Hospitals Play Pin the Price on the Donkey

Consumer knowledge is consumer power. That is why hospitals fight tooth–and–toenail against any efforts to post turnkey prices for medical procedures.

Bagley Salt Lake Tribune

Hospitals want to maintain price opacity. If you ask a hospital what it costs to have your appendix removed you get one of three replies: Uproarious, table–pounding laughter. Thinly veiled contempt at such an ignorant question. Or dead silence.

In theory health insurance companies should be staunch allies of consumers in this fight for price transparency. Unfortunately, health insurance companies are basically utilities run by bureaucrats who move paper instead of electricity. They’re content to be wards of the Obamacare state.

Fortunately, the Information Iron Curtain has been under assault by at least three local efforts.

The Dallas Morning News reports Crystal Roberts was rushed to an emergency room after a car crash. Fortunately, she was home in only three hours. Unfortunately, lacking insurance, she was billed at the ‘This Is Gonna Hurt’ rate and charged $11,037 for procedures that didn’t require hospitalization.

This exemplifies the greed and sadism that typifies hospital administrators. They attempt to charge the highest prices to people who have already demonstrated they are either broke or idiots because they don’t have health insurance in the first place.

It’s literally adding insult to injury.

Crystal found a personal injury lawyer working on commission and sued the hospital. The state supreme court, bless its heart, ruled if the hospital intends to prove its $11,000 walletectomy is “reasonable” it must “share … details about the discounted rates it had with health insurers.”

That’s real progress, but the danger is the rats will see their hospital ship is sinking and settle out of court without releasing the prices.

The Maryland Health Care Commission is our second example. It published a limited list of turnkey prices for medical procedures. Limited because the prices cover operations on women or the elderly or elderly women. But it’s a start. The numbers cover 21 different hospitals in the state and along with prices the percentages of medical errors are also posted.

Finally, the private sector has done its part. Kaiser Health News covered the North American Specialty Hospital company that offers its business clients a program where employees leave the country for less expensive surgery.

Donna Ferguson had a knee–replacement done in Mexico by a surgeon from the Mayo Clinic. You’re no doubt thinking, yeah Mexico this year but it’ll be Somalia in 2020 if greedy capitalists can save a dime. Our suspicion is misplaced. Donna had the option of staying in Mississippi. What made the difference was the $5,000 check she received from her employer for agreeing to the lower–priced package.

Now the Trump administration has joined the fight. If you doubt the importance of access to pricing information, the response of hospitals to the Trump administration’s Hospital Price Transparency Rule makes my point eloquently.

They sued to block implementation. That’s because if it were up to hospital administrators, patients wouldn’t be able to find out what it cost to park until they tried to exit the parking garage.

The New York Times explains, “The nation’s hospital groups sued the Trump administration over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.” Including the cash price it will accept from individual patients.

It’s interesting that while hospitals have no compunction about forcing Crystal to hold bake sales to make the monthly payment on her hospital bill, the effort involved in publishing price information would bring the friendly folks in hospital billing to their knees. “’The sheer volume of data that the government is proposing health plans disclose is staggering — dollar amounts for every single item or service, for every single provider and facility, for every single individual and employer plan,’ wrote executives from America’s Health Insurance Plans and the Blue Cross Blue Shield Association.”

If that’s really the case, how do hospitals calculate the bill? Is it by taking the total overhead and anticipated profit for the month and divide it by the number of procedures? Or does the information already exist and they are simply lying through their lawyers?

Hospital price transparency has been one of the few sustained efforts on behalf of normal people from the Trump administration.

This fight is too important to leave to lawyers and judges. Consumers need to be heard. Call your congressman and tell him you support the Hospital Price Transparency Rule. And send an email to the Department of Human Services in support, too.

If consumers don’t make their voice heard you can be sure the vacuum will be filled by the blandishments of hospital lobbyists.

Medical Migrants Head to Mexico

There’s hope for price competition in healthcare, but so far only with companies that self–insure and pay for all employee’s medical costs. I do my part by advocating price transparency for hospitals to create competition and put downward pressure on insurance rates.

Bob Englehart Political Cartoons.com

Simply require hospitals that accept federal money to post binding prices for the 25 most common in–patient surgeries; the 25 most common outpatient procedures and the 25 most common tests. These turnkey charges must also match the best price offered insurance companies.

Getting patients to act on the information is the problem. This is difficult because surgery candidates – like Instagram followers – tend to believe high prices indicate high quality. This is not necessarily so. Hospitals with high prices may only indicate a large number of Ferraris in the executive parking lot.

The Maryland Health Care Commission posts prices for a handful medical procedures along with associated readmission rates. A surgical readmission is when a patient goes back a second time and is charged more to remove the sponge left inside their body — something hospital executives would never tolerate if the mechanic left a loose wrench under the hood of their Ferrari.

