Financing Reform: Limiting Malpractice Liability?

"In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials."

Funding Reform: Drug Ads Deductions No More?

Ways and Means Cmte. Chair Charles Rangel has announced that the House is considering eliminating the advertisement tax break that Pharma gets, in order to pay for health reform. This idea has been around since before BO took office, when Rahm Emmanuel warned industry leaders.

"Rangel said he and other lawmakers believe it is wrong to let drug companies
deduct their advertising costs for prescription drugs. ... Rangel said it’s
inappropriate for taxpayers to subsidize ads for pharmaceuticals because they
encourage viewers to ask for drugs they may not need."

It never occurred to me that there is a tax break for advertising. It's a a business deduction as it is an "ordinary and necessary expense paid or incurred during the taxable year in carrying on any trade or business." Huh. Makes me wish I had taken more tax classes.



Now, while I'm certainly no advocate for BigPharma, I will say the Representative's argument has me thinking about a variety of issues:



Almost all ads are for things we don't need. The others are for things we need that we can get from a variety of sources in various permutations (that are probably unnecessary or undesirable alterations anyway). In this sense it's not a very strong argument.



What pharmaceutical drugs are needed anyway? What OTC drugs are needed? What drugs of any kind are needed?



Who should decide what's needed?



The Rep's problem isn't with consumerism, i'm sure. In fact, that is supposed to be ENCOURAGED in our society (hence a crux of the health care "debate"). The problem is who pays for this consumerism. Unless, of course, the Representative is concerned with the large amounts of side effects & subsequent treatments or deaths associated with prescription drugs. While this is a more humanitarian perspective, it is still a monetary problem as well. I wonder if Rangel was concerned about the taxpayer subsidization of these ads before he started pondering the costs of health care reform? He could have been. I don't know. I'll get back to you on that one.



Also, the Representative says ads encourage patients to ASK for drugs they may not need. What's the problem with that, Mr. Thought Police? People ask for things they don't need all the time. In fairness, it could be a problem if not only are the drugs not needed, but they're dangerous, or the ads are misleading or straight up lying (which does happen). That kind of speech is not protected. Otherwise, if the ads pass First Amendment commercial speech regulation tests, the problem would lie in the granting of an unreasonable request, which really would fall to the doctors, wouldn't it. Is this a veiled jab at health care providers, and by extension, the AMA, who vehemently deny their prescribing habits are tainted by the ad efforts of BigPharma? (BTW, BigPharma spends 3-4 times as much on ads & swag for drs than it does on direct to consumer ads. i'm sure that's because they find advertising to consumers more profitable & therefore a less worthy investment.)



Rep. Rangel's argument that ads make people want to buy things they don't need could just as easily be applied to a commercial for Taco Bell. ...except his argument points to a key issue (IMO) that doesn't get as much attention as I think it should--Health issues are not standard free market issues. Rangel says people purchase DRUGS they do not need. What makes Rx drugs different from a Fiesta Burrito? I'll leave that one to you.



So there's a little rant on tax breaks for drug ads. Take it all with a grain of salt, or whatever your drug of choosing, while you still can make the choice. Believe it or not after reading this post, I'd be in favor of such a measure, if it could be implemented in a logical & justified way, rather than simply a lame attack on a very profitable industry.

don't trust the insurance companies

I had been avoiding simply posting links with little commentary here, but in the interest of posting more, here goes.....

Op Ed from Paul Krugman in NYT on the need for a public option. It's refreshing that skepticism of the motives of the insurance industry in getting on board with reform is starting to get some public attention.

Common Sense

Check out Dan Carlin's podcast, Common Sense on "Sick Politics." An excellent and spirited commentary on health care today. Thanks to B at Is it Luck for the heads up.

And think about this quote when you listen to the podcast:

"Dismantling the private market ... is not something the president
supports. He supports moving forward and filling the gap, not disrupting the
entire market," Sebelius told the House Ways and Means Committee.

BO on reform

Tuesday the President sat in on a Senate Finance Committee meeting on health reform, and afterward released a letter addressed to Baucus and Kennedy summing up his support.



