professional health insurance agents in Peoria, Illinois on March 6. Then I laid out overwhelming statistics about state and federal spending, the increase in the national debt (in dollars and as a percentage of the Gross Domestic Product), and most appallingly, the total unfunded debts and liabilities of American government. And I talked about cultural and moral decline.

Please, don’t stop reading. This is a vitally important message.

Dr. Larry Kotlikoff, a Boston University economics professor, totals the U.S. unfunded liabilities at $211 Trillion - $676,000 for every U.S. resident currently counted by the U.S. Census Bureau. These are funds that must be spent if we are to maintain the programs currently on the books. But that spending will never happen because it cannot happen. It cannot happen because we will be bankrupt before it can happen.

According to Peter Ferrara, in his must-read tome, America’s Ticking Bankruptcy Bomb, the U.S. public debt ratio to GPS will be 107 percent by the end of 2012. It will quickly climb thereafter to a level exceeding that which is destroying Greece today. If there is no sharp change in U.S. spending, it will lead to a world economic collapse.

I know, I know, these are harsh words and hard to read; not at all uplifting. Now, however, is time for sobriety and seriousness. Frankly, I wish I could give this same talk to all Americans. Maybe I could do it as a webinar. It is an urgent talk, a vital talk.

But there is more.

The U.S. at its root is not about money: it’s about ideas upon which we have built a great nation of free people, an exceptional nation in every way. One of our foundational ideas is moral integrity.

“We do not have money problems,” Alan Keyes often said during his 1996 presidential campaign. “We have moral problems.” The moral problems are directly related to how and why we spend money, as individuals, families, and governments. How we spend money on healthcare is directly related to our moral dilemma.

What I am about to write is likely to cost me some readers, because some people do not want to deal with these disturbing trends. Each of them, and far more, contributes to our cultural, moral, and financial decline.

Recently, a British bio-ethicist opined that a newborn baby should be treated the same as an unborn child – only he uses the “scientific” term, fetus. This “ethicist” believes that abortion law should apply to newborn babies – meaning parents should be free to kill the unwanted infant, just as they are able to do with babies still in the womb. Dr. Peter Singer, of Dartmouth, made the same observation years ago.

Dr. Zeke Emmanuel, former adviser to President Obama on healthcare reform and brother to Chicago Mayor Rahm Emmanuel, believes we spend too much on healthcare for certain populations. In a 2010 Lancet article, Emmanuel and his co-authors suggested that we should reduce spending for children younger than about five, and adults older than about 62. He believes we should focus healthcare spending on others, healthier people with more life expectancy. Who should decide? Under ObamaCare, the Independent Payment Advisory Board, and others of the new federal MediCrats who know better than you, or me, or pastors, priests, rabbis, and Imams.

An 18-month old girl toddler declared one day, “I am a boy.” As a result, her parents are raising her as a boy, and intend to treat her with hormones to delay the onset of puberty. By age 17 or 18, the parents reason, the girl can choose to be a boy for life, and undergo transsexual surgery. The story is told in the context of an article about an emerging pediatric practice, whereby children are choosing to live as genders different from the one God created (oh, of course, they do not see that God has a role to play a role in these issues).

Parents of children with gender confusion hope that health insurance will pay for their children’s treatment as preventive care.

Lastly, is the latest report on children born out of wedlock – excuse the old-fashioned term. If you wish, I can just say “born to single mothers.” These statistics should set off alarms for the social cost awaiting our country, none of which figure into Dr. Kotlikoff’s calculations.

According to the National Institutes of Health, 29 percent of Caucasian babies are born to single moms. As bad as this sounds, 53 percent of Hispanic babies are born to single moms; the number for African-American babies soars to 73 percent. Even during slavery, as Alan Keyes points out in Masters of the Dream, only 15 percent of African-American babies were born into families without a father present.

We must integrate the underlying facts about our country’s financial and cultural demise with every decision we make about the future of U.S. healthcare. To pretend these are not relevant is to self-destruct.

The root cause and the real solution are the same: personal moral responsibility. A remnant still has it, but society in general seems to be tossing it aside.

We will keep fighting for healthcare consumerism, a reduction in wasteful healthcare spending, doctor-patient relationships, healthier bodies, and all such pursuits. But, the one pursuit that overrides all this is that of moral character, at a far higher level than is apparent today.

In 2012, we can get started on one aspect of saving America; elect people of moral integrity to office, and throw the others out the door.

Go ahead, Try to make a wise prediction. Can't happen.

2012-02-29T07:55:00.000-08:00

Predictability. Stability. These are two critical keys to success for any family, business, or government. Neither exist in our present day politics or economy.

Who among us can predict our health care or economic future? Not one of us. All we can do is guess, and guessing is the wrong way to build anything that will last.

The Good Book asks the question, “What person who is about to build a tower doesn’t first sit down and count the cost?” But how can anyone count the cost when the rules change almost daily?

A Washington Post article promoted the idea that President Obama might be open to giving states flexibility on Medicaid mandates. He might even grant states some leeway in the implementation of health benefit insurance exchanges. The test? Any flexible plans must meet the intent of the ACA? What does that mean? What flexibility? What, pray tell, is the intent of the ACA?

The Secretary of Health and Human Services has been woefully lax in issuing ObamaCare rules, and now President Obama suggests the rules that are not yet rules may change – if the federal government deems that states mean to do what the Affordable Care Act requires; as if anyone can figure out exactly what that means.

We await the ruling of the Supreme Court about the ACA. Will it overturn all of it, just the mandate, or let it stand? Which is worse?

If it lets the ACA stand, then we face years of rules that are not rules, waivers that are not waivers, and endless political bickering. If the Court overturns the individual mandate, and lets everything else stand, we face the end of insurance companies (some would cheer this, but not stockholders). If the Court overturns everything, we face chaos.

Right now, today, someone somewhere is creating the next miracle medical device, discovering a new surgical procedure, harnessing some unknown element of creation that will revolutionize medical care. Why would anyone invest in the entrepreneur’s idea, when the investor knows that the rules will change?

Right now, today, banks and venture capitalists are pondering how to grow their money. The safest bet is not to bet on stability and predictability, because there is none. Keep the money in the vaults until America decides who and what it is. Speculate on the stock market, but avoid new ventures. For certain, keep your money far from Solyndra projects, because when the clouds carrying financial collapse produce economic thunderstorms, and America is caught up in a flood of bankruptcies, no one will worry about green energy.

Or, maybe the rules will change and none of this will happen.

The greatest damage President Obama has done to America is to leave us without any sense of stability, or ability to predict with some rational certainty, where we are headed. On the other hand, it is possible to rationally predict that we are headed for a financial disaster.

One other prediction: The election of 2012 will determine our survival as a nation of free people. That prediction you can take to the bank.

Health Care Threatens Your Liberty

2012-02-15T14:42:00.000-08:00

Take a few minutes to view this YouTube speech. It's one I gave to the Association of American Physicians and Surgeons, on January 20, 2012, at a Las Vegas meeting.

Private behavior has a public cost: We all will spend more

2011-08-03T06:44:00.000-07:00

Cigarette smokers have taught us that private behavior has a great public cost. Governments have no problem imputing large taxes on smokers and shaming them through tax-supported public service announcements. When it comes to smoking, we get it. But, when it comes to sex, not so much.

“Don’t impose your morals on me,” is the common cry of not just libertines, but all of us. The idea here is that private behavior is private and, as long as it does not affect others, people should be left to their own wills. This worked well when society expected people to exercise personal restraint. It was enough that public consensus kept people in line; few government sanctions were necessary. Healthcare reform, however, is exposing flaws in that argument as it applies today.

The Federal Secretary of Health and Human Services, under the authority granted by the Affordable Care Act of 2010 (ACA), recently issued eight mandates on private health insurance. The Secretary’s order means that in the future, health insurance must pay 100 percent of the cost of preventive care for these eight mandated categories. At least five of these mandates are directly related to sexual promiscuity. We will all pay the cost in higher insurance premiums.

Specifically, the new Federal guidelines require that all Health Insurance policies must cover preventive care for these five behavior-oriented conditions:

Human papillomavirus (HPV) DNA testing for women 30 years and older;
Sexually-transmitted infection counseling;
Human immunodeficiency virus (HIV) screening and counseling;
FDA-approved contraception methods and contraceptive counseling;
Domestic violence screening and counseling.

Before moving on, read the list again. It is true, of course, that even the most careful, pious person or monogamous married couple could conceivably suffer from one or more of these conditions: but the incidence of such is certainly low enough not to allow a federal official to order preventive healthcare payments for medical tests related to these behaviors.

HPV, STDs, and HIV, for the most part, are diseases resulting from promiscuous sexual behavior. American society has, for the most part, considered medicinal contraception acceptable, although tens of millions reject it on religious grounds. No one that I know of considers domestic violence acceptable behavior; about this, society continues to impose moral and legal strictures.

Physicians are expected to withhold moral judgment while deciding whether to treat an individual. No matter the cause, a hurting or ill person needs medical attention. The man infected with HIV or AIDS should get medical care. The woman suffering from STDs or cervical cancer should get medical care. Despite potential medical, emotional, and psychological dangers, we do not withhold medicinal contraceptives from single or married women who desire to prevent pregnancy. We tolerate cohabitating partners as a price we pay to keep government out of private lives (and we celebrate it in our popular culture). These all come with a price tag, and now, the Secretary has increased it for everyone.

You see, there really is a financial cost to all of us for not embracing the “old” morality, the morality that reserved sexual intimacy for marriage between a man and woman. We have fallen so far from this higher moral standard that today, a Federal official orders that everyone must pay more just to screen for diseases that naturally follow promiscuous behavior.

“We cannot put enough policemen on the street if there is no policeman in the heart,” to paraphrase Alan Keyes, who has sent this on numerous occasions. Public morality flows from private morality, and a lack of it costs all of us.

We do not want government to impose morals on us, but we should not want government to order us to pay for the results of immorality.

“Mandatory Life Insurance,” Cries California Congress Person

2011-06-29T16:50:00.001-07:00

Perfect Match for Health Insurance Exchanges

BROADMOOR, CA. June 29, 2011: “Tomorrow I plan to introduce the Affordable Life Insurance Empowerment Act in Congress,” said Arly Esperson, Congressperson from California’s 54^th Congressional District. “Now that the Sixth Circuit Court of Appeals has ruled the health insurance mandate is constitutional, I think it’s time we take the next step.”

Today, a three-judge federal appeals court in the Sixth District upheld the cornerstone of the Affordable Care Act of 2010. “The progressives in Congress wanted to be sure the court upheld the mandate before we started moving ahead with the rest of our agenda,” Esperson explained. Esperson spoke about the controversial ACA provision known as the individual mandate that will require every American resident to enroll in a health insurance plan by 2014.

Progressives breathed a sigh of relief over the decision, Esperson said. Esperson leads the Latte Party Caucus in Congress, a group of lawmakers who believe government needs to do more for “working people. And that’s why I am moving ahead with this new bill.”

The Affordable Life Insurance Empowerment Act (ALIE), Esperson explained, would require all United States’ residents to purchase a minimum of $10,000 in what Esperson called “lifetime coverage.” Ron Kelly, a spokesman for New Mexico Life Insurance clarified the term: “Esperson means whole life or cash value insurance, and it lasts a lifetime, or, well, until death.”

Esperson’s bill would go farther and require everyone older than 35 to own a minimum of $250,000 in term life insurance in addition to the $10,000 whole life policy. “This will do several things for working people,” Esperson explained. “First, there will be money for burial cost. Second, it will help settle estates. And third, and just as important, the federal tax of 25 percent on the death benefit will help to reduce the national debt.”

ALIE overcomes two hurdles that might otherwise doom the bill: premium cost for low-income people, and accessibility coverage.

