Health Care

Return to Common Sense

February 23, 2013

Section: Culture – Health Care

“The longer the federal government delays a transition to patient-centered, consumer-based health care, the more likely the existing health care system will drag the federal government into bankruptcy; and the American public has made their preferences known, if only politicians listened.”

“The answer for healthcare is market incentives, not healthcare by a Godzilla-sized government bureaucracy.” Mitt Romney.

Philosophy (Background, Issues, Objectives):

The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

· HHS represents almost a quarter of all federal outlays, and it administers more grant dollars than all other federal agencies combined.

· HHS’ Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year.

· Medicare and Medicaid together provide health care insurance for one in four Americans.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

· EMTALA requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.

· There are no reimbursement provisions.

· Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

Top ten causes of death in the U.S. for 2010 according to the Centers for Disease Control and Prevention:

Heart disease: 616,067
Cancer: 562,875
Stroke (cerebrovascular diseases): 135,952
Chronic lower respiratory diseases: 127,924
Accidents (unintentional injuries): 123,706
Alzheimer's disease: 74,632
Diabetes: 71,382
Influenza and Pneumonia: 52,717
Nephritis, nephrotic syndrome, and nephrosis: 46,448
Septicemia: 34,828

Medicare is the federal government’s health insurance program for all Americans age 65 and older and for the disabled.

· In 2010, the program covered 47 million enrollees.

· Medicare is projected to spend $549 billion in 2011, increasing to $891 billion per year by 2019.

Part A covers in-patient hospitalization, hospice care, and some home health care. It is funded by a 2.9 percent payroll tax, but projected spending will far exceed future tax revenue.
Part B is voluntary and covers physician services, outpatient hospital services, preventive care, and some home health services. Beneficiary premiums cover just 25% of Part B costs. Taxpayers pay for the remaining 75 percent.
Part C, the Medicare Advantage program, is also voluntary. It consists of private plans that already compete in the Medicare program.
Part D is the voluntary Medicare prescription drug program. While beneficiary premiums account for approximately 10% of Part D financing, 82% comes from general federal revenues, and approximately 8% of the funding comes from states and other sources.

· Medicare Part A and Part B together are sometimes referred to as traditional Medicare or Medicare fee-for-service (FFS).

Medicare is facing insolvency as the baby boom generation goes fully into retirement.

CBO projects Medicare to exceed 25% of all tax revenue by 2030.

o In 1965 Medicare was enacted as part of the social security program for all those over 65.

o Life expectancy has risen and the fastest growing portion of the population is over 65.

o Currently over 40 million elderly and disables people enrolled in Medicare.

o Defensive medicine practices have driven the cost of Medicare up dramatically

o From 1970 to 2005, average spending per Medicare beneficiary rose 8.9%.

o Medicare's cost had soared from 42 billion to over $468 billion between 1970 and 2008 - an 11-fold, or 1000 percent, increase.

As of 2008, the present value of liabilities of future Medicare benefits is $36 trillion.

Medicaid is unfit to meet the needs of working families without health care coverage.

Medicaid is a joint federal-state “free” public program for the poor (means testing).

o Health care costs are invisible to beneficiary since the company pays the premiums.

o In 2006 companies now pay $9,000 for a family policy.

Medicaid is a form of welfare, discouraging self-sufficiency and encourages dependence.

o Total federal and state Medicaid expenditures will reach $349 billion in 2007, of which 57% is federal.

§ Medicaid typically pays physicians 56% of the amount that private insurers pay.

o Medicaid is now the largest government health care program, surpassing the cost of Medicare.

o Medicaid patients have poorer health outcomes, than privately insured patients.

o 65% of adults between 19 and 64 would prefer private health care coverage over Medicaid.

o With huge budget deficits and exploding costs, states are over-extended and have begun rationing.

Federal government intervention has resulted in higher costs and lower efficiency.

Health care is not in the Declaration of Independence or Constitution as a “human right.”

o Compulsory health insurance was defeated under Presidents FDR, Truman, and Nixon.

Federal attempts such as McCarran-Ferguson Act, Medicare, Medicaid, ERISA, CLIA, and Stark I & II have all made health care more expensive.

o In 1973 the Employee Retirement Income Security Act (ERISA) allowed large employers (300+) to “self-insure” and be exempt from McCarran-Ferguson.

§ IRS decision allowed health insurance benefit to be tax-free.

§ ERISA coverage was employer based, but was not employee portable.

o In 2005 public health programs account for $2 trillion spent on U.S. health care (16% of GDP).

o 80% or more of all medical-care pricing is based on government reimbursement rates set by Medicare.

o Government regulations imposed on the industry cost more than $330 billion a year.

Medicare bureaucracy has no experience buying outpatient prescription drugs.

o Federal negotiation of drug prices has resulted in a reduced and older drug list at the VA’s National Formulary (VANF).

o Medicare’s market clout is in fact, inferior to that of the largest existing pharmacy benefit managers (PBMs).

Medicare reimbursements for doctors and hospitals do not cover the total cost of treatment.

o Doctors and hospitals routinely “cost shift” by charging private insurance higher prices to cover the Medicare shortfalls.

People are uninsured for various reasons, but a majority chooses to be uninsured.

Only 6% of Americans buy health insurance directly from those insurance companies.
Some smaller businesses buy policies for their employees but together this constitutes less than 15% of the market.
The largest bloc of Americans (about 40%) have health benefits, not insurance.

o Employer self-ensures under the federal ERISA program, which allows employers to offer their employees health coverage free of state and federal taxes and cumbersome state mandates

U.S. Census data shows over 47 million people uninsured during 2006, though long term very small.

o 17%, over 8 million, “can not afford” health insurance.

o 20%, over 9 million, will have insurance again with 4 months after job transitions.

o 27%, over 12 million, are not citizens and ineligible for government assistance.

o 38%, over 18 million, earn enough but choose not to be insured.

o 80% are working uninsured, while at least one member of the family has a job.

