Interview With Rep. Rob Bishop (R-UT)
I was able to interview Rep. Rob Bishop (R-UT) today for about ten minutes, thanks to Ericka Andersen of the House Republican Conference. Below is our exchange (paraphrased and based upon notes I took during the interview):
DS: Debt is out biggest issue. My father believes that we will never get out of the debt hole Presidents Bush and Obama are putting us in. How would you work to get this country out of this debt and deficit load?
RB: I don’t mean to over-simplify the solution, but federalism should be applied. We need to redefine what the role of the federal government is. We have good programs, but who runs them? The federal government. It’s too big to run so many programs well.
We should have the states run many programs, and give them the tax revenue that would otherwise be given to the federal government.
Creativity, efficiency and justice can only be done at the state and local levels- the federal government is just too big. We need to get the federal government out of peripheral areas. Foreign policy and national defense should be handled at the federal level, though.
DS: What would be your strategy to federalize these programs?
RB: Empower states to fight Congress. Back in 1988, Bruce Babbitt proposed empowering the states to oppose Congressional acts. The basic proposal was that if 2/3 of the states opposed a Congressional act, it sunsets in a year. National defense and foreign policy would be exempt.
DS: The Pentagon budget is as full of waste, fraud and abuse as any program, including Medicare. I know it’s hard for a Republican to commit to streamlining the Pentagon budget, but would you do so?
RB: No. I would not. That’s partially because the Pentagon has already started a lean program in Depot Force, and is asking people on the front line of building what our military needs how we can make things cheaper, with less of a footprint and with fewer people.
Healthier Care
In an op-ed for today’s New York Times, Paul Krugman criticized Republican support for Medicare as hypocritical. He’s correct. An argument that condemns a federal takeover of the healthcare industry (let’s be clear about what’s really going on here), while at the same time defending Medicare, is as principally sound as a vegan cannibal. It just doesn’t make sense. All that whining about the lack of bipartisan cooperation is downright pathetic. The real problem isn’t the way that we’re reforming healthcare, the real problem is that we’re reforming healthcare at all. If we truly want better healthcare, we must cut regulations and restore freedom to both doctors and patients alike.
Republicans Are Focused On The Wrong Target
President Obama’s budget is massive, full of debt and, according to USA TODAY, “…did not propose any major savings in Medicare, Medicaid and Social Security, the three entitlement programs that consume nearly 40% of federal spending. By 2020, they’ll eat up 46%.” However, Republicans should not concentrate their fire on the president. Congress holds the purse strings to the federal government, and while Obama is an easy target for both Members of Congress and activist groups to go after, it is Congress that will decide what gets spent, and how it gets spent. Going after the president certainly feels good…but it won’t do the job of holding down federal spending. Only going after Congress will do that.
How Medicare Cuts Should Work
In an odd twist of political fate, Democrats have called for cuts in Medicare of up to half a trillion dollars over ten years, and Republicans have opposed those cuts. While not a fan of Medicare, but certainly a fan of cutting the massive wasteful spending that occurs in the system, I believe a more ethical way of weaning Americans off of Medicare must be created.
Conservatives may not like this approach, but older people have paid into Medicare for 35 or more years with the promise of a financial return. To cut their benefits with the ax Democrats have proposed is not right. It will hurt the nation financially, but I think the cuts must be phased in over a period of time, in order that Americans who will be the recipient of said cuts will have time to save money and adjust their retirement goals before the cuts kick in. Of course, stopping the massive fraud and the aforementioned waste in Medicare would help the sustainability of the program quite a bit, and perhaps give us a bit more time to phase Americans out of Medicare, or at least into a more sustainable version of it if the program isn’t eliminated.
The Mayo Clinic Speaks
Senator Reid, when The Mayo Clinic, possibly the most respected medical establishment in the nation, dislikes your bill, you are in trouble.
President Obama and The Mayo Clinic have worked together on health care reform this year. Mayo has critiqued the health care reform efforts before, but also praised efforts on payment reform. However, consider the following regarding the current Senate bill: “Expanding this system [Medicare] to persons 55 to 64 years old would ultimately hurt patients by accelerating the financial ruin of hospitals and doctors across the country. A majority of Medicare providers currently suffer great financial loss under the program. Mayo Clinic alone lost $840 million last year under Medicare. As a result of these types of losses, a growing number of providers have begun to limit the number of Medicare patients in their practices.? Despite these provider losses, Medicare has not curbed overall spending, especially after adjusting for benefits covered and the cost shift from Medicare to private insurance.? This is clearly an unsustainable model, and one that would be disastrous for our nation?s hospitals, doctors and eventually our patients if expanded to even more beneficiaries.”