First, Esperson explained that low-income people – the threshold is set at family income of less than $50,000 a year – will receive help paying their mandatory life insurance premiums. “America’s richest individuals often use life insurance to dodge paying estate taxes,” Esperson said. “We will levy a 35 percent tax on the life insurance proceeds of all plans that exceed $500,000.” In this manner, “we will make sure the rich pay their fair share.”

Second, Esperson plans to fold enrollment in mandatory life insurance plans in the Health Insurance Exchanges required by the ACA. “Hey, every state must have the Exchanges, and it would be nothing for Exchange enrollers to fill out life insurance applications.”

Under ALIE, insurance companies will have to issue life insurance to anyone, regardless of their medical condition or age. “That’s why we mandate ownership,” Esperson explained, “to eliminate cherry picking of insured people, as the life insurance companies do now.”

The other ALIE key feature will help keep the premiums low for everyone, according to Esperson. “We will limit the premium rates on a three to one ratio, so that the younger people will not get stuck paying too high of premiums.” People under 33, according to ALIE, would pay one-third as much as people older than 65.

“This is the perfect adjunct to the Affordable Care Act,” Esperson said. “For the first time in our nation’s history, everyone will have health and life insurance.”

President Obama has remained silent on ALIE.

We elected Sue Johnson as President proving girls can govern

2011-06-18T14:14:00.000-07:00

Cong. Michelle Bachmann

Michelle Bachmann wants to be President of the United States. She’s a girl. I can attest to this because I have met her personally. You can take my word for it.

But can a girl win the presidency? Yes, and on this you can also take my word for it.

In 1961, Sue Johnson defeated me, Dave Racer, for the Presidency of Dr. James Phillips’ Ninth Grade Core Class. Sue served admirably. I think I became secretary of something.

Alright, running a Ninth Grade class isn’t exactly like being The Most Powerful Leader in the World. I grant you that.

But what makes a good U.S. President? It depends on the times and the challenges.

For my money, the next president have a demonstrable record of commitment to solid principles of faith, family, thrift, limited government, and understand that we are going broke. In my family, it’s the girl that worries most about budget – and not overspending.

Okay. I am convinced that Michelle Bachmann is qualified to be President of the United States for the times in which we live. She may not be the only candidate so qualified, but she is the Real Thing.

In fact, I am willing to say it straight: If any one of the GOP boys want to be President, they should quickly adopt Bachmann’s convictions. I’m pretty sure that Mitt Romney can’t do it, and I wonder about Newt Gingrich. Ron Paul has convictions, but not for these times (he is either two centuries too late or 10 years too soon).

I see Tim Pawlenty, my governor, as an enigma. This is because I am not a pragmatist, and because I am an idealist. Pawlenty governed exceptionally well, but faced a Democrat legislature most of the time. Pawlenty also had to deal with Minnesota’s GOP “conservatives,” many of whom are to the left of a Missouri Democrat. Clearly, he can do the job, but he also knows how to cut a deal – and I’m thinking this is not the era where we need deal-cutters.

But I got off course. My purpose in this odd piece is to demonstrate that the problems we face in the United States are so ponderous that we have to throw aside the trivial arguments about race and gender, and find someone to bring about a change in course. The change, of course, is to give Barrack Obama the chance to play golf everyday – even twice daily if he wishes, and keep him away from the White House.

Don’t carp at me that Michelle Bachmann kissed George Bush, or said something silly about Paul Revere. Every politician is flawed. This is because they are human beings. Even Sue Johnson had flaws, but far fewer than mine.

If you don’t want a girl to be president (or at least the girl named Bachmann) then lean on the boys to prove they can do it.

Resisting Federal Encroachments: Founders v. Today

2011-06-08T08:19:00.000-07:00

“Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shown, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security…”

The Declaration of Independence – 1776

Why not read those words again before you move ahead with this blog. Do they sound extreme to you? I mean, “throw off such government;” that certainly sounds extreme, doesn’t it? Or does it?

Throwing off the chains of oppressive government meant taking up arms to the Founders. They did not have the protection of a Constitution they had dutifully adopted, endorsed, and wished to defend.

The Founders cited the primary reason for establishing government to be to “secure these [unalienable] rights,” the God-given rights to life, liberty and the pursuit of happiness (translated in the Bill of Rights and the Fourteenth Amendment to mean, the right to own property). Simply, a government that no longer defends life, liberty, and property, said the Founders, must be thrown off.

“The individual mandate is outside Congress’ Commerce Clause power, and it cannot be otherwise authorized by an assertion of power under the Necessary and Proper Clause. It is not Constitutional,” [i] wrote Federal Judge Roger Vinson. (Vinson ruled on the individual mandate to purchase health insurance required by the Affordable Care Act of 2010, passed by Democrats in Congress, and signed by President Obama.) Other judges have disagreed with Vinson, and the Supreme Court will ultimately decide.

When Congress acts in such a manner so as to attack liberty and property, as Vinson stated clearly in his ruling, what should we as citizens do? Well, if we agree that no one should be coerced by government to purchase something they may not want (in this case, health insurance), maybe we should resist? Sam Adams and the other Declaration signers would cheer us on.

Has the time come to resist?

The Declaration speaks of “a long train of abuses and usurpations” as a critical element in deciding whether to “throw off such government…” Judge Vinson’s decision looked back at how Congress has butchered, sliced, and diced the enumerated powers of the Commerce Clause; mostly since the 1930s. Vinson identified a train of ever-increasing, ever-broadening Congressional encroachments on private commerce. He quoted the Congressional Research Service and the Congressional Budget Office, both of which stated the individual mandate is an unprecedented expansion of the reach of the Commerce Clause.

When Congress decides to tell us that we must purchase health insurance has their action crossed the line into tyranny, or is that too strong of word? Would you supply me with an alternative? And is this a one-time assertion of power, or evidence that Congress intends to continue a long train of usurpations?

When you view the growth of government under the light of the Founders’ reasoning, and then under the scrutiny of history (including recent history), you see the “long train of abuses and usurpations” upon which the Founders based their claim to independence. The Founders chose to fight a hot war of rebellion as their answer, but resistance can take many other forms long before war becomes the only option. This is one of the chief blessings of our United States Constitutions.

What methods of resistance?

We express resistance to tyranny at the ballot box. We elect individuals to represent our views. If our view is that Congress does not have the power to force someone to purchase health insurance, we will resist Congressional tyranny by electing a different Congress. In fact, we started that process through the 2010 election, and hopefully, will continue it in 2012. So elections are an alternative to taking up arms, as an expression of resistance – God be praised.

Are there other ways to resist tyranny beyond the next election?

Lawsuits, such as the one Judge Vinson ruled upon, are one way to resist. Another is to ask state and federal lawmakers that are currently serving to use every possible legal scheme of which they can conceive to resist all federal encroachments on liberty. It means asking lawmakers to scrutinize all legislation related to the Affordable Care Act of 2010, searching for any instance in which they dare to challenge the federal government by taking no action, or taking adverse action.

There is an ultimate form of resistance to tyranny that falls short of the Founders’ resort to arms: If millions of Americans choose en masse to resist laws that threaten unalienable rights to life, liberty, and property, Congress and the Courts will notice. Perhaps, if the individual mandate stands, we should incite millions of Americans to drop health insurance coverage as a form of civil disobedience; sort of like dumping tea into Boston Harbor.
On the other hand, millions of Americans may remain indifferent. Today’s elected state lawmakers may choose, instead, to capitulate to Congress. If so, James Carville may prove to be right when he said recently, “…we’re going to start to see civil unrest in this country. I hate to say that, but I think it’s imminently possible.”[ii]

[i] Case No.: 3:10-cv-91-RV/EMT - State of Florida v. United States Department of Health and Human Services

2011 Federal Court, Florida District: Florida. P 56.

[ii] Carville, J. (2011) “Carville: There Will be Civil Unrest—Over Economy.” Newsmax.com. June 6, 2011. http://www.newsmax.com/InsideCover/Carville-Obama-Clinton-civilunrest/2011/06/06/id/398990. Retrieved June 8, 2011.

Who should ration health care?

2011-06-01T07:51:00.000-07:00

“Racer,” you may have already said, “why resort to false, emotional words like ‘ration’ when what we need is a serious discussion about health care reform?”

Easy. Rationing is an essential element of the ACA way.

Fifteen commissioners, each earning $165,000 a year, will do the rationing. They are called the Independent Payment Advisory Board, and are foundational to how ObamaCare will function.

President Obama and the Democratic members of Congress, in passing the misnamed Affordable Care Act of 2010 (ACA), took $500 billion away from future Medicare payments. They did this knowing that more than 78 million Americans are beginning to qualify to enroll in Medicare. What happens when less money is available for more people? You choose your favorite term: I use the appropriate one: It’s called rationing.

Make no mistake about it. Rationing will happen as revenue fails to keep up with cost of care.

Medicare Revenue is directly linked to the expansion (or retraction) of the economy, except that President Obama does not believe this. Instead, he believe there is a finite amount of money, and the role of politicians is to divide it up.

The way to divide up a finite amount of money in Medicare is to ration care. The instrument to accomplish this is the Independent Payment Advisory Board (IPAB). This 15-member board, set up under the ACA, will decide what care will be allowed to be provided to Medicare enrollees, and what will be denied. Denial of care is called rationing.

It is true that there are other forms of rationing. If a person has no money, and there are not medical providers willing to care for that person, it is called rationing. But the Affordable Care Act will create more of this type of rationing, not less. Why? Because the ACA discourages individuals from becoming physicians. If there are no doctors, there is no health care – well, professional health care.

If a person has prepaid health coverage (some call it insurance), and the insurance company or Health Maintenance Organization (HMO) is in charge of deciding who gets what coverage, that is a form of rationing. But it is far different from the way the IPAB functions. There is at least some competition among health care insurance companies to provide coverage for individuals. If there would be only one insurance company, it could dictate – yes, dictate – who will get what care, when, where, and under what conditions. This is precisely what the IPAB will be able to do, because Medicare is single payer, government-run health care – it has no competitor.

Repeat it. Tell the truth. ObamaCare, the ACA, is the process to ration health care. First, to senior citizens on Medicare, and then to the rest of society (as Exchanges give way to single payer systems, and as Accountable Care Organizations submit to the federal paymaster).

We start to fix this by repealing the IPAB. And the requirement for Exchanges. And the individual mandates. We fix it by expanding access to consumer-directed health care, Health Savings Accounts, and medical entrepreneurism.

We cannot, absolutely cannot waste our time trying to fix the ACA. It cannot be fixed. It must be rationed out of existence.

Health care decisions are the realm of patients, their families, and doctors. Communities join this process voluntarily. This is the way to pursue rational decisions about health care.

A Father and Daughter Deploy to Afganistan

2011-05-29T12:14:00.000-07:00

What ideas are so strong that Americans fight and die for them?

Today I stood in church next to a father and daughter, both members of the United States Army. The pastor asked them to stand and be recognized: They are both to soon deploy to Afghanistan.

Wow. Why do people volunteer for military service?

He introduced another man, an ex-Marine, whose combat ribbons and medals would cover the entire breastplate of uniform. Among other things, the Marine flow #2 on the Blue Angels. The glory from flying those Blue Angel airshows pales in comparison with the Marine’s war record.

Incredible. For what reason did this man risk his life time and again?

I served four years in the Air Force during Vietnam, but am humbled by the service of these others.

What drove me to enlist in the Air Force, knowing that Vietnam awaited, if the military so chose to send me? An honest answer includes my preference not to be drafted into the Army. Yet, I had a heart full of patriotism and love for America, and wanted to do my part (I know, these are old-fashioned ideas to modernists, and maybe even sound silly).

A few weeks ago, I asked a close friend of mine to list three non-negotiable issues for me. I asked, “If you served in the Minnesota legislature, tell me three issues where you would draw the line.”

