LTE: Free people in a free society

Re “On insurance, easiest choice may not be best” (Monitor Forum, Dec. 12):

Lisa Kaplan Howe informs us that people “were allowed to keep” old insurance policies. But this turns on its head the relationship between a people and their government.

Free people in a free society aren’t allowed to keep things – it is their inherent right to keep what they think is best for themselves. The question should not be what the government allows people to do; it should be what the people allow their government to do.

Should a woman have the right to choose what insurance is right for her, or should government make that choice for her? Obamacare interferes with a woman’s right to choose her insurance; now many women have lost their choice of doctors.

Howe warns us that we “may be paying more than you need to.” Does she not know that the new Obamacare policies have much higher premiums and higher deductibles? She tells us that “assisters won’t keep any of your personal information.” Is she unaware that the assisters (navigators) have not had background checks and that some of them could be felons? Has she not heard of all the security flaws in the website that make it easy for hackers to obtain private information? Obamacare has proven to be a disaster. The solution is more freedom of choice. Let people decide what is best for themselves, not what the government will “allow” them to have.

(Published in Concord Monitor, Dec. 19. I like that the Monitor added emphasis as seen above.)

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Just ignore Anthem’s new narrow network

Re “ ‘Just give me the option’: Anthem’s narrow-network plan spurs frustration, confusion” (Monitor front page, Sept. 27):

There is a very simple solution to the problem. Don’t find a new doctor. Stick with the doctors you like. Ignore the insurance company’s network. You don’t need the insurance company’s permission to visit the doctor of your choice any more than you need anyone’s approval to buy whatever food, clothing or housing you prefer.

If you have a high deductible, the insurance company is not going to pay anything anyway, so why let it interfere with your choice of doctor? Just tell your doctor that you are bypassing the insurance company. He or she won’t have to fill out any insurance paperwork, won’t have to wait months for partial reimbursement from insurance. You will pay with a debit or credit card, or with check or cash – the same way you pay for almost everything else you purchase. Most doctors will give you a discount for paying directly and avoiding the insurance hassle. More and more doctors are deciding not to accept insurance, including Medicare or Medicaid. By skipping all the paperwork, they are able to reduce their overhead by 40 percent and are able to reduce their fees while providing better care to their patients.

Eliminate the insurance company middleman. Get the care you want from the doctor of your choice. Let your doctor and you decide your treatment, not an insurance company or government bureaucrat.

(My letter published in Concord Monitor, October 7)

Down in Concord

“Politicians are interested in people. Not that this is always a virtue. Fleas are interested in dogs.” — P.J. O’Rourke

Every so often someone writes yet another column asking “Why can’t Republicans and Democrats get along? Can’t they talk to each other, work together, find a compromise?” The short answer is “We do, most of the time.” A second answer is “There are times when we should not.”

The simple truth is that NH legislators do work together, are very civil to each other (with rare, though well publicized, exceptions), and often become life-long friends. Anyone who says otherwise either has not observed first hand how the legislature works or is trying to make a political point. All too often, it is a mixture of both. Someone starts a narrative about the mean old nasty so and so party, repeats it over and over again, then people with no first hand knowledge come to believe it. (After all, politicians never lie.)

Let’s start with some anecdotal evidence, then some numbers. Earlier this year I went down to Concord to testify against a bill. It happened that one of my former colleagues, a very left Democrat, also testified against that same bill and he happened to go first. Later, when I testified, I remarked that this was the first time in two years that he and I had agreed on a bill. Later, we met out in the hall and laughed together. We encouraged each other to convince other members of our two parties. (The bill was eventually defeated with a bipartisan vote.)

Last session, a hard left Democrat and a hard right Republican worked closely together on a particular bill. Coincidentally, the two were geographically on the far left and far right sides of the state. They both worked very hard to pass their bill; they managed one of the rare instances of overturning a committee recommendation on the House floor. I was happy to work with both of them on that bill. Later the two of them worked together on another bill.

Now let’s look at some numbers. This year the House and Senate passed 281 bills. A full 188 of those bills, were passed by the House on the Consent Calendar. For those who may not have read my previous columns, suffice it to say that bills on Consent have all but unanimous support. Two-thirds of all the bills that were passed, were unanimous. (And of the bills that were killed, many, perhaps most, were also unanimous.)

