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The House bill on health care cleared the House Committee on Energy and Commerce with a vote of 31 to 28. Five Democrats joined all 23 Republicans. Compromises were reached with Blue Dog Democrats, centrist Democrats who had concerns about the cost of the health care overhaul. The bill will be taken up again in September after the August recess, when Congress will be faced with the task of recociling the House and Senate versions and reaching common ground on a number of proposals. Some common ground has already been achieved between centris and Blue Dog Democrats and Democratic members who support Obama's proposals. Among the changes on which consensus was reached in the House version: 1. Access Insurers will have to accept all applicants and will not be able to charge higher premiums because of medical history or current illness. All insurers will have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans will be required to have insurance. Insurers will have to get prior approval from the government before increasing premiums over a certain amount. About 95% of Americans will be covered this time. The cost will still be approaching $ 1trillion over 10 years. Federal subsidies will be given to those who cannot afford health insurance and Medicaid coverage will be expanded. And the insurance will be made more affordable for the uninsured. Democrats also reached a consensus on creating some sort of government insurance plan or nonprofit cooperative to compete with private insurers. 2. Mobility And under this new plan it will be easier to change jobs as one would retains one's health insurance. This should actually help the job market, and help promote the mobility that is needed, now that jobs are shifting out of sectors like autos to sectors like energy. 3. Cost The Energy and Commerce Committee voted 47 to 11 to set aprocedure for the government to give federal approval of generic versions of expensive biotechnology drugs. By one estimate this saves $9 billion over 10 years. The Democratic proposals from the Energy and Commerce Committee would authorize the Health and Human Services Secretary to negotiate prescription drug prices for Medicare benificiaries. The agreement and consensus among the conservative, liberal and centrist Democrats, and Democrats with ties and connections to the health care industry was reached after intensive negotiations, and adoption of a package of amendments that helped bridge the differences they had. ...

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All sides joined the President at the White House, as part of his consensus building efforts, and to get aseat at the table in restructuring health care. The insurers and health care providers, including technology providers, all committed to cutting the cost of health care. New social insurance programs to cover 45 million uninsured Americans, and to make health care affordable for businesses and individuals, will be unworkable at currently projected rate of increase in health care costs of 6.2% a year for the next decade. The industry promised to reduce that by 1.5% through voluntary efforts, even though there is skepticism about whether they will deliver. The insurers are against a government sponsored health plan fearing it will drive them out of business. Insurers and health care providers are lobbying against the cuts in their Medicare payments, and insurers are fighting Obama's cuts to their private Medicare Advantage plans by a total of $176 billion over 10 years. Doctors are fighting a 21% cut in their Medicare fees scheduled to take place in January 2010. Pharmacuetical companies and makers of medical devices are concerned that new products will have to pass a cost-benefit test before being approved for coverage under Medicare. Its just that they all see the continued rise in costs as somehow unsustainable, especially in the current economic crisis, and share the feeling with business and the rest of the country that the system is broken. At the same time like the banks and bank executives, health care companies and their executives go on lobbying aggressively and doing things the old way, which raises questions about how well these systems that are broken can be put on the right path....

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Rosa Ines Rivera, a cook at the cafeteria for the Y.H. Chan School of Public Health, Harvard University, with 2 small children, describes the protests over the increase by Harvard administration of the premiums charged on health insurance that now take up over 10% of the income. She says she lives in public housing with her parents as she lost her apartment because she is behind on the rent, and now cannot afford to pay the increase in premiums. About 750 workers at Harvard are on strike on this issue. She says dining hall workers want the current pay of $31,193  a year increased to $35,000 to provide a living wage that helps them afford medical care, because of the high cost of living in Boston.  To get some idea of the plight of workers who provide the kind of nutritious meals that a lot of students depend on for healthy living- Rivera says she takes in about $450 a week after taxes, or about $1800, rent is $1150, which leaves $650 for herself and two children for all food, and expenses in Boston. The $4000 in premiums for health insurance would be about 330 per month, leaving her about $320 for food and living expenses with 2 children. Why the need to bring up children in poverty in America, for generation after generation, after putting in a full day of work? ...

