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The Right Prescription
A Roadmap to Repeal and Reform
Cutting off those Obama-Berwick cronies who would cash in on Obamacare.
Obamacare is both the mechanism and ultimate manifestation of what Ronald Reagan described as abstract theorizing of the kind that turns off the American people. It is the purest expression of what George Mason economist Donald Boudreaux describes as “how one group of people (the politically successful) should engineer everyone else’s contracts, social relations, diets, habits, and even moral sentiments.”
Hence, in repealing the law it is important for Republicans and like-minded Democrats to identify and eliminate those sections of Obamacare essential not only to imposing and enforcing the view of social engineers who created it and will profit under it, receiving billions in contracts and grants designed to centralize medical decisions and rationing care. Congress should replace these oppressive features with policies that restore freedom, protect life, and promote prosperity.
First, Congress should vote to repeal the Patient Protection and Affordable Care Act and replace it with a comprehensive bill or super-amendment that meets this goal. (A combination of tax credits, laws to permit purchase of coverage across state lines, expanded funding for high-risk pools, and protection of patients with pre-existing conditions.)
If this effort stalls in the Senate or is vetoed by the President, Congress should move to eliminate what Senator Mitch McConnell calls Obamacare’s “most egregious provisions.” At the top of the list should be any program, agency or grant the rewards or leads to the replacement of the collective intelligence of the American people with the decisions of self-anointed elite. These include:
1. Cutting the budget ($610 million) of the Agency for Healthcare Research and Quality, the entity that conducts research on the comparative effectiveness of new medical technologies, to FY 2008 levels or eliminating it altogether. The British government is eliminating its rationing agency not only because it was hurting people and discouraging medical innovation but because it was duplicating private sector research and unable to keep up with medical breakthroughs. AHRQ could be eliminated and no one would notice, except the academics and consultants who both set AHRQ’s research agenda and get paid for the research.
2. Eliminate other programs or agencies designed to centralized medical decision making: That includes the Center for Medicare and Medicaid Innovation (CMS) ($10 billion through 2019), Patient-Centered Outcomes Research Institute (avoiding taxes on health plans of about $500 million a year), funding for Shared Decisionmaking and Quality Measurement Development ($75 million). The new NIH National Institute on Minority Health and Health Disparities (NIMHD) ($220 million) should be cut because it duplicates existing research.
3. Programs requiring “such sums as needed” are slush funds and should be eliminated. For example, the requirements for grants to establish Shared Decision Making Resource Centers are tailor-made for CMS administrator Donald Berwick’s colleagues at Health Dialog, which sells and evaluates such tools, its non-profit arm, the Foundation for Informed Medical Decision Making, and the Dartmouth Hitchcock Medical Center’s Center for Shared Decision Making (funded by Health Dialog).
4. Eliminate the Independent Payment Advisory Committee, set up to restrict the kind of care and treatments Medicare patients can receive.
5. Eliminate or waive medical loss ratio requirements where are a back door to controlling the definition of what is medical care.
6. Reaffirm by adding an amendment that bars HHS from restricting access to what it rules is the “least costly alternative ” treatment.
7. Eliminate funding to hire 16,000 IRS employees ($1 billion).
In addition, Congress can cut the duplicative pork and payoffs to special interests embedded in the law: The Prevention and Public Health Fund ($1.5 billion per year); the mental illness demonstration grants that emphasize individual wellness ($150 million); the “community wellness demonstration program,” the “individual wellness demonstration program” and (if you can believe it) workplace wellness grants ($200 million!). There are dozens more.
Cuts to restore freedom and protect life should be paired with reforms that make healthcare coverage immediately affordable, cut taxes, and restore coverage to Medicare. They include:
1. Restoring Medicare Advantage funding to 2009 levels so seniors can keep their current coverage.
2. Restoring hospice funding (the most despicable cut of all).
About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.
Letter to the Editor View all comments (31) | Leave a comment
More Articles by Robert M. Goldberg
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Carol| 11.10.10 @ 6:54AM
Mr. Goldberg:
You should be in charge to make sure all of your suggestions are taken into consideration by the GOP and carried through.
