kinesjl

I received my acceptance letter yesterday. Orientation is August 17th.

I think we should be hearing something around the second or third week of July. Good luck to you.

On a per-person basis Medicare's administrative costs are actually higher than those of private insurance--this despite the fact that private insurance companies do incur several categories of costs that do not apply to Medicare. If recent cost history is any guide, switching the more than 200 million Americans with private insurance to a public plan will not save money but will actually increase health care costs. In 2005, Medicare's administrative costs were $509 per primary beneficiary, compared to private-sector administrative costs of $453. In the years from 2000 to 2005, Medicare's administrative costs per beneficiary were consistently higher than that for private insurance, ranging from 5 to 48 percent higher, depending on the year. This is despite the fact that private-sector "administrative" costs include state health insurance premium taxes of up to 4 percent (averaging around 2 percent, depending on the state)--an expense from which Medicare is exempt--as well as the cost of non-claim health care expenses, such as disease management and on-call nurse consultation services. It is worth noting that some of the additional private-insurance costs cited by pubic plan advocates, such as marketing and profit, are included in the above figures for private-insurance administrative costs. Directly provided health services and state health insurance premium taxes are also included. Even without these costs, Medicare administrative spending is still higher--suggesting that Medicare's administration is even more inefficient compared to private insurance than is suggested by its higher per-beneficiary administrative costs. Medicare administrative costs per beneficiary have substantially exceeded those costs for the private sector, this despite the fact that private insurance is subject to many expenses not incurred by Medicare. Contrary to the claims of nationalization advocates, moving millions of Americans from private insurance to a Medicare-like program will result in program administrative costs that are higher per person and higher, not lower, for the nation as a whole.

That part is rather simple, significant cuts in pay and ample increase in workload.

In many ways Canadian health care is less centralized and regulated then the current U.S. system despite Universal coverage.Furthermore, all current U.S. health care reform proposals would only increase this level of centralization, along with all of the problems that come with such a system, which I have already delineated quite thoroughly in several previous posts.

I'm hoping my 223.12 points is enough but I'm not taking anything for granted.