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The startling truth about health "reforms," - they won't control spending, and without that the whole system of health care will rapidly become unaffordable and unsustainable. Obama's Council of Economic Advisors points out in new report that since 1975 annual health spending per person, adjusted for inflation has grown 2.1 percentage points faster than overall economic growth per person. At this rate health spending which was 5% of the GDP in 1960, and is 18% of GDP today, would grow to 40% of GDP in 2040. Medicare and Medicaid would increase from 6% of GDP now to 15% in 2040, or equal to three fourths of federal spending. Employer paid insurance premiums for families which grew 85% in inflation adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040. This would force employers to reduce take home pay. Samuelson says the uncontrolled health spending is singlehandedly determining national priorities, reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs, while it is producing large amount of waste in medical spending. See the link to Prof. Tyler Cowen of George Mason University in NYT, 6/14/ 2009, who cites the habit of doctors to write many expensive tests as one of the prime culprits in the wasteful spending. And in the process it delivers higher cost for lower overall quality of health for the American people. This at a time when many European countries provide live examples of doing it in a better way- lower cost, better health. The serious problem with the Obama health reforms says Samuelson is that it talks about restraining spending but may end up increasing spending. Its talk about controlling spending he says is good intentions, but based more on hopeful thinking, public realtions and risks becoming cosmetic reform. Because to really control spending will require coming to grips with its fundamental cause- hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, private or governmental. Such a system encourages doctors and hospitals to provide more services, expensive tests, favors heavy use of expensive medical technologies to increase profits, and for patients to expect them. Samuelson puts his finger on the root of the problem - there is no incentive and every disincentive for all the players in this game , doctors, hospitals and patients to seek reform of this system. For doctors and hospitals the hope would be that this cosmetic "reform" would leave the system basically unchanged, and patients to continue with a lifestyle and expectations that do not not acknowledge the fact that a lot of healthcare does not come from spending but from preventative care, education, good eating and exercize habits, and healthy lifestyles. And the uninsured are no exception, they would simply start consuming the expensive care for lower quality of overall health like everyone else. With this kind of situation confronting us, the views of Samuelson, and Professor Tyler Cowen of George Mason University, as welll as a growing chorus of informed public opinion on this subject, is that insuring the uninsured is a good idea, but doing it within the bounds of the present system, can only increase the costs. And too much is at risk, to rely on what Samuelson calls a scattershot of measures to control costs made up by Congress such as "evidence -based guidelines," "electronic record-keeping," "bundled payments to hospitals, to give the illusion of progress that won't make a serious difference. A sweeping restructuring of health care is needed, that would overhaul "fee-for-service" payment and reduce the fragmentation of care. It will also need what has not even be touched on adequately in the debate. This is the massive need for education in the schools about nutrition, eating, exercize, healthy lifestyles. It would also require opinion leaders in each field from sports and other fields to lead by example and with constant public presence, the media, and companies to form a partnership with private institutions to change existing eating habits and lifestyles that encourage obesity, smoking, fast food eating habits, large portions in restaurants....

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How companies like United Health are lobbying aggressively to shape the new helathcare legislation to their benefit. BW says the health insurers like United Health, Aetna and Wellpoint are already winning through clever and effective lobbying of Congress. Former Senator Tom Daschle works as aconsultant for United Health. Senator Conrad who has led aeffort to replace the public plan with nonprofit medical cooperatives, which would be a weaker competitive threat to insurers, is also influened by the insurers. United Health's CEO Helmsley and its person working with Congress on healthcare Simon Stevens met with Conrad on June 4. When lawmakers in Congress cite consulting group Lewin Group, that 88 million or 56% of those with employer provided coverage would desert private insurance for a government run program, they are quoting acompany owned by United Health. The Congressional Budget Ofice says these numbers are too high. United Health has used savy presentations on how to cut costs, and help Blue Dog and other Democrats articulate their positions, to gain influence in shaping the plan to their interests. United Health thus counts a lot with Matheson, and Mike Ross of Arkansas, who are prominent with the 52 Blue Dog Democrats. and with Senator Mark Warner of Virginia. And United Health put together an effective lobbbying group, even hiring the chief of staff of House Democratic leader Steny Hoyer. ...