A knee replacement at the brand name Sinai Hospital in Baltimore costs $32,000 and risks an 18 percent readmission rate. Or you can pay $23,000 at the generically named Suburban Hospital, off in a parking lot somewhere, and only worry about a 0.6 percent readmission rate.

Unfortunately, health insurance companies are basically utilities run by bureaucrats who move blood instead of water. A creative solution from insurance companies to motivate patients to comparison shop was going to be difficult. That’s why I cautiously suggested the company apply a portion of the discount to the patient’s deductible in that year and the next.

I am indebted to Phil Galewitz, of Kaiser Health News, for reporting successful, effective incentives for patients do exist, but only for those fortunate enough to work for an enlightened company that self–insures.

Galewitz introduces Donna Ferguson of self–insuring Ashley Furniture in Mississippi who needed a knee replacement. Ashley’s own business is fiercely competitive and it evidently sees no reason why competition won’t work in health care.

That’s why Ashley is a client of North American Specialty Hospital. NASH currently works with 1,200 companies and some 3 million employees. Hospitals aren’t required to post prices in Jefferson Davis’ home state, but we do know in Maryland the low–price, high–quality knee replacement runs $23,000.

Even that lower price is almost twice the $12,000 knee replacement NASH offers in Cancun, Mexico.

The location may give you some pause now that Cancun is mostly famous for decapitated heads that occasionally wash ashore. Unpleasant sure, but none of the deaths were caused by hospital error. NASH makes all the arrangements for employees who opt for south of the border surgery. Travel, hospital, pre– and post–operative care, physical therapy and accommodations at a Sheraton attached to the NASH hospital are included. All the patient has to do is supply the problem.

Donna’s surgeon was a Mayo Clinic trained US doctor flown in for the procedure. All local hospital personnel are US–trained medical professionals. The NASH package even includes travel for one companion. In this instance mom got a knee replacement and dad got a vacation.

Some of you are no doubt thinking, yeah Mexico this year but it’ll be Somalia in 2020 if these greedy capitalists can save a dime. I’m suspicious of corporations, too, but in this case, it’s misplaced. Donna had the option of staying in Mississippi for her surgery. What made the difference was the $5,000 check she received from Ashley for agreeing to the lower–priced NASH package.

Plus, by using a US doctor Donna said, “she could file a malpractice suit in the US” if something went wrong. An option everyone who has ever watched a ‘Call 1­–800–SUE–PAIN’ commercial wants to retain.

Patients, companies, hospitals and insurance companies are the four variables in adding competition to healthcare. Hospitals, if they are required to post the turnkey, will lower costs on their own or suffer revenue shortfalls. The 1,200 companies NASH serves have already adopted a competitive shopping outlook. And Donna Ferguson and the other 140 Ashley employees who have agreed to travel for a medical procedure show that patients will respond to incentives.

The last and most difficult target are the insurance companies who are currently content as Obamacare wards of the federal government. Convincing these competitively inert organizations to share savings with patients or adopt other incentives is going to be tough.

Maybe the threat of ‘Medicare for All’ and the potential end of insurance companies will provide motivation before November 2020.

Sen. Mike Braun’s Backwards Healthcare Reform

Two years too late a senator has finally taken a tentative step toward increasing competition in the healthcare market, lowering insurance costs and removing the dead hand of Obamacare from the nation’s throat. It’s partial implementation of a plan I’ve advocated, but it repeats my mistake and unfortunately adds a new one.

Rick McKee, The Augusta Chronicle, GA

It’s unfair to blame Sen. Mike Braun (R–IN) for being late since he wasn’t in the Senate when Republicans frittered away Obamacare repeal. The problem is his bill attacks cost from the wrong end.

Braun’s plan is called the True Price Act. As he told Breitbart.com, his plan “would require insurers to disclose the negotiated price for each medical service covered by a person’s insurance plan and any cost-sharing amounts (co-pays or deductibles)…The bill would require the prices to be posted on the insurer’s website and in paper form.”

That’s backwards because the insurance companies can’t predict what hospitals charge for a procedure because charges vary according to the rapacity of the facility. Braun says he wants to reverse concentration in the health insurance market by “by making it transparent and competitive, letting the best providers survive.”

His bill would only encourage concentration and limit consumer choice because the only way an insurance company can be certain of a procedure’s cost is if the insurer limits coverage to hospitals it controls or with which it has negotiated an agreement.

The People’s Republic of Maryland proves my point. The Maryland Health Care Commission has a limited program that compares turnkey prices for common procedures affecting patients who are either women, old or both. It found Sinai Hospital charges $32,500 for a knee replacement, while UMD Medical Center at Easton charges over one–third less at $22,700, with fewer readmissions from complications. 

Braun would accomplish more by requiring hospitals that accept federal money to post turnkey charges and forget the insurance companies.