Mayo spends a fraction what the most expensive Medicare-accepting hospitals do on patients and uses fewer resources by far. When they can’t break even on Medicare, who can? Yet Democrats want to expand Medicare? Former Vermont Governor Howard Dean was on MSNBC the other night- I was in the gym and decided to watch Keith Olbermann for a few minutes- and he fully supported the expanded Medicare concept. That alone is almost enough for me to oppose it, though when a single-payer advocate in Congress supports it as well and Stuart Butler of The Heritage Foundation is against it the opposition becomes complete.
Mayo has its critics- but many of those critics merely claim Mayo can keep costs down because it has patients that are less racially diverse, wealthier, etc. Those critics add to the case Mayo makes above, because if Mayo does have the advantages critics claim and still can’t break even on Medicare reimbursement, how can the vast majority of the rest of the nation’s hospitals even come close?
Liberals make the argument that Medicare brought millions of elderly people out of poverty- this may or may not be true, but the simple fact is that many or perhaps even most Congressional Democrats don’t have a clue about financial sustainability- granted, nor do most Congressional Republicans- and by expanding Medicare they hasten the bankruptcy of America.
Government Pays More Health Care Than Private Industry
The non-partisan Congressional Research Service has released information showing that government spends more on health care than the private sector. While this should come as no surprise- the vast majority of health care costs are borne in the last months to years of life, after all, and that is what Medicare is for-? Senator Tom Coburn (R-OK) is taking full advantage of the information to once again show how government is the problem in health care spending.
RightSideNews.com, where I found the above information at, also compares a number of government health care negatives not as well-known as they should be. Take a look at the first link’s comparative information- it’s kind of interesting when contrasting Medicare with the private sector.
P.S. Coburn is also causing problems with Democrats in Congress- many of whom are backing his amendment for all Members of Congress to join a public option if it’s legalized. Kudos to those Democrats who have so far volunteered to join the public option if it passes, and support the Coburn amendment. I disagree with their public option support, but respect their putting their money and health care where their mouths are.
Taking $1 From Every American
Last evening thelobbyist’s founder Nick Brown gave me the quote of the day: “So what you’re telling me is they took a dollar from every American to pay off [Senator Mary] Landrieu (D-LA) to vote for health care reform?”
In short, Senator Landrieu demanded $300 million for her vote to start debate on the Senate’s health care bill. Initially worth $100 million, her critical vote for Democrats is increasing in price. The Senate is trying to hide its bribery by claiming the money is for any qualifying ?state,” saying, among other things, that it would be states that ?during the preceding 7 fiscal years? have been declared a ?major disaster area.?” In other words, for Hurricane Katrina and Louisiana.
Can we please call our senators and kill this bill? Then, next year, let’s vote the bums out. Please. In both parties. Starting fresh is a great way to go. Or, we could always rebel. Put a government in place that represents the people, institute constitutional term limits, have transparency with every political donor required to be listed on political websites and in every office, eliminate business subsidies, eliminate bailouts and cut the waste in defense, education, Medicare and Medicaid. Oh, and put in a flat tax or, even better, the Fair Tax that Mice Huckabee has made almost famous.
Senator Reid Releases Senate Health Reform Bill
Various news sources have information for the willing:
Congress.org has five interesting provisions about the bill, as well as a link to the bill itself.
CNN has an article, a political analysis of sorts as well as a link to the bill.
NRTL blasts the bill, according to Politico.
AP, NYT, and NPR compare the House and Senate bills.
Remember- this bill does not include the more-than-quarter-trillion dollar “Doc Fix” bill that failed in the Senate a month ago. So whatever the Congressional Budget Office says…add that to it. The current CBO score is $849 billion, which includes Medicare cuts and raising some taxes, and will reduce the debt by $127 billion. So, in reality, the debt will increase by $118 billion, unless the government and CBO estimates are underestimates, which is generally the case.
Either way, the CBO score is great momentum for Senator Reid (D-NV) with fiscally conservative Democrats- who may ignore the “Doc Fix” numbers for the final vote on the Senate bill- and bad for those of us opposed to many of the Democratic health reform concepts. Fortunately or unfortunately, depending on how you look at it, abortion is covered in the bill and there is a public option. This is bad because they are bad ideas, but good because it will allow moderate Democrats to oppose the bill if abortion and the public option are included, as some have said they will do. Whatever else happens, let’s at least hope the public option and abortion are eliminated. Contact your Senators.
One last note: this is the preliminary CBO score Democrats are all excited about. The final one is supposed to be out today.
An Actual Solution To Health Care Reform
As a third year medical student keeping a close eye on the progress of the health care reform proposals moving through the Democrat-controlled Congress,? thoughtful analysis leads to one conclusion ? a government takeover of the health care system is not the solution to the catastrophic problems we face.
