I got to share my thoughts on the State Children’s Health Insurance Program with Farai Chideya of National Public Radio’s News & Notes program yesterday.

Click here to listen.

My review of Shannon Brownlee’s new book says,

The point is that getting the advantages of McMedicine may not be a matter of sheer collective will, as Brownlee would have it. Instead, it might require radical deregulation of medical licensure and practice regulations.

I like the fact that her book often inverts the usual story of villains and victims in health care. For example, lawyers and doctors who fight insurance companies for approval of a desperate cancer therapy turn out to be wrong.

Amid the debate over the State Children’s Health Insurance Program, author and Washington Examiner columnist Tim Carney asks the question, “Does SCHIP insure kids or subsidize savvy HMOs?”:

[W]hile Democrats are dragging children to the White House for photo ops, as if the children are the primary constituency of this bill, federal lobbying records tell a different tale.

Lobbying records from the first half of 2007 show that the health care industry spent more than $227 million lobbying Washington. Congressional Quarterly Healthbeat News reported last month: “What’s behind health care lobbyists’ spending frenzy? Most signs point to … SCHIP.”

Sure enough, the biggest lobbyists in the industry all support the Democratic bill. America’s Health Insurance Plans (AHIP), the trade association for HMOs, supports the bill, as do its biggest members, such as Blue Cross Blue Shield.

The Pharmaceutical Research and Manufacturing Association (PhRMA), one of Washington’s most powerful lobbyists, is also behind the bill. So is the American Medical Association.

Because the details of any substantial bill or regulation will be complex, the mainstream media will always portray the debate as a battle between the interested parties. In this case, the official storyline is that it’s poor children against a president overly concerned about the boogie man “government-run health care.”

But poor children don’t have clout on Capitol Hill. They’re not the reason this bill got 68 votes in the Senate and 265 votes in the House.

It’s got to be nice [for] the Democrats now. You get to do a favor for the HMOs, and everyone’s convinced it’s “for the children.”

I include the nation’s governors — who are always in favor of more federal money — in the bootleggers category.

Kudos to Tim Carney for reporting what less-rigorous reporters will not. (Why, oh, why can’t we have a better press corps?)

(This story was originally sent last week by Declan McCullagh to his politech e‑mail group. Most of Declan’s e‑mail follows.)

The Gilpin County Sheriff’s Office in Colorado, a rural area not that far west of Denver, recently set up a highway checkpoint where motorists were stopped and, at least in some cases, not allowed to leave until they gave breath, blood, and saliva samples for the benefit of a private research firm. A report by Ernie Hancock says the National Highway Traffic Safety Administration was involved as well.

A Denver Post article is here:
http://​www​.den​ver​post​.com/​h​e​a​d​l​i​n​e​s​/​c​i​_​6​9​22089

More:
http://​cw2​.trb​.com/​n​e​w​s​/​k​w​g​n​-​i​n​v​a​s​i​v​e​-​c​h​e​c​k​p​o​i​n​t​,​0​,​2​0​9​2​7​3​2​.​story http://​world​net​dai​ly​.com/​n​e​w​s​/​a​r​t​i​c​l​e​.​a​s​p​?​A​R​T​I​C​L​E​_​I​D​=​57733

http://​free​dom​spho​enix​.com/​D​i​s​c​u​s​s​i​o​n​-​P​a​g​e​.​h​t​m​?​I​n​f​o​N​o​=​0​24006

The Post says the private organization in question is the Pacific Institute for Research and Evaluation, or PIRE, in Calverton, MD. Their Web site seems to be down but can be viewed here:
http://​web​.archive​.org/​w​e​b​/​2​0​0​5​0​8​2​6​1​7​3​0​3​8​/​w​w​w​.​p​i​r​e​.org/

The thoroughly-misnamed PIRE is a major DC government contractor (and in fact its offices are within walking distance of the Beltway). It specializes in funneling over $35 million of taxpayer money a year into its own coffers through law enforcement contracts of dubious utility, mostly dealing with drugs and alcohol, from sources including the U.S. Department of Justice. 100 percent of its budget appears to come from government contracts or grants.

Although PIRE pretends to be a “nonprofit” organization — at least that label helps to collect those fat taxpayer-funded checks from the DOJ — in reality it spends about $1.35 million a year on lobbyists. Not a bad 30-fold return on investment. And its employees are paid six-figure salaries that would be handsome even by for-profit standards.