Institute of Medicine 2004 study concluded 18,000 people died because no health insurance, when no correlation was shown or proved.
Non-emergency care is being provided in hospital emergency rooms.
Small businesses are unable to afford health insurance for their employees.
Individuals purchasing a policy must use after tax dollars.
State Children’s Health Insurance Program (SCHIP) is designed to extend coverage to children.

o Extensions to SCHIP are being proposed to cover more people including adults.

o Minnesota and five other states spend their SCHIP dollars largely on adults, not kids.

o SCHIP extension is based on a 1993 Hillary Clinton political strategy to subliminally expand into a universal healthcare program.

Americans have expressed their preferences (Gallup Polls) on health care reforms:

94% prefer tax breaks for small businesses.
86% prefer to de-link jobs from insurance.
81% prefer pay-or-play mandate for large companies.
77% prefer reduction in government regulation of insurance.
76% prefer subsidies for low-income Americans.
69% prefer limits on malpractice lawsuits.
68% prefer tax credits to buy health insurance.
68% prefer federal funding for state health programs.
Only 54% prefer single payer national health care system.
Only 54% prefer repealing tax cuts to pay for health care.
Only 53% prefer individual mandates.

Health Savings Account (HSA) and Health Reimbursement Account (HRA) have been proposed.

Conservatives proposed personal health accounts, with retained ownership by the employee.
Democrats proposed reforms at Hyde Park Declaration for reform and personal retirement accounts.
Liberal obstructionists are in crisis denial and insist that Medicare does not have a problem.

Health issues have been sensationalized based on poor research and exaggerated implications.

Genetically modified food and bacteria that would create out of control transgenic life forms has proven to be a baseless fear.
AIDS remains a very low threat to the health of the vast majority of Americans, since it is restricted primarily to homosexuals and IV drug users.
New particle accelerators that were built to replicate the Big Band Theory might inadvertently create a black hole swallowing the earth has been proven not to be a threat.
In the 1980s environmentalists predicted that the ocean would die if not immediately cleaned up, but these predictions of its demise were proven incorrect.
Smoking research has proven a relationship between smoking and cancer, but not causal.

o Secondary smoke research has reached no real causal conclusions, only inferences.

o 1993 EPA report on secondhand smoke was vacated in 1998 based on poor research methodology and lack of scientific proof.

Cancer fear of electric and magnetic fields created by power lines had no evidence to support it.
Global hunger based on a population explosion has been forecast by Thomas Malthus two centuries ago and Paul Ehrlich 40 years ago, but these predictions were proven wrong.
Obesity exaggerated claim of deaths due to obesity was adjusted downward by 93% after scrutiny.
High fat has been proven not to have a direct correlation with coronary heart disease.
Anti-meat activists published bogus study lining beef consumption and risk of colon cancer.
National Academy of Science announced no safe exposure of radiation, despite 82% is natural.
FDA warning on soft drinks was removed after discovering no scientific basis for warning.
Trans-fat ban is attacking single dietary factor (> 2% of calories) that affects blood lipids.
Bird flu hysteria was used to lobby for money to prevent a non-existent U.S. epidemic.
Assisted suicide is being offered as a health care alternative to the terminally ill.

o Oregon has begun to offer assisted suicide drugs when prescriptions are not covered.

o If a physician prescribes a lethal overdose, when that physician completes the death certificate, he or she is required to list the underlying disease as the cause of death.

State health insurance experiments to tailor their health care needs have uncovered problems.

Hawaii tried a play-or-pay scheme which backfired with low enrollment.
Oregon reformed its health care systems in 1989 by formalizing rationing, which did not work.
Wisconsin proposed doubling state taxes to install single payer health care, but died in House.
Connecticut balked at the price tag associated with universal health care.
Maine passed its Dirigo Health Reform Act to cover uninsured, but enrollment is tuck at 25%.
Massachusetts passed a state subsidized universal health care in 2006 requiring everyone to purchase insurance, which has resulted in primary care providers turning away patients.
Illinois proposed comprehensive health care reform, but was defeated 107-0.
California is proposing a single payer system, which will require new taxes to support.

The Organization for Economic Co-operation and Development (OECD) reported on health care and found the U.S spends substantially more per capita on health care, yet does not have superior health system performance.

The United States spends substantially more per capita on health care than other developed countries.

The OECD uses mortality metrics to measure health care system performance, but these data do not adequately indicate health status differences and do not accurately judge health care system efficiency.

o Infant Mortality - three overlapping infant mortality measures: Infant (deaths in the first year per one thousand live births); Neonatal (deaths in the first twenty-eight days per one thousand live births); and Perinatal (deaths in the first week after birth, plus fetal deaths after twenty-eight weeks of gestation or fetuses that exceed a weight of one thousand grams).

o Life Expectancy - can be measured at birth or at older ages such as forty, sixty, etc. but incorporates infant mortality and not identically measured across all countries.

o Premature Mortality - determined by potential years of life lost (PYLL), though it is also strongly influenced by infant mortality but does not factor in lifestyle.

National Health Care systems in other countries have proven that there is a big difference between universal coverage and actual access to medical care.

Socialized medicine in Great Britain has slowed down treatment for critical diseases.

o TaxPayers’ Alliance in London estimates low quality health care killed more than 17,000 Britons in 2004.

o NHS has determined drug-coated stents are not cost effective so they are rationed.

o National Institute for Health and Clinical Effectiveness (NICE) has denied anti-dementia drugs to Alzheimer’s patients.

o Vision care sector of NHS has been deregulated and partnered with private opticians.

o Britain claims to fund dental care, but many have incredible difficulty obtaining care.

o One in ten dentists has stopped offering treatment under Great Britain’s NHS.

o More than 70,000 Britons, known as 'health tourists,' have gone as far as India, Malaysia and South Africa for major operations, and is expected to rise to almost 200,000 by the end of the decade.

