http://article.nationalreview.com/?q=NjJmNjY4MjA2ZmNkZWNmZDU2ZmY1NTUwZmMzNmIxMjE=&w=MA==


September 28, 2009, 4:00 a.m.

You Mislead!
Fact-checking Obama.

By Michael F. Cannon and Ramesh Ponnuru

It is a good thing that other congressmen did not follow Rep. Joe Wilsons lead. If they yelled out every time President Obama said something untrue about health care, they would quickly find themselves growing hoarse.

By our count, the president made more than 20 inaccurate claims in his speech to Congress. We have excluded several comments that are deeply misleading but not outright false. (For example: Obama pledged not to tap the Medicare trust fund to pay for reform. But there is no money in that trust fund, anyway, so the pledge is meaningless.) Even so, we may have missed one or more false statements by the president. Our failure to include one of his comments in the following list should not be taken to constitute an endorsement of its accuracy, let alone wisdom.

1. Buying insurance on your own costs you three times as much as the coverage you get from your employer. The Congressional Budget Office writes, Premiums for policies purchased in the individual insurance market are, on average, much lower about one-third lower for single coverage and one-half lower for family policies. It is true that individual insurance policies are generally 30 percent less comprehensive than employer-provided insurance, and comparable individual policies are about twice as expensive. But much of the extra cost is a function of the tax penalty on purchasing such insurance and the stunted market that penalty has yielded.

2. There are now more than 30 million American citizens who cannot get coverage.An outright falsehood, whether you use the presidents noncitizen-free estimate or the standard, questionable estimate of 46 million uninsured residents.

A study prepared for the federal government estimates that 9 million people counted as uninsured in the standard estimate are in fact enrolled in Medicaid. The left-leaning Urban Institute estimates that 12 million are eligible but not enrolled, meaning they could get coverage at any time. Health economists Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford estimate that one quarter to three quarters of the uninsured can afford to purchase coverage, but choose not to do so.

3.And every day, 14,000 Americans lose their coverage. The paper that generated this estimate assumed that two months of severe job losses would continue forever. Applying that papers methodology to a broader period of rising unemployment (January 2008 through August 2009) produces a figure below 9,000.

It also assumes those coverage losses are permanent. Like many of the 46 million Americans we label uninsured, many of those 9,000 will regain coverage after a number of months. (David Freddoso illustrates the absurdity of assuming that all coverage losses are permanent.)

4. One man from Illinois lost his coverage in the middle of chemotherapy. . . . They delayed his treatment, and he died because of it. He didnt die because of it. The originator of this false claim, a writer for Slate named Timothy Noah, has admitted he got it wrong.

5. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. Scott Harrington supplied more facts in the Wall Street Journal: The womans testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologists chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application. The woman deserves sympathy, but Obama has stretched the truth here.

6. Rising costs are why so many employers . . . are forcing their employees to pay more for insurance. Perhaps no other issue generates as much of a consensus among health-care economists as this one: The employers share of employees health-care costs comes out of those employees wages, not out of profits. In this comment and in five others in his speech, Obama contradicts that basic truth. Employers arent forcing their employees to pick up a larger share of the bill because they cant. Workers are already paying the entire bill.

7. Rising costs are why American business that compete internationally . . . are at a huge disadvantage. False. The rising cost of health benefits does not increase employers labor costs because, again, wages adjust downward to compensate. The Congressional Budget Office, under the leadership of Obamas OMB director, Peter Orszag, confirmed that health-care costs do not hinder competitiveness. Obama economic aide Christina Romer has called this competitiveness argument schlocky.

8. Those of us with health insurance are also paying a hidden and growing tax for those without it about $1,000 per year that pays for somebody elses emergency room and charitable care. That number comes from a left-wing advocacy group. A Kaiser Family Foundation study debunked the groups analysis, reaching an estimate closer to $200 per year for a family. The CBO report mentioned above reached the same conclusion.

9. At this point, Obama said, These are the facts. Nobody disputes them. This comment continues Obamas already long tradition of trying to curtail debate by denying that anyone disagrees with him.

