– Peter Morici is a professor at the Smith School of Business, University of Maryland School, and the former Chief Economist at the U.S. International Trade Commission. The views expressed are his own. –

Healthcare reform is in trouble, because President Obama and congressional leaders are not adequately addressing issues that trouble many Americans.

House of Representatives Speaker Nancy Pelosi and Health and Human Services Secretary Kathleen Sebelius caution Americans to ignore terrorist claims about death panels. Reasonable enough—unseemly critics on both the right and the left seek to stir up unwarranted hysteria.

Sebelius defends end of life counseling from physicians as a benefit families need when facing difficult treatment choices for elderly relatives. However, what worries people is such counseling in the context of government rationing.

All health insurers ration care—private insurers in the United States and government-run health services in Canada and Europe face tough choices and limited resources. U.S private insurers generally don’t deny or delay critical care that could cause death—officials implementing such a policy would land in jail.

Foreign public systems are noted for long waits for specialists and critical procedures like hip replacements and bypass surgery. In Sweden, for example, delays result in suffering and deaths that would not occur in the expensive, but more humane, U.S. system. No one is held accountable, the elderly are particularly vulnerable, and that is euthanasia, de facto if not de jure.

President Obama promises Americans they won’t lose private health insurance if they want to keep it. However, legislation moving through the House requires businesses to pay an 8 percent payroll tax if they don’t provide healthcare and creates a government-run alternative to private insurance. Moderate senators would like to create non-profit cooperatives instead but to gain support from liberals in Congress, those non-profits would operate much like government agencies.

It won’t be long before businesses that pay employees an average of $50,000, or even $75,000, annually figure out it would be cheaper and easier to pay the tax than continue providing private insurance. Many people who work in small businesses would be forced by employers to purchase insurance from a government or non-profit agency. Most Americans don’t want to rely on the Post Office or the United Way for their healthcare.

Healthcare costs at least 50 percent more in the United States than in Canada and Western Europe. Important factors include expensive malpractice suits, inefficient insurance company bureaucracies, poor staffing practices and dangerously low standards at many hospitals, and doctor fees and drug prices much higher than abroad.

Early on President Obama gave the tort lawyers a pass, and is busy cutting deals with drug companies and other healthcare businesses that won’t appreciably bring down U.S. costs. That is why his healthcare reform will require $1 trillion in new taxes.

The president promises to soak the rich to raise that cash, but he proposes to tax them for all his other initiatives too. Unless he wants all wealthy Americans to move to Switzerland, that is simply impossible.

Americans are losing patience. They want healthcare fixed but the president is not delivering what they want.

– Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own. –

When it comes to healthcare reform, as Aldous Huxley said, “Facts do not cease to exist because they are ignored.”

Three of the most common “urban myths” of American healthcare are that:
1. The lower life expectancy in the U.S. “proves” the total inadequacy of our system;
2. There are 47 million uninsured Americans — proving the inequity of our system; and
3. We spend “too much” on health care — proving the wastefulness of our system.

As the Ol Perfessor used to say, “Let’s look at the numbers.”

1. Lower Life Expectancy: According to N. Gregory Mankiw, Professor of Economics at Harvard University, “The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.”

This fact, according to Mankiw, is often taken as evidence for the inadequacy of the U.S. health system. But a recent study by June and Dave O’Neill, economists at Baruch College, from whom these numbers come, shows that the difference in health outcomes has more to do with broader social forces.

Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, and the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach nothing about the U.S. system of health care.

Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, the dividing line between overweight and obese, versus 17 percent of men and 19 percent of women in Canada. Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that the growing obesity problem in the United States is largely attributable to its ability to supply high-calorie foods inexpensively.

Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight, which is correlated with teenage motherhood. Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youths.

2. 47 Million Uninsured: This number from the Census Bureau is regularly cited by President Obama and almost every proponent of “universal healthcare” as evidence that the health system is failing for many families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

The 47 million includes about 10 million illegal immigrants. And all the current legislation being considered in Congress specifically excludes illegal immigrants from government healthcare. The “Big Number” also includes millions of the poor who are eligible for Medicaid but have not yet applied. They could be insured, on the government’s dime, tomorrow. And about a quarter of the uninsured have been offered employer-provided insurance but declined coverage, often because of cost. The solution to this isn’t Uncle Sam, MD, but smarter insurance regulation.

A new study by University of Minnesota economists Stephen Parente and Roer Feldman shows that Congress could boost by more than 12 million the number of people who have health insurance without spending taxpayer dollars. The change required is to allow people to buy health insurance across state lines, so they can shop for less expensive policies. For example, a typical health-insurance policy in heavily regulated New York costs more than three times as much as in less regulated Iowa ($388 a month versus $98 a month for the same coverage).

3. We Spend “Too Much” on Healthcare : In 1950, Americans spent about 5 percent of their income on health care. Today the share is about 16 percent. According to Harvard’s Mankiw, “many pundits take the increasing cost as evidence that the system is too expensive. But increasing expenditures could just as well be a symptom of success.”

And he hits a homerun with a clear, concise, and common sense explanation. “The reason Americans spend more than their grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Medical science has consistently found new ways to extend and improve lives. Wonderful as they are, they do not come cheap.”

Consider the question posed by economists Charles Jones of the University of California and Robert Hall of Stanford: “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing - or an extra year of life?”

As the old saying goes, everything you read in the newspaper is true, except for those things you know about personally. Healthcare reform is too important (and too complicated) to permit reform by sound bite.