I appreciate your pointing out the most awful part of Obamacare is the cutting of hospice care.
Hospice care is what a dying person deserves when the time is near. My mom was in hospice care for only 72 hours before she passed but she was cared for and treated with such dignity until the end. I am so thankful hospice care was there for her.
buckeyeman| 11.10.10 @ 12:10PM
Carol: My sympathy and respect for your mother, but what a dying person "deserves" is what that person or their family has set aside through savings or insurance to provide for that care. Mr. Goldberg has set forth a two prong approach with thirteen separate elements. What he's really saying, is "We Republicans could be more competent socialists than those damned Democrats, if you just gave us a chance".
Reading your post makes me wonder why you disapprove of Obamacare in the first place. This is just one more example of WHY WE ARE SCREWED. My own beloved mother is 88 and in an Altzheimers facility. Can I send you the bill? Can I come to your home and steal your belongings to pay for her care? Why do you think it is moral for the government to steal my money simply because you are too cowardly to try to rob me yourself.
Face reality. You are a socialist (and hence a thief). Mr. Goldberg is a socialist (ditto for him). His plan to "fix" Obamacare is almost as complex as the two thousand page document itself. There is no constitutional authority for the federal government to do ANY of this (however, providing public welfare at the state, county, and local levels is a different and interesting discussion).
Repeal Obamacare. The federal government had no authority to enact it and has no authority to enforce it. Do NOT replace it with a Republican version of socialized health care.
Carol| 11.10.10 @ 12:24PM
How dare you say I am a socialist or in favor of Obamacare! I want Obamacare killed and I am a conservative.
Did you read the article? The point of it was to say the things that could be done because Obama will veto whatever is brought before him. We get rid of him by replacing him with a Republican POTUS and then he will kill it!
Thanks for your non-sincere sympathy for my mother but she too was in an Alzheimer's home for 5 years before she became terminal. She paid for that care through an entire lifetime of HER PAYING FOR THE DAY SOMETHING HAPPENED TO HER! Nearly $5,000 a month for 5 years! She was in the hospital for nearly 4 weeks before it was time for her to die. Then hospice for only 72 hours. Are you saying my mother was greedy was receiving 72 hours of government provided hospice care? She paid for that through taxes. She wasn't a moocher or an government worker or a union thug or an illegal who received a dime from the government.
You are an effing moron!
buckeyeman| 11.10.10 @ 2:03PM
I didn't say your mother was "a moocher or an government worker or a union thug or an illegal who received a dime from the government"(sic). But you advocated on a public forum (as did Mr. Goldberg) that the federal government pay for hospice care because the recipients "deserve it". Of course, you know as well as I do that the issue isn't just hospice care. Other people's moms (and dads and spouses and kids) need short and long term acute care facilities, chronic nursing home care, chronic Altzheimers care ($300,000 over five years in your mom's case), chronic home health care, chronic medications and acute inpatient hospital care. Do they not "deserve" this care too? (Obama, et al thinks they do)
I simply assumed (perhaps wrongly) that you believed the government should pay for all of these other services that other people need but can't pay for (isn't this Obamacare?) as well as the hospice care that your mom needed. If not, and you believe the federal government should only pay for the hospice care your mom needed but not everyone else's needs, then maybe you are not a socialist, but I don't understand your reasoning.
I don't think I'm the horrific monster that you apparently believe me to be- I'm trying to understand all this but I just don't get it. Maybe that's because really am the "effing moron" that you called me.
Carol| 11.10.10 @ 4:31PM
You act like I want anybody getting anything for free. I want everybody to get cut off especially the government workers, the illegals, the union thugs, etc.
My mom went without for most of her life when she could have been like other moochers and spent all of her hard earned money to go on vacations, splurging, etc. She was a Depression era baby and knew what sacrifice was all about. She didn't want to leave us kids to have to take care of her. She had pride - something too many people have given up for a free ride.
I wish Barack Obama had never been born. He is the worst thing to ever happen to this country. I hate liberals, socialists, communists, and all the rest.
I love America and didn't have a say about the Obamanation being shoved down our throats.
