Kill the bills and do health reform right
WASHINGTON The United States has the best health care in the world—but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.
Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes—such as the 118 new boards, commissions and programs—is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.
The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:
—You’ll find mandates with financial penalties—the amounts picked out of a hat.
—You’ll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third—numbers picked out of a hat.
—You’ll find sliding scales for health-insurance subsidies—percentages picked out of a hat—that will radically raise marginal income tax rates for middle-class recipients, among other crazy unintended consequences.
The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.
Then do health care the right way—one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.
First, tort reform. This is money—the low-end estimate is about half a trillion per decade—wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.
The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits—resources wasted on patients who don’t need them and which could be redirected to the uninsured who really do.
In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare “limit attorneys’ fees or impose caps on damages.” Why? Because, as Howard Dean has openly admitted, Democrats don’t want “to take on the trial lawyers.”
What he didn’t say—he didn’t need to—is that they give millions to the Democrats for precisely this kind of protection.
Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.
Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn’t, oranges would be extremely expensive in Wisconsin, especially in winter.
And the answer to the resulting high Wisconsin orange prices wouldn’t be the establishment of a public option—a federally run orange-growing company in Wisconsin—to introduce “competition.” It would be to allow Wisconsin residents to buy Florida oranges.
But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need—the excuse—for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.
Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues—the largest tax break for individuals in the entire federal budget.
This reform is the most difficult to enact, for two reasons. Unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year’s election.
Insuring the uninsured is a moral imperative. The problem is that Democrats have chosen the worst possible method—a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.
The better choice is targeted measures that attack the inefficiencies of the current system one by one—tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000—and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.
Charles Krauthammer is a columnist for the Washington Post. His e-mail address is letters@charleskrauthammer.com.

Dec 5, 2009 at 6:48 a.m.
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To ProudFighter11: donnaw must be a "white male" WRONG!! I am a 68 year old grandma!! And can't wait til the next election to vote these bumbleheads out for the mess they have created!! But what do you expect from someone who never held a real job before or since!! I am not a Sarah Pallin supporter but when they complain about her lack of experience I have to laugh and say isn't that like the pot calling the kettle black!! She at least was governor of a state.
Nov 30, 2009 at 11:09 a.m.
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"If unsafe drugs were distributed, especially today, word would get out and the drug would be pulled, doctors would not prescribe, etc.."
So, you basically want people to be the "guinee pigs"? Nice. You would allow drug makers to claim their drug could cure any disease, without actual proof, and with no concern for long term side effects? These are just a few of the things drug companies have done, and would do, without regulations.
I won't even comment on the rest of your post, it's so ridiculous, and without basis in fact.
Nov 30, 2009 at 10:31 a.m.
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Don Diego --
1. Makes sure my food is safe.
Not really - People do that, when they properly cook the food, clean the equipment. What does the govenrmnet do? Nothing. They state the obvious.
2. Makes sure my drugs are safe.
Not really. If unsafe drugs were distributed, especially today, word would get out and the drug would be pulled, doctors would not prescribe, etc..
3. Provides roads unlike any other country in the world. Maybe, the potholes are so bad in many areas, that you really can't stand behind this.
4. Keeps me safe.
How -- Maybe, we could say the military protects our boaders, kills terrorists.
5. Provides my children with an OPPORTUNITY to the best education in the world.
Some of the best schools in America, are charter schools and private universities. The worst are public schools.
6. Provides vaccines to the extent that we have eradicated illnesses that use to kill millions.
Need I say more than H1N1?
7. Provides access to utilities and makes sure that they can't raise prices without civilian approval.
The free market would do much more. As rates rise, alternative energy would become more cost effective and each user could install there own solar and wind energy solution, taking control of their own energy consumption.
8. Makes sure that companies don't make and market products that are unsafe.
Not really. exploading gas tanks, three mile island etc,,, government didnt provide that protection, private citizens taking action did.
9. Makes sure that when a woman is pregnant she can't be fired.
This one I can agree with. Will give you this one. But I have still heard of instances where workforce reuctions were required, and of course, the person not producing would be 1st to go.