New Zealand has limited treatment for those over 75.
Healthcare appears to cost less in Canada than in the United States partly because Canadian government health insurance does not cover many advanced medical treatments and technologies that are commonly available to Americans.

o The health care system is so overburdened that hundreds of thousands in need of medical attention wait for care, or participate in lotteries to win appointments with the local family doctor.

o Total waiting time between referral from a general practitioner and treatment increased to 18.3 weeks in 2007.

§ Total number of procedures where patients are waiting for surgeries in 2006 is 770,641.

§ Modern medical equipment like CT Scans, MRIs, and mammograms are very limited.

§ Many doctors are leaving Canada because of the long time it takes to be paid.

§ Access to a waiting list is not the same thing as access to healthcare.

o By 2035 six of ten Provinces will spend half of their tax revenue on health care expenses.

o The Canadian single-payer system does not cover prescription drugs on a universal basis with only about one-third of the Canadian population eligible for various government-financed drug programs.

o Canada does not fund dental care and vision care excludes standard vision tests.

o Canadian physicians send patients to the U.S. and the Canadian government spends over $1 billion each year on health care in the United States.

Cuba’s vaunted health care system is more myth than reality, with a doctor shortage and higher than normal levels of diseases.

Sweden’s health care system date back to the 1930s, buy now is forced to ration service.

International health care priorities are set by politicians, not health care professionals.

· UN spent $3 billion on AIDS programs in Africa, while only $30 million on safe water projects.

Other countries have implemented successful market based health care programs.

Switzerland has successfully privatized health insurance as a market based initiative.
Singapore has implemented a healthcare system that puts decisions in the hands of the patients and doctors rather than government bureaucrats and insurers.

o Individuals contribute much more money at the point of purchase with the payment mechanism varying according to treatment and patient.

o Government doctors and facilities compete with private health care workers.

o Singaporeans are required to contribute to health savings accounts and purchase a catastrophic insurance plan.

o There is an insurance pool for the severely disabled and a fund to pay their bills.

o There are subsidies to providers based on their level of service.

o Singapore healthcare includes MediSave (mandatory pension program), MediShield (national insurance program for serious illness), MediFund (fund unable to pay), and ElderShield (private disability insurance).

o Singaporeans are considerably healthier than Americans, yet pay, per person (3.7% GDP), about one fifth of what American pay for their healthcare (15.4% GDP).

Principles:

Health care is a noble idea, but not a Constitutional right:

Everyone should be able to have private health care coverage.
The total cost of health care must be visible to aid in personal care decisions.

Personal control over health care will inject the free market values into health care.

Healthcare regulation must be fact based and statistically valid, not junk science!

Computer models are notoriously inaccurate forecasting the future.
Models must explain predicted behavior and also historical anomalies.
Cost benefit analysis must provide range of outcomes with associated range of costs.

A reformed and sustainable Medicare program should be based on five key principles:

Predictable and stable financing.
Broad personal choice of plans and options.
Standards that meet or exceed the Federal Employees Health Benefits Program’s (FEHBP).
Freedom of choice for Medicare enrollees.
Medicare savings for Medicare alone.

Patient-centered, consumer-driven health care reform key principles:

Individuals are the key decision makers in the health care system.

Individuals buy and own their own health insurance coverage.
Individuals choose their own health insurance coverage.
Individuals have a wide range of coverage choices.
Prices are transparent.
Individuals have the periodic opportunity to change health coverage.

10 Essential Principles of Health Care Reform:

1) Every American should be encouraged and incentivized to take personal responsibility for his or her health.

2) Every American should have genuine access to quality, cost-effective care that best meets his or her individual needs.

3) Every American should have health insurance coverage (private or public) that is affordable, accessible, and portable -- no matter where he or she chooses to work or live.

4) Health care providers should deliver the best possible care based upon best evidence or best practice.

5) Every provider of care, from doctors and nurses to pharmacists and hospitals, should be interconnected with an electronic health record for every American.

6) Payment to providers should be based on the quality of care delivered, not the number of transactions or services provided.

7) Cost, quality, and performance information should be available and accessible to all consumers.

8) Government should promote and encourage competitive, market-based solutions in the private sector.

9) Government should offer effective, efficient, and sustainable public programs for those who need them.

10) Government should aggressively invest in targeted clinical research, laying the foundations for future breakthroughs and cures.

Recommendations:

Short Term, improve health care coverage and performance.

Isolate the Medicare and Medicaid separating entitlements funding and unfunded liabilities from the total budget.

o Deliver Medicaid as a block grant to states to allow flexibility and eliminate overspending.

o Separate OMB forecast income and spending as a discrete entitlement expense.

o Budget long term (30 year) to identify shortcoming long before they become problems.

o Require program reauthorization every four years based on sustainability.

o Comply with GASB 45 to establish an accrual accounting approach to report the cost of benefits as an expense during the years in which the employee is working.

o Include a complete and objective cost benefit analysis in any healthcare regulations.

o Include State Children’s Health Insurance Program (SCHIP) as separate line item.

Defund, Repeal, and Replace ObamaCare, before more damage is done to health care delivery.

Return Health and Human Services funding to 2008 levels to erase recent unwarranted expansion.

o Reduce Food and Drug Administration funding by 62% to FY2008 levels.

o Reduce Health Resources and Service Administration by 34% to FY2008 levels.

o Reduce Indian Health Service funding by 46% to FY2008 levels.

o Reduce Center for disease Control and Prevention funding by 28% to FY2008 levels.

o Reduce National Institute of Health by 37% to FY2008 levels.

o Reduce National Institute of Mental Health by:

§ Eliminate the Division of AIDS Research ($184 million) as duplicative.