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How the French health care system works. France comes in first and the USA 37th in aWHO health care ranking. THe difference in deaths from respiratory disease is half that in the USA, and lower rates of death from heart disease and diabetes. IT has more hospital beds and doctors per capita than the USA. 65% of French people are satisfied with their health system compared to 40% in the USA, and yet France spends 10.7% of GDP on health care and the USA spends 16% for poorer results. THe French system is more generous to its seniors. Unlike Medicare there are no deductibles, just modest co-payments that are often dismissed for chronically ill. And diabetes and critical surgeries are covered 100%. French also buy supplemental insurance like Medigap for extra expenses like dental and eyglasses. Cancer patients are treated free of charge. Avastin treatments costing $48,000 a year are provided at no charge. France's PMI or Protection Maternelle et Infantile, is rated highly. It is anetwork of thousands of healthcare facilities, that ensure that every mother and child in the country receives basic preventive care. Mothers even receive afinancial incentive for attending their pre and post natal visits. France makes this care affordable by reibursing doctors at a much lower rate. The average yearly net income for doctors is around $55,000, about athird of what doctors in the USA make. But French doctors don't have to pay back huge student loans as medical school is paid for by the state and malpractice insurance premiums are only a tiny fraction of that in the USA. And again the French government pays two thirds of the social security tax for most French physicians- which is typically 40% of income. So the $55,000, is more like $92,000 taking that into account and more like $110,000 when student loans and malpractice is taken into account at US levels. Specialists who have 4 or more years experience can charge what they want, but as one gastroenterologist says, there in an unspoken and undefined limit to what you can cahrge or what is socially acceptable. Yet even in France there is inflation in health care costs that the government deals with through price controls and more spending. The French national insurance system is running increased deficits each year and this is now $13.5 billion, and it has led to higher taxes for employers and workers. ...

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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The Affordable Care Act subsidies are basically a band aid approach to a fundamentally broken health care system in the US, says Washington Post Editorial Board on Nov. 1, 2025. The 22 million ACA subsidies will cost $350 billion over 10 years. Democrats have the government shutdown over this issue of extending Obama ACA subsidies where enrolment increased in the covid and Biden years with generous subsidies. The Washington Post looks at how we got here since 1945, decisions made about employer insurance plans that created a patchwork of plans from private sector and other plans outside it with perverse incentives and inefficient subsidies. It calls the system stupid, and politicians looking to the next 2 year midterm elections wary of addressing the whole problem in the proper way for a system that will benefit all the people of the US.

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Jonathan Gruber, the MIT professor, who has done extensive modeling of U.S. health care systems. Gruber advised Massachusetts Governor Romney in crafting the health care law in that state. He also advised the Obama administration in crafting the health care mandate that requires all Americans to buy health insurance to keep costs down. Gruber estimates the number of newly insured Americans could drop to 8 million from an estimated 32 million if the Supreme Court strikes down the health care law mandate. The result he believes will drive insurance premium prices even higher.

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The Dec. 2013 CBS/NYT poll showed only 39% overall support the Obama health care law, a majority say it increases their health care costs. 57% of the uninsured without health coverage say it increases their costs and only 20% say it decreases their costs, for the very group it was designed to help. For the uninsured a third say they will not sign up for the law and pay the penalty. Annie Lowrey of the NYT looks at these numbers and says part of the reason for the lack of enthusiasm for the law is the sharp increase in deductible costs of insurance coverage- the percentage of Americans in health insurance plans with deductibles over $1000 has jumped to 38% in 2013 from 18% in 2008, according to a survey by the Henry Kaiser Family Foundation. During these 5 years the average deductible has increased to $1097 from $735. This is happening as incomes are stagnant or declining in inflation adjusted terms for many working Americans.