Then Braun repeats my initial mistake and ignores consumer motivation. Most medical shoppers, like whiskey drinkers, tend to associate high cost with high quality, when that isn’t the case. For a patient with a $3,000 deductible it makes both economic and status sense to choose the more expensive hospital. Ten percent co–pay on the costlier procedure wipes out his deductible and the rest of his health care that year is ‘free’!

A better solution is for the feds to encourage insurance companies to give the patient an incentive to be a comparison shopper by sharing the savings when he chooses a less expensive option. Instead of pocketing the $9,800 saved by paying for the knee replacement at UMD Easton, the insurance company could share by applying ten percent of the savings to the patient’s deductible for that year.

The patient would pay ten percent of the procedure ($2,270) and the insurance company would apply ten percent of the savings ($980) and his deductible for the year would be satisfied.

To ensure this wasn’t a one–time–only cost–conscious decision by the patient, the insurer could continue to apply 10 percent of procedure savings for the rest of the year to the patient’s deductible in outlying years.

This is good for the company because it reduces customer churn by giving the patient a reason not to change policies and the customer saves money on future annual deductibles.

Braun is right that cost transparency will encourage competition, but the place to start isn’t with the middlemen. It’s with the hospitals that generate the cost. Currently the consumer has severely limited options when buying insurance. It’s either the price set by the socialized premium mavens at Obamacare. Convert to Christianity and join a cost–sharing plan. Or join millions of uninsured illegals crowding the emergency room.

Sen. Braun would do better to allow insurance companies to offer coverage options and sell across state lines without crony capitalist interference from the various legislatures.

Combine that with price transparency for hospitals and incentives for procedure shopping on the part of patients and healthcare prices will finally start to go down.

The next step will be selling freedom of choice to the public and talking panicked Republicans off the ledge. But that’s another column entirely.

Hospitals Guard Prices Like the CIA Guards Secrets

Way back in 2017, before we were on the Road to Nuremberg With Donald Trump, the Washington Post was outraged that hospitals were trying to make a profit. Like most stories involving reporters, economics and healthcare it was both wildly inaccurate and agenda–driven.

Adam Zyglis The Buffalo News NY

The story’s one useful service was it introduced the public to the slightly ominous term “Chargemaster.” At first glance, the term “Chargemaster” might be mistaken for the cause of the so–called epidemic of “mass incarceration.” A fiendish device district attorneys use to jail minorities captured during the government’s regular sweeps in low–income areas.

Even for those who haven’t been to jail, the term has unsavory associations bringing to mind arrogant, price–gouging, monopolies who look upon customers as rubes to be exploited. (Ticketmaster, come on down!)

In reality, the “Chargemaster” has more to do with pricing than policing. Theoretically, it’s a complete listing of all the services and procedures a hospital provides patients, followed by the cost for each item.

What the consumer doesn’t know is the price listed after any procedure is as hyperbolic as an entree description on a Trump restaurant menu. The cost paid by Medicare or a health insurance company often bears little relation to what’s listed on the Chargemaster. Just as the window sticker on a new car is only a starting place in the negotiation.

The US healthcare market is currently designed to guarantee high prices, encourage waste and discourage price shopping. That’s because consumers can get a binding estimate on building a house, but they can’t get any kind of estimate on removing a gall bladder. Requiring hospitals to post the Chargemaster on the web is supposed to give consumers this vital information, but in truth all it will give most of them is a headache.

I predict it will be easier to read the privacy agreement for Facebook victims than it is to comprehend the Chargemaster. If it were up to hospital administrators consumers wouldn’t even be able to find out what it cost to park until they tried to exit the lot. Instead of a simple procedure equals cost equation, the consumer will no doubt have to assemble the procedure himself, which is just how the hospitals want to keep it.

Maryland made a tentative effort to lift the cost veil. The Maryland Health Care Commission has a website with the inane name of “Wear the Cost,” which sounds like the surgery bill will be tattooed on your backside. Instead, it compares turnkey prices for common procedures affecting patients who are either women, old or both.

Consumers who fit within that medical straightjacket can finally see what hip replacement, knee replacement, hysterectomy and vaginal delivery prices are at 21 different hospitals. Unfortunately, hospital patients, like whiskey drinkers, tend to associate high cost with high quality. That’s not necessarily true as the medical complication and readmission rates for the procedures at various hospitals demonstrates.

Patients can have high–quality care for lower cost if they will only do their research among these limited options.

The feds need to build on the Chargemaster unveiling by demanding all hospitals that accept federal money post binding prices on the web for the 25 most common surgical procedures; the 25 most common outpatient procedures and the 25 most common tests. The listed, turnkey charges must also match the best price offered insurance companies.

That’s half the battle. The other half is getting the consumer to act on the information. In Maryland Sinai Hospital charges $32,500 for a knee replacement, while UMD Medical Center at Easton charges over one–third less at $22,700, with fewer readmissions. If the patient has a $3,000 deductible and the co–pay is 10 percent, many would still choose the more expensive Sinai because it wipes out their deductible and all the rest that year’s healthcare is ‘free’!