§ Eliminate the Intramural Research Program ($172 million) as better done with research grants to universities.

§ Shut down the Substance Abuse and Mental Health Administration ($3.4 billion) as ineffective.

Reform Medicare and Medicaid to discourage government dependence by individuals and families.

o Abolish the Office of the Surgeon General.

o Repeal McCarran-Ferguson Act that restricts competitive interstate insurance markets.

o Reject any expansion of the State Children’s Health Insurance Program (SCHIP).

o Promote individual responsibility and realign economic incentives for the purchase of value-based health care.

o Restructure health care financing to assist low income Americans in purchasing coverage.

Promote greater opportunities for individuals to manage and control their health care spending with Health Savings Accounts (HSAs).

o Create opportunities for individual health savings accounts

o Continue improvements like Medicare Advantage (2003) to expand personal choice in health care options.

o Provide health care tax credits to ensure equity between individual and business based health insurance plans.

o Offer direct subsidies to lower income workers and families for purchase of private health care.

o Liberalize the tax treatment of health insurance for individuals and families.

§ Ensure guaranteed renewability.

§ Provide assistance to low and moderate income workers for basic insurance coverage.

§ Provide block grants of Medicaid and SCHIP back to the states.

§ Incorporate state uninsurable risk pools.

Restructure Medicare and Medicaid from a defined benefit, open ended entitlement to a defined contribution system.

o Establish a system for those retiring after 2011 based on Federal Employees Health Benefits Program.

o Restructure Medicaid financing to be patient centered, helping to identify higher cost cases.

o Give states greater flexibility to experiment with adjustments in their Medicaid programs.

o Eliminate individual incentives to qualify inappropriately for Medicaid long term care services.

o Ensure inclusion of catastrophic protection.

Administer Medicare and Medicaid “safety net” with each state defining level of coverage.

o Return fiscal responsibility for individuals with mental illness to the states.

o Discontinue federal government insurance premium collections.

o Abolish federal healthcare revenue redistribution to states.

o Allow states to put conditions on SSI and SSDI payments.

Examine health care reforms to salvage program such as:

o Transform drug benefit into targeted benefit for low income seniors who lack coverage.

§ Require a means test to the Medicare prescription-drug benefit.

o Reduce benefit levels, number or types of treatments covered.

o Increasing premium costs, deductibles or co-payments.

Replace jury malpractice system with expert health courts.

Long Term, privatize all health insurance to transition to patient centered care.

Enable Health Insurance Exchanges (HIE) to open up health care to individual coverage.

o Enable health insurance portability, moving with the individual.

o Create open market for health insurance aligned with moral principles.

o Limit mandates to allow more custom design of policies.

Enable medical transparency by making medical information including performance directly available to consumers.

o Make physician pricing fully transparent.

o Make treatment pricing fully transparent.

Privatize health insurance allowing each person to buy directly, like other types of insurance.

o Phase out employer-sponsored health insurance replaced by individual insurance.

§ Businesses pay employees monies directly, that are currently spent on healthcare premiums.

o Allow health insurance providers to establish risk pools to lower costs.

o Individuals choose their own health care coverage based on their individual needs.

o Retired workers able to use small fraction of accumulated funds to buy long term nursing home insurance.

· Provide five year transition for current recipients (over 50-55) with program as currently exists.

o Everyone will be responsible for their own health care planning, protecting those with pre-existing conditions.

References:

“The Sky’s the Limit: Medicare’s Upwardly Mobile Drug Cost Projections” by Derek Hunter dated August 12, 2003 published by The Heritage Foundation on http://www.heritage.org/Research/HealthCare/wm464.cfm .

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“Fringe Costs: Bush’s Health Insurance Plan Would Eliminate a Pernicious Tax Preference” by Jacob Sullum dated January 31, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=19217 .

“Just What the Doctor Ordered” by James C. Capretta dated January 31, 2007 published by National Review Online at http://article.nationalreview.com/?q=NjAzODYyNjI0NGEzZDQyMDlmZDc5NGJjZTc1ZTQwZTc= .

“Personal Accounts, Not Tax Increases” by Peter Ferrara dated February 1, 2007 published by National Review Online at http://article.nationalreview.com/?q=MTE0YjlhNjYwYjQwNjk4MmQ0ZTc2NmQ3MzM3MjVlNGQ= .

“The Five Big Questions about Health Care” by Arnold Kling dated February 12, 2007 published by TCS Daily at http://www.tcsdaily.com/article.aspx?id=020807B .

“National Health-care expenditures” dated February 20, 2007 published by Hoover Institution at http://www.hoover.org/research/factsonpolicy/facts/5854746.html .

“The Health Insurance Exchange: Enabling Freedom of Conscience in Health Care” by Connie Marshner dated March 1, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1377.cfm .

“It’s Not About Health Care” by Herman Cain dated March 12, 2007 published by Town Hall at http://www.townhall.com/columnists/HermanCain/2007/03/12/it%e2%80%99s_not_about_health_care .

“More Medicaid Means Less Quality Health Care” by John S. O’Shea dated March 21, 2007 published by The Heritage Foundation at www.heritage.org/Research/HealthCare/wm1402.cfm .

“Everything You Wanted to know About Medicare But Were Too Confused to Ask” by Joseph Antos dated March 27, 2007 published by American at http://www.american.com/archive/2007/march-april-magazine-contents/everything-you-wanted-to-know-about-medicare-but-were-too-confused-to-ask .

“It’s time for a dose of reality in federal health-care spending” by Ed Feulner dated March 30, 2007 published by Town Hall at http://www.townhall.com/columnists/EdFeulner/2007/03/30/its_time_for_a_dose_of_reality_in_federal_health-care_spending .