He responded with life – he is prolife. And the other two resembled freedom and pursuit of happiness. Good answers.

What about you? The answers you give are the reasons we go to war, did you know that? These are the issues that make America different, and special. Life. Liberty. The Pursuit of Happiness.

Our founding fathers wrote that governments are created to protect inalienable rights, and when governments attack those rights or refuse to defend them, it is our right, and in fact, our duty to throw off “such government” and establish new forms that seem better suited to us to defend our inalienable rights. Heavy stuff, right? This is why America’s founding citizens went to war with England. And it is the same reason we fight for America today.

Now comes the tough question. Do you believe it? Do you believe that life, liberty, and the right to own property (pursuit of happiness) are willing to defend and protect, even to the point of sacrificing your life, fortune, and sacred honor? If you answer “yes,” then take some time to evaluate how you are doing so today, and how you might be doing the opposite.

I can think of one major problem that threatens our liberty: our increasing dependence on government, and more specifically, for our health care. I’ve spent the last six years studying this, and am convinced that too many of us are willing to defer to Big Government on this critical issue.

When the federal government controls all of health care, your life, liberty, and pursuit of happiness will be in total jeopardy.

I cannot imagine anyone willing to fight and die for single payer health care, can you? Such a thought would shake the hearts of America’s founders, and of the millions who have fought and died for our liberty.

Elections that go our way have consequences - Sometimes we don’t like them

2011-05-25T06:26:00.000-07:00

During the summer and fall of 2010, I traveled across Minnesota – and other states – to deliver a message to professional health insurance agents: Get involved in this election, because the next legislature will decide what kind of health insurance exchange you will have.

A funny thing happened on the way to the election. Minnesotans sent conservative Republicans to the state capital, and created a GOP majority. Not surprising, most of the new legislators are committed conservatives – and they refuse to create health insurance Exchange.

Without the votes of the freshmen legislators, the ones for whom many of us campaigned so vigorously, the Exchange went nowhere. It could resurface in a special session, or next year. But there is no indication the freshmen legislators would change their vote.

We elected principled conservatives and they actually voted that way (or in this case, withheld their vote). Elections have consequences, even when they go our way.

Consider the alternative. If we had not elected conservatives, Gov. Dayton would have signed an Exchange bill early in the session. We know what it would look like. These are some of the features of a bill passed by a liberal legislature and a liberal governor (who is on record supporting single payer):

1. All health insurance sold in Minnesota would go through the Exchange.

Health insurance agents would have no role in the Exchange.
Health insurance agents would either go out of business or sell different lines of insurance.

I am not making this up. I have seen the bill offered by Minnesota liberals. If you believe in a market-based health insurance system, and especially, if you believe in the health insurance agent system, you will not like what liberal legislators and a liberal governor give you.

Last summer, I risked my health and safety, driving and flying thousands of mile, to ensure the new legislatures across the country would protect a private market health insurance system. I lectured insurance agents, and tried to motivate them to engage in the process to avoid a liberal legislature and liberal governor. We won, but our win resulted in the unexpected consequence that legislators would actually do what they said they would do.

The conservative governor candidate lost by several thousand votes – a tiny fraction of the total. If he had won, everything would have been different except one thing (and about this I speculate): With Tom Emmer as governor, and a conservative GOP legislature, there would be no Exchange bill passed in Minnesota.

So if you believe that your state needs an Exchange, don’t elect principled conservative legislators because, well, they will do what they promised to do: They will oppose “ObamaCare” on every level.

This leaves you with the very risky strategy of electing a moderate or liberal legislator and governor that you will work like crazy to influence, hoping to secure a market-friendly Exchange. After that, if successful, you will have committed yourself to electing the same kind of folks for the next decade, and then work to maintain your influence.

Conclusion: Elections have consequences. If you do not want to fight the Exchange, or fight “ObamaCare,” then do not elect conservatives. But, the trade-off is twofold: 1) You will work your fanny off for the rest of your carreer to influence legislators in order to protect your preferences, and 2) You will be more highly taxed, and have a more activist government than you might otherwise prefer.

I made up my mind decades ago: Three first principles - Life, Liberty, and the right to private property (pursuit of happiness).

Medicare Funds Dining

2011-05-13T12:27:00.001-07:00

This short article will change how you perceive Medicare. You will realize how vital Medicare is to our economy, but you will view this in a new light. (maybe, like me, it will seem ironic and a bit troublesome.)

Walk into your favorite family restaurant. In Minnesota, I mean Perkins, but this will be true at Denny’s. Huddle House, even McDonalds. The best time is between 9:00 AM and 2 PM. Look around for people who appear to be 65 or older.

My bet is that “seasoned citizens” far outnumber the others. It is safe to assume that almost all of those older folks are Medicare enrollees. The fact is, without Medicare, some of them would be “pushing up grass” (to quote Rush Limbaugh).

Instead, there they are, some of them every day, or several times a week, eating a price-discounted breakfast or lunch, sipping on a “senior coffee,” and having a great time. At 63, I think I can say this openly: I love old people, especially when they’re having a great time.

The idea struck me, as it will strike you now, that without Medicare and Social Security, most older Americans would have barely enough money for necessities – like home-cooked food, and shelter (and health care).

Think of it. Without Medicare and Social Security, many older folks might have to rely on younger people, maybe even live with them. Our society decided decades ago to ensure that grandparents remained independent from their adult children. About this, I make no value judgment, but it has created an irony, and a very expensive one that at. Every American aged 30 or younger today owes $289,000 just to pay the unfunded Medicare debt.

You might be thinking that I have this all wrong. After all, don’t we pay Social Security and Medicare taxes on income to prepay our own cost of government retirement benefits? Well, no. The taxes we pay today pay the cost of benefits for today’s retirees. It won’t be long when two income earners will be required to pay the Social Security cost of one retiree. Today’s young people will receive Social Security and Medicare from children not yet born.

But thanks to Medicare, since it protects older folks from financial catastrophe due to illness, there is money for a daily trip to Perkins. There is also money for Branson, time shares, golf, a winter home, Starbucks, shopping malls, travel, symphonies, and most church donations. Without Medicare, young working Perkins’ servers, paying income, Social Security, and Medicare taxes, would have no job at all. (Or, wait a minute. Maybe they would have a better job. We can’t know that.)

A Boston actuary calculated that each Medicare recipient will spend about $250,000 more in health benefits that they paid into the system. By my calculations that will buy 41,650 Perkins lunches at the senior discounted price of $6.00.

To add a little fun to your next trip to Huddle House, see if the older fellow at the next booth orders off the senior discount menu. Thank you President Lyndon Johnson for Medicare.

Medicare makes dining possible

2011-05-12T13:13:00.000-07:00

To add a little fun to your next trip to Huddle House, see if the older fellow at the next booth orders off the senior discount menu. Thank you President Lyndon Johnson for Medicare.

Exchanges are not the same as the Federal Employee Health Plan

2011-05-10T15:02:00.001-07:00

Exchange supporters talk about the Exchange as the same model as government employees “enjoy” through the Federal Employee Health Benefit plan (FEHB). But it is not true.

The Affordable Care Act (ACA) of 2010 requires all 50 states to launch health insurance exchanges by January 1, 2014. If they do not, the federal government will do it for them. Exchanges, its supporters allege, will make health insurance more accessible for the masses.

FEHB officials brag that government employees have hundreds of insurance options from which to choose. True enough, at least for individuals that live in multiple states at the same time. But for real humans who can only live in one place at a time, there are only a handful of choices, just like normal non-government employees.

The FEHB plan uses what is called a defined contribution model (others call it a voucher). Simply, the government gives its employees a defined per-month amount that the employee can use to purchase their health insurance.

The federal employee can apply their voucher to the purchase of the few plans available to them in the state in which they reside. If the employee chooses an option that costs more than what the government allows, the employee pays the difference.

ACA-supporters claim that private employers and employees would relish the same opportunity afforded federal government employees in the FEHB plan.

The Massachusetts Connector, in its never-ending attempt to entice more people to enroll, modeled a program after the FEHB plan. “[Private] employers would offer employees a fixed ‘voucher’ and allow them to choose any plan or carrier [in the Connector]. This was a failure and was discontinued.”[i]

Why did the Connector’s private employer voucher system fail? It provides a clue as to why FEHB’s plans are different from those owned by normal, non-government employees.

Government employers pay much more of the employee’s health insurance cost than private employers pay for their employees. The Employee Benefit Research Institute (EBRI) found in 2008 that the employee health benefits paid by governments cost 235 percent more than those paid for by private employers. In other words, private employers insure 2.35 employees at the same cost as the government insures one.[ii] (Are you surprised?)

Perhaps just as startling are the differences in overall employee compensation. Government employees enjoy a 151 percent more generous compensation package than the private sector employees that pay the taxes to support them.[iii]

The government employee premium subsidy for FEHB plans is large enough to cover most of the cost of a family health insurance policy. Private employers cannot afford to subsidize family health insurance to the same extent as the federal government does in the FEHB plan.

In Minnesota, for instance, state taxpayers subsidize 100 percent of an employee’s health insurance cost for the basic plan, and the employee pays only 15 percent of the dependent’s premium. Total premiums for both exceed $16,000 a year – thank you taxpayers.

Private employers may pay 50-80 percent of an employee’s premium, but many pay far less for dependent coverage. And very few small group Minnesota employers provide family coverage at $16,000 a year. Only government employers can afford such luxuries.

An Exchange FEHB-type voucher plan could only work if it provided much less expensive coverage than Federal employees “enjoy.” Most private employers could never provide funding for the family coverage common to the FEHB plans .

The Massachusetts Connector has already demonstrated that a FEHB plan does not work for private employers. Soon after states or the federal government launches Exchanges, we will all understand the same fact.

After all, the primary purpose of the Exchange is to enroll people in tax-subsidized health insurance. The end game is to create more dependency on government.

[i] A Massachusetts’ government insider, whose identity is protected, provided this insight.

[ii] Fronstin, P. (2008) “Benefit Cost Comparisons Between State and Local Governments and Private-Sector Employers.” Employee Benefit Research Institute. Washington, DC. June 2008, Vol. 29, No. 6, p. 3.

[iii] Ibid.

Realtors Online is not a Health Insurnace Exchange Model

2011-05-09T07:11:00.000-07:00

President Obama says health insurance exchanges work like a Real Estate website. He’s expecting you won’t think too deeply about it, because if you do, you’ll see how foolish a comparison it is.

Let’s buy a house using online tools at the current “Real Estate Exchange.” We enter data about where we want to live, how much we are willing to spend, and other desirables such as distance to schools, churches, parks, and other amenities.

Once we enter our data, the web engine spits out some options. Then we call a realtor. We do not point, click, and purchase the house that looks right for us. But let’s consider for a moment that President Obama designed a Home Owner Purchase Exchange (HOPE) and we did purchase homes this way.

First, we find limited choices: maybe five models. These might range from 800 square foot starter homes (or retirement homes) to extravagant 1,400 square foot family homes. To make sure states feel they are a part of the plan, the federal government would allow legislators to design the interior and exterior, as long as they stay within federal limits.

Our HOPE works like the Massachusetts CommonwealthConnector, the nation’s “most successful” health insurance exchange, with its seven plan choices – down from 24 at its inception. Why? Because the Connector is not capable of providing customized choices, and the people do not know there are many options beyond what the Connector offers.

Second, the primary reason we want to purchase our home on the HOPE is to receive federal mortgage payment subsidies. Why not? If an insurance exchange is like a Realtor website, then the HOPE would have mortgage subsidies (WARNING: do not share this with any member of Congress). In the HOPE, our federal government pays part of our mortgage based on our income, or lack of income. So what if we only have seven home styles from which to choose: We should be thankful that the government allows us so much freedom.