10. Removes snow from the street so I can get to work.
Maybe -- In some areas outside your little world, the cost of the equipment is prohibitive.
We forget that personal responsibility is what we really need.
Nov 30, 2009 at 10:03 a.m.
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"I have no health care right now, but that is my choice. I do not expect someone to be paying for it nor do I want to pay for anyone else."
You are the problem. Everybody gets sick or injured in their life. EVERYBODY. If you require a major medical procedure, costing tens or hundreds of thousands of dollars, and you end up filing bankruptcy because you can't possibly pay the bill, who do you think pays for that? Everyone else who buys insurance or pays for medical care out of their pockets.
The purpose of health care reform is to provide AFFORDABLE health insurance to as many people as possible, so people can pay something into the system, not FREE health insurance. As RAF pointed out, everyone has ACCESS to health care. Access isn't the problem, cost is.
Nov 30, 2009 at 9:28 a.m.
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Any health care bill should assure that eveyone have equal access to the same level of health care at the same cost. If that means that Politicians, UAW workers, teachers, etc. see either reduced services or increased costs as a result so be it. Fair is what its all about right?
Nov 30, 2009 at 8:04 a.m.
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I agree with RAF 100%. I have no health care right now, but that is my choice. I do not expect someone to be paying for it nor do I want to pay for anyone else. I pay for enough of their crap right now as it is. If these people on welfare want to receive a check they should be painting fire hydrants and cleaning the freeways, afterall thats the direction we're heading in right "communism.
Nov 30, 2009 at 7:59 a.m.
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Emergency health care is an expensive last resort, not the kind of care that is conducive to keeping healthy.No preventative, diagnostic, life style care before an emergency arises, and it might be too late for the patient. You are already paying for other peoples health care under the present system, and according to CBO people like you who buy their own insurance will see a reduction in premiums under the Senate bill. Talk to Reagan about raiding Social security, hopefully we have learned something. Bush campaigned in 2000 on a promise of not doing it, but by 2007 he had taken over $1 trillion from the fund, a broken promise. Medicare Advantage is overpaying by 14-17%, changing that results in immediate savings, and that is proposed. The people on that plan get much better benefits than other Medicare covered people.
Nov 30, 2009 at 7:24 a.m.
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"National health care first came up in the Teddy Roosevelt administration, do we have to wait another 100 years?"
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100 years for what? Do you not have health care? Everyone in this country has a right, protected by law, with access to life saving health care. The problem is some people wanting someone else to pay for it.
Nov 30, 2009 at 7:21 a.m.
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"All the time some of you are saying "cut the spending", well, what do you cut?"
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Even the weakest strategy of not increasing spending every year is a better approach to what is in place now.
If your paycheck/income goes down do you maintain the same level of spending?
Nov 30, 2009 at 7:04 a.m.
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"Medicare/Medicaid cuts to help finance this plan"
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If these same politicians thought there was money to save from these plans why wait till now to do it?
Nov 30, 2009 at 6:57 a.m.
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"I know, I know, SS is going broke"...yet you use it as an example.
Nov 29, 2009 at 6:36 p.m.
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When Social Security was passed in 1935, benefits were not scheduled to begin until 1942. The monetary base of the system must be set before payments can start. I know, I know, SS is going broke, but only because our politicians raided the trust fund. If the money had been left alone, there would be no problem. So, you are going to say the same thing will happen to the health care fund. Maybe, maybe not. We should learn from the past. People are saying there will be Medicare/Medicaid cuts to help finance this plan, that is true, waste ,fraud, and abuse should be addressed, even if this doesn`t pass. All the time some of you are saying "cut the spending", well, what do you cut? SS, Medicare/Medicaid, defense, interest on the debt, if you don`t touch those that leaves discretionary spending. Money to run the government, education, payments to states, foreign aid(2%), etc. There are things in that group I don`t like paying for, and others you don`t like, but if we would have cut ALL discretionary spending in 2008, we still would have had a deficit. Some of those other payments, including SS, Med./Medi., will have to be looked at for cuts. National health care first came up in the Teddy Roosevelt administration, do we have to wait another 100 years?
Nov 29, 2009 at 6:02 p.m.