– James Pethokoukis is a Reuters columnist. The opinions expressed are his own –

You can’t beat something with nothing” often passes for political wisdom in Washington. In 1994, Republicans defeated Bill and Hillary Clinton’s healthcare reform plan with pretty much nothing — well, at least with nothing positive.

Republican congressional solidarity, along with help from business group attack ads and the Clintons’ own political miscues, were enough to doom the landmark legislative effort. Back then, “No” was sufficient.

But 2009 is not 1994. A “Just say no” strategy seem laughably insufficient this time around. Economic anxieties are much higher, the Democrat president more popular, the Democrat-controlled Congress more committed and aggressive.

Want even more evidence of the changed economic and political landscape?

Just take a look at the 248-page Patients Choice Act, a comprehensive GOP healthcare reform plan drafted by Senators Tom Coburn and Richard Burr, and Representatives Paul Ryan and Devin Nunes.

A big feature of the plan calls for redirecting the $300 billion-a-year tax exclusion for employer-based health benefits into refundable tax credits to purchase private plans.

Low-income families would be subsidized so they could also buy private health insurance. The theory here is that people act more like cost-conscious consumers when they have to select and purchase their own health insurance rather than pay premiums indirectly through their employers via lower wages.

While the bill doesn’t stand a chance of passage with the Obamacrats in charge, it does reflect a recognition by congressional Republicans that if they are to derail or significantly modify Democratic healthcare efforts, they need a positive and serious policy rejoinder of their own.

“I think it is a good, bold, free-market alternative,” says James Capretta, an economist at the Office of Management and Budget under President George W. Bush and now a fellow at the Ethics and Public Policy Center.

“Broadly defined, this is where the conservative coalition can plant a flag and begin engaging in the debate.”

But is the bill really a choice rather than an echo? The indisputable conservative credentials of Coburn, Burr, Ryan and Nunes have not prevented some free marketeers from scowling and some liberal policy wonks from cackling after taking a look at the legislation.

Michael Tanner, a healthcare expert at the libertarian Cato Institute immediately tagged the plan “Obamacare Lite” and claimed it would “increase regulation, mandates and government control over the healthcare system.”

At the same time, liberal healthcare blogger Ezra Klein was almost rapturous: “The core elements of this plan…make it the same type of plan Democrats are offering….And it’s further evidence that the argument over health reform is narrowing, rather than widening. And it’s narrowing in a direction that favors the Democrats.”

Both Tanner and Klein have read page 5 of the bill’s summary and this sentence in particular: “Many states have led the nation in finding comprehensive healthcare solutions for their citizens, including the well-known, bi-partisan achievement of universal healthcare through a private system in Massachusetts.”

Now many on the right consider that state’s 2006 healthcare reform, led by former Governor Mitt Romney, to be a big-government system which mandates every resident buy health insurance.

Even worse, in their view, is the Connector, a “state exchange” that Tanner describes as “a super-regulatory body, adding new mandated benefits, restricting consumer’s choice of plans, and adding both regulatory and administrative costs to insurance.”

Indeed, the Coburn-Burr-Ryan-Nunes bill explicitly states that it “will utilize state-driven exchanges to facilitate real competition between private plans and give Americans — for the first time — a choice of health care plans.”

But no worries, say the bill sponsors who have been reassuring worried conservatives privately that their version of a state exchange is similar to the one found in Utah which acts more like a matchmaker between insurers on one side and individuals and small businesses on the other than a big regulatory body.

When pressed on whether the Coburn-Burr-Ryan-Nunes plan increases the role of the government in healthcare or diminishes it, Tanner can conclude only that “it’s mixed”.

Now all this brings to mind what a high-ranking Republican House member asked me earlier this spring: “So what should we do about healthcare? More health savings accounts?”

Given both the member’s snarky tone and the context of our preceding conversation, this is what I’m pretty sure the high-ranking House Republican actually meant by those questions: “We are going to get our collective heads kicked in if we don’t come up with a strong alternative to Obamacare. Health savings accounts alone ain’t going to cut it. We need to raise our game, and fast.”

And part of that “game raising” means accepting that it won’t be easy to budge voters.

Not all American families are going to prefer high-deductible HSAs — previously the Republican healthcare policy of choice — especially when one of the supposed selling points of these plans is the ability to invest money from accounts into the battered stock market.

And certainly voters are not ready for a hypermarket approach such as the one advocated by libertarian economist Arnold Kling. He has argued that “real” health insurance would pay only for treatments that are “unavoidable, prohibitively expensive and relatively rare.” Everything else would be out of pocket.

And that “game raising” also apparently means adopting some of the Democratic rhetoric on healthcare to appeal to more centrist voters.

In addition to using the Massachusetts plan as an example rather than the plan from conservative Utah, the authors employ a liberal-flavoured critique of America’s healthcare system:

“The health care system in America is broken. Costs are rising at an unacceptable rate — more than doubling over the last 10 years, which is nearly four times the rate of wage growth. Too many patients feel trapped by healthcare decisions dictated by HMOs. Too many doctors are torn between practicing medicine and practicing insurance. And 47 million Americans worry what will happen to them or their children if they get sick.” Ted Kennedy couldn’t have said it better.

The big risk to Republicans is that if they adopt the language and critique of Democrats, the public will miss the policy subtleties and start viewing the Dem and GOP approaches as more less the same. That could give further momentum to Democratic healthcare efforts and actually bring about the outcome Republicans are trying to avoid.