In Massachusetts, the average health insurance premium for a non-smoker 40-year old on a family policy is $2,000 a month – more than a mortgage payment. The Connector does not reduce premiums, it just uses taxpayer money to help reduce the individual’s share of premium.

Now, here is how the real world Real Estate Exchange works as a private market health insurance exchange: Go to http://dci.buymnhealthinsurance.com/plansearch.aspx and you will find 137 health insurance choices. After you input basic data, you will want to talk with the agent about the one that best fits your situation.

Private market health insurance exchanges already exist. If the goal of the federally imposed exchanges was simply to help people find health insurance, it has no need: The need is already being met in the private market.

So why does the ACA require a federal/state health insurance exchange when http://dci.buymnhealthinsurance.com/plansearch.aspx already exists everywhere, all across the nation?

The primary purpose of the exchange is to subsidize health insurance premiums. When the federal government achieves its goal to subsidize the health insurance premium payment of up to 60 percent of the population, it will control all of health care.

Gray is a real color

2011-04-29T11:53:00.000-07:00

Wide swaths of private liberty should never, ever fall to political oversight. Once politics engages, liberty, pretty much a black and white concept, becomes grayed through the political process.

“Gray or grey is a color seen commonly in nature. It is created by mixing white and black in different proportions. Depending on the amount of light, the human eye can interpret the same object as either gray or some other color.”[1]

Politics drives me crazy, in some measure because I can't rid myself of passion toward it. Otherwise, because it is an endless sea of gray coloration, and I want to be a black or white kind of guy. For those who see political theory through rose colored glasses, the truth is your vision is distorted.

Here is a great example. I see Medicare, just as ObamaCare, as unconstitutional. You might think I am irrational for thinking so: but the United States Constitution does not enumerate the power for the federal government to create a national health insurance program. If you find it, please tell me where and why you believe it to be true.

On the other hand, Medicare is engrained in our national psyche. Trying to save it by modifying it may send Republicans to the back bench. What are we who see black and white to do about this? Would we be better off with a rigid, perfectly white view of Medicare’s nature, and then tilt at windmills trying to undo it? Or, do we try, connive, coalesce, and work incrementally to remove some of its most perverse aspects? In other words, do we shade our black and white view to become more gray in the hope of eventually restoring some semblance of constitutional balance?

ObamaCare is patently unconstitutional, despite what the Supreme Court might eventually rule. But what if the Court only chisels away the individual mandate, and leaves the balance intact? Obama’s devotees, who also see things as black and white (I might have said red and white), argue that the mandate is required for the whole bill to work. Obama’s detractors argue that the mandate is required for the whole bill to work. This is about the only aspect of ObamaCare upon which they agree. This odd agreement could mean nothing to the Court.

The Court very likely could rule the mandate to be unconstitutional, and let the balance of the bill stand. Such a ruling would protect the federal government from endless state-led lawsuits on any new federal law a state despises, and upset federal sovereignty. My bet is the Court will finesse this gray decision, and leave the country in confusion.

We who prefer black and white politics to gray politics are likely to be engaged for the next 20 years trying to adjust the shade of gray to more closely match our own perspective. We may be forced to attempt to reform health insurance exchanges, or accountable care organizations, or defang the competitive effectiveness crowd, while at the same time making it appear we are not trying to rid ourselves of them. This is highly frustrating to a black and white guy which finally gets me to the whole point of this article.

As politics has touched health care, we have been subjected to an endless cycle of grayed policies that do nothing but pit freedom-loving people against powerful political factions and yes, the hated interest groups. If ObamaCare stands, we will have lost what little liberty remains.

[1] http://www.wordiq.com/definition/Gray_%28color%29

Cong. Ryan takes one step toward Medicare cure

2011-04-07T13:01:00.001-07:00

If we want America to survive, we have to fix Medicare (and a host of other entitlement programs).

Since Medicare’s launch in 1966, politicians have continuously tinkered with health care and methods to pay for it. Today, reasonable and honest politicians (no, that is not always an oxymoron) realize Medicare threatens our children’s financial future.

The simple fact is that each person younger than 30 years old already owes $289,000 to pay the unfunded cost of Medicare. There is no equivocation on this: Medicare is broken, and we cannot afford it as it is currently financed.

What solutions can we offer, other than government rationing of health care to Medicare enrollees? Cong. Paul Ryan got us off dead center this week by recommending what he euphemistically calls “premium support” payments for those individuals enrolling in Medicare starting in 2022.

(Premium support is another name for tax subsidies which is another name for welfare payments, if I might be so bold. Why do I say welfare? Because Medicare enrollees today and tomorrow will receive medical services valued far beyond the dollars they contributed to the program. You can call it Medicare benefits, but I call it welfare for old folks, like me, in 2012.)

Now don’t get me wrong. I commend Ryan for taking the first step. But we must do more.

The Democrats’ answer to Medicare and health care’s soaring cost is to tax us more, create new government bureaucracies to launder the money, and then expand the programs. Reid, Pelosi, and Obama decided to pay for this the backs of “high” income earners and every day citizens. For “high income” earners, the Democrats increased taxes on their incomes – more income taxes and fewer dollars to invest in new businesses and jobs.

Democrats also added tens of billions in user taxes to fund Obamacare. These are taxes on consumable medicines and durable medical products, plus a tax on health insurance. These types of taxes better fit the Founding Fathers’ concept of taxation – excise taxes, user taxes, consumption taxes – but they never favored income taxes.

Fixing Medicare, in my humble opinion requires the following (although I hold my nose with anything smacking of income tax manipulation):

1. Means test Medicare by requiring those with greater incomes and assets to pay a larger share of their own cost. This is not necessarily good, but it is better than having everyone regardless of income and assets pay the same. Why should Billionaire Warren Buffet qualify for the same benefit at the same price as Warren Smith, whoever that is?

If the idea of requiring individuals to spend down their personal assets for their own health care is repugnant to you, if it makes more sense for children yet unborn to pay these costs, then I will change my position on the death tax: If you want to stash your mattress with cash and use my grandson’s piggy bank to pay for your health care, then let’s take 50% of your estate in taxes when you die.

2. As Cong. Ryan’s bill would do, let Medicare pay a flat amount to the health plan of your choice for coverage. If you want a rich plan, go ahead, but use your own money to pay the difference. If you want a stripped down plan, by all means, do so. You choose, not the government. However, being able to afford the coverage you want might mean tapping your own funds and that is why I added the next step.

3. Expand the use of Health Savings Accounts (HSAs). HSAs provide a safe haven for your hard earned income, and allow you to accumulate money in a non-taxable savings account. This money can be used to pay all manner of health care related expenses.

4. Allow doctors to “balance bill” their patients. This means that doctors would be allowed to charge you a real price for medical services instead of the reduced price the government allows them under Medicare today. Balance billing is currently illegal, and partly explains why nearly 30 percent of doctors will no longer see Medicare patients.

5. Here is the toughest change. Extend the age of qualification to enroll. Start it now. Perhaps 67 for my age group, and then move it to 71 over the next 10 years. Then index it in relationship to life expectancy.

Medicare has become a pox on us. Of course, I understand it has provided health care to tens of millions of people. I get it. But it also opened the door to endless meddling by politicians and as a result, when compounded by other Great Society programs, today our nation faces financial ruin.

Let’s find the courage as a people to face the fact: Medicare, Medicaid, federal government solutions, threaten our liberty. Let’s get on with this first step toward sanity.

Q: Where do you get the best price for an MRI?

2011-03-31T18:15:00.001-07:00

How can you find the best price for an MRI (and why would you care)? I should have gone to Medibid.com, but didn’t. “My bad,” as the kids say.

My wife tore her meniscus during 2009. By the spring of 2010, the pain had finally became too great. We though she needed surgery. Since we have a Health Savings Account (HSA), though, we wanted to make sure an expensive surgery made sense.

We headed to Summit Orthopedics to see Dr. Jack Drogt.

Drogt suggested first to treat her with a cortisone shot, rather than recommending an MRI and surgery. That made sense. The shot, at $180, could knock the pain down and surgery – at thousands of dollars – could be unnecessary. (He never said it, but I suspect this is a practice guideline for all but the most obvious surgical situations.)

Weeks later we returned with the sorry report: The knee hurt, and perhaps even more. Drogt prescribed an MRI with a consultation thereafter.

Can you tell me the price of an MRI (no fair looking at an Explanation of Benefits – once you have that, it’s too late to worry about price)? Have you ever asked? If you did, would anyone tell you? Do you care about the price? You do if you have an HSA and want to hang onto your money.

In Minnesota, the law requires doctors, hospitals, and insurance companies to tell you ahead of time the price of a medical service, product, procedure, medicine, and so forth. The law (Sec. 62J.81) calls this price quote a “good faith estimate;” like going to the auto repair shop to get new brakes. Auto mechanics are used to giving you an estimate – doctors not so much, but this transparency idea is a new thing.

I called three MRI service providers. One quoted $1,050. A second, $980. These two clinics were free-standing, non-hospital based. I knew better than to call the hospital for a quote, because I had made that mistake in 2008. The third option, an MRI machine dragged around in a 40’ trailer, gave an $750 estimate, but I felt wary of their service.

I also knew about Smart Choice, an MRI clinic in Milwaukee. Smart Choice promises a $600 price for all MRIs, regardless of what kind of scan the doctor prescribe. I had to decide whether it was worth it for me to drive five hours to save the money, and therefore, chose not to do so.

We chose the $980 option – and wasted $600. I could have checked Medibid.com, and received the MRI for less than $400 at a clinic just a few miles away.

Medibid.com, founded by my good friend and Canadian expatriate Ralph Weber, allows a person to input a request for bid for a variety of medical procedures, including MRIs. You should check out Medibid.com right now (no, this is not a commercial and I do not get paid for it – I just believe in what they are doing).

Dr. Drogt performed the surgery, and my wife received therapy at his clinic. We spent several thousand dollars, but her knee seems “fixed.”

Drogt is a first-class orthopedic surgeon, but guess what? If I would have gone to Medibid.com, I could probably have found an equally first-class surgeon in a nearby community to do the surgery and saved hundreds or thousands of dollars. (Now I remember!)

I tell you about Medibid.com because it is an example of how the marketplace can answer the health care pricing problem. It is not “the” answer, it is “an” answer.

What we must guard against is a government bent on destroying the Medibid.com types of innovation or the two people working day and night in a garage somewhere to create the next miracle medical device.

What I fear, and fear is the right word, is an Independent Payment Advisory Board deciding that even though Medibid.com is a fabulous idea, it does not fit their payment model and therefore, must be shut down. Or, it must be shut down because Ralph Weber is an outspoken critic of government-run health care.

Board to Death and The Coming Revolution

2011-03-26T13:44:00.000-07:00

No, I did not get the headline wrong. Using independent boards to strip us of our freedom appears to be the modus operandi of the Obama administration.

Since my focus has been on health care reform for the past six years, I have not kept up with the broad range of constitutional concerns to which we all should pay attention. My sense, however, has been that the Obama administration is busily, and often quietly, carving out a series of administrative cabals that threaten to choke off liberty: You have heard of the czars?

Czars run this or that project, and many do not answer to Congress nor to voters – only to the person that appointed them: President Barack Obama.

Each czarist fiefdom seizes on one or another project “in the public interest” with the clear intent of controlling the organic behavior of private industry, or that of private individuals. Simply stated, your personal liberty is being eroded by a group of nearly-silent streams of incremental bureaucratic overreach. You know you feel uncomfortable, but not quite able to decide if it is something about which to fuss or fume.

Perhaps this will help bring some focus: Stories about two of new federal ruling boards intersected on my digital desk this week, causing me to finally put pen to paper (or keyboard to software).