10. [Reform] will slow the growth of health-care costs for our families, our businesses, and our government. In July, CBO director Douglas Elmendorf said, In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health-care costs. The CBO projects that the legislation that Sen. Max Baucus (D., Mont.) has since introduced would reduce the federal budgetary commitment to health care, relative to that under current law, during the decade following the 10-year budget window, but hints that the 40 percent cut in Medicares reimbursement rates, which helps Baucus achieve that feat, is politically unrealistic. (More on that below.) Health economist Victor Fuchs writes that the proposals before Congress aim at cost shifting rather than cost reduction. Obama and his allies have yet to demonstrate anything to the contrary.

11. Nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have. Obamas wording is lawyerly: While not denying that his plan would cause people to lose existing coverage with which they are satisfied, he leads us to believe that he is denying it. But even on its own terms, Obamas claim is false. The CBO estimates that slashing payments to Medicare Advantage, as Obama advocates, would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans. It would also cause some people to lose their coverage.

12. Requiring insurers to cover preventive care saves money. Nope. According to a review in the New England Journal of Medicine, Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.

13. The [bogus] claim . . . that we plan to set up panels of bureaucrats with the power to kill off senior citizens . . . is a lie, plain and simple. Sarah Palin claimed that Obamas death panels would deny people medical care, not actively kill them. If Palin believes her claim, it is not a lie, plain and simple. Most important, the substance of Palins claim is, in fact, true. Obama himself proposed a new Independent Medicare Advisory Council with the authority to deny life-extending care to the elderly and disabled.

14. There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms Im proposing would not apply to those who are here illegally. For better or worse, the presidents plan would, in his words, insure illegal immigrants. Various federal agencies, immigration critics, and the media all acknowledge that a small number of undocumented aliens obtain Medicaid benefits despite being ineligible. The president seeks to expand Medicaid, which would create greater opportunities for ineligible aliens to enroll.

The House Democrats health-insurance exchange, which Obama supports, would apply to undocumented aliens. The CRS writes that the House legislation does not contain any restrictions on noncitizens participating in the Exchange whether the noncitizens are legally or illegally present. Nor does it require that the legal status of people receiving subsidies be verified.

Finally, Obama supports granting legal status to millions of illegal immigrants, which would make them eligible for government benefits under his health plan.

15. Under our plan, no federal dollars will be used to fund abortions. Unless Obama refers to some draft legislation inside his head, this claim is false. The House bill allows the government option to pay for abortions directly from the U.S. Treasury. Both the House and Baucus bills would subsidize private insurance that cover abortions. (See Douglas Johnsons comment on this article.)

16. Critics of the public option would be right if taxpayers were subsidizing this public insurance option. But they wont be. Ive insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. How quickly we forget the example of Fannie Mae and Freddie Mac. Like those institutions, the public option would benefit from an implicit subsidy: Everyone would know that Washington would not allow the program to fail, and financial institutions would therefore offer it better rates. (During the Clinton administration, Obama adviser Larry Summers reported that a similar implicit guarantee was worth $6 billion per year to Fannie and Freddie.) The public option would thus be able to undercut its less-subsidized competitors.

17. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need. Unless the president proposes to abolish insurance, or abolish all care management, there will always be tension between patients, doctors, and public/private insurers over what patients need. Such tensions are sure to arise under the presidents IMAC proposal.

But even if a new program would be administered by the government, just like Medicaid or Medicare, it would interfere in those decisions. As an administrative-law judge wrote to one of us after Obamas address: I am a government bureaucrat . . . and I just happen to be reviewing [six] cases, albeit involving Medicare and Medicaid, where the government has inserted itself between the patient and the care prescribed by the physician.

18. I will not sign a plan that adds one dime to our deficits either now or in the future. The plan will not add to our deficit. None of the bills before Congress can credibly claim to keep the deficit from rising. The one that comes closest, the Baucus bill, does so by making the wildly implausible assumption that Congress will allow 40 percent cuts in physician payments under Medicare to take place in 2012. Congress has routinely refused to support much smaller cuts.