Here's the gist: BO supports reduced costs, keeping the health insurance you have if you want to. These things are neither new nor surprising. The letter continues, "I agree that we should create a health insurance exchange." Saw that one coming. And BO strongly supports a public health insurance option to compete with private plans. Yep. Further the President is "open to [some Senator's] ideas on shared responsibility." What does this mean, you ask? Insurance mandates. BO was not open to such an idea for anyone other than children during the presidential primaries. I will admit I'm slightly surprised this one is coming up so soon, though i note the noncommittal "openness" which shows a flexibility to jump on board or off whenever the jumping is good. I do believe that the President supports a mandate but will bide his time until a politically safe moment.


...
I've now been sitting here staring at this screen trying to figure out the best way to analyze and sum up my feelings about the president's letter. All I can say right now is: Get ready America.

The Money/Medicine Mix Mistake

The free market at "work" in health care = increased costs.

Says Kevin Schulman of Duke U:

“These costs keep growing despite the recession, and health care is going to
shoot up as a percentage of our GDP even more. It’s just spooky.”

From AHLA newsbriefs:

The Palm Beach Post reports that the "giant companies that dominate Florida's health insurance market are stifling competition and escalating premiums," a new report by Health Care for America Now argues. The report said health insurance "premiums in Florida rose 3.6-times faster than wages from 2000 to 2007"; and two companies, "Blue Cross and Blue Shield (BCBS) of Florida and Aetna Inc., control 45 percent of the health insurance industry in the state." ... But United Healthcare spokesperson Roger Rollman charged, "The idea that UnitedHealthcare market share is driving premium costs is nonsense." Rollman contends that "the growth in premiums is mostly driven by overall health costs."

Similarly, the Houston Chronicle (5/21, Ackerman) noted that Texas health insurance premiums rose "nearly six-times faster than wages between 2000 and 2007"; and the report showed that "BCBS and United Healthcare control 68 percent of the Texas market." ... Notably, the Justice Department "considers a market 'highly concentrated' if one company holds more than a 42-percent share."

The Chronicle quotes an HCAN researcher: insurance companies’ profits between 2000 and 2007 belie their arguments [that an ageing population is the reason for increased costs]. He noted that the net incomes of the 10 largest insurance companies grew from $2.44 billion in 2000 to $12.8 billion in 2007. The Chron continues, During that time, Texas premiums have increased 87 percent, according to the report — 5.8 times faster than wages. For family health coverage, the average annual combined premium for employers and employees rose from $6,635 to $12,403.

That's bulls**t.

Okay, rant time.

Do we care about money or people? The cost of health care, the cost of treatment, the cost of an ageing population, the cost of premiums, profits, profits, profits, the market, the cost of innovations, pharmaceuticals, insurance, HMOs. This is what you hear in the news when you hear about health care. The only time people come in to the equation is when you hear "46 million uninsured." But again, look at that statement--"46 million uninsured." Not 46 million without health care, not 46 million people who are unhealthy or don't have access to preventative medicine. And even less frequently do you hear about the "underinsured," who pay their hard earned money to be "covered" yet still face huge bills and forgo medical treatments. Why? Because no matter what they're under, at least they're INSURED.

And being insured means you get the care you need right?

Well...certainly not in countries with the wrong kind of insurance--public. People in those places face long waits, and certain technologies aren't as widely available, right?

And, well...not in a place that's mandated insurance coverage for everyone either--say, Massachusetts. How long is the wait there now for a visit to the doctor? Many offices have stopped taking new patients, and the wait for an appointment can be up to a year.

So the country's discourse--and whatever possible "solution" comes of it--is based on faulty logic. Having insurance DOES NOT EQUAL having care.

I can't say I have the answers, but I can say the question needs to be rephrased.

"Cadillac Insurance" Tax

During the presidential campaign, one of the legs on which McCain's health plan platform stood was an elimination of tax breaks for employer sponsored health benefits in exchange for creating a tax credit for individuals and families who then chose to purchase insurance on the Free Market instead. The plan was that encouraging people to obtain insurance on their own instead of through their employer would create a more competitive insurance market, though McCain acknowledged this plan was effectively a tax on the wealthy.