· The Consumer Financial Protection Bureau

· The Independent Payment Advisory Board (IPAB)

Taken by themselves, these two command structures are reason enough to recall the President – but darn it, the Founders never gave us that option, except at election time.

Elizabeth Warren runs the Consumer Financial Protection Bureau cabal right out of the White House. Despite Congress and the law, knowing the Senate would never approve of her appointment, Pres. Obama let her set up shop without bothering with the constitutional nuisance of actually getting the U.S. Senate to approve her appointment.

Warren and her Czarist Bureau, with a projected budget of more than $500 million, answers to no one, except on paper (written with disappearing ink). She is already badgering banks to shake them down to refinance home mortgages. Warren believes mortgage holders should cough up $20 billion, sometime before the 2012 election, to write off mortgage principle for thankful debtors – called voters.

“But,” you protest, “One of the primary obligations of government is to enforce legal contracts.” Czar Warren, however, threatens to use government police power to cajole unwilling contract-holders – mortgage lenders – into giving up their legal rights.

Next is the 15-member Independent Payment Advisory Board (IPAB) created by the Democrats with the “Affordable Care Act of 2010.” We will someday come to call this the Absolute Coercion Act.

The IPAB will execute a financial stranglehold on how, how much, when, and what for doctors, hospitals, and health care providers are paid. Never mind the individual medical needs. Never mind the financial aspects of providing medical services. The 15 Czars in the new command-and-control health care system will decide what is good for us, and how much professionals should be paid to favor us with it. Is there anyone on the planet that can call this liberty? Yet, it gets worse.

Although the Absolute Coercion Act of 2010 (see above) requires the President to win Senate consent for the 15 IPAB Czars, that does not mean it will happen. The Congressional Research Service explains:

“There is no constitutional or statutory qualification on the President’s ‘Power to fill up all Vacancies ....’ Because the President’s recess appointment authority is unqualified, it appears that he could fill member positions on the IPAB by recess appointment during any period when he could otherwise make such appointments.”[1]

Silly idea, apparently, requiring presidents to get the approval of elected U.S. Senators for the appointment of people that will hold the power of the federal purse in their hands.

Knit these two boards together (the IPAB and the CFPB). Political appointees of the current president, without the approval any single elected official or a single citizen vote, will hold power over lending, shelter, life, and death. But more worrisome: These are but two of the many federal fiefdoms fostered by this president.

The Declaration of Independence makes it clear: Government serves by the consent of the governed. Government is established for the singular purpose of protecting the unalienable rights of the governed. Among these unalienable rights are protecting human life, securing individual liberty, and providing maximum latitude for the individual decisions we make about pursuing our own happiness.

The Obama Czars are a direct assault on unalienable rights, a clear violation of the purpose of government, and war against government by consent of the governed.

The Declaration also states clearly that once government has thrown aside the rights of citizens to consent to their government, citizens have the right and duty to throw off that government, and create new forms that will protect rights. We still cling to the hope of correcting this at the next election. Pray that we will do so, because if we do not throw out the Czars in 2012, what follows after will make the American Civil War look like an afternoon skirmish.

[1] Staff. (2011). Independent Payment Advisory Board Membership: The President’s Recess Appointment and Removal Authorities. Memorandum. Congressional Research Service. March 18, 2011. Washington, D.C.

$289,000 or maybe $812,000

2011-03-08T19:33:00.000-08:00

I am going to suggest we are not good men [people]. “A good man leaves an inheritance to his children’s children… Proverbs 13:22A.

The two numbers that title this missive relate to the unfunded Medicare (just Medicare) debt we are leaving for our children, children’s children, and even their children. It is immoral.

According to the U.S. Census Bureau, about 128 million Americans are 30 or younger. These are the ones that will be paying the unfunded Medicare debt. The debt, depending on whose numbers one uses, and the assumptions you accept, ranges from $37 Trillion to as much as $104 Trillion.

We are leaving our progeny with somewhere between $289,000 and $812,000 (or more) each to pay for our profligate health care spending. Some people blame the 78 million Baby Boomers for this (I am one, and Medicare eligible in 2012). I blame politicians for being gutless.

Oh, did I mention, this is only the Medicare debt, and does not account for Social Security shortfalls, or the Obama deficits.

A farmer that eats his seed corn dies. A nation that consumes its children’s inheritance dies, and deserves to do so.

As a 63-year old father and grandfather about to become Medicare-eligible, I suggest four immediate changes to Medicare coverage (if those already on Medicare refuse to participate, so be it – nothing stops us from embracing change):

1) Delay enrollment for Baby Boomers. I am 63. I will wait – 70 sounds like a good starting point. And then index it.

2) Means test it.

Medicare is a welfare program. There, I said it. Welfare. The average Medicare enrollee today has paid in less than $40,000 over a 40 year work life, and will receive more than $250,000 in free services during Medicare enrollment. That is a welfare program.

3) Allow doctors and hospital to “balance bill.” This means, let medical providers charge a fair rate, instead of the underfunding they receive today. Without doing this, Baby Boomers will seldom find a doctor willing to serve them.

4) Change Medicare to a defined contribution program. Instead of paying for benefits, no matter what they are, provide a fixed amount each month to be used to purchase health coverage. The Medicare enrollee will have to make up any difference in cost (yes Matilda, we can make some arrangements for low-income welfare recipients, but it’s the middle-class and wealthy Medicare welfare recipients that need to start paying their own way.

5) (Yes, I know I said four, but this one is profound enough to make you think. Maybe it’s time we came face-to-face with the reality that we do not have the right to live forever, when it means we steal from our great-grandchildren.)

Let’s have a robust discussion about this. How many of you could care less about what we leave for our children’s children? Okay, you three move further to the left. The rest of us want to fix this problem.

Federal health care reform - Does it promote an evil practice?

2011-02-11T17:40:00.000-08:00

Despite the fact that I have written 25 books, a thesis, and hundreds of papers, apparently, I am a failure at writing this kind of information. Why? Because already, a number of you who have contacted me about this piece have missed the whole point. So I am going to beg you, please, please, read the whole story. Do not make any judgment until you read it all. Then write down the point: The point is that the federal law declares that what doctors are taught and what they believe, even what the law says is illegal, is suddenly okay because it is practiced in a government-approved mega-corporation. Now, if you cannot get that out of this article, please write me immediately so I know that I am compelled to go take a "Blog Composition 101" course.

What I am about to say uses a make believe doctor to tell a story. As you will hear shortly, what he does is immoral, unethical, illegal, and even evil. But almost no doctors do these things.

I am going to illustrate how the Affordable Care Act of 2010 throws ethics overboard to replace them with institutional behavior that would land a corporate leader in prison.

For purposes of this story, we’ll call your doctor Smith. How would you respond if Dr. Smith looked you in the eye and said: “You need an MRI for your sore finger, and I want you to use my clinic, the Smith Radiology Clinic across the hall.” Unless you own a piece of Smith Radiology, you would probably be incensed, not that the doctor owns another medical practice, but that he seemed to be forcing you to use his facility.

Let’s try another. “That really is a nasty rash you have there,” Dr. Smith says, “and I want you to go to Dr. Jones, the dermatologist, to have her look at it.” He fails to mention that Dr. Jones sends him $25 every time he does this. If you knew that Dr. Smith got a kick back (called fee splitting) from Dr. Jones, you would certainly find two new doctors.

And one more. “You appear to have hurt your right arm and left foot,” Dr. Smith says after examining you. “Let’s look at your arm today, then I want you to come back tomorrow so I can examine your foot.” He winks and adds, “That way I can charge two office call fees. But don’t worry, your insurance covers the cost.” That would be the last straw. Good bye Dr. Smith.

Dr. Smith, in this scenario, is motivated to do as many procedures as possible to wrestle away health insurance money, or your own. This is a nasty idea, and despite what Big Government planners want you to believe, the practice is limited to a tiny percentage of doctors.

If you discovered that Dr. Smith did self-referrals, fee-splitting, and manipulated the system to get more than one office fee, you would report him to President Obama, the FBI, and worse yet, Nancy Pelosi. What an outrage this would be.

This behavior is also illegal in most states, and unethical, immoral, and evil in all…until, well, until Congress passed the new health care law.

An Affordable Care Organization, called an ACO, is one of three lynchpins of the new law (the other two are insurance exchanges and the inevitable reduction in the number of health insurance companies). Here is how the ACO works:

Medicare, and eventually all medical payers, pays a flat fee to the ACO to pay for your medical services. You have access to all the doctors and other medical providers under contract or employed by your ACO.

If Dr. Smith is employed by or under contract to the ACO, he makes more money by providing fewer medical procedures. The fewer procedures Dr. Smith does, the more money retained by his ACO, and ergo, his bonus is greater. This is really the same thing Dr. Smith used to do when we called it evil, but it is in reverse. Before, more medical care and more money. In the ACO, less medical care and more money.

Rather than fee split with a doctor friend, however, Dr. Smith now does his fee splitting with the ACO, and the federal government blesses him for it. When Dr. Smith sends you to a dermatologist or radiologist under contract with his ACO, he receives a gold medal for sticking to the plan, and incidentally, the ACO gets paid. It is true that Dr. Smith would probably examine both your arm and leg the same day, but he would do it as quickly as possible. Or, more likely, the ACO will have Nurse Practitioner Johnson or Physician’s Assistant Peterson see you – they cost the ACO less, and leave more on the table for Dr. Smith.

Studies show that when doctors work under contract where they earn a salary their productivity falls – often as much as 50 percent. In the new ACO, Dr. Smith can work less, make more, and still be able to self-refer and fee split, plus get back door fees from his ACO peers. What a deal.

The federal reformers tell you the ACO is a better way to deliver health care than a fee-for-service plan: It is true if your doctor is immoral, evil, and unethical, like an ACO. The purpose of the ACO is to consolidate services in a closed system to cut cost. While it may be true it would be effective helping people with chronic illness get more coordinated care, it does so using the very reimbursement arrangements it labels illegal or immoral when done by individual doctors.

ACOs that rely on self-referral and fee splitting, which they do, should be judged by the same standard you use on Dr. Smith. But if you complain to President Obama, he will “call you out,” and Nancy Pelosi will whine and shake her finger at you.

Over time, I plan to share the 50,000 foot picture of the ultimate intent of ACOs, Exchanges, and massive consolidation of care and insurance. Just stay well, please!

Judge calls out Congress as constitutionally stupid

2011-02-05T10:52:00.000-08:00

Politicians should avoid tempting the constitution, because principled judges can make them look stupid.

Federal Judge Roger Vinson recently overturned the new federal health care law. He did this because the mandate that would force everyone to sign up for health insurance is unconstitutional. Note that I said it is unconstitutional. Not too long from now, we will learn if the Supreme Court also understands the constitution.

Almost two years ago I offered to be the lead plaintiff opposing the individual mandate. Thank goodness, 20 state attorneys general did this on our behalf.

I teach the constitution. My high school students can read it and pretty much understand it. They read it in plain language, and in the context of the Founding Fathers who wrote it. But more importantly, they learn that it is a document of enumerated powers, not of unlimited powers.

If the Democrats that passed the new health care law knew this truth, that the United States constitution tells the federal government what it can and to some extent, what it cannot do, they would never have passed the individual mandate. If Congress stuck to the spirit and letter of the constitution, they could have avoided having this judge make them look constitutionally stupid.

For years, of course, the federal courts have also ignored the constitution, and wrote their own modern ideas into their decisions. We now know, clearly, that when men choose to make up laws as they go along, without regard to rules, we end up with confusion. Confusion may be good for lawyers, who earn their living off it, but it is bad for citizens.

That is why I am so astonished when several members of a Minnesota State Senate committee recently said, “We deal with health policy. We don’t deal with constitutional issues. That’s not our job.” I hate to say it, but it is true. The Senators that said this were all Democrats, and so were all of those that voted for the unconstitutional federal health care law.

