the salt makers

The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):

Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

So, you can’t try to seek alternatives to lawsuits if you’ve actually done something to implement alternatives to lawsuits. Brilliant! The trial lawyers must be very happy today!

While there is debate over the details, it is clear that medical malpractive lawsuits have some impact on driving health care costs higher. There are likely a number of procedures that are done simply as a defense against future possible litigation. Recall this from the Washington Post:

“Lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits, congressional budget analysts said today — a substantial sum that could help cover the cost of President Obama’s overhaul of the nation’s health system. New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but would also spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin Hatch (R-Utah).”

Stay tuned. There are certainly many more terrible, horrible, no-good, very bad provisions in this massive bill.

Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo? Answer: They're all more profitable than the health insurance industry. In the health care debate, Democrats and their allies have gone after insurance companies as rapacious profiteers making "immoral" and "obscene" returns while "the bodies pile up."

Ledgers tell a different reality. Health insurance profit margins typically run about 6 percent, give or take a point or two. That's anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones.

Profits barely exceeded 2 percent of revenues in the latest annual measure. This partly explains why the credit ratings of some of the largest insurers were downgraded to negative from stable heading into this year, as investors were warned of a stagnant if not shrinking market for private plans.

Insurers are an expedient target for leaders who want a government-run plan in the marketplace. Such a public option would force private insurers to trim profits and restrain premiums to compete, the argument goes. This would "keep insurance companies honest," says President Barack Obama.

The debate is loaded with intimations that insurers are less than straight, when they are not flatly accused of malfeasance.

They may not have helped their case by commissioning a report that looked primarily at the elements of health care legislation that might drive consumer costs up while ignoring elements aimed at bringing costs down. Few in the debate seem interested in a true balance sheet.

But in pillorying insurers over profits, the critics are on shaky ground. A look at some claims, and the numbers:

THE CLAIMS

_"I'm very pleased that (Democratic leaders) will be talking, too, about the immoral profits being made by the insurance industry and how those profits have increased in the Bush years." House Speaker Nancy Pelosi, D-Calif., who also welcomed the attention being drawn to insurers'"obscene profits."

_"Keeping the status quo may be what the insurance industry wants their premiums have more than doubled in the last decade and their profits have skyrocketed." Maryland Rep. Chris Van Hollen, member of the Democratic leadership.

_"Health insurance companies are willing to let the bodies pile up as long as their profits are safe." A MoveOn.org ad.

THE NUMBERS:

Health insurers posted a 2.2 percent profit margin last year, placing them 35th on the Fortune 500 list of top industries. As is typical, other health sectors did much better - drugs and medical products and services were both in the top 10.

The railroads brought in a 12.6 percent profit margin. Leading the list: network and other communications equipment, at 20.4 percent.

HealthSpring, the best performer in the health insurance industry, posted 5.4 percent. That's a less profitable margin than was achieved by the makers of Tupperware, Clorox bleach and Molson and Coors beers.

The star among the health insurance companies did, however, nose out Jack in the Box restaurants, which only achieved a 4 percent margin.

UnitedHealth Group, reporting third quarter results last week, saw fortunes improve. It managed a 5 percent profit margin on an 8 percent growth in revenue.

Van Hollen is right that premiums have more than doubled in a decade, according to a Kaiser Family Foundation study that found a 131 percent increase.

But were the Bush years golden ones for health insurers?

Not judging by profit margins, profit growth or returns to shareholders. The industry's overall profits grew only 8.8 percent from 2003 to 2008, and its margins year to year, from 2005 forward, never cracked 8 percent.

The latest annual profit margins of a selection of products, services and industries: Tupperware Brands, 7.5 percent; Yahoo, 5.9 percent; Hershey, 6.1 percent; Clorox, 8.7 percent; Molson Coors Brewing, 8.1 percent; construction and farm machinery, 5 percent; Yum Brands (think KFC, Pizza Hut, Taco Bell), 8.5 percent.

A group in British Columbia has offered medical waiting-list insurance to members whose government treatment is on hold — another example of why state-run health care must be avoided.

Canadians have a health care system that should be the envy of no one. It's not free, it's funded by taxpayers, and it isn't truly universal. Two Canadian Supreme Court justices made this clear three years ago when they concluded that "access to a waiting list is not access to health care."

Delayed treatment in an overused system has been the root of much unnecessary suffering. To prevent premature deaths and the needless misery that are hallmarks of Canadian care, the British Columbia Automobile Association began offering waiting-list insurance to some of its members in August as part of a pilot program.

Those who bought the coverage would receive treatment in a private clinic in British Columbia or the U.S. if they were placed on a government care waiting list longer than 45 days.

The program, which took two years to develop, never got beyond the pilot phase, however. The association shut it down when critics howled and government officials checked to see if such a program was actually legal in Canada.

"This is an example of a company that's actively soliciting for clients that have the ability to pay for the privilege of queue-jumping," said Adrian Dix, a member of B.C.'s Legislative Assembly. "In my view, and in the view of the legal opinion that we obtained, it is illegal, and it violated both provincial and national health legislation."

It's hard to understand why an elected official, or anyone else, would knowingly trap people in a system that can't take care of the public it is expected to serve. Yet there are many Canadians who would, in the name of "fairness" and "equality," deny others' right to take care of themselves outside of the collective. They are outraged that some of their countrymen could escape the agony of the waiting lists while others languish in the bureaucratic wreckage.

But the real outrage, to quote Brian Day, former director of the Canadian Medical Association, should be that a government would actually force "a citizen in a free and democratic society to simply wait for health care, and outlaw their ability to extricate themselves from a wait list."

That, however, is the system Canadians have been living and dying with for decades. Only in recent years does it seem that they've had enough of it. First in Quebec and now in B.C., private clinics have been opening to treat those who either don't want to wait or are too sick to endure the system's waiting list. Whether they will remain legal and open will be decided this fall by the courts.

Meanwhile, Canadians keep waiting — and waiting. The Fraser Institute in Canada reports that the median wait time from a general practitioner's referral to actual treatment by a specialist was 17.3 weeks in 2008 (see chart). That's a full week better than the previous year, but far worse than a decade and a half earlier when the wait time was 9.3 weeks.

Despite the decline from 2007 to 2008, the long-term trend indicates that wait times will continue to grow. It's a discouraging pattern that the U.S. will follow if Washington forces any kind of government care on this country.

Zach

7 months after the stimulus, 49 of 50 States have lost jobs. The table below compares the White House's February 2009 projection of the umber of jobs that would be created by the 2009 stimulus law (through the end of 2010) with the actual change in state payroll employment through September 2009 (the latest figures available). According to the data, 49 States and the District of Columbia have lost jobs since stimulus was enacted. Only North Dakota has seen net job creation following the February 2009 stimulus. While President Obama claimed the result of his stimulus bill would be the creation of 3.5 million jobs, the Nation has already lost a total of 2.7 million – a difference of 6.2 million jobs. To see how stimulus has failed your state, see the table below.