So any time you hear complaints about legislators being mean and nasty to each other, not working together, please realize that it is almost always someone trying to stir up trouble for partisan advantage. The truth is that they DO work together, usually in a collegial, respectful atmosphere.

But there are times when they should not compromise. Suppose a Democrat and a Republican decide to drive down to New York City. For those who are geographically impaired, NYC is mostly South and a little West of us. Now let’s suppose that the two politicians approach an intersection. The Democrat wants to turn left and head North; the Republican wants to turn right and head South. Should they compromise and head East?

On some issues the division is just as stark as the choice between driving North or South – it makes no sense to compromise on East.

Republicans, generally speaking, want to cut taxes; Democrats want to increase taxes. This year Democrats pushed hard for an increase in the gas tax of 15 cents. They later offered a compromise of 12 cents. Why should Republicans compromise on any increase at all, when what we really want is to reduce taxes?

Democrats for the most part want bigger, more powerful government. Republicans want smaller, limited government. How can the two sides compromise when they are such opposites? (Historically, Republicans have compromised on a little bigger here, a little bigger there – which is one reason many people think there is little difference between the two parties.)

Affordable health care is a nice goal. The two parties have opposite solutions. Democrats thought the solution was to write a 2,000+ page bill, write tens of thousands of pages of regulations, hire 10,000 IRS agents. Now even many of the original supporters realize that Obamacare is a train wreck in progress.

Republicans know that the solution to more affordable, higher quality health care is a free market, with many providers competing to find the best solution at the best price. This approach has proven to work and is working today in those places where government regulations allow it.

Some Democrats call for compromise on so-called “gun safety.” What they fail to understand is that the criminals don’t obey the existing 10,000 laws and won’t obey one additional gun law. Republicans understand that the only thing that stops a bad guy with a gun is a good guy with a gun. Republicans believe that self-defense is a fundamental right, that a woman has the right to choose whether to carry a handgun to protect herself against a rapist. Would Democrats compromise and allow any woman for her safety and the safety of her children to carry a concealed weapon without a permit?

Democrats and Republicans do compromise on a large majority of bills, but on some issues they cannot and should not compromise.

Down in Concord

There are two kinds of people, those who do the work and those who take the credit. — Indira Gandhi

Just like high school or college kids making up for lost time, the House leaders (Democrats) finished the budget process with a late, late, late night session. After wasting most of Friday, Monday, and Tuesday, the budget conferees met Wednesday at 9 am and did not finish until Thursday in the wee hours of the morning, 3:42 am to be precise.

The short story is that the House is to be congratulated for persuading the Senate to agree to all of the Senate’s demands. That’s right, the final budget is pretty much the Senate (Republican-led), not the House (Democrat-led), budget.

Observers tell me that the Democrats opposed this budget up until the very end when they caved. Senior leaders, including representatives of the governor, were holed up behind locked doors for hours apparently searching for a way out. There was even talk that they would reject the budget and go for a Continuing Resolution (CR) while they tried to negotiate a better budget. In the end, “the House acceded to the Senate” on almost every issue.

House Democrats are trying to put the best spin on it. The Democrat chairman of the House Finance Committee wrote that they “… produced a balanced and fiscally responsible budget investing in the priorities of the people of New Hampshire without increasing taxes or fees. … there is a great deal for us to be proud of in this budget.” But the fact is that the budget is almost entirely what was passed by Senate Republicans, which every single Senate Democrat voted against.

The Governor “applauded the bipartisan budget agreement” even though it is virtually identical to the Senate Finance Committee budget, which three weeks ago she slammed for (so-called) “deep cuts”, “nothing short of devastating”, and a “fiscally irresponsible approach”. Now she labels that same budget as “fiscally responsible” (which it is) and praises the restored funding (added by Senate Republicans).

Why do so many politicians not tell the truth? Either they lied weeks ago when they decried the Senate budget as terrible, or they are lying now when they say it is great. Perhaps both. (How do you tell when a politician is lying? His lips are moving.)

I would have more respect for them if they admitted, “We don’t like this budget. We wanted to spend much more money; we wanted to eliminate some programs and create other programs. We agreed to the Senate plan because we didn’t have a good alternative. Our only fallback was a Continuing Resolution, which would have given us even less money to spend.”

But politicians like to take credit for everything – even if they had nothing to do with them. If they told the truth now and admitted they don’t like the budget they couldn’t take credit for it.

Democrats cannot be happy about this budget. Total spending is $400 million less than the Governor requested, $300 million under what the House Democrats approved.