Even more astonishing, however, were the comments of Hennepin County Board Chair, Mike Opat. Yes, he, too, is a Democrat. When asked specifically if the constitution was important to the county board’s decisions, Opat said, “I believe the constitution is irrelevant to what we do at the county. We are reactive.” Well, how about reacting in concert with the law, Mr. Opat? And State Senators, and Federal Congress members?

This thumbing of the nose at the constitution by legislators and other government policymakers is exactly why Judge Vinson’s ruling is so important. If our policymakers are free to create any and every kind of scheme they devise, without regard to the rules under which we the people have ordered them to live, then we do not have a government – we have an oligarchy, aristocracy, or worse, a dictatorship of the chosen ones.

So paradoxically, one of the blessings of the unconstitutional federal health care law is that we finally, might actually get to talk about the rule of law again. We might get to teach lawmakers and citizens alike that We the People are in charge, not them, and we will enforce the constitution.

Do we spend too much or does it cost too much?

2011-01-31T08:35:00.000-08:00

We can’t even ask the right questions.

Maybe it’s the writer in me, but it drives me nutty when smart, educated, informed people say we have to cut health care cost, when that’s not what they mean. What I believe they mean, taken from the context in which this phrase is usually used, is that we spend too much on health care (and I believe that assertion is hard to defend).

The evidence of what I say? Listen to the discussion. “We spent $2.5 trillion on health care, 16 percent of our GDP. We have to cut the cost of health care.” So, do we spend too much or does it cost too much? Furthermore, is health care spending a good thing or a bad thing?

Cost. Every purchase we make reflects built in cost. Cost includes labor, materials, administration, marketing, and various other overhead expenses. The cost of a pacemaker, for instance, includes research, development, marketing, the buildings in which all this is done, taxes, snow plowing (lately, all across the country), administration and a whole lot more. You get the idea.

Price. Every purchase carries a price. Price is different from cost. Price usually reflects cost plus some degree of margin. If the total cost of making a pacemaker is $15,000, and the manufacturer wants a 10 percent return on investment (before taxes), the price will be $16,670.

Spending. When all purchases are combined we can arrive at a spending level. Spending includes cost and price, plus use or the quantity of purchases made. My insurance buys me a pacemaker. Nine others in my town also receive pacemakers (thanks to their health insurance or government health plan). Our health care payers just spent $167,000 on the pacemakers (plus at least that much for the doctors, surgeons, scanners, MRIs, X-rays, blood test, hospital room, surgical center, etc.).

Every facet of the health care industry reflects cost and selling price. Spending reflects purchase quantity.

The definitional difference is critical to our health care redesign debate. Because spending, quite frankly, is directly related to rationing. Someone is going to ration health care because someone has determined that we spend too much in the aggregate, or we spend too much on a certain type of procedure.

The best way to control cost, on the other hand, is through competition. When Smart Choice of Milwaukee figured out how to do all MRI’s for $600, it should have resulted in other MRI providers finding a way to reduce their cost if they want to stay in business. Unfortunately, the third party payer system seems to prefer to pay a higher price and real cost competition falls aside.

Yet, at $600 each, we cannot say whether health care spending would fall just because the price is less – because Smart Choice found a way to reduce cost. Spending could very well double as more people turn to less expensive MRIs in place of less effective but cheaper X-rays. Such is the nature of health care spending.

Ask your health care guru, Congressman, or state legislator this question: Do you intend to reduce health care spending? Or do you intend to reduce the cost of health care?

There is something Congress and legislators can do to reduce cost, and they ought to do it quickly. The cost of business regulation in the United States during 2009, according to The Wall Street Journal, was $1.75 trillion dollars or 14 percent of GDP. What if a miracle occurred, and elected officials decided to reduce the imposed cost of doing business that result from over-regulation? These regulatory costs are included in every increment of health care cost.

If the government-imposed regulatory cost were reduced, the price of health care services would fall, thanks to competition. This is a winning strategy, but it does not address the other question: How much do we and should we spend on health care?

Stay tuned.

Congress actually is doing something constitutional

2011-01-25T16:47:00.000-08:00

Republicans in the U.S. house want to cut federal spending back to the 2008 level. That’s a good start.

Consider the irony of this, however. The cuts they are proposing now, in 2011, are not for 2012’s budget. They for the current budget.

The Constitution is quite clear about what Congress is supposed to do – somewhat less clear, thanks to the Supreme Court and some very aggressive politicians, about what it cannot and should not do. One of the very clear tasks is this: appropriate money.

All bills that spend money must originate in the House, so says the Constitution. The Senate cannot create bills to appropriate money, although they certainly can, and so, amend them – billions in earmarks each year. The President cannot write a bill to spend money – all he can do is find creative ways to spend what Congress allows.

The point is that it is a primary responsibility of Congress to figure out appropriate, constitutional ways to spend money. That is why Congress passes a federal budget every year except, well, last year.

Instead of passing budget, which is their constitutional obligation, Congress bailed out big business, wrote a federal takeover of health care, grabbed more power over banks, started the process of dictating rules and regulations, and a plethora of other constitionally questionable actions. Is it any wonder that voters threw out the old rascals and elected new ones?

The new House, however, actually seems to want to listen to and obey the Constitution. They had the gall to actually read it aloud on the House floor – can you imagine? Now, the House actually wants to write a budget, and properly appropriate money. Will wonders ever cease?

Imagine the incredible freedom we could all enjoy if Congress and the President focused on what is constitutional, instead of the continuous increase in federal power over us. Imagine. Well, like our founding fathers imagined.

Given a chance to do it right, maybe the GOP will usher in a new day in a America, a shining city on a hill. But let’s be clear about this: it will only happen if We the People continue to lead and insist on it.

Accountable Care Organizations: Accountable how, to whom, and how does that work again?

2011-01-18T17:43:00.000-08:00

Take a look at the two pictures included in this article.

The first one is a picture of our health care system – many disconnected or sort of connected pieces that work in a relatively chaotic manner to deliver care. This system is very hard to manage and by nature, is beset by some level of inefficiency. It is also, however, extremely dynamic and able to quickly add new technology, practice concepts, treatments, medicines, and evermore refined medical delivery.

The second picture is how the Affordable Care Act wishes our health care system could look – an organized, coherent, manageable monolith. This is kind of system that can more easily be managed from the top down, like the Army, a football team, or a single payer health care system. (Actually, the analogy falls apart with single payer; it’s just a way of saying that is what single payer adherents believe to be true.)

The Affordable Care Act of 2010 (ACA), the new federal health care law, in trying to create this coordinated, efficient, top-down health system model, points toward three large organizational structures to accomplish its goal: The Health Benefit Insurance Exchanges (one in each state), consolidation of health insurance companies (the eventual result), and Accountable Care Organizations (ACOs). Here I want to briefly address the ACOs, and will leave the others to another time.

Dr. Richard Reece, who has been writing about health care reform efforts for nearly 50 years, calls ACOs, “Another attempt to herd doctors into large organizations.” Other of my MD-friends call them “HMOs on steroids.” Or, “super-sized HMOs.”

The simple definition of an Accountable Care Organization is this: a broad system of doctors in a wide variety of practice types, along with hospitals, clinics, and other health care service providers. ACOs will deliver services under contract with the Centers for Medicare and Medicaid Services (CMS). ACOs will also contract with private insurance companies. CMS believes by bundling care into these super-sized HMOs, it will be able to accomplish several purposes, the most important of which is to reduce the cost of health care.

The “Accountable” part of the ACO is designed to use manufacturing quality control concepts to evaluate the performance of a doctor or hospital. If the doctor follows the prescribed guidelines (i.e., is accountable), the doctor will be rewarded with a bonus. If the doctor fails to follow the guidelines (never mind the uncooperative patient that refuses to obey the medical cookbook), the doctor receives no bonus – and might be paying to keep his or her job.

It’s essential to understand that the ACO on its own is not designed to reduce the use of health care, nor will it reduce overall spending. Its purpose is to reduce the unit cost of care.

Using the ACO to reduce the cost of care is something like thinking that if we could eliminate small bakeries and have all pastries made and distributed from one source that our donuts would cost less. We will probably buy as many donuts or even more, but each one would save us a nickel.

I believe that the purpose of the ACO is to make it more possible for the federal government to manage the health care of everyone who receives care from an ACO. And who might that be? Well eventually, you, me, and everyone.

What’s a doctor to do?

Right now, doctors all across the country are trying to decide what to do about these ACOs. Do they sell their practices and go to work for the hospital or mega-medical system that sits at the center of the ACO? Do they try to continue in private practice, or in small, independent group practice? A cash only practice might work, unless you are a cardiac surgeon.

More regularly now, the march is toward selling a private clinic or practice to join the ACO, as if it is a matter of fate. Many doctors believe it is a way to escape from the underpayments he or she receives whenever a Medicare or Medicaid patient enters their clinic.

(For the non-doctors reading this column, understand that more than 75 percent of doctors report that Medicare’s payments for their services barely meet the hard cost of providing the service, or in fact, the doctor loses money every time he or she sees a Medicare patient. But even at that, Medicaid is far worse. Doctors report receiving as little as 28 cents on the dollar for each Medicaid patient. Therefore, many doctors are refusing to see anymore Medicare and Medicaid patients.)

When the doctor contracts with the new ACO, he or she may have walked into a trap, and it might be one from which extracting oneself is nearly impossible. Here is why: Hospitals cannot turn away Medicare or Medicaid patients. When the doctor joins the ACO in concert with a hospital (and an ACO cannot exist without a hospital), the doctor has by default agreed to accept Medicare and Medicaid payments for service. So what was inadequate before is just as inadequate in the ACO, except the doctor has no recourse, other than to quit the ACO.

The others that join ACOs – nurse practitioners, physician assistants, perhaps pharmacies, medical device resellers, etc. – to flee the Medicare and Medicaid reimbursement system will find themselves at the financial mercy of the ACO. The ACO, in turn, will be subject to the reimbursements it can win from the remaining, huge, private health insurance companies and the granddaddy of them all, CMS.

This is all driven, in my humble, yet studied opinion, by the belief that large organizations are more manageable and efficient than are small organizations. More so, that solving the health care “crisis” means that the federal government must be in charge. Here is the greatest worry about all this. The federal government wants Accountable Care Organizations so government planners can hold someone accountable. But, who holds the government planners accountable?

The Second Rule of Politics: The Single Most Important Vote

2011-01-14T12:21:00.000-08:00

Former Speaker of the House Nancy Pelosi, D-Ca., gave her “farewell” speech a few days ago. Then she handed Rep. John Boehner, R-Ohio, a huge new gavel. Pelosi’s symbolic gesture of handing over the reins of power is an incredibly important civics lesson.

You see, Pelosi never gave Boehner the gavel. Boehner earned the gavel by convincing the new GOP House Caucus to vote for him as Speaker. That singular vote is the most important vote the GOP members will take during the 112^th Congress (barring replacement of Boehner at some later date).

By electing Boehner, the voters that elected the GOP House majority created an entirely new governing structure. The Speaker, you see, is responsible to decide which committees will be created or allowed to continue, who will serve as chairs of those committees, and which members will serve on them. Sure, it is true that seniority plays a significant rule in choosing chairs and committee members, but the real power rests in the Speaker’s office.

Nancy Pelosi demonstrated the Speaker’s power by breaking enough Democrat arms to pass the Affordable Care Act of 2010. Using her power, she convinced dozens of Democrats to throw away their political careers and vote against their constituents. Don’t lose the lesson here: The House Speaker is more powerful than the constituents that send members to Congress.

How John Boehner uses his power as Speaker will be seen. I expect it to be more benevolent than Pelosi’s, but when the Speaker needs votes, he will get them.