Smart insurance companies would give the patient an incentive to be a smart shopper by sharing the savings. Instead of pocketing the $9,800 saved by paying for the knee replacement at UMD Easton, the insurance company could share by applying ten percent of the savings to the patient’s deductible for that year.

The patient would pay ten percent of the procedure ($2,270) and the insurance company would apply ten percent of the savings ($980) and their deductible for the year would be satisfied. To ensure this wasn’t a one–time–only cost–conscious decision by the consumer, the insurer could continue to apply ten percent of procedure savings to future deductibles. This is good for the company because it reduces customer churn by giving the patient a reason not to change policies and the customer saves money on future deductibles.

That’s an ideal situation. What we have is Confusionmaster and that’s probably where the feds will call it quits.

What If Obamacare Sold Homeowner’s Insurance?

If homeowner’s insurance worked like Obamacare, in no time at all homelessness would be a viable option for residents trying to lower their insurance cost.

Under Obamahome, construction contractors would talk endlessly about how compassionate their employees are. Edgy companies would assert that dealing with an English–speaking crew makes rebuilding your home a breeze. But no company would be talking prices or making binding estimates.

Instead homeowners would hire the company that was closest or had the most caring spokesperson. Really shrewd homeowners might check a Yelp review, but that would be the extent of the research. When it came time to sign the contract the homeowner would pay his deductible and the bill for the covered procedure would go direct to the insurance company.

The homeowner would remain blissfully unaware of what his newly repaired roof, siding, basement or deck cost to fix.

Under Obamahome, renters are also covered, but renters wouldn’t be required to pay a premium. And homeowners who had a loss, but weren’t covered by insurance — because they opted to make the final payment on their Sistine Chapel tattoo — can both buy a policy and file a claim during the same transaction.

At premium–setting time, homeowners would discover Obamahome rates had to be set high enough cover their house and their prorated portion of the renter’s and the pre–existing damage claims.

Soon they’re confronted with Obama’s Choice: To get an affordable premium, homeowners must choose between a much higher deductible for the same coverage or the same deductible for much less coverage.

The result is a $12,000 deductible that covers everything up to and including Hurricane Stormy or a $1,000 deductible that covers tornados and fire, but excludes hail, wind, lightening and floods.

Fortunately, homeowner’s insurance doesn’t malfunction like Obamacare, and with any luck the Texas Supreme Court may force hospitals to adopt pricing reform.

The Dallas Morning News reports Crystal Roberts was rushed to an emergency room after a car crash. The good news is she was home three hours later. The bad news is accompanying her was a bill for $11,037.35 for X–rays, CT scan, lab tests and ‘other’ services. Crystal was charged the ‘This Is Gonna Hurt’ rate because she lacked insurance.

But she didn’t lack a lawyer, so Crystal sued. The Texas Supremes ruled that if the hospital intended to prove Roberts’ bill “reasonable” it must “share … details about the discounted rates it had with health insurers, data that’s generally seen as proprietary and confidential.”

I’ll say it’s “confidential.” You’d have better luck finding Trump’s tax returns. The only price information a patient gets on a visit to the hospital is what it costs to park.

One wouldn’t know that from the story, though. Economics illiteracy among journalists continues unchecked, “While few dispute costs are out of control and transparency would help, the ruling is seen as unprecedented by some, who worry it could deal a big blow to free market competition in health care.”

The statement couldn’t be more wrong. It’s like saying if we banned Consumer Reports Car Buying Service and prohibited window stickers on new cars it would increase competition and lower prices.

The ability to compare prices encourages competition, while concealing prices encourages price–fixing.

The decision is a tentative step toward my simple, Constitutional, solution for increasing healthcare competition. First, require any hospital taking federal money to post turnkey prices for the 25 most common hospitalized surgical procedures; the 25 most common out–patient procedures and the 25 most common tests. All charges must match the best price offered insurance companies – the information the Texas hospital doesn’t want to share.

Second, allow insurance companies to compete across state lines, creating a national market. Any national policy won’t be subject to state-level regulations. This means state politicians with itchy legislative fingers can’t force companies to cover pap smears, prostate exams, birth control, or any medical fad do-gooders want to force on consumers. Individual buyers will be able to pay for the coverage they want and not be forced to pay for coverage a major campaign contributor wants them to have.

Policies must be offered in all states to escape individual state regulation. Any company selling a policy within a state must conform to that state’s financial stability rules.

Third, no exclusions for pre-existing conditions if the patient can prove continuous coverage for the prior six months. Otherwise, a six-month waiting period. Patients who don’t want to buy private insurance can participate in a federal high–risk pool.