What are those tax breaks? Briefly, the money an employer spends that is received in health benefits are not taxed as income. Further, an employer is able to contribute to those benefits with pre-tax dollars. McCain wanted to say bye-bye to that. What did now-President Obama say? No way.

Fast forward to May 2009. The plan to remove the tax breaks is still on the table. Somewhere. Some members of Congress (read: Baucus) and unnamed members of BO's administration are supportive of elimination of the employer benefit tax breaks. What will the President say now?

The obvious move for employers if this were to occur, which was part of the McCain health plan ideology, is that without the breaks, employers will cease to offer benefits, or offer less attractive (expensive) packages. This affects many many Americans as approximately 2/3 of those under 65 who are insured receive benefits from their employers, according to NYT. Of course, NYT does not differentiate on how good those benefits those are, but I suppose that doesn't matter when (1) something changes and (2) suddenly you're paying more for the same thing. No one likes that, right?

There is no talk in the NYT article about "balancing the platform," as McCain was to do with his tax credit. Why? Because the balance would be people using the public option, and that's an article of a different color, for both the NYT and this blogger. More to come........

Sebelius--One step closer, despite her "lack of candor".

Republican Senators Roberts (KS) and O.Snowe (ME) joined the Dems this week on a Senate Finance Committee vote giving Gov. Sebelius the green light to a full Senate vote on her nomination for HHS Secretary.

It's high-time for some highlights on Sebelius. (It's not like I have to read an entire book or anything... )





Brief Bio:

• A political family: Father was John J. ("Jack") Gillian, a Democrat who served in WWII before becoming a member of the US Congress in the 60s as an anti-war Dem, Governor of OH in the 70s, and next head of the Agency for International Development under Carter.
• Sebelius served as Insurance Commissioner in KS from '94-'98, declining to take contributions from insurance companies. Her term culminated in blocking giant Blue Cross from merging with for-profit Anthem, a move many cite as a key indicator as to why she's a fantastic, or horrible, HHS Secretary candidate, depending on which camp you're in.
• Sebelius has served as President of the National Association of Insurance Commissioners, past chair of the Democratic Governor's Association, and past Chair of the Education Commission of the States.

And on to the nomination-related news:

• Sebelius joins the ranks of many-a-member of the BO administration, by having mistakenly failed to pay taxes. The Gov payed over $7,000 in back taxes owed for '05-'07. A paltry sum compared to her peers, but her "unintentional error" is noteworthy nonetheless.



• Sebelius is the Moderate Pro-Choice candidate? Bob Novak, no stranger to controversial reporting, has called the Gov a "national pro-choice poster girl," and states there is "substantial evidence she has been involved in what pro-life advocates term "laundering" abortion industry money for distribution to Kansas Democrats." An interesting op-ed links the Gov's political activity to the "apex of a complicated Kansas financing system involving the famous abortion provider George Tiller of Wichita," Planned Parenthood, and the court system--more involved than I would like to get on this blog right now, but click the link. During her first confirmation hearing in front of the SFC she said she will remain "staunchly pro-life, and will advocate for the lives of the unborn."



• And speaking of the famous doctor, Sen. Grassley is concerned about Sebelius' "lack of candor" with respect to her "inadvertent omission" of campaign contributions from late-term abortion doc Tiller (who has been spied partying at the Gov's Mansion). The Gov had to amend her statement to the SFC after stating she and her PAC received $12,450 from the doc in '94-'01, when the total was really more like $40,000.

• Despite her record of vetoing and speaking out against various abortion laws, at the end of March (right before her confirmation hearings) Sebelius signed a law that gives women the option to view a sonogram before an abortion. The Gov had previously vetoed legislation including such a provision, though the language in the vetoed legislation included mandates, not options, and also reporting requirements.

• Sebelius supports BO's reform plans, including a public insurance option. In April, the Gov signed a law to use federal stimulus money to subsidize health insurance for those who have lost their jobs.