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Full Yield is a startup in Boston that is trying to help address the nation's obesity problem by introducing healthier foods and meals in cafeterias. It plans to introduce a line of Full Yield branded food made from fresh items and natural ingredients for sale in corporate cafeterias and prepared food sections of local supermarkets. It is based on a simple idea that if you eat healthier food you will be healthier. A study in the Jan-Feb issue of journal Health Affairs says 75% of the $2.5 trillion in health care spending deals with obesity, Type 2 diabetes, heart disease and cancer. And how much of this traceable to obesity and bad eating habits, smoking and lack of exercize? This study says most of the cases are preventable by changing these behaviours. Dr. Kenneth Horpe, chairman of the department of health policy and management at Rollins School of Public Health, Emory University, shows that if trends continue U.S. annual health care costs related to obesity would reach $344 billion by 2018, which is 20% of total health care spending. In 2009 it accounts for 9%. Thorpe says if even the 1987 levels of obesity were reached it would free up enough money to cover the uninsured population today. For American companies the problem has grown to alarming proportions and yet no nationwide coordinated plan bringing together companies, government, universities, public interest organizations, and other groups exists in the U.S. The CEO of U.S. grocery chain Safeway, Steven Burd, says Safeway was spending $1 billion to cover health care insurance for workers by 2005, with costs rising 10% a year- this meant putting out twice in health care insurance than Safeway's earnings and hitting another $500 million by 2010. Between 2004-2009 the costs of insurance surged 31%, making this the fastest growing single corporate expense, according to Towers Perrin. This reduces incomes of workers as companies pass on part of the extra cost, and reduces the profits that can be put back in new investment for economic growth....

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Senate Finance Committee chairman says Senate Democrats have found ways to reduce the cost of the health care plan from $1.6 trillion to $1 trillion. A tax on some employer provided health benefits, cuts in Medicare and Medicaid spending, employers helping to pay the cost of health insurance for low-income workers, and limiting the eligibility for subsidies to households with incomes at 3 times the poverty level or $66,150, instead of 4 times the poverty level. Also a reduction in the plan to give tax credits to small businesses to help them buy insurance. And expansion of Medicad would be delayed to 2013.

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The fee-for-service system that is seen as the main reason for the inability to control costs. Patients don't see the costs of healthcare as long as they see companies and employers paying for their health care. About 75% of those with insurance say they are satidfied with their care even though the system encourages excessive testing and increases costs year after year.

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Many important changes in the health care bill do not come till 2013 or 2014. Its only in 2014 that government will hand out tax credits to low and middle incoem Americans to offset the cost of buying insurance and expand Medicaid federal-state programs to help expand insurance for the poorer sections of society.

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US president Biden's 2024 Budget places great emphasis on aid to workers and families in the US and shores up the Medicare hospital-insurance trust fund. He will do this by raising taxes on the wages, investment gains and self-employment income of people making more than $400,000 a year. Additional savings come from increasing the drugs on which Medicare can negotiate prices from 20 to 50 drugs.  Childcare- families making less than $200,000 a year will get subsidized child health care, the lowest income families paying nothing. Housing- Building and preserving 2 million housing units. Series of tax credits to make buying homes more affordable. College education- Reducing the cost of going to education with $12 billion allocated for this. Offering tution free community college. Family and Medical Leave- Federal paid family and medical leave program. Retirees- a $2000 cap on out of pocket cost of prescription drugs for retirees. Reduced taxes for under $400,000 income households- This would be done without increasing the deficits to extend the tax reduction from the 2017 tax cuts to households making less than $400,000 a year.     ...