The Kennedy-Dodd legislation would provide new insurance premium discounts to households with incomes below 500 percent of the federal poverty line. These subsidies would be phased in slowly over a number of years. Total federal costs for the program are expected to be near $1.5 trillion over 10 years, and costs for the bill might go as high as $2 trillion depending on certain legislative specifications. Even more troubling is the expectation that costs will rise rapidly every year, even beyond the 10-year budget window. The Congressional Budget Office (CBO) has estimated that the annual cost of the insurance subsidy program in an early version of the Kennedy-Dodd bill would rise 6.7 percent per year after it is fully phased in. There is nothing in the legislation that would lead one to expect that pace to slow after the first decade. Rapid cost growth for a health care entitlement is nothing new, of course. The federal government already runs two other health entitlement programs--Medicare and Medicaid--and they have been growing faster than per capita GDP growth virtually every year since their enactment in 1965. CBO has estimated that between 1975 and 2005, average per capita Medicare spending exceeded average per capita GDP growth by 2.4 percentage points, and Medicaid's "excess cost growth" rate was nearly as high (2.2 percentage points). The rising costs of these entitlement programs are expected to push the federal government deep into dangerous levels of debt under current law. CBO projects that between 2010 and 2040, federal spending on Medicare and Medicaid alone will rise from 4.4 percent of GDP to 10.2 percent. That jump in spending--5.8 percent of GDP--exceeds the size of Social Security today. As matters stand, the bills emerging in Congress would add yet a third unfinanced health entitlement on top of the two already on the books. President Obama and his top health care policy advisors have pledged to work on a health care bill that "bends the cost curve" throughout the health sector. But the ideas that the Administration has put forward to date would either do little to slow rising costs or shift costs from public insurance to private premium payers. First, the Administration has suggested a series of reforms that might be called "efficiency through government engineering." The idea is that the health care system can be made more productive with government-led "investments" in health information technology, comparative effectiveness research, and prevention and wellness efforts. Some of these concepts may in fact be meritorious. However, as CBO has stated on numerous occasions, absent more financial incentives for consumers or suppliers of medical services, these reforms alone are highly unlikely to produce much by way of savings. Furthermore, the government has been running the Medicare program for nearly half a century now, and it is clear from that record that the government has little capacity to drive efficiency in health care. Medicare remains largely a fee-for-service insurance arrangement, which pays any licensed provider of medical services the same rate, regardless of the quality of the services delivered to patients. Repeated efforts to steer patients and services toward a higher-quality, lower-cost network of providers have failed. For instance, a long-running effort to buy durable medical equipment (DME) services for Medicare enrollees through a competitive bidding process was blocked by Congress last year. In its place, Congress passed an across-the-board payment cut for all DME suppliers to meet a budget target. Recently, in an effort to put more "scoreable" cost-cutting ideas on the table, President Obama proposed to cut Medicare and Medicaid reimbursement rates for various health care providers by an additional $313 billion over 10 years. Those cuts come on top of the $309 billion the President proposed in his 2010 budget submission to Congress, for a total proposed reduction in Medicare and Medicaid of $622 billion over 10 years. These proposed reductions in Medicare's reimbursement rates, many targeted at hospitals, are emblematic of how the government runs a health insurance plan. After much talk of trying to pay for value instead of quantity, the government is resorting to arbitrary, across-the-board fee cuts--which generally hit all providers, regardless of quality or cost--to meet budgetary goals. Moreover, these fee cuts are not likely to change the underlying cost structure in health care. In the past, when Medicare has cut reimbursement rates, providers of medical services have raised rates for private insurers to make up the difference. There is every reason to believe President Obama's proposed payment rate cuts would also lead to cost shifting. The only reliable and lasting way to drive greater efficiency in health care is with cost-conscious consumers in a reformed marketplace. The "Patients' Choice Act" would implement the reforms needed to build just such a marketplace. Americans would get fixed tax credits toward the purchase of insurance. If they used those credits to buy a more expensive plan, they would pay the cost difference. If, on the other hand, they enrolled in less expensive coverage, they would keep all of the savings too.That is the way to provide strong financial incentives to insurers and the suppliers of medical services to reorganize themselves to be more efficient and patient-focused. The government can and should play an effective oversight role in such a marketplace, much as the Centers for Medicare and Medicaid Services have done with the new Medicare prescription drug benefit. But the government cannot bend the cost curve from Washington without resorting to arbitrary caps and price controls that always lead to a reduction in the willing suppliers of services and waiting lists.

Do you realize that the governemnt does not create wealth? Every penny spent by the government is a penny appropiated through taxation. If it wasn't for the disgusting profits of those evil corporations, not only would our government collapse, but health care would be non-existent. It's absolutely laughable that you honestly believe that the politicians in Washington are doing this becase they care about us. The CBO recently scored the Kennedy Bill and found the annual cost per person covered to be $62500. We could give everyone in American without health insurance an annual $10,000 tax credit for the purpose of obtaining insurance, and even allow any remaining money to be deposited tax free into a health savings account to cover any and all foreseeable patient cost sharing, and it would STILL cost a fraction of the govenrment proposal. Why do the politicians then, support UHC as opposed to market based reform? It's quite simple really, nationalized health care gives greater power and control to the politicans. It's power that motivates these people not concern for the general welfare. Lastly, if this really is such a great piece of legislation, why did Congress specifically EXEMPT themselves from the plan? An honest answer to that question will end this debate once and for all.