Depending on judges to reform healthcare is spotty and imprecise.  We need Congress. The only negative impact my reform might have is on hospitals and the Medical Industrial Complex. That’s why it won’t happen. Those insiders make large campaign contributions and the likes of Crystal Roberts don’t.

Ever Wondered Why Hospitals Don’t Give Estimates?

If your goal was to design a system that guaranteed high prices, encouraged waste and discouraged price shopping there is no need to start from scratch. Just adopt the US health insurance market and you’re good to go.

Rick McKee, The Augusta Chronicle, GA

If we bought cars the way we buy healthcare it would work something like this. First you decide which car purchase policy to buy. Do you want a “bronze policy” that has a lower monthly premium, but a much higher deductible due when you pick up your new car? Which, by the way, is likely to be one of those suppository–sized Fiats, since that’s the tier of car covered under bronze.

Or do you want to go for the “gold” policy that has much higher premiums, but also grants you the red–carpet treatment when you waltz into the Tesla dealership?

What’s certain is, regardless of whether you opt for the suppository or the showboat, the final cost is immaterial. There’s no window sticker glued to your new ride. No sitting on a metal folding chair in the salesman’s cubicle while he “goes to check with his manager.” There’s not even any need to go to different dealers. Simply pick the one closest to home or the dealer with the best uppity coffee maker in the waiting room.

The dealer sends the invoice to the car purchase insurance company and you drive home. Price is no object when the company picks up the tab. Under that system we’d soon have two giant federal takeovers of the economy: ObamaCare followed by ObamaCar.

Health care pricing is totally opaque to the consumer and hospitals do their best to keep it that way. Constitutionally the federal government can’t order hospitals to disclose prices. (I know this is no impediment to leftists, but conservatives must try to be consistent.) But it can require hospitals that take federal dollars to meet certain standards.

If the goal is to encourage competition while lowering prices, the standards would include posting turnkey prices on the web for the 25 most common surgical procedures; the 25 most common out–patient procedures and the 25 most common tests. The listed charges must also match the best price offered insurance companies.

That would be the beginning of real healthcare reform. Strangely enough the People’s Republic of Maryland has taken a tentative step. The Washington Post reports the Maryland Health Care Commission has a website with the inane name of “Wear the Cost,” which sounds like the surgery bill will be tattooed on your backside. Instead it compares turnkey prices for common procedures affecting patients who are either women, old or both.

Consumers can finally see what a hip replacement, knee replacement, hysterectomy and vaginal delivery prices are at 21 different hospitals. Niall Brennan, of the Health Care Cost Institute (HCCI), agreed with me when he told the Post,  “[Medical] providers pretty quickly figured out that consumers were immune to the price of health care because it was all being picked up by insurance companies, which led to rapidly increasing prices.”

Like whiskey drinkers, hospital patients associate high cost with high quality, which leads to hangovers in both instances. Take knee replacements. At the brand name Sinai Hospital a shiny new knee will set Blue Cross back $32,493.00. For that princely sum the patient risks an almost a 15 percent chance of going back into the shop due to complications.

Meanwhile the University of Maryland Shore Medical Center at Easton — which for all I know is located in a Walmart parking lot — only charges $22,687 with a complication rate that’s a fraction of Sinai’s.

Healthcare “expert” Kevin Volpp doesn’t believe information will make a difference. By his way of thinking, even if the knee was replaced in an abortion mill the cost would still consume the patient’s entire deductible so the total won’t matter. That overlooks co–pays. Twenty percent of Sinai’s $32,493.00 is $6,498.00, while the co–pay on $22,687.00 is almost $2,000.00 less.

Smart insurance companies, probably an oxymoron, could seize the moment and offer reduced deductibles to patients who agreed to surgery in lower–cost hospitals, saving money for everyone involved and encouraging competition.

Naturally I had questions regarding this breakthrough. Namely are there plans to get pricing data for more procedures? Does the Commission intend to add out–patient surgery? How about prices for medical tests? And will males under age 65 ever find useful information?

Unfortunately, chairman Robert Moffit — evidently a Republican, since he formerly worked for the dreaded Heritage Foundation — and his staff were “too busy” to respond, so the answers to those and other questions remain unknown.

What we do know is this initiative is an excellent start. Let’s hope the hope the hospital–industrial complex doesn’t manage to kill it.

Congressional Obamacare Hypocrisy: They Get the Subsidy, Taxpayers Get the Bill

Sen. David Vitter (R–LA) is in lonely fight against Congressional Obamacare hypocrisy.

Republicans claim to be against Obamacare, yet many protect their staff, along with their health plans, from the same federal meddling, cost and inconvenience taxpayers must suffer. One expects that from Democrats but it’s infuriating from Republicans.

Vitter has been trying to end this shuffle for more than two years.

Now there may be hope that Vitter will succeed with a little help from you over the Christmas and New Year holidays.