Sebelius had originally taken her name out of consideration for cabinet positions, citing a need to focus on her responsibilities to Kansans in tough economic times.

That's what I've been saying!

Howard Dean is back on the scene. After being passed over for HHS consideration, he keeps on trucking. His newest health care campaign: Stand with Dr. Dean.



Now, call me naive, but this is what I've been saying when I talk to my pals about health care reform. (though I hope I didn't speak like I've never read cue cards before.) Makes total sense.

In America, you can go to public school, you can pay more for private, or you can home school. You can get on public transit (for a small fee) or you can buy a car. You can use the USPS or you can ship FedEx. You can call the police when you hear a noise and you can buy your own alarm system. Why why why is health care different? As "Governor Howard Dean, Dr. Howard Dean," says, this is the system already set up in health care if you qualify for Medicare/caid (read: you're poor, disabled, over 65). Why stop there? (*cough* insurance lobbyists *cough* AMA *cough*...)

Care costs $... bigger entity, more moolah.

Catching up, at home and in MA.

Been away a while while graduating/taking the bar/subletting my apartment & moving. Now I'm trying to sort through old news & catch up with the new. Onward!


On March 15, 2009, NYT published an article on the costs of care in MA & how the Commonwealth is trying to deal. Costs were high in the projected plan, and have soared even higher.

Alan Sager, a professor of health policy at Boston University, has calculated that health spending per person in Massachusetts increased faster than the national average in seven of the last eight years. Furthermore, he said, the gap has grown exponentially, with Massachusetts now spending about a third more per person, up from 23 percent in 1980.

All of that, and still 2.6% of residents, 167,300 people, are not covered. Now, while that's comparatively nothing to sneeze at, we still have to contemplate just how much money is being spent, and that the return is not universal.

Why do we care about health care in MA? Well, beyond the general desire to watch an experiment at work, the Obama administration has certainly taken a liking to it, and even without Daschle, the Plan is peppered all over policy talk from the White House.


The article offered a very nice nutshell of Phase I of the MA plan, which was simply getting it enacted, including the sell of Mandatory Coverage. Phase 2 of health care reform in MA involves an ambitious restructuring of payment schedules.

They want a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided. ... If Massachusetts becomes the first state to make this conversion, health policy experts argue that it would be as audacious an achievement as universal coverage.

Again, significant on a Federal level. Paying for quality instead of quantity is already creeping in to the Federal system (for example, Medicare's new non-reimbursement rule for certain complications after patient admission), and managed care organizations have also experimented with/enacted various quality-based payment systems very similar to what MA may be proposing. This proposition is not without logic since chronic disease is a huge chunk of health care spending, and can either be prevented or effectively managed by patients and doctors for lower costs overall.

Of course the problem of determining sufficiency of quality is common to pretty much every health care delivery quandary: WHO decides? But that's a post for another day.


The article goes on:

Those who led the 2006 effort said it would not have been feasible to enact
universal coverage if the legislation had required heavy cost controls. The very
stakeholders who were coaxed into the tent — doctors, hospitals, insurers and
consumer groups — would probably have been driven into opposition by efforts to
reduce their revenues and constrain their medical practices, they said. Now
those stakeholders and the state government have a huge investment to protect.

Well wasn't that a slick move.

congressional health care caucus

live streaming now.

Gender discrimination in insurance

In CA, as in most states, the State says it's okay for insurers to charge more to women, as long as the determination is backed with statistics. This is known as "gender rating." In San Francisco, the city attorney's office has brought suit against state insurance regulators for this practice.

Market says: gender discrimination is legit, state sanctioned, and
makes financial sense.

Rights advocates say: discrimination is bad, m'kay?

The fact that women generally pay more than men for the same insurance is a great illustration of dichotomy between free market health care solutions and more equality-based health-care-as-a-right, universal ("socialist")-types of solutions.

Industry people say that the reason for the discrimination is that women are more likely to use health services. Blue Shield spokesman Tom Epstein put it this way:

"women [are] more accident-prone than men and more likely to break bones or get
sick"

Okay, I'll buy that women use health services more, but Tom sounds like an abusive husband. And funny, Tom doesn't mention that women are more likely to get pregnant than men, which also requires some doctor care.