“Walter Reed: A clear warning on Hillary Care” by JT Thompson dated March 30, 2007 published by American Daily at http://www.americandaily.com/article/18199 .

“Universal healthcare’s dirty little secrets” by Michael Tanner and Micheal J. Connon dated April 5, 2007 published by Los Angeles Times at http://www.latimes.com/news/opinion/la-oe-tanner5apr05,0,2227144.story?coll=la-opinion-center .

“The Massachusetts Health Plan: An Update and Lessons for Other States” by Robert Moffit dated April 4, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1414.cfm .

“National Health Care Can Kill” by Michael Reagan dated April 6, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=20148 .

“Uncle Sam, Regulate Me!: A good federal solution” by Eli Lehrer dated April 9, 2007 published by Competitive Enterprise Institute at http://www.cei.org/utils/printer.cfm?AID=5862 .

“The Social Security and Medicare Trustees Report Again – And Again Problems Have Worsened” by J. D. Foster dated April 24, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/Budget/wm1430.cfm .

“The Future of SCHIP: Family Freedom or Government Control?” by Nina Owcharenko dated May 21, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1464.cfm .

“What’s Ailing Health Care?” by James C. Capretta dated Spring 2007 published by The New Atlantis at http://www.thenewatlantis.com/archive/16/capretta.htm .

“Insuring Against Regulatory Catastrophe: Compound, or Compact?” by George A. Pieler and Lawrence A. Hunter dated June 2007 published by Institute for Policy Innovation at http://www.ipi.org/ipi/IPIPublications.nsf/PublicationLookupFullTextPDF/0D60B26D30DFB632862572F40062DFEC/$File/InsuringAgainstRegulation.pdf?OpenElement .

“No Right to ‘Free’ Health Care” by Onkar Ghate dated June 13, 2007 published by American Daily at http://www.americandaily.com/article/19196 .

“Against Universal Coverage” dated June 21, 2007 published by National Review Online at http://article.nationalreview.com/?q=ZWFkZDBlNjk3YjFhMDE1MWVlODc5NGM4MmQ4MmRhMTM= .

“SCHIP and ‘Crowd-Out’: How Public Program Expansion Reduces Private Coverage” by Andrew M. Grossman and Greg D’Angelo dated June 21, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1518.cfm .

“A ‘Right’ to Health Care?” by Michael F. Cannon dated June 29, 2007 published by National Review Online at http://article.nationalreview.com/?q=MDEyZGVkNTYxODRlNjg5NjgwYWMxNmJiN2ZmN2RkYTI= .

“The State Children’s Health Insurance Program: High Stakes for American Families” by Connie Marshner dated June 27, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1528.cfm .

“The Massachusetts Health Plan – The Good, the Bad, the Ugly” by David A. Hyman dated June 28, 2007 published by The Cato Institute at http://www.cato.org/pubs/pas/pa-595.pdf .

“Health Insurance Deregulation” by David Hogberg dated July 9, 2007 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=11691 .

“Single-Payer Fantasies of Sicko, Michael Moore” by Gary Krasner dated July 14, 2007 published by American Daily at http://www.americandaily.com/article/19584 .

“Socializing with Socialism” by Bill O’Reilly dated July 14, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=21523 .

“Send the General Home” by Tom McClusky dated July 16, 2007 published by National Review Online at http://article.nationalreview.com/?q=MGI4ZjIyNTZjYjhiZDRjZDA0OWQ3YmVlZGI2OWYxZDg= .

“My Body, My Choice” by James L. Payne dated July 16, 2007 published by The American Conservative at http://www.amconmag.com/2007/2007_07_16/article.html .

“Health Care Lie: ’47 Million Uninsured Americans’” by Julia A. Seymour dated July 18, 2007 published by http://www.businessandmedia.org/printer/2007/20070718153509.aspx .

“Medicaid’s Soaring Cost” by Jagadeesh Gokhale dated by July 19, 2007 published by Cato Institute at http://www.cato.org/pub_display.php?pub_id=8485 .

“State Health Reform: How Pooling Arrangements Can Increase Small-Business Coverage” by Edmund F. Haisimaier dated July 23, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1563.cfm .

“Cheese Headcases” dated July 24, 2007 published by Wall Street Journal Opinion Journal at http://www.opinionjournal.com/editorial/feature.html?id=110010374 .

“Trust Fund Dysfunction” by James C. Capretta dated July 26, 2007 published by National Review Online at http://article.nationalreview.com/?q=MDQ5MmUyOGIzN2QxM2ZlM2I1ZWE3NzUyMDUwY2Q3ZjM= .

“SCHIP A Step Towards Socialism” by Mike Franc Dated July 27, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=21705 .

“HillaryCare Exposing Itself as a Catastrophe” dated July 29, 2007 published by Free Republic at http://www.freerepublic.com/focus/f-news/1873219/posts .

“Beyond SCHIP: A Serious Proposal to Reduce Uninsurance” by Robert E. Moffit dated July 30, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1577.cfm .

“Health Care Tax Credits: The Right Prescription for Expanded Health Care Coverage” by J.D. Foster dated July 31, 2007 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1579.cfm .

“Health Insurance Blues: Give Choice a Chance” by Chuck Muth dated August 6, 2007 published by Town Hall at http://www.townhall.com/columnists/ChuckMuth/2007/08/06/health_insurance_blues_give_choice_a_chance .

“Private Sector Healthcare Can Also Be ‘Universal’” by Emily Beuhler dated August 9, 2007 published by The American Magazine at http://www.american.com/archive/2007/august-0807/private-sector-healthcare-can-also-be-universal .

“Nanny State? No, Thanks; Government Should Quit Mandating Health-care Perks; Edicts Hike Costs; Shrink Coverage” by Michael Franc dated August 6, 2007 published by The Heritage Foundation at http://www.heritage.org/Press/Commentary/ed080607b.cfm .