The failing Massachusetts experiment, like the failed Clinton health plan of 1994, relies on coercion, mandates, price controls, and government rationing. If comprehensive health-care reform happens in 2009, it will follow suit — and perhaps go even farther, by creating a new socialized health-insurance program as an option for Americans under age 65. Tens of millions of Americans would lose their current health insurance and could also lose their current doctors, President Obama's reassurances notwithstanding. Since there aren't enough Americans earning more than $250,000 to finance the estimated $1.7 trillion price tag, reform would mean higher taxes for the middle class, violating another promise Obama made during the presidential campaign. Worst of all, these reforms would — through government rationing and the sclerosis that government brings to health-care delivery — reduce the quality of medical care and cost many lives. Universal coverage is impossible without coercion; that's why the leading Democratic proposals would force Americans to obtain health insurance, either on their own or through an employer. Those who do not obtain the prescribed level of coverage would pay a fine. Those who do not pay the fine would go to jail. During the 2008 primaries, Hillary Clinton attacked Obama's plan for not being coercive enough: She proposed to compel all Americans to purchase coverage with a so-called individual mandate. Obama criticized this mandate, claiming that Clinton would "have the government force uninsured people to buy insurance, even if they can't afford it" — but in reality, his plan was scarcely less coercive. He proposed an individual mandate for children's coverage — don't worry, only the parents would face jail time — and an employer mandate that would compel employers to provide "meaningful" coverage to their workers. Whatever coercive power an employer mandate lacks because it exempts small businesses, part-time workers, and the unemployed, it more than makes up for in other ways. Obama's National Economic Council chairman, Larry Summers, once wrote that employer mandates "are like public programs financed by benefit taxes": They can increase unemployment, work against the very people they purport to help (i.e., low-wage workers and the sick), and "fuel the growth of government because their costs are relatively invisible." Economists Kate Baicker of Harvard and Helen Levy of Michigan estimate that, by effectively increasing the minimum wage, an employer mandate could kill 315,000 low-wage jobs. Unlike the hundreds of thousands of jobs lost to the current recession, those jobs would not return: The mandate would continue to eliminate jobs as long as the growth of health-insurance costs outpaces that of low-wage workers' productivity. Since employers finance health benefits by reducing wages, it is practically irrelevant whether a government enacts an individual mandate, an employer mandate, or both. One way or another, the cost of any mandate comes out of the worker's hide. Politicians such as Obama tend to prefer an employer mandate, however, for the reason Summers suggests: Employer mandates hide the implicit "mandate tax" in the form of reduced wages, where workers are less likely to notice it. During the campaign, Obama vaguely defined "meaningful" coverage as being at least as good as what members of Congress get. That standard could end up forcing half of all those with private health insurance (roughly 100 million people) and all of the uninsured (an estimated 46 million) to get a more comprehensive plan, whether they value the added coverage or not. Whatever the meaning of "meaningful" is, the mandate tax would grow over time as a result of "mandate creep." As they have done at the state level, patient advocates and providers will demand that Congress mandate lower deductibles and coinsurance, as well as coverage of particular services. Since the 1970s, states have gradually enacted nearly 2,000 laws requiring consumers to purchase specific types of coverage. The Congressional Budget Office (CBO) estimates that such laws increase premiums by an average of about 3 percent: less in states with few mandated benefits (such as Idaho: 13 mandated benefits) and more in states with many (Maryland: 63). Massachusetts already had 40 such laws by the time Mitt Romney enacted an individual and employer mandate in 2006. After that, mandate creep accelerated. Bureaucrats and lobbyists imposed coverage for prescription drugs, preventive care, orthotics, prosthetics, dependent students, and domestic partners. They imposed other costly restrictions, including limits on cost-sharing such as maximum deductibles (no higher than $2,000 for individuals and $4,000 for families), a ban on per-illness or per-year caps on total benefits, and a ban on coverage providing a "fixed dollar amount per day or stay in the hospital." The result is absurd: There's zero evidence that anything beyond a basic health plan actually improves health outcomes, yet the individual and employer mandates gradually make coverage less affordable by outlawing the leaner, less expensive plans. (If Congress enacts these mandates, we can say goodbye to health savings accounts as we know them.) As a result, insurance premiums are rising rapidly in Massachusetts, as are the subsidies required to help residents — including families of four earning up to $66,000 — comply. Government spending has far outpaced projections, with the total cost of reform reaching $1.9 billion last year. Tax increases on tobacco, hospitals, insurers, and employers have failed to stanch the bleeding. Combined public and private health spending has grown an estimated 66 percent faster than it would have without the reforms. The true believers in universal coverage are so committed to this disaster that they spin the cost overruns as evidence of success. Of course, cost overruns are a success if your goal is simply to boost health-care spending. That's why the health-insurance lobby and physicians' groups such as the American Medical Association support an individual mandate, which opens the spigot by forcing more people to purchase more of their services. One insurer-funded study practically celebrates how the Massachusetts reforms hide the runaway spending by dispersing the burden across higher premiums, higher taxes, and lower wages. The biggest sticking point has been whether to create a new socialized health-insurance program. While many Democrats fear that a new government program would jeopardize health reform's chances for passage, Obama and Baucus want such a program to be an "option" for those under age 65, within the context of a new federally regulated market that Obama calls a "National Health Insurance Exchange." House Speaker Nancy Pelosi and four House caucuses representing more than 100 Democrats have stated that a "public-plan choice," modeled on Medicare, is the sine qua non of reform. Sixteen Democratic senators have signed a letter signaling their support. Not even the 1993 Clinton reforms envisioned so radical a step. One analysis by the Lewin Group, a prominent health-care-policy firm, estimated that