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The second ten years the plan cuts the deficit an additional $600 billion. Let`s see what they "concoct" to pay for Afghanistan, or will it be a tax cut? Maybe pass another Medicare bill like 2003, with no "concocting" on how to pay for it. I ,for one, am glad somebody is finally "concocting" a way to pay for something, and a good fiscal conservative should be too.
Nov 29, 2009 at 5:34 p.m.
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Krauthammer is really going off the deep end. Comparing oranges to health care is ridiculous. Oranges are a commodity; health insurance is not.
Each state currently determines their own minimum requirements to sell insurance there. If insurance companies are allowed to sell across state lines, they will all simply sell their plans from the state with the least amount of regulation and consumer protections. Selling oranges, or any other food, across state lines works because every seller must satisfy uniform FDA regulations. Damn that pesky government.
Nov 29, 2009 at 5:25 p.m.
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Zoom, where is the CBO wrong? I never said their numbers were wrong; they based their 10 year study on the plan put forth by the senate leadership...concocted to get a good score. Any program that collects fees and taxes for 3+ years before spending anything looks good on paper.
Now, try to debate the facts.
Nov 29, 2009 at 5:15 p.m.
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I knew RAF would drop his unwavering support for the CBO whenever their analysis didn't agree with his worldview.
Nov 29, 2009 at 12:06 p.m.
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Donnaw must be a "white male"
Nov 29, 2009 at 5:40 a.m.
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Just what we need, 118 new bureaucracies in Washington--new salaries, benefits (gov health insurance-not the one they are forcing down our throats) pensions, etc. And if 58% of Americans are against and only a third of Americans are for this plan, why are they doing it!! Because they think the govt is always the answer. I would rather let the states handle it. I feel I have more influence over what happens in our state than our federal govt, which seems like one big sesspool. Everytime we send money to Washington everybody has their hand out on the way there and the way back. How inefficient!
The mainstream press has been asleep at the wheel on this one--not much fact reporting, just trumpeting the need for the plan. Hope we vote these idiots out of office!
Nov 29, 2009 at 4:26 a.m.
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greatplain if you think it is such a great deal give it a try.
Nov 28, 2009 at 8:16 p.m.
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RetiredAirForce- You received funding for your insurance in the service supplied by taxpayers, right?
How was it?
Nov 28, 2009 at 7:36 p.m.
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And the second decade the deficits go down over $600 billion. Was CBO right about the tax cuts causing huge deficits? Yes! In Ryan`s plan he touted the savings from Medicare reform, did you believe him because it was a Republican saying it? They sure have a track record of deficit/debt reduction don`t they? Is Medicare/Medicaid socialism? Let`s see if you can get rid of them.
Nov 28, 2009 at 6:29 p.m.
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Typical reaction declaring belief in the CBO now vs then. Deal with the facts.
If this bill was scored when benefits start it is a budget buster. The current scoring from the CBO expects a complete ~+400 billion reduction in Medicare and counts money collected for +3 years before paying anything out.
If the bill was really deficit neutral why employ budget tricks? I hear Harry Reid has ocean front property for sale in Nevada if you want it too.
Nov 28, 2009 at 5:15 p.m.
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It's hard to see how anyone can be against a health reform plan that becomes insolvent, by design, less than 7 years after benfits kick in. It's the only way we can get ourselves out of the current deficits we are already running.
Nov 28, 2009 at 3:18 p.m.
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they do all that for us with the help of PRIVATE BUSINESSES. without them, it wouldn't work. just like what will happen when the government wipes out all the insurance companies. i.e. single payer.
Nov 28, 2009 at 2:52 p.m.
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"Only a lawywer would be against tort reform," I am not a lawyer, and not against tort reform, but it does not do the job of reducing costs. The people in states that have done it have seen no lowering of their health insurance premiums. The only way health care will work if it can be sold across state lines is if the government sets minimum standards for policies, otherwise all the work states have done to protect consumers could be for nothing.
Nov 28, 2009 at 1:16 p.m.
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#10 only works here in Janesville for the first snowfall and only if they get out with the plows before 2 am. other wise the budget is broke and so are we the tax payers
Nov 28, 2009 at 12:37 p.m.