This budget has zero tax or fee increases. Democrats had proposed numerous new taxes or fees. They voted overwhelmingly (155-35) for a beer tax; they didn’t get it. They really, really wanted a massive increase in the gas tax; they didn’t get it. Ditto an increase in cigarette taxes. They proposed to delay scheduled business tax decreases; the Senate nixed that idea. Democrats passed increases in the Salt Water Fishing license fee and the Marriage License fee; Senate Republicans removed them.

Democrats included a provision letting the Governor raid 400 dedicated funds to spend the money elsewhere. Senate Republicans said no.

Senate Republicans added funds for LCHIP (the Land Conservation and Heritage Improvement Program) and for the UNIQUE scholarship program. The Senate increased State Aid Grants for water treatment projects. Democrats now try to take credit for these increases.

Democrats reduced funding for Charter Schools and put in a moratorium. Senate Republicans fully funded them and removed the moratorium. House Democrats repealed the school choice scholarship program passed last year. Senate Republicans killed that bill and removed a parallel provision from the budget.

Democrats had been emphatic about expanding Medicaid as part of Obamacare. The Speaker of the House, Terie Norelli, had declared that without Medicaid expansion, “I do not know if I could get the votes in the House to support the budget.” As late as Wednesday afternoon, conference Chairwoman Wallner said there would not be a budget agreement unless the Senate budged. The Senate replied that this issue was too important to rush into without a thorough study, they called her bluff and the Democrats folded.

In addition to the budget bills, there were 22 other bills reported back by conference committees. The changes appear to be slight and the bills seem uninteresting. There were eight bills where House and Senate conferees could not reach agreement. These bill also seem uninteresting; few will mourn their loss.

On Wednesday, July 26, the House and Senate will each meet to vote on conference reports. It is very likely that all will be passed and go to the governor for signing.

Down in Concord

Survival in politics requires denying mistakes and sticking with the policies you advocated, while blaming others for the bad results. — Thomas Sowell

Suppose that you have a term paper due June 20. You have known for months that it will be due that afternoon. Would you begin your research on June 17 and start writing it on June 18? Would any of us wait until the last minute to start work on the paper?

Well, that is what House Democrats are doing with the state budget. They have known to a certainty that the Senate would amend their budget. They have known officially since June 6, that the Senate did in fact amend the budget. They have known for literally years that a Committee of Conference is how the legislature resolves differences between the House version and the Senate version of a bill. Last Wednesday, June 12, the Senate formally agreed to a conference.

House leaders, knowing that there are major differences to resolve, could have scheduled an all day conference last Friday, the 14th. They could have met through the weekend. Instead, they have scheduled an informational meeting for Monday, June 17, and the first work session for June 18. The conferees will have two and a half days to reach an agreement on 800 pages of budget bills, and then a few hours to write their report.

The House leadership and the Governor know that the current state budget ends June 30. Without legislative action the state government will have no authority to spend a dime after June 30. In theory, the state government will shut down July 1 unless the House and Senate agree on a budget.

One wonders if the Democrat leaders of the House are deliberately trying to create a budget crisis. They had the option to schedule twice as much time for conference meetings. (The House controls scheduling of House bills, including the budget bills; the Senate controls scheduling of Senate bills.) Are they scheduling so little time because they plan simply to accede to the Senate’s recommendations? Somehow I doubt it. Do they expect the Senate to quickly give in? Bad idea.

If the House Democrats are not playing a game of chicken, knowing that a deadline is approaching and hoping that the Senate will blink first, then what are they doing?

Perhaps they are planning a government shutdown and they will blame it on Senate Republicans. But why would they think that would work? When two sides cannot agree, which side is at fault? The Senate is proposing a 7% increase in spending. That is hardly a cut. They offer a larger amount than the House proposed for HHS spending. Why would anyone think that the shutdown would be the fault of the Senate more than of the House?

There are only two ways to avoid a government shutdown July 1. The usual is to pass a budget and for the governor to sign it (or at least not veto it). The second is to pass what is called a Continuing Resolution (CR). In essence that is a short-term extension of the current budget. Spending would continue at the current rate for about a month. That gives the two sides time to negotiate a full two-year budget.

The current rate of spending is roughly 10% less than the House and the Governor have proposed. So one would think they would prefer the Senate budget, which would allow about 7% higher spending.