19. Now, add it all up, and the plan Im proposing will cost around $900 billion over ten years. Even the supposedly parsimonious Baucus bill would cost closer to $2 trillion than $1 trillion once we add it all up. The CBO says that bill would spend a mere $774 billion over ten years, in part because the spending begins late in that ten-year window. Republican staffers on the Senate Budget Committee estimate that the Baucus bill would cost $1.7 trillion over the first ten years of full implementation.

Moreover, the preliminary CBO score does not measure the full cost of the bill because it does not include the mandates Baucus would impose on states (about $37 billion) and the private sector (not yet estimated, but 60 percent of total costs in Massachusetts). The other bills would cost even more.

20. The middle class will realize greater security, not higher taxes. Obama would make health insurance compulsory for the middle class (and everyone else). If he thinks that isnt a tax, he should listen to his economic adviser Larry Summers, or his nominee for assistant secretary for planning and evaluation at HHS, Sherry Glied. Both liken the individual mandate to a tax, as do other prominent health economists like Uwe Reinhardt (Princeton) and Jonathan Gruber (MIT). The CBO affirms that the penalties for non-compliance would be equivalent to a tax or fine.

If Obama thinks the middle class wouldnt pay the taxes he wants to impose on the drug and insurance companies, he should read this CBO report or talk to the junior senator from West Virginia, who accurately describes those levies as a big, big tax on middle-class coalminers.

21. I wont stand by while the special interests use the same old tactics to keep things exactly the way they are. Who are these special interests? In case Obama hadnt noticed, everyone from the drug-makers to the unions to the insurance companies he demonizes are spending millions to build momentum for his version of reform in no small part because Obama has promised to buy them off with middle-class tax dollars.

When President Obama makes a factual claim about health-care policy, he does not deserve the benefit of the doubt about its accuracy. We do not know whether he has been badly misinformed or is deliberately trying to mislead. Either way, he cannot be trusted to reform American health care.

Michael F. Cannon is director of health-policy studies at the Cato Institute. Ramesh Ponnuru is a senior editor at National Review.
National Review Online -http://article.nationalreview.com/?q=NjJmNjY4MjA2ZmNkZWNmZDU2ZmY1NTUwZmMzNmIxMjE=

How the U.S. Government Rations Health Care
The agency that would likely run the 'public option' was slow to pay for implantable cardiac defibrillators.





By SCOTT GOTTLIEB

President Barack Obama deflects criticism that his health-care plan will bring on government rationing of medical care by arguing that insurance companies ration care. Everyone knows private payers limit access to some health care. But government does it in far more byzantine and arbitrary ways.

Consider the $450 billion Medicare program. It provides a model forindeed its bureaucracy could well end up runningthe "public option" health plan that Mr. Obama wants to offer all Americans under the age of 65. In recent years, Medicare's staff has been aggressively restricting coverage for costly treatments. Looking for ways to control spending on medical productsand preserve the illusory "trust fund" that pays Medicare claimsis what shapes the culture of the organization and motivates the agency's staff.

This often means limiting access to the costliest technologies. To do this Medicare relies on its rationing and pricing systems. National coverage decisions (NCDs) are assessments issued by Medicare's medical staff that define who is eligible for new but often expensive treatments. Medicare then assigns medical products and procedures with "codes" that determine which regulated category they fall into. Finally, price "schedules" are developed by Medicare's staff each year to assign each unique code with its own updated payment rate. The process for getting a favorable code on a new product is a source of intense lobbying. It can make or break a technology.

For a remote agency like Medicare, far removed from clinical practice, it's easier to try and manage the use of a high-cost but specialty treatment than a much lower-cost but very widely used product. Yet cheaper, more commonly used products can still be mispriced and account for more total cost to the agency. For example, low-tech orthotic devices and other "durable medical equipment" are a known source of wasteful spending. These medical products often evade Medicare's attention in favor of less used but more expensive items such as a biological cancer drug.

Take the agency's tortured decisions concerning the use of implantable defibrillators that jump-start stopped hearts during cardiac arrest. Medicare sharply restricted their use in the 1990s. Mounting research proved that the $30,000 devices could be saving many more lives. So in 2003 Medicare adopted a novel theory to expand coverage to some, but not everyone, who needed one. The agency said only patients with certain measures on their electrocardiograms (called "wide QRS") seemed to benefit.