I am concerned by the justification given by Democrat leaders and liberal newspaper editorial boards for supporting the ?public option.?? The Miami Herald recently opined ?private insurers don’t make a profit by insuring people likely to need coverage? ? which could be distilled to ?sick people cost more.?? The significance here is that insurance companies then charge them more making coverage increasingly unaffordable.? To complete the argument, the ?public option? would solve this problem.? The CBO says otherwise.? The non-partisan referee of this domestic policy heavyweight bout says the public plan would be more costly than the average private plan because it would ?engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees?. In other words, sick people are more expensive independent of who is paying the bill.
To some, the answer to this problem is ?guaranteed issue? ? colloquially known as making it illegal to discriminate against those with pre-existing conditions.? This is known to drive up insurance premiums, in one study by 227%, making coverage for the young and healthy cost-prohibitive.? These are the coveted participants referred to obliquely above that allow the spread of social risk.? In the House bill, the penalty associated with foregoing insurance is 2.5% of adjusted gross income.? For a young person making $40,000, this amounts to $1000 ? small fare if purchasing insurance will cost between $6000 and $8000 ? especially if you don?t think you are going to get sick.? What to do now? As is the case with many government interventions into the private sector, we quickly become mired in how to fix the fixes.
The solution is much less complicated.? What Speaker Pelosi failed to do Friday in 1,990 pages of definitions, distinctions, and dictums, I will do in 418 words.
First, go after Medicare and Medicaid fraud.? A CBS 60 minutes investigation estimated the cost of that enterprise to the taxpayers at $60 billion a year.? A GAO study showed that in 2007, $32.7 billion of Medicaid payments were improper – this cost the state of NY alone over $5 billion. How can we justify expanding the role of government in health care before fixing the current iteration?
Second, sever the union of employers and insurance by taxing employer health plans as income and returning it to employees in the form of a tax credit to purchase insurance.? This would empower patients to choose plans that meet their needs while simultaneously making their plan of choice completely portable.
Third, allow the purchase of insurance across state lines to create a robust market of choices with coverage mandates to be decided by a panel of physicians ? not bureaucrats.? This will facilitate creation of plans for the young and healthy based mostly on routine checkups and catastrophic protection alongside ones for the chronically ill centered on meeting evidence-based guidelines to monitor their conditions.? This prescription gives insurance companies something they want in exchange for something we need.
Fourth, institute meaningful tort reform.? The Pacific Research Institute estimates we spend $200 billion annually on defensive medicine.? Compensating those who are truly harmed and punishing the neglectful does not require trial lawyers.? Physicians traditionally spend 4 years in undergraduate school, 4 years in medical school, and between 3-7 years in residency with a fellowship to follow should they decide to further specialize.? Loss of a license equals loss of a career and loss of 10+ years of one?s life spent intensely training.?? In this medical student?s opinion, there exists no harsher punishment.
Finally, reform the Medicare physician payment formula.? The SGR is an archaic method to determine reimbursement that underpays doctors and forces them to take on less Medicare patients and more of the privately insured in order to cover costs.? The current legislation under consideration in both houses of Congress imposes a 25% across-the-board pay cut to Medicare?s physicians ? Svengali accounting at best and because it will never happen, also blatantly dishonest.? 13 Democrats joined all 40 Republicans voting down the ?doctor fix? bill in the Senate two weeks ago largely because it was seen an attempt to hide the true cost of health care reform.? The adjustment will cost $250 billion over a decade but is a necessary addition to comprehensive legislation to ensure that our senior citizens continue receiving high-quality care.
This five-point plan at Ms. Pelosi?s price of $2.2 million per word only costs only $1 billion.? Please make the check payable to Nicholas Rohrhoff.
From hearing the gentleman repairing my family’s refrigerator the summer before medical school mention how many more he has to repair in order to afford his coronary bypass surgery to sitting in a classroom of 150 extraordinary colleagues called to serve their fellow citizens in the noblest of professions;? From seeing my father?s corporate job disappear in the financial meltdown along with my family?s insurance policy to having a colleague at the University of Florida ask me if we, as future physicians, are going to need second careers in order to secure our financial futures ? I?ve drawn an undeniable conclusion: people are policy.
Health care reform is the domestic issue that will define my generation.? How we decide to take care of each other will be our legacy. ?Unleashing the remarkable ability of the American patient as consumer to bring down costs and increase quality (with appropriate consumer protections and subsidies for those in need) and incentivizing physicians to provide high-quality care and push the envelope of medical innovation is the answer.? As Candidate Obama said, ?We are the ones we?ve been waiting for.?? We are the real public option.
-nicholas rohrhoff is a third year medical student at the University of Miami?s Miller School of Medicine