Perhaps the Governor plans to call a Special Session to pass a new budget. A CR would allow the government to operate until a new budget is passed. But why would the the Governor and House expect the Senate to pass a budget significantly higher than what they just passed?

To this short-term budget watcher and to other long-term watchers, the current budget process doesn’t make much sense on the House side. Given the June 20 deadline for the budget conference to file a report, we will know the budget plans in a few days.

*****

In the meantime, the House and Senate are in Conference on 40 bills other than the two budget bills. Some conferences started last week on June 10 and 11 and seven have already reached agreement. Others won’t start until this coming Monday, Tuesday, and even Wednesday. Since all reports are due by Thursday, I expect that the committees not meeting until Wednesday will deal with very small differences that can be resolved quickly.

By Thursday afternoon, we should know the story for all bills. Next Wednesday, June 26, the House will meet to vote on all conference committee reports.

 

Down in Concord

“The government solution to a problem is usually as bad as the problem and very often makes the problem worse.” — Milton Friedman

The House is not in session this week or next. Many members will be busy in Committees of Conference trying to resolve differences between House and Senate versions of bills. Each conference committee crafts a compromise on one bill, then submits the compromise bill with explanation to both the House and the Senate by June 20. This year there are 26 bills headed to conference. The biggest and most important bills are, of course, the budget bills.  On June 26, the House will vote on conference committee reports, and that should be their last session of the year.

Most of the bills other than the budget bills will be of little interest to most people. (Does a bill “consolidating the property appraisal division and the municipal services division of the department of revenue administration” interest anyone?) Most people probably aren’t particularly interested even in the budget bills – for the simple reason that most people have little interest in anything to do with politics.

There is one bill that might interest quite a few people. And that is the Medical Marijuana bill, HB 573. The House approved it by an overwhelming bipartisan majority, but the governor said she had problems with parts of the bill, so the Senate amended it, and then passed it by a 3-1 bipartisan majority. Advocates of medical marijuana no doubt will be contacting their representatives trying to influence the conference committee.

Down in Concord, the most difficult, time-consuming, and important conference will be on the budget. The numbers aren’t all that different – the Senate increases spending by 7%, the House increases by 10%. The Senate spends $23 million more than the House on the Department of Health and Human Services. Governor Hassan labels that increase a “devastating cut”.

In the State House there is an Office of Legislative Budget Assistant (LBA), staffed with professional number crunchers. One of the many documents they produce is a line by line – 1611 pages worth – comparison of the House and Senate budgets. One column shows the dollar difference between the two versions. On page after page after page the difference is zero. I managed to get through about 800 pages before I ran out of energy. It is fair to say that over 90%, perhaps closer to 99% of the spending proposals are identical.

The numbers aren’t the problem. The contentious debate won’t be about a million here, a million there. The debate will be about expanding Medicaid to cover not just the poor but people with incomes up to 138% of the federal poverty level. Proponents say that it will help thousands of poor people, that it will cost us nothing because the federal government will pay 100% of the cost for three years.

Opponents reply that “If it sounds too good to be true, it probably is.” There are always unintended consequences from any program, especially from a federal government program. Let’s look at the long-term effect of this program.

People often complain that politicians rarely plan beyond the next election. Well, the New Hampshire Senate is now saying let’s look beyond the two years of this budget to study whether this program will be good for the long term.

Politicians all too often judge a program by its intentions, not by its results. They feel good for how much money they spend, rather than how many people are actually better off. They create some new program, congratulate themselves for how well it will work, but only rarely measure the results of the last program they created.

Supporters of expanding Medicaid live in a fantasy world where every program works as intended. Let’s look at the real world.

A study of 13,000 Oregonians conducted by Harvard and MIT economists and recently published in the New England Journal of Medicine concluded that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first two years.”

A University of Virginia study of 1 million surgeries showed Medicaid patients were twice as likely to die as those with private insurance. The same study showed that compared to NO insurance, Medicaid patients were 13% more likely to die.

A Journal of Cancer article showed that Medicaid cancer patients are two to three times more likely to die than other patients.

Our neighboring state of Maine 11 years ago decided to expand its Medicaid coverage. Supporters thought it would reduce the number of uninsured, thus reducing the costs of uncompensated care. A decade later, the number of uninsured was unchanged at 12 percent. Medicaid participation grew 7 percent but private health insurance dropped by 7 percent. The main effect of expanding Medicaid is shifting people from private insurance to government insurance and sticking taxpayers with the bill.