It was an easily measurable but ultimately imprecise way to allocate the devices. After another major study firmly refuted the QRS theory, Medicare expanded coverage again in 2005, potentially saving 2,500 additional lives according to a press release issued with that decision.

That experience wasn't unique. From 1999 to 2007, Medicare denied access in a third of the treatments it evaluated through its coverage process, taking an average of eight months to complete its reviews. When coverage was granted, in 85% of cases the treatments were restricted, usually to patients with more advanced illnesses.

Medicare is lately increasing its use of the national coverage process and is becoming more tightfisted. Since 2008, according to my review of Medicare data, it conditioned access in 29% of its reviews and denied new or expanded coverage in fully 53% of cases.

Medicare's methods can also be arbitrary. Take the travails of the pharmaceutical company Sepracor and its drug Xopenex, an innovative respiratory medicine that competes with the chemically distinct and much cheaper generic albuterol. Both are inhaled aerosols used to treat asthma and chronic obstructive pulmonary disease. Xopenex has the same benefits as albuterol, but some believe fewer of its cardiac side effects. Medicare didn't agree.

The agency tried to make a "national coverage decision" on Xopenex but couldn't come up with a clinical justification to limit the drug's usage. So Medicare manipulated its payment process, saying it would pay Xopenex a price equivalent to the "least costly alternative" form of generic albuterol, 10 cents a treatment compared to about $2.50 for Xopenex. Then Medicare was sued by a patient, and a Federal court recently ruled the agency exceeded its authority.

Medicare finally succeeded in reigning in the use of Xopenex with its coding system. By issuing Xopenex the same classification as generic albuterol, it was able to pay both products the same "blended" pricean average of the cost of each individual drug. That lowered the price on Xopenex, but ironically increased what Medicare paid for the generics.

It's not a stretch to say that Medicare spent hundreds of cumulative man-hours focusing on Xopenex while other priorities languished. The question is why? There weren't safety concerns. Xopenex may have been used in lieu of a cheaper alternative, but at peak Medicare sales of about $300 million it represented far less than one one-thousandth of the agency's budget. Simply put, a few staffers inside Medicare were consumed with the drug and its higher pricerevealing a process that is capricious and often disconnected from science.

Worse still is how impenetrable these programs have become. Drug and device companies spend millions of dollars trying to influence Medicare decisions. The hundreds of consultants they hire to advise them typically command $20,000-a-month retainers.

Formal patient and provider appeals to Medicare took an average of 21 months, according to a report issued in 2003 by the Government Accountability Office (using 2001 data), with delays in "administrative processing" due to "inefficiencies and incompatibility" of data systems eating up 70% of the time spent processing appeals.

There's nothing inherently wrong with a program like Medicare seeking value for taxpayers. But it shouldn't make up the rules as it goes. When private plans ration care, patients can appeal directly to an insurer's medical staff. Only a small fraction of Medicare's denied claimsabout 5%are ever formally appealed because its process is so impenetrable. People can also switch insurers, and in many cases patients chose a policy because it matched their preferences in the first place. These options don't exist in a government health program.

Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services. He is partner to a firm that invests in health-care companies, and he advises health plans.

http://online.wsj.com/article/SB10001424052970204488304574435464052451436.html#printMode

Wellllll....he "meant" well....and even IF he does get his facts a little bit wrong remember....he's only looking out for us ignorant "little people" that demanded this man and his troupe takeover the country and lead us to the leftist utopia of socialism! The ends always justifies the means when leftist politics are the concern....and once the elitist socialist are in total control we'll forget all about little "mis-statements" won't we!

The language of priorities is the religion of Socialism.....Aneurin Bevan

Having the National Review or anyone associated with it "fact check" anything is no more valid than having the Huffington Post doing the fact checking, it is biased and without a doubt twists facts to support that bias. 

It is as misleading as it accuses Obama of being.   

" it is biased and without a doubt twists facts to support that bias.

It is as misleading as it accuses Obama of being."