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Hangzhou, hard hit by closing export focussed factories, is trying a$100 million voucher program to increase spending. Since January, a fifth of the residents of this city have received $30 vouchers, and more vouchers are being issued. Taiwan just tried a voucher program with $102 going to each Taiwanese citizen. Taiwanese President Ma says 50,000 retailing jobs were saved and about two-thirds of one percent addded to GDP. The problem in China is the lack of a safety net and poor access to health care, that is making average Chinese to save over one fourth of incomes. Consumer spending is 35% of GDP. The government has focussed on exports, and used export generated revenues for huge infrastructure spending. With exports down by over 25% in January, the export model is fading away quickly. Japan and Taiwan have seen much higher drops in exports, and China should see even more deceleration in exports, with a lag of some months, as a lot of products made in China use parts made in countries like Japan and Taiwan. The China Development Research Foundation says one fourth of the population have no health insurance at all. Though by some estimates this number may be about two thirds of China's 1.3 billion people. Hundreds of millions of people have huge bills for treatment of serious illness that are not covered by even the most basic insurance. Public pensions cover less than one third of the workers. And an estimated 130 million migrant workers have no unemployment insurance. Even payments to the poor reach only a fraction of people eligible. The government has only tentatively moved to correct his. And outside economists say that something needs to be done in abig way to build this safety net. The government has announced a $123 billion 3 year initiative to deliver basic, universal health care and health insurance. This follows a 3 year drive to provide compulsory and free education to students through 9th grade. David Dollar, the World Banks's country director, described ameeting with Finance Ministry officials, and wrote in areport on the Bank website that the government had the resources to expand these programs quickly. Instead the government has taken a piecemeal approach when action on a large scale is needed. One of the problems may also be that to make universal health insurance, the current health system may need to be examined and rebuilt, so that economical cost effective treatments are encouraged and costs are managed effectively. This would make universal health care affordable by keeping costs manageable, in the same way that the Obama administration is trying to do in the USA. ...

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The Republican House health care bill AHCA  keeps some some of the more popular parts of the Affordable Care Act such as not taking pre-existing conditions to deny insurance, keeping children covered on parents insurance till age 26, and increase contributions to Health Savings accounts. It is different in that the expansion of Medicaid at 138% of poverty rate threshold is rolled back. Age is used for tax credits instead of income, hitting those approaching Medicare age harder. The maximum charged to older people is now set at  5 times compared to 3 times what young have to pay. In general the Republican bill is seen as targeting the elderly to keep premiums down. The elderly on low incomes are hit hardest. Fox News O'Reilly Show showed the host questioning House Republicans, citing the CBO estimates that elderly on low incomes may have to pay as much as $14,000 a year for insurance making it basically unaffordable, and 52 million Americans would be affected adversely. Large companies are no longer required to offer mandatory health insurance under the new bill. Conservatives from Freedom Caucus wanted to see the essential areas of benefits covered by the law limited to fewer than the ten areas in the Affordable Care Act. The ACHA Republican bill leaves to states to determine what are required essential benefits. At one point maternity benefits were to be dropped but this was changed to let states decide. As a result the bill is 33 votes short of the number needed for passing the house in March 2017.   Neither the Democrats Affordable Care Act or the Republican House bill of Speaker Ryan do much to tackle the real problem- the absolute amount and increases for health care dollars for treating each disease in the U.S. compared to European and other countries. As a result health care has become more of a partisan struggle between the two parties than a real effort by all to overcome the problems that have to be tackled. Republicans want to see premiums drop and keep the burden on the deficit down- but with the level of U.S. health care costs disproportionately high compared to Europe and the rest of the world the arithmetic is tough and ends up leaving out vulnerable groups such as the elderly on low incomes, thus making the whole proposition prone to fail. For the same reason the Democrats failed to keep premiums down with a wider safety net leading to calls for repeal of their version.   ...