“Kids First…” by David Freddoso dated August 22, 2007 published by National Review Online at http://article.nationalreview.com/?q=MzA3YzNlYTUzNzZkZjBkODRhM2JiYTk4ODE5ZTkyYTU= .

“The SCHIP Open: Hidden Incentives for States to Spend Federal Funds” by Robert B. Helms dated August 2007 published by American Enterprise Institute at http://www.aei.org/publications/filter.all,pubID.26708/pub_detail.asp .

“The ’47 Million Uninsured’ Myth” dated August 29, 2007 published by Investors Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=273280379232127 .

“Healthy Medical Reforms” by David Hogberg and Jeremy Taglieri dated September 11, 2007 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=11995 .

“Compulsory Universal Health Insurance – Neither a New Idea, Nor a Good Idea” by Diana West dated September 12, 2007 published by Town Hall at http://www.townhall.com/columnists/DianaWest/2007/09/12/compulsory_universal_health_insurance_--_neither_a_new_idea,_nor_a_good_one .

“Sinking SCHIP – A First Step toward Stopping the Growth of Government Health Programs” by Michael F. Cannon dated September 13, 2007 published by The CATO Institute at http://www.cato.org/pubs/bp/bp99.pdf .

“How The Swiss Do Health Care” by Bill Steigerwald dated September 14, 2007 published by Town Hall at http://www.townhall.com/columnists/BillSteigerwald/2007/09/14/how_the_swiss_do_health_care .

“One Flew Over the Bird Flu’s Nest” by Michael Fumento dated September 14, 2007 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=12014 .

“Hazards of the Individual Health Care Mandate” by Glen Whitman dated September/October 2007 published by CATO Institute at http://www.cato.org/pubs/policy_report/v29n5/cpr29n5-1.html .

“The 2008 Presidential Candidates on Health Care Reform” updated September 17, 2007 published by Council for Affordable Health Insurance at http://www.cahi.org/cahi_contents/resources/pdf/2008CandidatesHealthCareReform.pdf .

“Hard to Swallow” by Andrew Cline dated September 18, 2007 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=12035 .

“Republicans Can Win on Health Care” by Karl Rove dated September 18, 2007 published by Wall Street Journal Opinion Journal at http://www.opinionjournal.com/forms/printThis.html?id=110010620 .

“Hillarizing Health Care” by Peter Ferrara dated September 18, 2007 published by National Review Online at http://article.nationalreview.com/?q=MjM5OWRhYjk1NWM3MDk0MWMzOTY1OTMzZWY0MTA2NGY= .

“Looking at HillaryCare” by Jennifer Rubin dated September 19, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=22456 .

“No More Free Lunch at the Health Care Buffet” by Frank Pastore dated September 23, 2007, published by Town Hall at http://www.townhall.com/columnists/FrankPastore/2007/09/23/no_more_free_lunch_at_the_health_care_buffet .

“Hillary and Health Care Prove a Toxic Mix Again” by Kevin Hassett dated September 24, 2007 published by Bloomberg at http://bloomberg.com/apps/news?pid=20601039&refer=columnist_hassett&sid=a1z0CUu7cB_g .

“HillaryCare II: A Big Leap in Federal Control” by Robert E. Moffit dated September 24, 2007 published by Human Events Online at http://www.humanevents.com/article.php?id=22490 .

“Optional Federal Charter for Insurers; FAQ” by Eli Lehrer dated October 2, 2007 published by Competitive Enterprise Institute at http://www.cei.org/gencon/004,06170.cfm .

“Diet and Fat: A Severe Case of Mistaken Consensus” by John Tierney dated October 9, 2007 published by New York Times at http://www.nytimes.com/2007/10/09/science/09tier.html?ref=science&pagewanted=print.

“Not True That Thousands Died for Lack of Health Insurance, Critic Says” by Pete Winn dated October 11, 2007 published by Cybercast News Service at http://www.cnsnews.com/ViewPrint.asp?Page=/Nation/archive/200710/NAT20071011a.html .

“Newer Reforms Prescribe Doses of Competition” by David S. Broder dated October 12, 2007 published by Investors Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=277074871527128 .

“The Freedom to Spend Your Own Money on Medical Care” by Kent Masterson Brown dated October 15, 2007 published by CATO Institute at http://www.cato.org/pubs/pas/pa601.pdf .

“Friends Want Friends to Do Health Care” by Michael F. Cannon dated October 16, 2007 published by National Review Online at http://article.nationalreview.com/?q=NWJlZjA3ZTQ4ZmQ2NmEzZDZiOGI1MjY0ZjViZGU5N2Q= .

“Freedom to Choose” by Jennifer A. Marshall dated October 17, 2007 published by National Review Online at http://article.nationalreview.com/?q=MDNiODcxOGE4MWI0Mzg1OTJkM2Y0NGZiM2Y2MTJhNzM= .

“Rationalize Health Care” by Byron Schlomach dated October 17, 2007 published by National Review Online at http://article.nationalreview.com/?q=NDZjMGUzMjczYzQ2YmFlN2U0ZDBiNzY5N2M4M2RjYWE= .

“Universally Bad” by Sally Pipes dated October 18, 2007 published by National Review Online at http://article.nationalreview.com/?q=NmQ3MjFiOTQ5ZTJhNmJiMDcyN2Y5YjBlNzI4MjZhN2E= .

“Medicare for All?” by James C. Capretta dated October 19, 2007 published by National Review Online at http://health.nationalreview.com/post/?q=MjAxOTMzY2Y0NmVjMWYzNGMyNDRiYWIyMWYxY2JiYzE= .