But...you don't know that's the truth do you....you paint it with your partisan brush in order to dismiss everything as lies. Do you expect the Huffington Post to come out and be honest if the honesty shows Obama and the leftist in anything other than a good light? It's absurd to pick and choose which "facts" to believe based on partisan views of the subject...thus you are the one that loses as does all like you that will not search out other reports....ala believing Clinton's lies until the "Blue Dress" showed-up! There's a perfect example of my point....the women were scorned as liars and the press never looked for the actual truth even though they knew the Clinton's were spinning a web of lies to cover both their asses! and the leftist swallowed every drop of the spin and lies....until he was caught red faced in allll those lies...and then the subject matter was changed into....it's a private matter...or....It depends on what "Is...Is" and on and on to muddy the waters of truth! Wake-up...Obama and his troupe of socialist are for real and this is really happening to this country!

The language of priorities is the religion of Socialism.....Aneurin Bevan

I have read other reports, skip, that is why I say that it is biased and that it twists the facts to fit the bias.  I am not going to do a point by point analysis, I just want to point out the bias and leave it at that. 

And, of course, Fox News is always wrong until a month to six weeks later the other news sources decide to report the truth or simply suppress it. How about ACORN. Poor Charley over at ABC pretended that he knew nothing about it.

Investigative reporting is not for the weak-minded who refuse to dig for the truth and refuse to ask the hard questions.

" I am not going to do a point by point analysis"

of course not

Speaking of fact checking.  CNN actually fact checked the Saturday Night Live Obama accomplishments parody.

Talk about thin skinned! 

 

Having the National Review or anyone associated with it "fact check" anything is no more valid than having the Huffington Post doing the fact checking, it is biased and without a doubt twists facts to support that bias.


like a Global warming "scientist" whose grant money depends on perpetuating the scare?

There's a bunch of "he said they said" here without much provision of documentation to tell us which version is more accurate. Sure, Obama may have an agenda but surely you'll admit that The National Review has one as well?


I'll visit the first few points. Maybe I'll have time for more later ...

Point 1) Obama said privately purchased insurance is three times as expensive. NR, after first trying to obscure the issue buy interjecting the irrelevant point that if you buy less coverage it'll be cheaper, says it costs twice as much. We a re not directed to the authority for either claim. But twice as much still sounds pretty bad to me.


Point 2) Obama says 30 million citizens can't get insurance. NR calls this an "outright falsehood." As evidence, they present a series of claims regarding the people in the 46 million standard estimate:

We are told of "a study prepared for the federal government" which estimates that 9 million people counted as uninsured in the standard estimate are in fact enrolled in Medicaid. We are not told who did this study, or when they did it. Even if this unsubstantiated figure is accurate, that leaves 37 million uninsured in the "standard estimate."

We are then told that "left-leaning Urban Institute" estimates 12 million are eligible for Medicaid. The implication seems to be that we are to add that to the alleged 9 million already covered, but there is no evidence that the "left-leaning Urban Institute" believes or takes into account that number, so we have no way of gauging how large an overlap there may be between these estimates. Arguably, this still leaves us with 35 million who cannot get insurance, if the overlap is complete.

Then we are told that two academics "estimate that one quarter to three quarters of the uninsured can afford to purchase coverage." Again, we are not directed to any documentation of this claim, nor are we even told whether this is based in rigorous research. It's a pretty damn broad range they're tossing out there. And again we have no information as to whether this overlaps the previous sets or not.

So maybe the actual number of citizens who cannot get insurance is less than 30 million, but we have precious little evidence of what the real number is based on these point. Even if these claims are all true, the number could still be in the 20 million range.


Point 3) `President Obama stated that every day, 14,000 Americans lose their coverage. Here at least, NR admits that there is research which says exactly that. I could rest my case there, but I'll go on to point out that their counter-number of 9000 is still pretty bad.

Furthermore they claim that there's an assumption that those people never get insurance again. I see no such assumption in President Obama's speech. But I'd point out that with regard to any preexisting condition, it is indeed true that such people will never get insurance again for those preexisting conditions as things stand today.