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Einer Elhauge, professsor of law and founding director of the Petrie-Flom Center in Health Law Policy at Harvard University, says there are limits to Congressional powers under the Commerce clause such as enacting a law requiring Americans to eat broccoli. If the health care law required all Americans to subject themselves to health care this would be the case. But the law only requires all to buy insurance so that insurance can cover the costs of healthcare for all. He points to the "necessary and proper clause" as also authorizing the health care mandate. That clause gives Congress the power to pass laws that are "rationally related" to execution of constitutional powers, such as criminalizing the interference with mail, on the basis of the constitutional power to setup post offices. In this case the health care law mandate is related to the constitutional power to regulate premiums and prohibit rejecting the sick, says Elhauge.

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During the years 2002-2008 the growth in doctors per thousand people at about 1.5, and hospital or clinic beds per thousand people at 3, are essentially flat. See graph. Figures from China's Ministry of Health. Now the State Council, China's cabinet is giving details on a $120 billion plus initial phase of a revamp of the country's health care system. Its a big step for China. A construction surge by 2011 is to give every village a medical clinic, and every county at least one hospital. Under this plan state subsidies for insurance premiums will aim at giving at least basic coverage to 90% or more of China's 1.3 billion people. For 30 years since China moved to a more capitalistic type system health care costs have been borne by the people, and these cost made access to health care difficult for a large number of people. These are steps to rebuild the social safety net in China in this crisis.

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Howard Dean, former Governor of Vermont, where Dean helped set up health care improvements, says the bill currently in Congress for health care reform does not deserve to be called reform and may do more harm than good. He points out that it does not insert competition into insurance markets, does not significantly lower costs, and does not improve the delivery and use of health care services. And few Americans will see any benefits till 2014, by which time premiums will have increased significantly. He sees insurance companies as winers in this bill, and the American taxpayer about to be fleeced with a bailout in a situation that dwarfs even AIG. One of his keen criticisms is already apparent to the public in this health care bill, that clear thinking has been thrown out in favor of compromise and political calculus, and by political moves the bill has been stripped of real reform , the end result being a bill crafted for votes and not to reform health care. It also then sets an irreversible course of how future healthcare reform is done, doing more harm in the future. ...

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Ron Wyden, Democratic Senator from Oregon, on maintaining competitive choice for 200 million Americans who have to buy insurance outside the Exchange proposed in many of the bills being put forward in the U.S. Congress. This lack of choice between seriously competitive plans will leave the situation in the same way that it is today, with little hope for controlling runaway costs and doom health care reform. The key to controlling costs says Wyden is introducing choice and competition. Wyden will introduce this plan as an amendment called Free Choice to legislation being debated in Congress.

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Brooks says no to the current health reform bill as most experts say it does little to control the bulging healthcare cost curve which will take it from 17% of GDP to 22% and beyond. He goes over the pros and cons. Passing this gets little done for health care reform in a fundamental way that is so badly needed today. Says Brooks the system today is rotten to the bone with opaque pricing and insane incentives, with consumers insulated from the costs of their decisions, this won't change with the current health care bill. In fact he says according to the chief actuary for Medicare it will cause health care spending to grow faster. At this rate we will be giving more money to insurance companies and programs that have great social value like expanded preschool and other needs that America has will be shoved aside. In coming years as the population of America ages there will be growing needs for health care. With no increase in supply, and the perverse incentives still in place, prices will continue to grow rapidly without the focus on efficiencies that is badly needed. Brooks points out that its not the politics is the chief obstacle to reform as most people say, but the reverse is the truth, unless one gets the fundamental incentives right politics will be terrible forever. ...

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This editorial in the WSJ describes the sharp increase in premiums under the Affordable Care Act of president Obama. The average premium increase is about 24.2% according to a Barclay's analysis, and as high as 43.9% in states such as Illinois. Bill Clinton calls it the craziest thing with small business affected, and some premiums doubling. Of the 17 million people in the individual market eight million buy without subsidies. One in five enrollees cannot qualify for subsidies. Democrats say subsidies are too small. Hillary Clinton has proposed to have a Medicare "buy-in" for people ages 55-65, and a "public option" government run plan. Republicans want to rewrite the law. But this depends on which party wins the Senate, with the election in Missouri giving Democrats an opportunity to maintain a Senate majority.