Just don't accuse someone of being something they aren't - especially me. If you knew my husband or my virtual pals on other websites I visit under other names they would testify I'm further right than Rush.
Sorry - but you hit a nerve when you talked about my mom. She didn't deserve what happened to her and I will stick up for her until I die.
MikeD| 11.10.10 @ 4:42PM
You two kiss and make up and then come out swinging...at Obama! The best thing to do is to repeal the complete healthcare act (4646) as well as the moronic and destructive stimulus act and start over from a position of common sense, a thing sorely lacking in Washington. The problem is overwelmingly Democrats, but they don't have a monopoly on stupidity; Republicans have demonstrated a lack of brains, and, worse, courage. This is the time to slash and burn. I'd rather they err on the sign of throwing the baby out with the bath water than let any of the garbage the Dems have been sneaking through to continue destroying our country. At least we might get our weekends back without having to lay in bed late Saturday nights worrying about what pelosi and reid were sneaking through under cover of darkness. (Caps intentionally deleted because I don't think they deserve the respect caps infer.)
buckeyeman| 11.10.10 @ 6:17PM
Mike, Imagine yourself at a gathering of friends (I guess that leaves me out!) and someone said they hated Obamacare but loved medicare. Would you question them as to the basis of these beliefs? What response would you find to be an acceptable explanation? To me it just doesn't make sense. And just how can we "come out swinging" at Obama while extolling the virtues of Medicare and Medicaid (currently covering 39 million and 58 million Americans, respectively).
My advice, BTW would be for God's sake don't challenge the logic of your friend. I wish I hadn't made my comment now. I didn't attack Carol's mom, I attacked Carol's thinking about who should be forced to pay for other people's healthcare and the cognitive dissonance that I felt was implicit in her comments. My reward? Carol called me an "effing moron" (I do have two college degrees, a phi beta kappa, certification from the American Board of Surgery and a couple of faded good behavior ribbons from grade school) but she didn't explain anything about her thinking. I'm willing to listen if there's a good explanation that I haven't thought of yet. So far, it just seems pointless.
Fred| 11.14.10 @ 9:32PM
You'll repeal nothing but you'll waste a lot of tax payer money trying. The stimulus worked, we need Health Care reform and it is here to stay. Act like adults for a change.
Fred| 11.14.10 @ 9:30PM
"Face reality. You are a socialist (and hence a thief)."
What awful hole did YOU crawl out of???
martin j smith| 11.10.10 @ 8:18AM
The battle lines are drawn and the battle lines have been drawn and the battle lines drawn--it is Socialism or Capitalism--Freedom or Trrrany !!!!!!!!!!!!
So, this one issue is a very small element of this wart. Those people who voted and worked hard in the campaigns--guess what. We are now back at it agai--it is a political-propaganda war not less vital than the election itself. The behavior of all Republicans must be monitored and called out when needed. Call ins to those who do not get it must be made. And, major propaganda efforts must begin. It should be obvious to anyone aware of our environment that there will be a BIG FIGHT< No nicy nicy --its toe to toe . Fight for the People who voted NO to Socialism !!!!!!!!!!!!!
martin j smith| 11.10.10 @ 8:20AM
Oh yeah, I forgot: NO TO SOCIALIZED MEDICINE 111111111111111 NO OBAMACARE
Petronius| 11.10.10 @ 8:39AM
FYI
Senator McCaskill is set to cash in big being in the nursing home biz.
Yosemeti Sam| 11.10.10 @ 9:54AM
Road map?
Um, yeah, a la - patent PATTON!
Mike W| 11.10.10 @ 10:34AM
I would add another repeal: the requirement that restaurants and vending machines post calorie counts "conspicuously" next to each item. How did such an inane, nanny-state provision make it into a bill that was supposed to be about health insurance? If I were President, that alone would have made me veto the 2000-page monstrosity and tell Congress, "Take this back and send me a 100-page bill that stays on topic."
Clinton nee Publius| 11.10.10 @ 12:43PM
None of this comes back to the core issues: patient access is limited under our current insurance system and the insurance capital funding approach has proven to be outdated and not up to the task at hand.