The single most important vote, then, is the vote for Speaker of the House. In the U.S. Senate, it is for the Majority Leader. This will become more evident as the 112^th Congress gets about doing its business. The contrast between Sen. Harry Reid, D-Nev., the Senate Majority Leader, and Speaker Boehner will become evident quite quickly. Reid will be the obstructionist, running interference for President Obama. Reid has the power, albeit not to the same extent as Boehner, to stop good things from happening.

The Second Rule of Politics is, the single most important vote a member of the House or Senate takes is for their senior leader. And the second part of that formula is the party that holds the majority elects the leader.

Cong. Colin Peterson, D-MN, is viewed by many as a Blue Dog Democrat, willing to buck Speaker Pelosi and vote more like a Republican whenever principle demands it. Two things are wrong with this formulation: First, Peterson voted for Pelosi as Speaker. His own convictions, with this vote, took second place. Second, Peterson voted with Pelosi 92 percent of the time, and why not? She was his leader.

Next time you find yourself thinking or saying, “Well, all those other Congressmen are liberal but my Member is more like me,” remember this: The single most important vote your member will take is for the Speaker of the House, or the Senate Majority Leader. This is precisely why you must vote for the opponent of even the most benign, conservative Democratic Congressman or U.S. Senator. Vote wrong, and you lose it all.

Be sure to go to freemarkethealthcare.com and download the "Myths and Misconceptions" piece.

The First Rule of Politics - Proving to be True

2011-01-13T07:28:00.001-08:00

(This posting is also available as a video from on off-site server.)

State Senator Linda Berglin, D-Mpls., slowly made her way to her chair in the Minnesota State Capitol hearing room. She came 20 minutes late. As she reached her chair, she slowly panned her eyes across the gallery, trying to make sure everyone noticed her. She sat down slowly, and somewhat dramatically picked up her folder of hearing materials. No one cared.

Since 1972, Sen. Berglin served in the Minnesota House or Senate majority. For the last 18 years, she dominated the making of health care policy in the state. In other words, she orchestrated Minnesota’s march to the left. But after the 2010 elections sent her to the minority, things have changed for her, and for Minnesotans.

As I traveled last summer and fall talking about health care reform, I taught four political laws, the first of which is, “It is far better to talk with a legislator that believes as you do than one who is deaf to your ideas.” I used Sen. Berglin as my example, all across the country. Sen. Berglin, you see, is deaf to people who understand that a market-based approach to health care reform is far superior than a Statist approach. No matter how many facts we presented, no matter how many zany ideas we shot down, no matter how fiscally irresponsible was the constant expansion of government-run health care, she remained immune to what we had to say, acting as if she were deaf.

So, we changed the majority party and elected new committee chairs.

This past week, leaders from the Minnesota Association of Health Underwriters gave a Health Insurance 101 presentation to the House and Senate committees on health care policy. These are the committees that will write and rewrite Minnesota’s health insurance laws.

For the first time at least since 1992, these elected officials heard the story of risk pooling, underwriting, what agents do, how insurance works, and that there are better, market-based ways to deliver health insurance. It felt as though a cool breeze had entered the stuffy hearing room. I cannot over-emphasize how different this message was – 180 degrees – from what the legislature has been hearing for 18 years.

All of this is a result of electing a new majority, with leaders that are willing to listen to, analyze, and use ideas offered by people like us. The new majority has fulfilled the first law of politics.

Do not let this lesson be lost on you. If you have not elected a market-friendly legislature yet, make sure you do it in 2012. And if you have, as we have done in Minnesota, make sure you return that majority to power again. Start now, because I can assure you, the “deaf ones” are already plotting to grab back their power.

You might enjoy reading the “Myths and Misconceptions” piece I wrote for the legislators. Grab it here and download it. Spread it around to everyone. It’s really good stuff.

That's why I pay taxes

2010-12-28T07:07:00.000-08:00

Inspired even while on "vacation," the idea of Christian charity came to the fore this morning. The ultimate civics lesson centers on the individual's role and interaction with the citizenry to meet personal and corporate needs. The debate today,is over Christians rely so much on others to do what Christ taught were individual responsibilities.

Dr. Humphrey, my dear Masters' mentor, wrote to me yesterday about the woeful lack of Christian societal engagement in meeting the medical needs of American war veterans. Humphrey's personal charity toward veterans extends to helping them find the necessary medical care they need. His corporate vision is that the American Christian Church would step forward and bring that relief, rather than rely on a government bureaucracy to do so.

I posed Dr. Humprhey's question privately to Dr. Paul Speros, my personal optometrist (does that sound like an elitist statement?), and dear friend. He reminded me that were it not for the 16th Amendment, by which Americans sacrificed their financial privacy in return for paying others to do their charity, perhaps Christians would do more for their fellow man than they do today.

Speros and Humphrey are onto something here: the relationship between control of one's own property (of which income is key) and willingness to give. Americans have ceded much of their personal charitable compulsion to a discompassionate government bureaucracy, thereby believing Christ's charge to be compassionate has been fulfilled - corporately, through Washington, DC and state capitals. It does not work, it is wasteful, and most certainly does nothing to advance the Christian imperative to serve others.

When citizens send 25-35-45 percent or more of their money to government, and government provides "human services" programs, it gives the individual a sense that they have fulfilled their commitment to others. But Jesus taught that individuals serve Him when they serve others. Jesus never suggested a follower should send a thirsty man to the State Charitable Water Board for a drink of cold water.

"When you give a cup of cold water in My Name, you are serving Me," Jesus taught. The act of handing over a cup of water is a personal, close up, and perhaps tactile experience. Give a cup of water to someone and your hands might even touch, your eyes will meet, your smile and look of kindness will warm the spirit of the receiver and the giver. This is charity, and charity is love.

On the other hand, when government extracts taxes to pay for a Human Water Resource Board to deliver the cup, it will have cost us a great deal. Never mind the extremely expensive method of collecting the money, accounting for it, overseeing it, signing water contracts, establishing water distribution kiosks, checking the rights to public board usage, and hefty retirement packages for the water distributors - the greatest cost is the loss of personal engagement, the touching of hands, connecting of hearts, and expressions of personal love and respect.

Expecting government - paying government - to do what we are called to do is a horrible waste of money and an immeasurable waste of love and Christian service.

The modern measure of compassion is "the rich should pay their fair share" so I can enjoy mine.

Another proof that the ACA of 2010 is phony

2010-12-21T08:13:00.000-08:00

Kathleen Sebelius, Secretary of Health and Human Services, actually said this today: “Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius.

Profits soar. Another useful myth to sell government-run lives, er, I mean, government-run health care. Yes, there are for-profit insurance companies and by definition, they need to make a profit. But the plethora of “non-profit” insurance plans lays bare the administration’s ongoing obfuscation on the issue of insurance premiums.

Minnesota, like most states, relies on a handful of huge non-profit insurance companies. And many states already regulate insurance premiums. The imposition of the federal will on local insurance commissioners only makes the process more complicated and expensive, ergo, premiums will increase as a result.

But here is the greatest lie, and why the new federal law will utterly fail, at least to hold down health care prices: “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.” What baloney.

Think about it. Health insurance companies collect premiums to do what? Premiums pay insurance claims. Insurance claims drive premiums. Claims come from whom? People that use medical services and purchase medicines and medical products.

Insurance companies aggregate funds from premiums to pay claims and yes, to pay their overhead expenses (which, by the way, are a fraction of government overhead expenses – but more on that elsewhere).

The best solution to reduce health insurance premiums is for individuals to use fewer services. Really. And it does not take a fortune invested in wellness or preventive care to do so. This is why consumer-directed health care is the key to reducing insurance cost. But not for this Administration or the outgoing, defeated Congress. No no. Their solution is imposed cost control.

This idea that the federal DHHS can force health insurance companies to restrain themselves is a little like setting a federal cap on the price of a gallon of gasoline. Never mind that Americans keep no buying gas, because to the government-planners, demand makes no difference. Rather, to reduce the cost of gas, “the Affordable Gasoline Act will bring unprecedented transparency and oversight to gasoline prices by reigning in the excessive oil company profits.” Oh, and never mind that finding a functioning gas station will become more elusive. The best way to hold down gasoline prices is to use less.

Get ready for a spate of public fights over rate request denials, and soon after, the shuttering of hundreds of health insurance companies. Then be prepared for the federal Health Payment System Bureau that will eventually oversee the five national insurance utilities that will survive ( and will own Congress).

Taking the best action takes courage Do We the People have any?

2010-12-17T05:49:00.000-08:00

Every time I reason out what the best solutions are to our health care “crisis” (dilemma is a far more apt term), I return to this: Without individuals taking responsibility for their families and themselves, we cannot solve our dilemma.

One of the favorite PowerPoint slides I developed is the circle of healthy traits that makes up a healthy life. I’ve included these: weight, exercise, diet, no tobacco, sleep, reduced stress, family, and the spiritual element. There are more, of course, but when these eight factors form a basis of life, we can expect that, barring genetic illness or accidental injury, we will live relatively healthy lives.

“Which of these can the government influence,” I ask each time I show the circle of healthy traits slide. After a moment of silence, I hear, “Stress. They can reduce taxes and we’d have less stress.”

Reducing health care spending will result from consuming fewer health care services. Consuming fewer health care services is a natural result of better health.

Each time I show the healthy traits slide, I follow it with another stark object lesson -- an obese man, lying on the couch with a TV remote at the ready on his bulbous belly. He symbolizes how most Americans view health care. We allow ourselves to become fat, lazy, and unhealthy, then we place an enormous burden on the health care delivery system to fix us when (not if) we fall ill.

Government responds to all this by “giving” us “free” preventive health care services. Government fails, because the only preventive service that works is beyond governments’ control – individual choice.

Now we face the health care dilemma. Collectively, without coercion, we the people have decided someone else is responsible for our health. Collectively, with subtle seduction, we have made the [im]moral decision to require others to pay for our own lack of courage.

Lack of courage? It takes courage and discipline to care for oneself. This is true with family, finances, faith, and especially personal health.

“Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.” President John Adams – Second President of the United States.

When Adams spoke this truism, he lived among a courageous people that rested their actions on a foundation of faith. Lacking the trappings of trillion dollar governments, the brutal injustice of bureaucratic oversight, and focused on families as the centerpiece of governance, Adams and his peers saw government not as a provider, but a protector. Provision arose out of a moral imperative to do the righteous thing, and that took courage.

At the root of our health care dilemma, then, lies this question: Is there a strong remnant of moral, courageous behavior among our people? If not, we have but one ultimate solution to our health care dilemma – a single payer, government-run system with regulatory rationing of care.

Please: Come on. We are in charge here.

2010-12-08T15:37:00.001-08:00

Now that “our side” won the 2010 election, we all want them to do the right thing. But, do we know what doing the right thing actually means?

“Let’s show them our ideas, and then ask them what they want to support.” Is this how we get them to do the right thing? Implicit in this is our support to help them get their new ideas passed into law.

Helping elected officials get good ideas passed into law is good, but it is an incomplete understanding of our role – and I think it can be dangerous over time.

After all, what is the driver behind successful legislation? Or better yet, who is the driver?

Government serves people within the confines of the rules under which it must operate (constitution). We the people wrote those rules. But we get it backwards. We keep on believing the lie that the constitution lays out our rights. Wrong!

The constitution tells the government what it can and cannot do. This is called enumerated rights.

American government is not about lawmakers choosing what they want to do, but about people choosing what the people want lawmakers to do.

We bring ideas to legislators and tell them this is what we want. To be successful at this, we try to find other people who agree with us, so a bunch of us can tell the lawmaker what we want him/her to do. It is our responsibility to convince them, and once convinced, support them as they move our issues ahead.