Obama's campaign plan would move 48 million Americans into a new government-run plan — essentially doubling the Medicare rolls. Lewin subsequently estimated that if Congress used Medicare's payment rates and opened the new program to everyone, it could pull 120 million Americans out of private insurance — more than half of the private market — and boost the government rolls by an even larger number. Two-thirds of Americans would depend on government for their health care, compared with just over one-quarter today. That would strike a historic blow against even the possibility of limited government. Medicare and Medicaid are the reason that the size of the federal budget will double from 20 percent to 40 percent of GDP within 80 years. Medicare's unfunded liabilities are in the neighborhood of $80 trillion. The CBO estimates that all income-tax rates would have nearly to double by mid-century (top rate: 66 percent), and increase by nearly 150 percent by 2082 (top rate: 88 percent), just to pay for existing federal programs. If Congress creates a new government health program instead of reforming the ones we've got, tax increases will be inevitable and painful: The CBO estimates that by 2050, economic output could be 20 percent lower than if government remained at its current share of GDP. And tax cuts will be a pipe dream: In 1995 and 1996, Bill Clinton showed that the most effective strategy for defeating tax cuts is to paint them as a threat to voters' health care. If two-thirds of Americans come to depend on government for their health care, whether through a new program or through subsidized "private" coverage, we can forget about limiting government within our lifetimes. Despite Medicare and Medicaid's failure to contain health-care costs, the Left claims that one more government program ought to do the trick. Their main strategy, which they seldom admit, is explicit government rationing. Thus the $1 billion in the stimulus bill for "comparative effectiveness" research — which would help government bureaucrats decide, e.g., whether Mom's next round of chemo (in the words of a draft committee report on the stimulus bill) "will no longer be prescribed." Massachusetts has created a commission to help the government develop a "common payment methodology across all public and private payers," including the use of "evidence-based purchasing strategies" — code for explicit government rationing. Unlike Britons, though, Americans won't allow government bureaucrats to make their medical decisions. Neither will doctors, drugmakers, and device manufacturers, who don't like federal agencies questioning the value of their services. That's why Congress, at the behest of the industries, has repeatedly defunded agencies that produce industry-offending research. Even if a new comparative-effectiveness effort were to survive, the CBO estimates that after ten years it would reduce federal health spending by "less than one one-hundredth of 1 percent." When explicit rationing fails, the government will turn to its old standby: implicit rationing, typically via price controls. Government already controls the prices for roughly half of all health-care spending. Medicare sets somewhere close to a million different prices. In Medicaid, the states do the same. The leading Democratic proposals would vastly expand government's role as price setter, primarily by moving tens of millions of patients into price-controlling government programs. Indeed, many reformers want a new government program to use the very prices Medicare does. Obama, Baucus, Wyden, and others seek to control private health-insurance premiums as well. A government-controlled price is almost never right. Price controls are responsible for both the current surplus of specialists (because prices are too high) and the shortage of primary-care physicians (because prices are too low). Medicare and Medicaid price controls are generally not binding on private payers, though they do influence overall supply. That's one reason, for example, many Massachusetts residents — particularly those newly insured under the Romney plan — are facing long waits for primary care. Price controls enable a veiled form of government rationing: If government sets the prices low enough, many doctors won't participate, which creates non-price barriers to access. States set Medicaid's prices so low that nearly half of all doctors limit the number of Medicaid patients they will accept. Some 20 to 30 percent refuse all Medicaid patients. Medicaid patients often travel hours to find a participating provider. That is not to say that price controls are an effective tool for reducing spending. When government sets prices too high — as with specialty care, agricultural price supports, and 20th-century airline regulation — spending may rise. Government can ratchet prices downward, yet providers know more than regulators about their actual costs and are difficult to monitor. Northwestern University economist Leemore Dafny thus finds that hospitals are "quite sophisticated" in their "strategies" for gaming Medicare's price controls. Physicians likewise push back by increasing quantity and substituting higher-priced services (e.g., CT scans rather than X-rays). Even setting prices too low can sometimes cause spending to rise: In 2007, Maryland's low Medicaid price controls kept Deamonte Driver from seeing a dentist for his toothache. (Only one in six Maryland dentists accepts Medicaid patients.) The infection in Driver's abscessed tooth, which could have been treated with a simple extraction, spread to his brain. That led to $250,000 of medical services, including two unsuccessful brain surgeries. Price controls do not contain costs so much as pretend that certain costs don't exist — like the loss of Deamonte Driver, who died at age 12, as the Washington Post put it, "for want of a dentist." If anything, Medicare errs on the side of providing too much access to care. One-third of Medicare patients looking for a new primary-care physician have difficulty finding one, but that amounts to just 2 percent of enrollees. That cannot last, particularly if Congress creates a new government program. Given the cost pressures facing these programs, Medicare and any new program will start to look more like Medicaid. There will be more Deamonte Drivers. Price controls even allow politicians to rob producers. Wharton professor Mark Pauly notes that the government's "raw bargaining power . . . can permit [it] to be inefficient . . . and actually incur higher true costs than other competitors, and to cover up those inefficiencies by the transfers extracted from providers." The Lewin Group estimates that if Congress moves 130 million Americans into a new government program, physicians and hospitals would see their net incomes fall by roughly $70 billion in 2010. That pay cut, which works out to about $47,000 per physician, may just correct existing overpayments. But what about the next $47,000 cut? Price controls on insurance premiums create another form of implicit rationing. Premium caps, which Massachusetts governor Deval Patrick is currently threatening to impose, force private insurers