We can get universal health care coverage, we can get it on an affordable basis and we can eliminate the problems we have with accessing, using and paying for health care today, but none of these problems - as in not a single one - can be solved by having government run health care, government pay for health care or government own health care assets.
Until you understand these basic issues, these prescriptions amount to nothing more than glossing over the actual problems with sophistry and the bonhomie of honest, populist intentions - none of which do anything but guarantee our children's children will be paying the freight.
Thanks for nothing.
MikeD| 11.10.10 @ 4:46PM
We have to all remember to keep beating one main fact into the heads of every elected official WE send to Washington, or anywhere else: (Repeat after me as ofter as it takes!)
GOVERNMENT HAS NO MONEY THAT IT DOES NOT TAKE FROM US!
Plus: Government CREATES NOTHING, it consumes the fruits of the peoples's labor and ingenuity.
Repeat over and over until they get it. Obama certainly doesn't understand it.
StevieLee| 11.12.10 @ 3:56PM
I would love to know how we can get universal health care on an affordable basis?
PhilTheCapitalistPig| 11.10.10 @ 1:08PM
To be perfectly honest, if they can't defund Obamacare while Obama is in office, and Obama is re-elected in 2012, then none of these strategies matter.
The big elephant in the room that noone seems to be looking at is the fact that companies are going to start dropping coverage left and right. Businesses are only staying in now for the prospect that Obamacare will be repealed before 2014. But mark my word, if Obama gets re-elected, shortly after, you will see the crash of Employer-paid benefits. You're already seeing hints from Mcdonalds and 3M. Once it starts it will be like a snowball coming down the mountainside and when it gets to the bottom, we will all have one option left, the Government Option.
Its simply because this bill is making it entirely too expensive to provide benefits for employees. You can't cover "children" up to age 26 and waive all pre-ex underwriting, not to mention lifetime max's, and expect claims experience to not increase.
But one of the biggest pocket busters in this bill is the mandate that insurance companies have to run 80% loss ratios on small groups and 85% on large group. And if the Carriers don't meet these ratios the government is forcing them to return the premium to the customer.
Let me relate how this works to car insurance. If I pay $1500 in premiums for car insurance in 2009, and I don't have a wreck or submit any claims, then the insurance company has a 0% loss ratio. But what about the guy that totaled his car worth $15000 and he only paid $1500 in premiums?
This is the concept of health insurance. The healthy people subsidize the sick. So now what insurance companies are doing, is they are charging extra to ensure they don't lose money, and if they don't hit the loss ratio they will give the premium back that wasn't used in claims. But since they aren't allowed to balance out groups that lose money and the groups that make money, they have to cut out the losses on some groups altogether.
So you see a rise in prices on two fronts. The insurance company covering their ass against losses, and the fact that you are covering "children" up to age 26.
You know, its funny, I'm 28 and I feel more like I'm getting old. I wish I felt like a "child." Maybe if I were really a child then I could ignore and be oblivious to the destruction of this nation from the inside.
heir2freedom | 11.10.10 @ 1:30PM
Goldberg's roadmap to repeal is well thought out.
Let me add that we shouldn't forget that this odorous leviathan will see its day before SCOTUS and the unconstitutional mandate under the commerce clause will be ruled just that.
No where in our history has congress been granted the authority to "compel commerce" on the citizenry with a threat of a fine.
This shouldn't, however, deter the 112th Congress from doing everything within its means to block, de-fund and obstruct this steaming pile of legislation.
RELATED ARTICLE:
"NEW HOUSE OVERSIGHT CHAIRMAN ISSA (R-CA) VOWS TO TOSS A BA-RACK OF OBAMA DEMS ON THE BARBIE"
http://heir2freedom.blogspot.c.....-r-ca.html
Fred| 11.14.10 @ 9:41PM
Eight years we had a nut case in the WH breaking all international rules and our own laws. Where were you 'fine folks'? You aren't going to get a repeal of HC reform, the GOP will pull so many stupid stunts before 2012 gets here and Obama will get another 4 years in office. Simply because the GOP will send their worst idiots up against him, and miscalculate the conservatives and independents like Stockman and Bartlett who know there really is no GOP. So the Drudge Report fans will get to suffer dyspepsia and flatulence for another 6 years. Good for you.