Medicaid is a program of low quality and high cost – not just in dollars but also to the well-being of the recipients of poor care. If we truly care about people who need help – not just feeling good about throwing money at a problem – we should try to find a replacement, not expand Medicaid.

Down in Concord

“It is much more important to kill bad bills than to pass good ones.” — Calvin Coolidge

Down in Concord, the Senate Finance Committee has made its recommendation about the State budget. The full Senate no doubt will approve it next Thursday, June 6. Their version of the budget calls for spending $10.7 billion. The Governor initially proposed $11.1 billion, which the House reduced to $11 billion. The budget for the current two years is about $10 billion, so the new budget will be an increase of about 7%, perhaps more.

A piece of the budget that has received little press is downshifting of Medicaid costs to the county budgets. In Sullivan county, and I think in most counties, the single biggest expense is not the nursing home, not the jail, it is paying for Medicaid. Last I looked at the Sullivan county budget, we had to write a $4.5 million check to the state to pay for Medicaid. Our next largest expense was a net cost of $3 million for the county nursing home. The House-passed budget downshifts an additional $8 million Medicaid expense to the counties. The Senate budget still downshifts but not as badly – about $3.5 million.

One of the main reasons for the difference between House and Senate spending is a difference in revenue estimates. E.g., the House estimates $107 million more revenue from the Medicaid Enhancement Tax than the Senate estimates. Given that the House revenue estimators have consistently overestimated revenue for more than four years, I trust the Senate estimates more than the House estimates.

Opponents of the Senate budget quickly demonstrated a lack of understanding of simple arithmetic or the English language. Gov. Hassan and other Democrat leaders complained about “devastating cuts” to the Dept. of Health and Human Services. Try this quiz: Which is higher, $1296 or $1319? The Senate budget increases spending on HHS from the House-passed $1296 million to $1319 million. Is higher spending a “cut”? Is it “devastating”?

For Developmental Services, the Senate proposes spending the exact same amount as the Governor and as the House. All three budgets increase spending over the current budget by about $38 million, or about a 15% increase. What is Hassan’s definition of “devastating”? As the old saying puts it, “She is entitled to her own opinion but not to her own facts.”

In terms of the legislative process, the House has not officially received the Senate amendment to the budget. You and I have heard about it, but the full Senate has not yet voted on it and the House has not received written notification about it. In the meantime the House continues with routine business. Wednesday, June 5, it will vote on the last of its Senate bills. If it doesn’t finish them Wednesday, it will meet the next day because its deadline for all Senate bills is June 6. This week and for the next few weeks, committees will meet to work on retained bills. (If you have been reading my columns, you know all about retained bills.)

On Thursday, June 6, the Senate will meet to vote on the last of its House bills, including the Finance Committee’s recommendations on the budget bills. When the Senate has voted on the proposed budget, it will send an official message to the House declaring that it “has passed House Bill 2 with an amendment and requests the House concurrence thereon.”

When it meets on June 12, the House will officially receive the Senate message. It then has three options: 1) It can Concur with the Senate amendment, thereby sending the Senate budget to the Governor for signature. It won’t do that. 2) It can Non-concur, which would have the effect of killing the bill, leaving the state without a budget. It won’t do that. 3) What the House will do is Non-concur and request a committee of conference.

The Senate, meeting on June 13, will receive the House request for a conference and will “Accede” to that request. On occasion, and only on relatively unimportant bills, the Senate might refuse a request for conference. It won’t refuse a conference on a budget bill. So finally, more than two weeks after everybody knows what is in the Senate budget, finally the committee of conference will meet to discuss an agreement on the budget. Their deadline is just seven days later, June 20, so I expect they will be rather busy in those seven days.

The House and Senate conferees must reach a unanimous agreement on the compromise budget. On occasion the Speaker of the House or the President of the Senate will replace a conferee with someone more willing to accept a compromise. Once a compromise has been reached, the bill will go to the House for a vote on June 26, and to the Senate for a vote on June 27. The votes will be up or down, no amendments will be allowed.

In the unlikely event the two sides cannot reach an agreement, they will vote on a Continuing Resolution (CR) to keep the government running past the June 30 deadline. That CR would be based on the current budget, which is less than either the House or the Senate budget, so they and the Governor behind the scenes have some motivation to pass a normal budget.