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What does the government do well (not perfectly):
1. makes sure my food is safe.
2. makes sure my drugs are safe.
3. provides roads unlike any other country in the world.
4. keeps me safe.
5. provides my children with an OPPORTUNITY to the best education in the world.
6. provides vaccines to the extent that we have eradicated illnesses that use to kill millions.
7. provides access to utilities and makes sure that they can't raise prices without civilian approval.
8. makes sure that companies don't make and market products that are unsafe.
9. makes sure that when a woman is pregnant she can't be fired.
10. removes snow from the street so I can get to work.
We often forget the successes of the government because we get focused on the failures. Look around and be grateful for what our government has done for us.
Nov 28, 2009 at 11:24 a.m.
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name one thing the government has a monopoly on, and does right.
Nov 28, 2009 at 10:33 a.m.
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its time for single payer health care...
Nov 28, 2009 at 10:25 a.m.
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There are ways we can reduce health care costs to a point but we have to realize we get what we pay for (or in obama's plan we get what other people and our grandkids pay for.) There is always going to be a significant cost for a significant benefit such as with the best health care in the world.
Nov 28, 2009 at 10:23 a.m.
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only a lawyer would be against tort reform. the government can't run welfare, medicade, or medicare. how are they going to fix health care? anyone who can stand by such a stupid decision is a sheep for sure. looking to the government for everything has been the beginning of the end for many many countries. it breeds lazy expectant non productive generations to come. why work for a living if the rich people are going to pay all my bills!
Nov 28, 2009 at 9:32 a.m.
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CBO numbers are great when they are in your favor, and not to be believed when they are not. Right? We should have listened when they said the Bush tax cuts would balloon the deficit $!,5 trillion,. and the Medicare bill of 2003, and the wars were not paid for. This bill is paid for.
Nov 28, 2009 at 7:41 a.m.
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Yes, passing a terrible bill that will put this nation further in debt is a better choice...
Nov 28, 2009 at 12:12 a.m.
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In the ranking by OpenSecrets.org of campaign contributions by the top 100 special interests during the past 20 years, the American Association for Justice (AAJ) – formerly the Association of Trial Lawyers of America – ranks sixth overall. The AAJ is the trial lawyers’ Washington lobbying group, and 90 percent of its $30.7 million in contributions since 1989 went to Democrats. At the other end of this pay-to-play process in the nation’s capitol, AAJ has spent nearly $14 million lobbying Congress just since Democrats won control of both chambers, including $2.3 million thus far this year.
http://www.washingtonexaminer.com/opinio...
And by the way, John Kerry was also under that desk.
Nov 27, 2009 at 11:28 p.m.
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Hey, I heard a rumor somebody told me once so I don't know if it's true or not, but didn't the Republicans actually control both houses of Congress and the White House earlier this decade? I didn't see any tort reform then. Oh, that's right, they were busy checking under Bush's desk for nonexistent nuclear weapons. Well, priorities, I guess.
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This is something they only bring up to jab Democrats. If they actually cared about it they would have done it when they had power.
Nov 27, 2009 at 10:49 a.m.
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Why wait till now to come out with these "novel" ideas? Where were the conservatives on the health care issue in the past? When ten Senators, five from each party, sent Bush a letter early in 2007 offering to work with him to reform health care because of it`s problems, his answer was......? Krauthhammers low estimate on tort reform savings, is somehow over 400% higher than CBO`s. Besides, over 30 states have enacted tort reform, and the savings are what? I`m not against it, but it is not the "magic potion" that will reform health care. There is a form of interstate insurance sales offered in the House bill, I don`t know about the Senate one yet. But then the strict Constitutionalists will lose whatever reason they try to bring forth that national health care is unconstitutional because you would have interstate commerce. By the way, is Medicare/Medicaid unconstitutional? It`s a national health program, let`s see the uproar if we try to get rid of those programs. When people like McConnell say that they will fight health reform, no matter what amendments or changes(161 Republican amendments in the Senate Finance bill), is he doing what he was elected to do, or just obstructing?
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