Perusha| 11.10.10 @ 2:20PM
There is nothing inherently wrong with any kind of insurance, as long as those people who buy and sell it do so willingly.
But, the massive, sick elephant in the room of health care insurance is—moral hazard.
Life is always a matter of playing the odds. So, personal choices to move and have one’s being, whether driving a car, putting food or alcohol or drugs into one’s mouth, sky diving, or whatever, there will always be a result.
So, our “advanced” society uses insurance to “cover” possible deleterious outcomes.
As a math major, who took many statistics courses, I was “enlightened” or maybe foolishly deluded about insurance, or at least highly wary.
I served in Vietnam as a finance specialist. Before I went, we were told that only a couple of guy with our MOS had died, and they had been out looking for ladies of the night.
Well, I was probably---probability?---one of the very few soldiers who refused the SGLI, or the army life insurance, which cost $2 per month, as I recall. It was next to impossible to finally get the higher brass to okay this choice!
Mind, I also made sure to stay in safe places, if possible, and I certainly did NOT chase any Vietnamese putang!
At my safe post in Da Nang, the USO had created a small room lined with shelves of donated books. I filled my free time staying away from the beer “garden” and reading.
One of the key books was from an ex-life insurance salesman, which exposed the con game that term life insurance was, especially for a 20-something like me.
The best health insurance is self-insurance. Indeed, by paying a percentage of your regular wages to other people, creating a pool of resources that cover you if bad outcomes “happen”, is perhaps a perfect example of moral hazard---even though it’s a cost for you, other people’s money is there .
To self-insure, eat right, exercise and don’t take stupid risks!
Truly, only catastrophic insurance is necessary. I’m sure it wouldn’t cost much for everyone to be paying for insurance that covered cancer-like diseases, but what we NOW have is “comprehensive” insurance, AND people who don’t eat, exercise, or take care of the body, because---the insurance will cover them!
Finally I have two personal insurance stories, both of which blew my logical mind.
I was got a job working as an accountant for this restaurant that was going bankrupt. Their insurance agent happily signed me up, knowing I’d only pay a small amount of money before it was over, AND that I would use the insurance for much more expensive dental work. He wasn’t working for the COMPANY, eh?
At another job, there was a small fire in a business next to ours. We suffered no damage. But, the insurance agent pushed and pushed our owner to claim that some water damage occurred in our next-door basement, which was a total lie!
Insurance! Feh!
saleboter| 11.10.10 @ 2:55PM
1. Pass a seperate bill getting rid of these small special interest and really bad parts of the bill.
2. make the demos defend them independent of the bill in the Senate
3. make Babam veto repeal of things that are completely unjustified
Works for me
Ike| 11.10.10 @ 4:28PM
"In addition, Congress can cut the duplicative pork and payoffs to special interests embedded in the law..."; instead, do away with all of the pork and payoffs to every kind of interest other than the public interest; e.g., $300 million to Kansas. We - that's us, the public the people who get stuck for the bills and die in the walls - do not benefit when Congress gives away tax money - or borrowed money, even worse! - to their allies and friends and family members. Cut it all out.
LibertyAtStake | 11.10.10 @ 8:19PM
Somebody, quick, get this roadmap punched into Speaker Boehner's GPS!
http://libertyatstake.blogspot.com/
"Because the Only Good Progressive is a Failed Progressive"
Nite| 11.10.10 @ 9:32PM
Dr. Donald Berwick should be ousted ASAP. He was not confirmed. He was a recess appointment. No President should be allowed to make a recess appointment of an individual to manage a Secretary posession. The Independent Medicare advisory board now reports to Obama instead of Congress. Getting rid of Berwick would save millions.
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W.P.Koch| 11.12.10 @ 2:09PM
WHAT SHOULD HAPPEN
Congress and the White House should the White House stop squandering the people’s money and use savings to improve quality of basic invested entitlements. Preserve the 2010 tax schedule. Congress should improve basic Medicare. Vote opponents to this “out”. Citizens come first.