One concrete example:

Ten states (not including my home state of Minnesota) have decided to pass or attempt to pass legislation that would make Obamacare illegal in their states. Should we support this in our state? Here are two ways to approach the question:

1. Does our new legislative majority want to take this on? If so, we can help them.

2. Do we want our new legislative majority to take this on, and if so, how far will we go to make sure they do it? And when they do it, how far will we go to support them to make sure it passes?

In our form of government, the second option is the correct answer. If we are to continue to be self-governing people, then we must set the agenda. We choose. We lead, not follow.

Why do we tell them how much we earn?

2010-12-06T07:09:00.000-08:00

President Obama appointed a deficit reduction commission. Without surprise, it recommends sort of cutting back a few programs (mostly defense), keeping non-defense federal payrolls flat for three years, and pushing Social Security retirement age out a few months (but not for decades).

Furthermore, there is a call for reducing income tax rates, but not without doing away with several coveted tax deductions (i.e., mortgage interest, employer-provided health insurance).

The idea is to flatten out spending (not eliminate programs) and increase tax revenue.

Rather than parsing these paltry pickings, let’s get to the heart of the matter, because, when we start with the wrong premise, we will always get the wrong answer. And here is the premise, at least as seen by our founding fathers:

Our founding fathers passed along to us protections to our unalienable right to property. Furthermore, they specified in the fourth amendment a right to privacy in our papers and personal effects. So why is it that we Americans have so easily decided the federal government has a right to know how much we earn and how much we own?

Don’t think I am some anti-tax nut for bringing this up, because in the protection of privacy from government intrusion we find the roots of individual liberty. Let me state it bluntly: Except for the inexplicable fact that we do nothing about it, we should never be forced to reveal to a government how much we earn or own. It is because we allow governments to violate this most basic principle, that we can never find a solution to our tax dilemma.

We can find legitimate ways to provide necessary revenue for the federal government without forcing us all to financially undress every year. Despite the fact that unthinking liberal ideologues make fun of it, and politically correct moderates and conservatives are afraid of being labeled by liberals, the only tax that makes sense is the one the founding fathers endorsed – an excise tax.

Just for a moment, close your eyes and try to imagine a personal and corporate economy in which you were not required to tell the government how much you earn – an economy without an income tax. Because if you like the idea, and realize it is foundational to liberty, you can have it.

Here it is: Replace the income tax as soon as possible with an excise tax, with a national sales tax. From time to time, in future postings, I will expand on this and show its benefits. But for now, answer this question for me: Why do we tolerate telling the government how much we earn? And don’t you dare say, “It’s the law!” because this is a law that we must change.

How the federal government has caught us in a vice

2010-12-04T10:22:00.000-08:00

The fight over the new Medical Loss Ratio (MLR) rule provides a vivid insight into how the federal government is running roughshod over states, and private citizens. What you will read here happens every time Congress passes a law, but when it is something new, like the Affordable Care Act of 2010, the repercussions become more visible.

First, a quick and necessary definition of MLR. This new federal law requires insurance companies to pay out in medical claims 80 percent of the money it collects in insurance premiums. The government central planners, under this rule, will allow insurance companies to use up to 20 percent of the premium for their administrative, marketing, and other program costs. The new law required the federal Secretary of Health and Human Services to write rules to guide insurance companies - and the unknown thousands of others that rely on insurance payments for their existence - to write and publish the rule by June 23, 2010. Finally, just a few weeks ago, DHHS complied with the law. Now everyone is scrambling to try to comply.

The new MLR rules, just released, go into effect January 1, 2011. Everyone whose career has hung in the balance of this new rule, has been left with just a few weeks to figure out how it impacts them, and what to do with and about it.

This week I listened in to a tele-conference led by the Nevada Commissioner of Insurance (COI). The call included key stakeholders in the provision of and payment for Nevada health care, plus the chief state regulators and enforcers of the new law. Kudos to the all of these people, who are trying their darndest to figure out how to deal with it. But ask the most basic question: By what constitutional authority or by what common sense is the federal government doing regulating this state issue anyway?

The commissioner stated emphatically that Nevada would be filing for a waiver so that it does not have to comply with certain aspects of the MLR. This is critical to them, and to dozens of other states. But they only have a few weeks to get this done, because the federal DHHS failed to obey the law, leaving all these players hanging out to dry.

The COI stated casually and confidently, and I mean no malice by this, that there is no great hurry. He knows that once Nevada files its waiver request, the DHHS has 60 days to respond, and then there is another 30 day period before the rule actually becomes final. Then everything can be nicey nice again - set back to the sanity that existed on December 31, 2010. Except that...

Professional health insurance agents have learned that, in order to comply with this new, central-government edict, the insurance companies are cutting their commission rates - by 50 percent or more. This 50 percent pay cut is effective January 1, 2011. Get it? Not yet?

By miserably failing to comply with the new federal law when it missed the June 23 and subsequent deadlines, the federal DHHS has placed the entire health care industry in a whirlwind of activity. "Do we file? If we file, what do we need? Can we get it done in time? What about everyone that is stuck in limbo in the interim? How do we do any long term planning at all? Is anyone in the federal bureaucracy even sane?"

Yet, there is absolutely nothing anyone can do but make policy on the run, work overtime creating waiver requests for which no one has the time to evaluate outcomes, because unlike the federal government, everyone else faces a hard deadline!

We have not even begun to understand how disruptive the ACA is going to be to our economy, to needed services and commodities, to jobs, and to our personal lives. Meanwhile, the federal government continues on, steamrolling everyone else into compliance.

Oh, by the way, another ruling awaited from DHHS (among thousands) is a definition of what constitutes an "unreasonable rate increase." Now that sounds like a vital piece of enforcement language. DHHS hopes to define it by the fall of 2011. How nice of them.

About those health insurance agent pay cuts: Agents are caught in a vice, squeezed by income cuts out of their profession while DHHS and other government officials continue to draw fat taxpayer paychecks, missing deadlines, and creating havoc in the marketplace.

Constitutionally educated, but detached - A challenge

2010-11-30T05:49:00.000-08:00

James Phillips, PhD, my ninth grade civics teacher (1961-1962), taught me three principles that have helped shape my life. First, love the constitution. Second, love education. Third, pay attention to what is happening around you.

Dr. Phillips was a dark-skinned teacher. He would not have called himself African-American, because no one had coined that term yet. He may have used the term negro, but it made no difference to him or to me. He was, quite simply, the most passionate, intelligent, articulate, and motivating public school teacher of my K-12 years.

Remember, I am talking about pre-Civil Rights Act of 1964, pre-Martin Luther King, and far before today's slave-minded, left wing African American spokespersons. Dr. Phillips, with a PhD, able only to teach ninth grade in an inner-city public school, never let color be a barrier.

He knew his constitution well, and made sure we did, too. Our class tore it apart, clause by clause, line by line, word by word. Then we wrote our own. I believe I served on the Preamble committee. Why focus on the constitution? Because in it, Dr. Phillips found freedom, hope, and a future.

Since 1962, the U.S. Supreme Court has often turned the constitution on its head. Landmark decisions that seem transparently at odds with the definition of words, the culture in which they were created, and the purpose for which they intended to serve, were tossed aside. The Court's attack on the constitution began long before Dr. Phillips began my enlightenment, but since then, has often spun out of control, leaving us with little ability to have confidence in the document.

Dr. Phillips second admonition was to be educated. Actually, I believe he meant to keep on being educated. As Charlie "Tremendous" Jones said often, "Life is about learning to be learning, so that in learning, we can learn that we need to be learning."

The high school student holds a tiny seed in his/her hand that, with proper nourishment, will continue to grow into a solid, strong, tall tree of learning. But without nourishment, it will wither and become of little use. Eventually, it dies.

Life comes alive through ongoing learning.

Third, pay attention to what is happening. Perhaps this admonition is the reason I wrote a paper on creeping socialism for Dr. Phillips - in ninth grade. Phillips read five newspapers every day. TV and radio news helped shape one's knowledge of current events, but could not begin to compete with the in-depth reporting and commentary available through newspapers.

Today, I teach a class titled "American Government-For Real." My lesson today is on the media, and its impact on our system of government. My 30 students are bright, healthy, eager to learn, and pretty much ignoring what is happening. They may have never seen a newspaper, do not listen to radio, can not tell me what time TV news is broadcast.

On the other hand, my students are serious about study, and work hard at academics. But they are doing so in a vacuum, without contemporary context.

Their "media" is designed to entertain and distract them from the mundane [important] nature of life. A make believe world of villains, heroes, personalities, tragedies, but seldom tied to real life.

My students have had the "Phillips" treatment on the constitution, and they have bought into being educated. Now, the challenge is to get them to pay attention to the world around them. Constitutionally based citizens that are motivated to learn, who pay attention to what is happening makes a powerful force to move our country forward (and a bit more to the right).

Well, well, well. We can certainly give thanks now.

2010-11-26T06:34:00.000-08:00

My title is a bit short-sighted and selfish. It presumes that our instant predicament is worse than at times past. As in, "Wow, the American people woke up and actually threw some of the bums out." For that we can be thankful.

Compared to the mass starvation encountered by the Pilgrims that landed at Plymouth Rock, and the astonishing nature of Divine intervention in their lives through Squanto, our politics is piddly. Yet, the fact is that what those early Pilgrims eventually became - a great nation, dedicated to the proposition that all men are created equal - has truly been in jeopardy for some time now.

When 1980 voters elected Ronald Reagan, Larry Burkett, a teacher of Biblical financial principles said, "We may have bought another four years." By this he meant that the U.S. had staved off financial collapse, at least for time, because a conservative leader would make it so. Reagan did usher in an era of unprecedented growth, from which the world benefited.

The Democrats in the current Congress, and the Obama administration seemed intent on completely reversing our economic good fortune. Worse, our common sense and a fourth grade understanding of how money and incentives work, told us economic darkness had begun to arrive. Whatever Reagan had wrought, Obama was undoing.

Reid, Obama, Pelosi - ROP - did themselves proud, and as the scriptures teach, "Pride goes before a fall..." and "Those who are stiff-necked will suddenly fall, and at that, without recourse." ROP hung themselves. We reaped a harvest.

Squanto visited us again this Thanksgiving, with new reasons to celebrate faith, family, and freedom.

"We have given you a republic, ma'am," Ben Franklin said. The voters have done so, too, in 2010. Now, it is up to us to see if we can maintain it.

Thanks to God, in Jesus Christ, for His abundant blessings.

Can't Create Good Models from Bad Ideas

2010-11-25T12:37:00.000-08:00

The new health care law requires each state to establish an operating health insurance benefit exchange by January 1, 2014. I have written elsewhere about why the exchanges will never work, unless their purpose is to drag us into single payer health care.

The exchange has created a real political phenomena -- forcing otherwise intelligent, principled people to try to design it so that it will do as little harm as possible. So greatly do these well-meaning people fear the establishment of federally-dictated exchanges that they are working overtime to design state-based models.

Even while doing so, they know the exchange is a bad idea.

Worse, yet, they feel impotent to do anything else. Decades of federal government overreach has convinced these voting citizens that they are at the mercy of Big Government. If Congress passed it, and Obama signed it...well, we have no other recourse but to build it. This idea that we are powerless to resist bad, unconstitutional law is far more worrisome than the law itself.

The Declaration of Independence states that the purpose of government is to protect unalienable rights. Our United States Constitution is a document of enumerated rights, where we the people, in order to preserve our unalienable rights, tell the federal government what it can and cannot do -- not the other way around.

Here is the right strategy concerned unconstitutional laws, such as that which forces states to establish health insurance exchanges: Refuse, and instruct members of Congress to repeal the law. If they don't make them pay.

If we have no power to resist the health insurance exchange, then we have no power to resist any federal mandates about anything: This is not freedom , it is servitude.