There is a comparison made to auto insurance: on the whole, men pay more than women because they're more likely to file claims (wait, who's more accident prone?). But, as the same article points out, this is a faulty comparison. Utilization of the health care insurance product is preventative (saving money in the long run), while utilization on the auto side is catastrophic and reactionary (only spending money).

Here's the deal. Insurance is a business. Business has the privilege to incorporate when a State says so. States (not the federal government) regulate insurance. The State is society's mouthpiece. As a member of society, what do you want your State to say to this business that has the privilege of taking your money, and your neighbor's money with the State's blessing? What do you want your State to say to the nation (and beyond) about your value system as reflected in this regulation?

Currently, what States are saying is that it's okay to charge more (and in health care speak this means "make less accessible") to people that utilize care more. But the State is actually saying more. It's saying

"It's okay to charge more for people that utilize the care more no matter
what the reason."

Even if that reason is prevention, which creates a healthy, more productive society on the whole. Even if that reason is specific to 50% of the population but not the other (though the other half certainly benefits).

Is that what you want to say? Balance it with a free market (if that's important to you). One could make the argument that allowing more preventative care would be better for the economy (see above argument on more healthy, productive society), even though it may restrict insurers in the immediate sense.

Any Friedman-ites out there wanna chime in? I'm all ears.

the frankenstein analogy

I'm not the only one that associates Frankenstein with health care.

Capitalism Magazine published an article called The Medicare Bureaucracy is a Frankenstein Monster That is Destroying American Medicine.

And there's apparently something called the "Frankenstein Syndrome" in health care, "caracterized by an excessive reliance upon high technology medicine to compensate for healthy lifestyle."

Health Care as a Right

I recently wrote a paper about the MA health plan. Part of that paper included exploring whether health care is a right... It's a topic I've struggled with because while I'm all for everyone having health care, I don't necessarily believe that it is a right, given certain legal arguments that will be traced out below. It's a tough one to resolve, so here's the start of an argument..............

Some proponents of Massachusetts’ health care reform claim that health care is a right, and therefore Chapter 58 is appropriate and justified, despite any economic issues. There are two points of contention with this assertion: Is health care a right, and if it is, has the Massachusetts legislature protected this right with Chapter 58? Some proponents further argue that regardless of rights language, we have a moral obligation to provide health care to those who cannot afford it. Whether health care is a right or moral obligation is a long-fought and storied debate. For purposes of discussion of Chapter 58, I will simply highlight some arguments.

First, a distinction must be made: human or civil rights are not necessarily the same as legal rights. In the American legal system, rights are treated with great deference, and therefore, a statutory or judicial declaration that health care is a right carries tremendous weight and imposes a duty on the government for protection and support. In his seminal work on the right to health care, Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein described the countervailing view against health care as a right. Negative rights are those that require noninterference, whereas positive rights require a duty from another individual. Health care is a positive right, and as such, is not fundamental.

There is an argument that health care should not be a right because it is not justiciable.[1] However, courts have looked at similar issues, which could shed light on the judicial analysis in recognizing a health care as a fundamental right. In Washington v. Glucksburg, 521 U.S. 702 (1997) the Supreme Court articulates a test to determine if a right is fundamental. The right must be “carefully described,” deeply rooted in this Nation’s history and tradition, and implicit in the concept of liberty.[2] In Abigail Alliance v. von Eschenbach, 378 U.S. App. D.C. 33 (2007), cert. denied, ­­­­­­­­­­­­­­­128 S.Ct. 1069 (2008), the District of Columbia Circuit court sitting en banc relied on Glucksburg to strike down arguments that terminally ill patients had a fundamental right to experimental drugs. The dissenting judge attempted to root the right in the due process clause of the Fifth Amendment. The court declined to address whether “access to medicine might ever implicate fundamental rights,” and the Supreme Court denied certiorari on the case.
Regardless of whether health care is a right, people argue that there is a moral obligation for the United States to provide health care to all residents. This argument is usually supported by pointing to international declarations, laws of other countries, inferences from American history, and emotional appeals.