to manage care more tightly — i.e., to deny coverage for more services. Rating restrictions prevent insurers from pricing health insurance according to a purchaser's risk. According to Harvard economist and Obama adviser David Cutler, rating restrictions unleash adverse selection, which drives comprehensive health plans from the market. That rations care by forcing many consumers to accept less coverage than they would prefer. Rating restrictions also encourage insurers to avoid the sickest patients or skimp on their care — another form of implicit rationing. If those dynamics sound familiar, there's a reason. Congress already imposes a loose form of rating restriction on most of the market by prohibiting employers from charging different employees different premiums. Some 20 states already impose rating restrictions on health insurance sold to individuals. When the Left claims that government programs do a better job of containing costs than private insurance, what they mean is that government does a better job of hiding costs — such as the monetary and non-monetary costs it imposes on patients and providers. Pacific Research Institute economist Ben Zycher points out that the taxes required to run Medicare destroy economic activity, making that program's administrative costs "between four and five times [those] of private health insurance." The greatest danger of the Democrats' reform plans, however, lies in the fact that they would hamper and cut short thousands of lives by preventing markets from improving quality.Though America produces more new medical technologies than any other country, the way we deliver medical care is often backward and dangerous. We lack basic conveniences present in other sectors of the economy, such as accessible electronic records. Doctors too often do not coordinate the services they provide to a shared patient. The number of medical errors is frightening — an estimated 181,000 severe errors per year in hospitals alone, resulting in up to five times as many deaths as result from a lack of health insurance. And, yes, we lack crucial comparative-effectiveness research about which treatments work better than others. Each of these failures can be laid at the feet of government, specifically Medicare. The reason has to do with the difference between two ways of paying providers. Prepayment (also known as "capitation") is a payment system in which providers receive a fixed budget to care for a defined patient population. It encourages providers to invest in electronic medical records (EMRs), care coordination, error reduction, and comparative-effectiveness research. Kaiser Permanente, a prepaid health plan, leads the industry in these areas precisely because prepayment allows the Permanente Medical Group to keep any money it saves — by, for example, using EMRs to avoid duplicative tests or medical errors. Medicare's "fee for service" payment system, on the other hand, pays providers an additional fee for each additional service or hospital admission. That actually penalizes providers that try to improve those dimensions of quality. EMRs help avoid duplicative CT scans by saving and making accessible the results of previous scans. But Medicare will pay for a second scan. And a third. And a fourth. So a provider that invests in EMRs is not only out the cost of the computer system, but also receives fewer payments from Medicare. The story with medical errors is similar, but more horrifying. If a medical error injures a patient who then requires additional services, Medicare will pay not just for the services that injured the patient but also for the follow-up services. That's right: Medicare pays providers more when they injure patients. Again, if providers invest in error-reduction technologies, they are not only out that initial investment, but Medicare penalizes them with fewer payments. Rather than allow a level playing field for all payment systems, so that competition forces them all to improve, government tips the scales toward fee-for-service. Medicare is the largest purchaser of medical services in the U.S., and it operates largely on a fee-for-service basis. According to former Medicare chief Thomas Scully, "in many markets Medicare and Medicaid comprise over 65 percent of the payments to hospitals, and more than 80 percent in some physician specialties." No wonder a recent New England Journal of Medicine study found that only 1.5 percent of non-federal hospitals use a comprehensive EMR system. Name any quality innovation that might save money by avoiding unnecessary services — EMRs, bar-code scanners for prescription drugs, surgery checklists. Medicare blocks them all. The Left bemoans the resulting quality problems, yet is desperately trying to subject even more of the market to the very stagnation Medicare introduces. Massachusetts, with its commission to develop a single payment system for its entire health-care sector, is diving head first into the cement. It makes no difference if government chooses a different payment system than Medicare's. The problem isn't the particular payment system, but the lack of competition from other systems. Surgeon and scholar Atul Gawande writes: "When we've made a science of performance . . . thousands of lives have been saved. Indeed the scientific effort to improve performance in medicine . . . can arguably save more lives . . . than research on the genome, stem-cell therapy, cancer vaccines, and all the other laboratory work we hear about in the news. . . . Nowhere, though, have governments recognized this." Medicare has spent four decades and billions of dollars penalizing providers who try to save those lives, or develop the tools necessary to do so. We don't need to go to Canada to find horror stories about government-run health care. One hundred thousand deaths each year from medical errors should be frightening enough. Before the great health-care debate of 2009 is over, some Democrats and even some Republicans will reassure us that we can reach universal coverage without creating a new government entitlement if only we mandate "personal responsibility" the way Massachusetts did. If Massachusetts has taught us anything, it is that individual and employer mandates are a new government program. They effectively socialize health care by compelling participation in the marketplace, dictating what consumers purchase and at what price, eliminating both economical and comprehensive health plans, and raising taxes. Massachusetts shows that mandates lead ultimately to government rationing by granting government even more power to decide how providers will be paid and how they will practice medicine. The health care debate is not just about the freedom to make one's own medical decisions. It is about life and death. If we insist on a dynamic and competitive market, health care will be better, cheaper, safer, and more secure. If we go in the direction of new government programs, mandates, and price controls, we will see higher costs, more medical errors, more uncoordinated care, and more lives lost because people with government "insurance" nevertheless couldn't find a doctor who would treat them.