Complete details in my Newsmax column at:

http://www.newsmax.com/MichaelShannon/Congress-Staff-Taxpayers-Vitter/2014/12/12/id/612685/

Veterans Are the Healthcare Canary in a Coal Mine

Between today and June 6^th’s 70^th anniversary of the D–Day landing I want you to find a veteran and talk to him. This doesn’t mean cornering some unsuspecting vet and ambushing him with the latest insipid leftist cliché: ‘Thank you for your service,’ which manages to be both pretentious and condescending.

(However, it is an improvement over the left’s former greeting for vets: ‘How many babies did you kill today?’ But it’s still rote trivialization.)

Ideally your vet should be a veteran of either the Korean Conflict or the Vietnam War. Not because the fighting was far enough in the past be non–controversial, but because this vet has had plenty of time to experience the tender mercies of the Veterans Administration health care system.

And that system should be the main topic of conversation, because if the left has its way, everyone will experience this type of health care under the coming Obamacare regime. Don’t make the mistake — encouraged by the cheerleading mainstream media — of believing the VA is a problem unto itself and has no relation to civilian health care and certainly no relevance to the future of Obamacare.

That is spin and it is completely untrue. The VA hospital system is essentially the pilot program for Obamacare. It’s been a single–payer system from the beginning and single–payer is the ultimate goal for Obamacare. The VA system was designed to accommodate a smaller subset of the population and it was immune to competition from the private sector. Think of it as the United States Postal Service with syringes.

The theory is after the bugs have been worked out of the pilot program, then a benevolent government can expand it to accommodate the entire country. Unfortunately with leftist big government, when a pilot program fails the verdict is always the failure was due to a lack of resources. The cure is to take the same program, bulk it up with taxpayer dollar injections and make it mandatory for the entire country.

So the VA is very relevant to Obamacare

Our veterans have been used as guinea pigs since 1930 when the VA was founded. One would think 84 years is long enough to get the kinks worked out of the program, but one would be wrong. VA hospital horror stories have been a staple of government scandal coverage for years.

If you fall for the ‘it’s just the VA and won’t affect civilians’ cover story then you are believing what the Obama administration wants you to believe. The goal of the White House is to keep the VA scandal bottled up in a silo off to one side. Obama wants you to think it’s just a rogue VA hospital in Arizona that cooked the books.

But it’s not just Arizona. It’s Florida, it’s West Virginia, it’s Missouri, it’s all over the country. And the problem can’t be solved because there is no real penalty for failure and no competitive pressure to excel. And the same government that runs the VA will soon be running Obamacare if the left can expand it into a single–payer system.

My family has it’s own story of an encounter with the Oklahoma – Texas VA administration. One of my uncles — a WWII veteran — fell ill and went to the VA for treatment in the 50’s. The good doctors said he had suffered a nervous breakdown and they hospitalized him in the mental wing.

Today suffering a nervous breakdown means you are forever immune to negative job performance reviews and the Angel of Downsizing will probably pass over you, too.  But in the 50’s a mental problem was the kiss of death.

My uncle lost his career, his wife and his future. He was in and out of VA hospitals for two decades trying to find a cure so he could reassemble the shards of what had been a normal life. And then one fine day he got a new VA doctor. This doctor announced that my uncle had never had any mental problems and that all his difficulties had been caused by an undiagnosed and untreated brain tumor that had been growing in his skull since the first time he saw the inside of a VA hospital.

So my uncle went home to the bedroom he’d inhabited in my grandmother’s house since he lost everything he held dear. And he thought about his life. And he thought about what he had lost. And he carefully took a blanket off his bed, went over to the gas space heater, sat down on the floor, covered his head with the blanket and turned on the gas.

So my family knows all about VA medical care and we want no part of it.

These poor vets were promised first–class health care in return for going to war. Instead they received secret waiting lists, bureaucrat cover-ups, buck passing and incompetent care.

On the other hand the rest of us, that haven’t gone to war, have been promised we could keep our doctor and our insurance.

So find a veteran and ask him how the government keeps its promises.

The continual problems of the VA health care system are what the rest of the country will face if Obamacare isn’t stopped in its tracks. Government can’t run a smaller health care network and it certainly can’t run universal health care.

Our veterans have been the canary in the health care coalmine for decades, but Uncle Sam just keeps replacing the dead canaries with new ones.

Constituent Service Gone Wild

Football fans everywhere are indebted to Virginia Delegate Joe May (R–Leesburg) whose invention of the electronic first down marker added much needed precision to watching the game on TV. Unfortunately, May’s understanding of the free market is much less precise and is in danger of throwing taxpayers for a significant loss.

According to Liz Essley in a series of stories from Washington Examiner, May wants the state to buy the privately–owned, 14–mile–long Greenway toll road located west of Washington Dulles Airport. He is joined by Randy Minchew (R–Leesburg) and David Ramadan (R–Prince William), who also confuse the role of constituent service in conservative governing philosophy. It’s a troika of Republicans who should know better.