International declarations, which the United States have supported, assert every individual’s human right to health care. For example, the 1948 Universal Declaration of Human Rights, drafted by a committed chaired by UN ambassador Eleanor Roosevelt states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.[3]

The 1996 International Covenant on Economic, Social and Political Rights states:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.[4]

Each of these documents was accepted by the United Nations General Assembly, and each has been signed by the United States.[5]Proponents of the provision of health care as a moral obligation or right also frequently point out that the United States is the only industrialized country that does not offer universal care of some sort to its citizens, despite public support for a century.[6] Proponents rely on the moral values, justice, and equality upon which our society was built to support their claim.[7] Following this moral compass, there have been a number of U.S. presidents and lawmakers who have tried to implement health care reform on a federal level. Among them are Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson , Edward Kennedy, and Bill and Hillary Clinton.


[1] Puneet K. Sandhu, A Legal Right to Health Care: What Can the United States Learn from Foreign Models of Health Rights Jurisprudence? 95 Calif. L. Rev. 1151, (2007)
[2] Roy G. Spece, A Fundamental Constitutional Right of the Monied to “Buy Out Of” Universal Health Care Program Restrictions Versus the Moral Claim of Everyone Else to Decent Health Care: An Unremitting Paradox of Health Care Reform? 3 J. Health & Biomed. Law. 1, (2007).
[3] Universal Declaration of Human Rights, G.A. Res. 217A, at 71, U.N. GAOR, 3d Sess., 1st plen. Mtg., U.N. Doc A/810 (Dec. 12, 1948).
[4] International Covenant on Economic, Social, and Political Rights, G.A. res. 2200A, 21 U.N. GOAR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, (Mar. 23, 1976).
[5] http://www2.ohchr.org/english/bodies/ratification/3.htm
[6] Tom Daschle, Critical: What We Can Do About the Health-Care Crisis (Thomas Dunne Books 2008) (2008).
[7] Tamara Friesen, The Right to Health Care, 9 Health L.J. 205 (2001).

Soda Tax

A recent Business Week article discusses "A Tobacco-Style Tax on Fattening Drinks." I'm for it.

Let's bypass the libertarianesque arguments about taxes for right now (I'll save that bigger picture for my political blog, but in fairness, here's an argument against a soda tax) and assume it's a legit way for governments to act. The government uses taxes to create incentives/disincentives to do things. All. The. Time. It's the way things get done. Want to encourage creation of nonprofit entities? tax breaks. want to tie health care to employment? allow use of pretax dollars. i'm not a tax wiz, but you get the point.

Public health issues are hard to deal with. Unhealthy behaviors are very hard for the government to control, yet we deal with the consequences ...not surprisingly, tax money is one of the ways. But the bigger picture is that unhealthy choices translates to an unhealthy population. And when a person is unhealthy, it's harder to do things that life calls for & they enjoy (pay bills, vote, pay attention to job & school & family). It takes a toll on an individual and on a society. But what is a government to do? We've got this little thing called a "Bill of Rights..." and a capitalist society.


"Opponents say such a tax would disproportionately fall on the poor, punish thin people who merely happen to like soda and candy, and fail to address the many complex factors that contribute to obesity."



Okay, let's knock that shit down.

1. (1) That the poor would be disproportionately affected is a distraction because soda is not a necessity. This is the emotional argument. Further, it acknowledges the larger public health concern that healthy food is F*ing expensive and harder to get than bad-for-you food, and so makes me think we'd better address this. Also, if you want to talk in money and proportional representation, go back to the paragraph above about the use of tax dollars to "fix" what bad health choices bring, such as obesity-related diseases. the poor that are more likely to drink soda and smoke cigarettes are also more likely to use your tax dollars when they are sick. I'd really like to know who this "opponent" is that would make such an argument. It doesn't really benefit an advocate for the poor, who would probably have more important things to advocate for. Who else would be opposed to such a tax, I wonder?
2. (2) That the "thin" who "merely like soda" are punished is laughable--first, this is not punishment, it's prevention. Second, it's like saying those who "merely like cigarettes" but don't have heart disease or cancer (yet) are being punished with cigarette taxes, while those that are sick and pay the tax deserve it. thin does not necessarily equal healthy or invincible. argument fail.
3. (3) of course the tax does not "address the many complex factors that contribute to obesity." It addresses one. that's a pretty good start.