It is time the U.S. reduces its human rites and police activities for the World by lobbying the United Nations, NATO and Interpol to “take on more”. 800 bases in 63 countries across the world should be reduced. Starting with Iraq, continue training for self reliance. After a surge in Afghanistan repeat above and remove corruption starting with monitoring accounts, substituting minerals mining and food crops for drugs.
If we train make them pay. Decrease forces in selected areas such as Germany, Bosnia and Okinawa.
Cut bloated federal bureaucracy. Combine CDC, EPA and FDA. Combine the FAA, NHTSA and Transportation Department. Combine GAO and CBO. Phase in outsourcing. Departments should eliminate “must spend all”. Return “unused” yearly budget to the treasury. Cut consolidated department budgets (other than entitlements) on an average of 10%.
Eliminate all 32 CZARS Mr. president. Reduce your 469 member staff which makes nearly 39 million per year! Halt first lady $180,000 air force one vacation trips. Cancel $ 20,000,000 executive order (HB 1388) to relocate key Hamas members to U.S... Stop “$200 million per day” presidential foreign trips.
Contribute to only one of: The World Bank or International Monetary Fund or U.S. Agency for International Development.
Reduce foreign aid bribery. For example, no aid to oil rich -Iraq. $37 billion and increasing with $8.7 billion of Iraq development funds not accounted for. Halt $150 million aid to Palestinians.
Charge bailed companies (TARP) for their huge executive bonuses at taxpayer expense. Government should sell its shares to recoup for taxpayer. About $154 billion owed.
Congress should reduce the “stimulus” and monetary expenditures by halting: over budget projects, non relevant earmarks for vote bribery. Do not pay student loans for congressional staff. Please- no private or military jets for congress including Pelosi’s family of $2.1 million for over 2 years. Congress should set commercial travel cost standards and controls.
Reduce medical cost by: allowing purchasing anywhere in U.S., “tort reform”, and reducing “red tape”. Trace funds to local medical groups for expediting billing cost speed, doctor/patient verification and fraud reduction.
Federal government should enforce existing immigration laws. Complete the improved fence. Entitlements or benefits should be for only citizens. Deport criminal “illegals”. Only workers on a Visa Program qualify for needed medical benefits
Improve medical expense tax deduction for citizens reaching age 65. Provide corporations tax reduction incentives for hiring with healthcare.
The savings will improve funding for:” Medicare”, “Medicaid, and “Veteran’s Affairs”.
Healthcare quality should be at least that for Congress or the Federal Employee Health Benefits Program (FEHBP). Additional benefits are: dental coverage, improved visual coverage, no drug “donut hole”, no deductibles and co-pays except for extended skilled level nursing.
These actions will allow aid for unemployment compensation and Social Security with reinstated cost of living increases.
MandaR| 11.12.10 @ 10:38PM
Wow. With the current bloated-and-loving-it gov't in place, you will be lucky to see any of those things happen in this lifetime. Considering how many Americans cannot afford to even travel by air anymore, it is truly frightening that people we VOTE for are using our money for private jets. Maybe we should all run for office...the annual pay ain't much, but the bennies are phenomenal...
shipley130| 11.13.10 @ 1:23PM
I'm thinking we should get rid of much more than just Obamacare. We need to get on a path of removing many fed programs and get the feds back to constitutional responsibilities. Social Security requires thousands of fed jobs to run the program. Put that 6.2% right in the bank with a program run by the bank that will not let a person dig into it until they are 62 will be so simple. The bank won't perpetuate fraud like the social security office does. Just don't let investment banks have control over it and we should be OK.
shipley130| 11.13.10 @ 1:36PM
We are taking a great assumption that SCOTUS will rule Obamacare unconstituional. Look at the socialists sitting on the SCOTUS now. The wise latina will rule in favor of Obamacare. No doubt about that.
GKPAL| 11.14.10 @ 11:02PM
To repeal Obamacare we first have to "repeal" Obama in 2012. Between now and then, defund all aspects of Obamacare. It is that simple.