May wants the Commonwealth to issue hundreds of millions of dollars worth of bonds to buy the Greenway from the Macquarie Group. Joe contends this would be good news for commuters because he believes the state will be reluctant to raise the tolls, which is not been the case with private ownership where peak period tolls can run as high as $5.80.

And why not? The government body that runs the Dulles Toll Road doesn’t even bother to bill 90 percent of the drivers who use their pavement but refuse to pay. Let them annex the Greenway and commuter’s troubles are over, as the taxpayer’s are just beginning.

Plus everyone knows overall operations for a government–run toll road will be so much more efficient than in the free market. Just look at the pioneering work done at Metro. During the past twenty years the Metro bureaucracy has discovered that escalators installed outdoors without protection from the elements have a tendency to break down and need replacement. Metro’s study of the effects of failing to conduct even routine maintenance on subway infrastructure led to the discovery that the system will become unreliable and subject to unpredictable shutdowns and track work that will consume most of the coming decade.

And don’t overlook the Smithsonian parking lot where attendants stole over $1 million in parking fees with management none the wiser.

And of course government involvement means low prices, which is why the IRS estimates the lowest priced insurance policy under Obamacare will cost a family of five $20,000 a year. If you want a policy that lets you see an actual doctor, as opposed to a Jiffy Lube professional, that will cost extra.

So what could go wrong with Virginia buying the Greenway? If it becomes too expensive to operate without raising the toll, they can just shut it down on Saturday, like the Post Office wants to do with mail delivery.

Del. Minchew echoes May, “I really want to protect our citizens from having tolls reach higher amounts than they should,” he explained.

And Ramadan wanted to try something called “distance–based tolling,” but says Macquarie was not interested.

And there it stands, constituents complain about the price they pay to speed their commute and they want government to “do something!” Followed to its logical conclusion, this type of activist, meddlesome thinking regarding the role of government lead us to the door of Nancy Pelosi’s office. Conservatives do not rush to meddle in a situation the market is uniquely qualified to handle.

The Greenway has been a troubled project from its inception with wildly inflated traffic estimates justifying too much spending. Fortunately, government wasn’t involved, so the first set of owners took a financial bath on the project and sold the tub, ring and all, to Macquarie.

The cost to taxpayers was zero.

Average daily trips on the Greenway peaked in 2005 with a bit over 61,000 with the average toll was just over $2.00. Proving the economic demand curve is alive and well and living in Virginia, as the price for tolls has gone up, traffic volume has gone down. Until in 2012 average daily trips are about 46,500 and the average toll is $3.93.

Yet with traffic down 24 percent, Greenway management was still able to increase average daily revenue by almost $61,000. So the toll is obviously not too high. Otherwise market forces would mean fewer drivers AND less money. Now the price is obviously too high for at least 14,500 drivers because they are now taking another road to work.

And that’s how the market operates; consumers balance cost and benefit and make their choice. Democrats and confused Republicans run to government and plead with them to intervene.

I wonder if any of the esteemed troika members has priced a rib roast at Wegmans lately? Driving on the Greenway is mere transportation, but eating is life itself.

I haven’t had a rib roast in the last year, because they are too expensive and the Philistines at my house can’t tell the difference from a pot roast anyway. But if the state buys the Greenway, I may start talking about the cattle cartel at the next town meeting.

And what makes those particular Greenway drivers so special? How about, God help them, Metro riders? Or Virginia Railway Express passengers? Everybody has a gripe about something.

Del. May is “optimistic we’re going to find a deal that works for both sides” and believes buying the Greenway could cost Virginia nearly $1 billion (which is $21,500 per current trip or 14 years worth of toll charges), making the road green in more ways than one. Hard–bargain Joe’s $1 billion is an interesting figure, because according to TollRoads News the owners carry the Greenway on their books as a net liability of $490 million dollars, meaning the road is worth almost half a billion dollars less than it cost.

As the reporter points out, Macquarie could PAY Virginia $450 million to take the road off its hands and have the books come out $40 million to the good.

It’s time to throw the challenge flag in front of Del. May. Having the Commonwealth buy the Greenway is a bad idea, bad economics and profoundly anti–conservative. In this case what’s private sector should stay private sector.

Conservative Pacifists in the Culture War Part 2

The Obama Inauguration Committee features a new “Heretics Only” water fountain policy.

Christ was no doubt on to something when He limited His public ministry to three years. Any longer and a mere human may forget what he said before or, even worse, lose enthusiasm for an earlier message as the culture changes.

Which is evidently what happened to the Rev. Louie Giglio. Until recently he was scheduled to give the benediction at Obama’s second inauguration. Giglio — founder of the “Passion Conferences” that are marketed to college–age Christians — had lately been in the news for his work against human trafficking and had said grace, so to speak, over the Easter Prayer Breakfast in the White House.