“Unhealthy Health Care” by Linda Halderman dated October 19, 2007 published by National Review Online at http://health.nationalreview.com/post/?q=MTM2N2I4ZGQyYzRiY2E3OWNjMjNhOGIxZWEyNmFkZWQ= .

“Quack Michael Moore has mad view of the NHS” by Minette Marrin dated October 28, 2007 published by The Sunday Times at http://www.timesonline.co.uk/tol/comment/columnists/minette_marrin/article2753620.ece .

“Creative Destruction” by Jonathan Cohn dated November 12, 2007 published by The New Republic at http://tnr.com/politics/story.html?id=51faeaa7-5021-40d0-95d3-0f260b25edd4 .

“Global Warming is the New AIDS” by November 12, 2007 published by American Daily at http://www.americandaily.com/article/20913 .

“The Case for Health Care Tax Credits” by Greg D’Angelo dated December 3, 2007 published by Front Page Magazine at http://www.frontpagemagazine.com/Articles/Read.aspx?GUID=2C432783-19B5-4CA1-992D-149DB63582CA .

“Rx for Health Care: Pain” by Robert Samuelson dated December 5, 2007 published by Real Clear Politics at http://www.realclearpolitics.com/articles/2007/12/rx_for_health_care_pain.html .

“Hungry For Trouble” dated December 18, 2007 published by Investors Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=282873306405019 .

“Putting a Plague in Perspective” by Daniel Halperin dated January 1, 2008 published by New York Times at http://www.nytimes.com/2008/01/01/opinion/01halperin.html?_r=1&ref=opinion&oref=slogin .

“The Truth About Health Costs” dated January 10, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=284861446430958 .

“Bad Medicine” dated January 18, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=285552473520990 .

“Health Freezes Over” dated January 29, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=286502291658004 .

“A Clear Choice” dated February 1, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=286760850611327 .

“Washington Must Pull the Trigger on Explosive Medicare Spending” by Robert E. Moffit and Alison Acosta Fraser dated February 4, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/Budget/wm1796.cfm .

“Lines For Swedish Care Grow Longer” dated February 4, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=287022137319357 .

“Benefits of the President’s Proposed Standard Deduction for Health Insurance” by J.D. Foster dated February 6, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1799.cfm .

“Time to Rechristen SCHIP” by David Gratzer dated February 8, 2008 published by City Journal at http://www.city-journal.org/2008/eon0208dg.html .

“Make Medicare Budget Options Compatible with Comprehensive Reform” by Robert E. Moffit dated February 11, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/Budget/wm1807.cfm .

“State and Local Governments Must Address Unfunded Health Care Liabilities” by Greg D’Angelo dated February 11, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1808.cfm .

“Single Payer Systems Kill” by Deroy Murdock dated February 22, 2008 published by Human Events Online at http://www.humanevents.com/article.php?id=25137 .

“What Canada Tells Us About Government Health Care” by Doug Wilson dated February 25, 2008 published by Town Hall at http://www.townhall.com/columnists/DougWilson/2008/02/25/what_canada_tells_us_about_government_health_care .

“Promise of Choice” dated February 26, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=288921903474479 .

“WHOm Are They Kidding?” by Glen Whitman dated March 10, 2008 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=12865 .

“Medicare Prescription” by John Ensign dated March 11, 2008 published by National Review Online at http://article.nationalreview.com/?q=MzE3M2M1Y2RkNmMxZWRhZGE5YzNhNGRiMDI0NGZlMTY= .

“America’s Unstable Health Insurance System: Recommendations for increasing Stability and Coverage” by Michelle C. Bucci dated March 12, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2115.cfm .

“State Health Reform: Six Key Tests” by Robert E. Moffit dated April 23, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm1900.cfm .

“Health Care Reform: Design Principles for a Patient-Centered, Consumer-Based Market” by Edmund F. Haislmaier dated April 23, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2128.cfm .

“The Singapore Model” by Rowan Callick dated May 27, 2008 published by The American Magazine at http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model .

“Free Market Universal Care” by Peter Ferrara dated June 11, 2008 published by The American Spectator at http://www.spectator.org/dsp_article.asp?art_id=13352 .

“The Success of Medicare Advantage Plans: What Seniors Should Know” by Robert E. Moffitt dated June 13, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2142.cfm .

“Reform of the American Health Care System is Still Achievable” by Tom Price dated June 24, 2008 published by Human Events Online at http://www.humanevents.com/article.php?id=27147 .

“Canadian Health Care We So Envy Lies in Ruins, Its Architect Admits” by David Gratzer dated June 25, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931 .

“Coming Soon: Not-So-NICE Health Care?” by Sally C. Pipes dated June 25, 2008 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=299282658708852 .

“Have Health Reformers Forgotten Medicare?” by Joseph Antos dated July 7, 2008 published by American Enterprise Institute at http://www.aei.org/publications/pubID.28244,filter.all/pub_detail.asp .

“A Fork in the Road” by Michael Tanner dated July 29, 2008 published by Cato Institute at http://www.cato.org/pubs/bp/bp104.pdf .

“State Health Care reform: A Brief Guide to Risk Adjustment in Consumer Driven Health Insurance Markets” by Edmund F. Haislmaier dated August 1, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2166.cfm .

“Free-Market Medicine” by Paul Howard dated August 20, 2008 published by National Review Online at http://article.nationalreview.com/?q=NjY2ZTUxYjA0ZmYxMWVjNjA1YWI0ZGRiNDBkODQ4YmQ= .

“Medicare’s Financial Woes: Bigger Than Official Estimates” by J. D. Foster dated September 2, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/Budget/bg2174.cfm .

“Oregon’s Suicidal Approach to Health Care” by Rita L. Marker dated September 14, 2008 published by American Thinker at http://www.americanthinker.com/2008/09/oregons_suicidal_approach_to_h.html .