PIRE seems to specialize in devising new and intrusive ways of government meddling in personal lives. One PIRE success story helps to coerce retailers to card octogenarians who dare to try to buy a bottle of Cabernet. (“This method of enforcement gives retailers the necessary incentive to comply with the state’s law regarding the sale of alcohol, given that their next customer could be part of a compliance check. The Pacific Institute for Research and Evaluation (PIRE) has developed a detailed document to assist in the development and implementation of compliance checks.” See:
http://​www​.nht​sa​.dot​.gov/​p​e​o​p​l​e​/​i​n​j​u​r​y​/​a​l​c​o​h​o​l​/​d​o​t​p​a​r​t​n​e​r​s​/​c​h​a​p​t​e​r​_​5.htm

PIRE is an ardent supporter of the War On (Some Politically Unacceptable) Drugs, also known as an excellent way for Feds and contractors to fleece the public in a war that will never end, eviscerate the Fourth Amendment, and create a police state with perfectly legal no-knock raids. One PIRE researcher who focuses on “middle-school-based drug prevention programs” and has written a paper claiming anti-drug programs in schools actually work:
http://​www​.nida​.nih​.gov/​M​e​e​t​i​n​g​s​/​P​r​e​v​e​n​t​i​o​n​/​P​r​e​v​B​i​o​s​4​.html

PIRE also supports higher taxes on alcohol and firmly opposes lowering the minimum drinking age to be akin to Europe or Canada (something that would probably do much to limit abuse). See:
http://​www​.high​ered​cen​ter​.org/​t​h​i​s​w​e​e​k​/​t​w​0​1​0​6​2​9​.html http://​resources​.prev​.org/​d​o​c​u​m​e​n​t​s​/​B​e​e​r​T​a​x​e​s​N​e​w​s​R​e​l​e​a​s​e.pdf

The following is a letter I submitted to the editors of the Wall Street Journal regarding Mitt Romney’s recent oped [$] attempting to differentiate his Massachusetts health care reform law from Hillary Clinton’s reform plan:

Mitt Romney goes beyond spin in his attempt to differentiate his Massachusetts health care reform law from Sen. Hillary Clinton’s proposed reforms [“Where HillaryCare Goes Wrong,” September 20].

Romney claims “the reforms I led in Massachusetts…[did] not raise taxes or increase spending.” False. The Massachusetts law requires residents to purchase health insurance, requires many residents to purchase more coverage than they want, and imposes similar mandates on employers – all tax increases. Had Massachusetts not implemented the law, government spending would have been (at least) $385 million lower.

Romney notes that Clinton would “expand government insurance” by letting Americans enroll in the Federal Employees Health Benefits Program. He then writes that the Massachusetts law “instead allowed the uninsured to choose a private insurance product from one of the many private insurance companies.” The contrast is false. Clinton would open to all Americans a government program through which federal employees currently purchase coverage from private insurers. Romney created a “Connector” that allows all Massachusetts residents to do the same thing. Romney’s Connector is no more or less “government-run” than Clinton’s proposed FEHBP.

Romney claims his law resulted in “less regulation.” Though it did eliminate the Commonwealth’s “any willing provider” mandate, on balance Romney’s law increased government regulation. In addition to the individual and employer mandates, it created new requirements that consumers purchase drug coverage, prohibited many high-deductible plans, and added a new layer of government bureaucracy to Massachusetts’ already overburdened health insurance market.

The editors turned this LTE down, but ran some good critiques [$] of Romeny’s oped nonetheless.

Former CBO director June O’Neill and Dave O’Neill have a working paper comparing health outcomes in the semi-socialized U.S. health care sector and the fully socialized Canadian Medicare system. From the abstract:

Does Canada’s publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status… We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/​incidence ratios for various cancers tend to be higher in Canada… We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

There’s also this interesting observation from their concluding comments:

The need to ration when care is delivered “free” ultimately leads to long waits or unavailable services and to unmet needs. In the U.S. costs are more often a source of unmet needs. But costs may be more easily overcome than the absence of services. When asked about satisfaction with health services and the ranking of the quality of services recently received, more U.S. residents than Canadians respond that they are fully satisfied and rank quality of care as excellent.

And this crucial caveat:

One important issue that we do not address concerns the large differential in per capita health care expenditures which are about twice as large in the U.S. Is the U.S. getting sufficient additional benefits to justify these greater expenditures and where should we cut back if cutbacks must be made? Alternatively, what would Canada have to spend to increase their technical capital and specialized medical personnel to match American levels or to eliminate the longer waiting times? And would it be worthwhile to them to do so? To answer these questions more research is needed…

Economist and blogger Glen Whitman has an excellent article in the latest Cato Policy Report on the latest fad in health policy: requiring people to purchase health insurance, a.k.a. an “individual mandate.” Hillary, Arnold, Mitt, John … the kids, they just love this individual mandate! If you read only one article on the topic, let this be it.

Whitman adds a post-script to that article in a recent post:

Something I don’t mention in the article is why some free-market types support the individual mandate. In short, I think the reason is that they have given too little attention to the political dynamics of such a mandate, instead naively assuming that the mandate could be crafted once-and-for-all in a wise and lobbying-resistant fashion.