But then an aggressively homosexual lobbying group dug up a sermon Giglio delivered in the mid–90’s and accused him of being an orthodox Christian that believes in the Bible. Well, that was that and Giglio lost no time beating a hasty retreat from the inauguration.

Giglio might have made a better decision if he’d listened to his own sermon before deciding to run up the white flag.

In it the reverend is addressing the homosexual onslaught that traditional culture was just beginning to experience. Giglio wisely pointed out, “We must lovingly but firmly respond to the aggressive agenda of not all, but many in the homosexual community. Underneath this issue is a very powerful and aggressive movement. That movement is not a benevolent movement, it is a movement to seize by any means necessary the feeling and the mood of the day, to the point where the homosexual lifestyle becomes accepted as a norm in our society and is given full standing as any other lifestyle, as it relates to the family.”

That was not only wise, it was prophetic. Then Giglio mentions what both the Old and New Testament have to say regarding homosexual practices and concludes, “…homosexuality is not an alternative lifestyle…homosexuality is not just a sexual preference, homosexuality is not gay, but homosexuality is sin. It is sin in the eyes of God, and it is sin according to the world of God…That’s God’s voice. If you want to hear God’s voice, that is his voice to the issue of homosexuality. It is not ambiguous and unclear. It is very clear.”

Again, there is nothing that a plain reading of Scripture does not tell one. Giglio was not embellishing and he was certainly not personally condemning homosexuals. He just stated the obvious at it applies to the Bible and observant Christians.

Homosexual practices are not a lifestyle. The practice is a rebellion against God at the most fundamental level. God created woman for man and blessed the union. Any other arrangement is a perversion of God’s plan and God’s intent. And it remains a perversion in spite of the fact the only perversions elite culture recognizes today are smoking, obesity and magazines with a capacity larger than 10 rounds.

Giglio also said, “We must not sit quietly by and stick our heads in the sand and let whatever happens happen in our country. We’ve got to respond to the world we live in. That is the mandate that comes to us as people of God. And this issue is coming more and more to the forefront every day.”

Unfortunately, that is exactly what Giglio did not do. Instead he issued a weak statement that reads, “Due to a message of mine that has surfaced from 15 to 20 years ago, it is likely that my participation, and the prayer that I would offer, will be dwarfed by those seeking to make their agenda the focal point of the inauguration.

“Clearly, speaking on this issue has not been in the range of my priorities in the past 15 years. Instead, my aim is meant to call people to ultimate significance as we make much of Jesus Christ.”

This reads like it was written by the same people covering up the massacre at our consulate in Libya. And “ultimate significance as we make much of Jesus Christ” means exactly what?

Christ is significant with or without Giglio’s help. What He needs are teachers who will engage the culture. My fellow conservatives are off the mark when they view this incident as another instance of a politically correct culture that hostile to Christianity.

The culture has always been hostile to Christianity. Good grief, Herod murdered all the male children in Bethlehem aged two or under in an effort to end Christ’s ministry before it began. You can’t get much more hostile than that.

What Giglio has done is acquiesce in the disparagement of the truth of the Bible. What kind of message does this send to the young Christians that Giglio is supposed to be leading? Does Giglio hope the culture will be at least as accepting of him as it is of tobacco executives?

Does it mean Christianity has some vaguely disreputable beliefs that we only share privately with our friends, but the philosophy is not something we want to identify with in public?

How, exactly, does that differ from a meeting of the Klan?

We are losing the culture war because Christians are lead by pacifists, as I wrote about earlier. Giglio has “evolved” from confronting the culture to surfing cultural waves. His current cause is “human trafficking,” which has a number of advantages for a timid Christian. One, all the right organizations are against human trafficking. Two, you get to hobnob with celebrities. And three the chances of offending someone in the congregation are infinitesimal.

Mark Tooley, president of the Institute on Religion and Democracy, asked the Washington Post: “Are all Orthodox clergy now to be banished from civic life if they openly affirm their faith’s teaching about marriage and sexual ethics?” “Are only clergy from declining liberal denominations now acceptable according to hyper–political correctness? Will the same standard also apply to Muslims and members of other faiths who don’t subscribe to the views of Western secular elites?”

Giglio evidently thinks refusing to confront the administration’s “Heretics Only” drinking fountain policy is being polite. But the message it sends the flock is one of weakness and vacillation when it comes to the plain language of the tougher parts of the New and Old Testament.

And it really compares poorly with the Catholic bishop who is preparing to go to jail rather than comply with the Obamacare abortion mandate.

Lou Giglio is building a ministry designed to attract the young in Atlanta. Up until now the name was “Passion City.” In light of his failure to affirm his own message, I suggest Giglio might want to consider changing the name to “Mildly Enthusiastic (But Not to the Point Where We Would Offend Anyone) City.”