None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it's available at all. Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. "Health-status insurance" is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses. With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs. With health-status insurance, medical insurers would be allowed to charge sick people more than healthy people, and to compete intensely for all customers. People would have complete freedom to change jobs, move, or change medical insurers. Rigorous competition would allow us to obtain better medical care at lower cost. Most regulations and policy proposals aimed at improving long-term insurance—including those advanced by President Obama— limit competition and consumer choice by banning risk-based premiums, forcing insurers to take all comers, strengthening employer-based or other forced pooling mechanisms, or introducing national health insurance. These will, as they have everywhere they've been tried, lead to skyrocketing health costs and rationed care. The individual health insurance market is already moving in the direction of health-status insurance. To let health-status insurance emerge fully, we must remove the legal and regulatory pressure to provide employer-based group insurance over individual insurance and remove regulations limiting risk-based pricing and competition among health insurers.

Universal health insurance does not mean universal access to care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment. For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care. Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice. Rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch. Yet many naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases — and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform — taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc. — fall heavily on the middle class. Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion. Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes. Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially. Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money." There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S. If there is a lesson that we can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.

On the contrary, the state models, such as Massachusetts, which are often cited as a blueprint for health care reform, provide ample evidence of the pitfalls of governement health care. Although the state has reduced the number of residents without health insurance, 200,000 people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state's generous subsidies, not the celebrated individual mandate. Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by 28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average. Program costs have skyrocketed. Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a "global budget" on health care spending—with its attendant rationing. A shortage of providers, combined with increased demand, is increasing waiting times to see a physician. Giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.

Submitted my application last week with 223 points, I hope its enough. . .