Apparently the tax would not include diet sodas, which is a bizarre and artificial distinction. (get it?). (Raises the spectre of the menthol exception in the recent cigarette bill.) Diet sodas are even worse than regular sodas. Artificial sweeteners make people more fat by messing with the way a body counts calories and leading to overconsumption!! Read about it here and here, for a start. (And of course, there are those that believe aspartame, a.k.a. nutrasweet, is much less healthy than the FDA and manufacturers would have you believe... that discussion is for another day).

I think the article author is correct in saying it's only a matter of time...

Daschle's Critical: Outlining the steps from the laboratory of MA to the Federal Government

Just finished reading Critical. Had to return the book to the library (late) so bear with me as I go from memory (& can't quote).

Any suspicion that Obama's health care plans are following the drumbeat of MA has been confirmed. Daschle had nothing but praise for the state's plan, especially the Pay-or-Play, the Connector, the "shared responsibility..." In recalling the failed Clinton plan, I saw Daschle outlining lessons learned that I would expect the new administration will try to avoid: (1) non-transparency, (2) document too detailed and lengthy (3) timing.

So here's my prediction for Obamareform in a nutshell: The new administration is already addressing non-transparency by having the public meetings and getting input on the website. The long document problem will likely be addressed by pushing off the details to a (MA) Connector-like agency proposed by Daschle to be called the Federal Health Board. This helps by (1) getting reform more quickly (2) being able to blame someone else (3) lessens policy arguments that will bog down passage of the bill, especially the line-drawing wrt what's covered and what is not. I expect fast action on health reform to avoid the Clinton-esque problem of allowing the opposing troops (doctors, insurance) to mobilize, and fearmongre. We've already heard about the medicare-like program with benefits the same as federal employees. Finally, I expect moral and emotional appeals. Not only is this the liberal thing to do, but Daschle illustrates the effectiveness by discussing an appeal from a rabbi in MA at a State House meeting saying everyone should join together to create a "coalition of compassion" to do the right thing & pass health reform. Daschle suspects moral appeals as such would work on all Americans. And of course, there will be an appeal for individuals to take more personal responsibility for their health.

health care problem solved.

Daschle wants to model the FHB on the Federal Reserve, so it can be an independent agency without political pressures. Daschle thinks this is a good idea because of the transparency of the Fed, and how well they've done with the American economy over the years. Really.

I have read some articles/blogs saying the Daschle/BO plan will be paving the way for "socialized medicine." I've also read articles/blogs warning that evil opponents of liberty will claim TD/BO are paving the way for socialized medicine. I will say there are some moments throughout the book where Daschle seems to be in favor of single payor, saying things like "since single payor is not an option right now...." or pointing out how efficient it is, but it wouldn't work in America... BO said he was in favor of single payor in 2003, and of course the context is that this is not an instantaneous solution for America. However, until we get special interests and corporations under control, I don't see this happening, no matter who loves socialized medicine. Daschle points out that the health care industry is the nation's biggest lobbyist by far, followed by insurance. (each out-lobby Big Oil, he points out.) ...I noticed the reform posited in Daschle's book does not say anything about reforming the insurance industry, other than disallowing discrimination against people with pre-existing conditions. Though he does discuss putting togther a board to evaluate the cost effectiveness of new technologies, as many other countries have.

This is a quick fix that will give relatively fast and good results but is ultimately unsustainable and will not grant universal access. The goal, as in MA, is to get people insurance, not to get people care. The MA government acknowledges that not everyone will get care. The ones that need it the most--those that are "not poor enough" for medicare/caid, but earn too much for other programs fall through the cracks yet again. And just like in MA, the pay-or-play will more entrench health care through employers which is a plan that does not work for America anymore and the Auto Crisis is the prime example.