“You’re All Dead – and Don’t Know It” by Phillip Ellis Jackson dated September 20, 2008 published by Intellectual Conservative at http://www.intellectualconservative.com/2008/09/20/you%E2%80%99re-all-dead-and-don%E2%80%99t-even-know-it/print/ .

“State Health Reform: How States Can Control Costs and Expand Coverage” by Dennis G. Smith dated September 22, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2183.cfm .

“Affordable Health Care” by Walter E. Williams dated October 22, 2008 published by Town Hall at http://townhall.com/columnists/WalterEWilliams/2008/10/22/affordable_health_care .

“How a Federal Health Board Will Cancel Private Coverage and Care” by Robert E. Moffit dated December 4, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/wm2155.cfm .

“Employer-Based Health Insurance: Why Congress Should Cap Tax Benefits Consistently” by Jason Roffenbender dated December 5, 2008 published by The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2214.cfm .

“The Trouble with Canadian Healthcare” by Brett J. Skinner dated December 6, 2008 published by The American Magazine at http://www.american.com/archive/2008/december-12-08/the-trouble-with-canadian-healthcare .

“Obama’s Coming Health Care Headache” by Robert Samuelson dated January 9, 2009 published by Investor’s Business Daily at http://www.ibdeditorials.com/IBDArticles.aspx?id=316396380187863 .

“How to Reform Entitlement Spending” by Brian M. Riedl and Alison Acosta Fraser dated January 13, 2009 published by The Heritage Foundation at http://www.heritage.org/Research/Budget/sr43.cfm .

“Behind the 8 Million Ball” by Peter Ferrara dated February 4, 2009 published by The American Spectator at http://spectator.org/archives/2009/02/04/behind-the-8-million-ball .

“Obama’s False Choice” by Phillip Klein dated April 10, 2009 published by The American Spectator at http://spectator.org/archives/2009/04/10/obamas-false-choice .

“The Pauper Option” by Jeffrey H. Anderson dated April 15, 2009 published by The Weekly Standard at http://www.weeklystandard.com/Content/Public/Articles/000/000/016/385axoqj.asp .

“Health Care Deconstructed” by Bethany Stotts dated April 15, 2009 published by Accuracy in Media at http://www.aim.org/aim-column/health-care-deconstructed/ .

“Coming This Summer: Health Care Wars” by Newt Gingrich dated May 27, 2009 published by Human Events at http://www.humanevents.com/article.php?id=32017 .

“U.S. health care is not inferior” by Vincent Carroll dated June 23, 2009 published by The Denver Post at http://www.denverpost.com/search/ci_12667987 .

“Markets, Not Mandates” by Ronald Bailey dated July 28, 2009 published by Reason Magazine at http://www.reason.com/news/show/135081.html .

“Health Reform’s Taboo Topic” by Philip K. Howard dated July 31, 2009 published by The Washington Post at http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002816.html .

“The Bad Road to Baucus” by William Tucker dated October 20, 2009 published by The American Spectator at http://spectator.org/archives/2009/10/20/the-road-to-baucus .

“Bending the Cost Curve” by William Tucker dated march 10, 2010 published by The American Spectator at http://spectator.org/archives/2010/03/10/bending-the-cost-curve-with-a .

“The Entitlement Crisis” dated August 17, 2010 published by The Heritage Foundation at http://www.heritage.org/Research/Reports/2010/08/The-Entitlement-Crisis .

“Getting Health Care Reform Right” dated August 17, 2010 published by The Heritage Foundation at http://www.heritage.org/Research/Reports/2010/08/Getting-Health-Care-Reform-Right .

“How to Fix Medicare: A New Vision for a Better Program” by Robert E. Moffit and James C. Capretta dated December 13, 2010 published by The Heritage Foundation at http://www.heritage.org/Research/Reports/2010/12/How-to-Fix-Medicare-A-New-Vision-for-a-Better-Program .

“Sen. Paul Proposes Serious Cuts” by Chris Edwards dated January 31, 2011 published by Cato Institute at http://www.downsizinggovernment.org/sen-rand-paul-proposes-serious-cuts .

“Why Accountable Care Organizations Won’t Deliver Better Health Care – and Market Innovation Will” by Rita E. Numerof dated April 18, 2011 published by The Heritage Foundation at http://www.heritage.org/Research/Reports/2011/04/Why-Accountable-Care-Organizations-Wont-Deliver-Better-Health-Care-and-Market-Innovation-Will .

“Saving the American Dream” by Stuart M. Butler, Alison Acosta Fraser, and William W. Beach dated May 10, 2011 published by The Heritage Foundation at http://www.heritage.org/Research/Reports/2011/05/Saving-the-American-Dream-The-Heritage-Plan-to-Fix-the-Debt-Cut-Spending-and-Restore-Prosperity .

“How the Free Market Can Cure Health Care” by Matt Palumbo dated December 17, 2011 published by American Thinker at http://www.americanthinker.com/2011/12/how_the_free_market_can_cure_health_care.html .

“How to Bring Sanity to Our Mental Health System” by E. Fuller Torrey dated December 19, 2011 published by The Heritage Foundation at http://www.heritage.org/research/reports/2011/12/how-to-bring-sanity-to-our-mental-health-system .

“US health care: A reality check on cross-country comparisons” by H.E. Frech, Stephen T. Parente, and John Hoff dated July 11, 2012, published by American Enterprise Institute at http://www.aei.org/outlook/health/global-health/us-health-care-a-reality-check-on-cross-country-comparisons/ .

“Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Private Insured” by Kevin D. Dayaratna dated November 7, 2012 published by The Heritage Foundation at http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured .

“The Singapore Cure” by Matthew Continetti dated February 25, 2013 published by The Weekly Standard at http://www.weeklystandard.com/articles/singapore-cure_701312.html .