The Administration's Health Care Plan is analyzed in terms of meeting certain general criteria; current claims by proponents; and, current claims by those who attack Plan critics. Charts and data are presented that support a coherent, alternate approach.

1. A DISCUSSION OF THE OBAMA HEALTHCARE PLAN OF 2009 WHY THIS IS NOT GOOD FOR THIS

2. THIS PRESENTATION DREW FREELY FROM THE FOLLOWING 4 REFERENCES “ Healthy, Wealthy, and Wise” , By Daniel P. Kessler and John F. Cogan, Hoover Digest, 2004, No.3, http://www.hoover.org/publications/digest/3020766.html “ The Ethics of Health Care Reform”, Merrill Matthews, Ph.D, Inst. For Policy Innovation, Issue Brief, 07/20/2009 “ Trust the Government” , Newt Gingrich , www. Human Events.com, 08/12/2009 ET “ The Top Ten Myths of American Health Care, A Citizen’s Guide”, Sally Pipes, Pacific Research Institute, Oct 2008, www.pacificresearch.org

4. OUR HEALTHCARE SYSTEM - - IS IT REALLY SO SICK ?

5. The Obama Administration has been a leading critic of Medical care in the USA. They find it highly deficient vs. health care systems in the rest of the developed world . The President and many friendly observers are pushing for a far larger gov’t role in health care. Much of the public accepts his plan because the topic is complex and well supported by the Media. However, before turning to government as the solution, some lesser known facts about America's health care system should be considered. FIRSTLY - - WE INNOVATE BEST !

7. OTHER AMERICAN HEALTHCARE ACCOLADES

8. OTHER AMERICAN HEALTHCARE ACCOLADES

15. SOME ADDED THOUGHTS ON AN ETHICAL SYSTEM Canadian Supreme Court Chief Justice Beverly McLachlin , noted with regard to waiting lines: “ACCESS TO A WAITING LINE IS NOT ACCESS TO HEALTH CARE.” An ethical health care system doesn’t just PROMISE people to provide the care they need, IT EMPOWERS PEOPLE SO THEY CAN CHOOSE AND OBTAIN THAT CARE.

17. THERE ARE MULTIPLE HEALTHCARE “MODELS”

18. PAY-OUT-OF-POCKET MODEL $ $ DECISION FLOW WE’LL LOOK AT THE PAYMENT & DECISION FLOWS FOR EACH MODEL

19. INSURANCE MODEL $ $ DECISION FLOW

20. PURE SINGLE-PAYER MODEL $ $ DECISION FLOW

21. SINGLE-PAYER WITH OPT-OUT MODEL $ $ DECISION FLOW

22. GOV’T-IMPOSED PUBLIC-PRIVATE $ $ DECISION FLOW

23. CONSUMER –DRIVEN MODEL $ $ DECISION FLOW HSA TAX DEDUCTIONS; VOUCHER SAFETY NET

28. AMERICA SPENDS TOO MUCH ON HEALTHCARE CLAIM REALITY COSTS HAVE GROWN A LOT. TRUE. IN 1950, AVG AMERICAN SPENT $500./yr ON HEALTHCARE. IN 2006, SAME COSTS (INFLAT’N ADJ’D) HAD RISEN TO $7,026. /yr BUT THE VALUE RECEIVED HAS RISEN GREATLY ALSO. CHAD WILKINSON, IN 1998, AGE 25, WAS DIAGNOSED WITH NON-HODGKIN’S LYMPHOMA; HE SAID: “WHEN PEOPLE SAY THAT HEALTH CARE IN THE UNITED STATES HAS TOO HIGH A COST, … THEY’VE NEVER BEEN IN A FIGHT TO THE DEATH WITH CANCER. “MY CHEMO BILLS WERE THROUGH THE ROOF, BUT THAT TREATMENT WAS WORTH EVERY NICKEL .” 25, WAS MANY, MANY OTHER VALUES NOW EXIST AS WELL. E.g., JONAS SALK’S LIFE-SAVING POLIO VACCINE IS MORE THAN 50 YEARS OLD. UNTIL THAT TIME YOU COULDN’T SPEND $$ TO PREVENT POLIO. SIMILARLY, OTHER TREATMENTS WERE NOT AVAILABLE AND ARE NOW HAPPILY PURCHASED.

29. AMERICA SPENDS TOO MUCH ON HEALTHCARE CLAIM REALITY WE SPEND TOO MUCH ! NO, WE SPEND MORE BECAUSE IT IS WORTH IT. THE TYPICAL AMERICAN FAMILY SPENDS JUST 5.4 % OF ITS INCOME ON HEALTH CARE, AS OPPOSED TO 40.8 % ON HOUSING, 18.3 % ON TRANSPORTATION, AND 18.2 % ON FOOD. RESEARCHERS HALL AND JONES: “AS WE GROW OLDER AND RICHER - - WHICH IS MORE VALUABLE: A 3rd CAR, A 5th TELEVISION, MORE CLOTHING—OR AN EXTRA YEAR OF LIFE?” THUS, MORE SPENDING ON HEALTH CARE IS THE POSITIVE RESULT OF PROGRESS.

30. DRUG COMPANIES ARE GOUGING THE PUBLIC CLAIM REALITY DRUG PRICES ARE TOO HIGH ! YES, DRUG DEVELOP-MENT IS COSTLY, BUT MEDICINES REDUCE OTHER HEALTH COSTS. THE AVERAGE AMERICAN HOUSEHOLD SPENDS ALMOST $2600. /YR. ON PRESCRIPTION DRUGS. IN THE MID-70’s THE NATIONAL SPENDING AVERAGED 5-8% OF GDP; IN RECENT YEARS IT HAS PASSED THE 10% MARK. BUT DRUG BENEFITS HAVE PERMITTED MAJOR COST OFFSETS ON OTHER MEDICAL BILLS, SUCH AS: REDUCED HOSPITAL STAYS; LESS SURGERY; AND OTHERS.

31. DRUG COMPANIES ARE GOUGING THE PUBLIC CLAIM REALITY DRUG PRICES ARE TOO HIGH ! LET’S ANALYZE THE SOURCE OF THE COSTS. CHRONIC DISEASES LIKE DIABETES, CANCER IN REMISSION, HEART DISEASE, HIV, OBESITY, AND ARTHRITIS—ARE FAR AND AWAY THE BIGGEST DRAIN ON AMERICA’S HEALTH CARE SYSTEM. CHRONIC DISEASES HAVE LED TO A MASSIVE INCREASE IN HEALTH CARE COSTS IN RECENT DECADES. TODAY, CARING FOR PEOPLE WITH CHRONIC DISEASES ACCOUNTS FOR ABOUT 85 % OF ALL U.S. HEALTH CARE SPENDING.

32. DRUG COMPANIES ARE GOUGING THE PUBLIC CLAIM REALITY DRUG PRICES ARE TOO HIGH ! BUT IS THAT THE TOTAL STORY ? A 2005 STUDY PUBLISHED IN MEDICAL CARE FOUND THAT EVERY ADDITIONAL DOLLAR SPENT ON DRUGS FOR BLOOD PRESSURE, CHOLESTEROL, AND DIABETES SHAVES $4.00 TO $7.00 OFF OTHER MEDICAL SPENDING . SIMILARLY, A RECENT PAPER FROM THE NATIONAL BUREAU OF ECONOMIC RESEARCH (NBER) FOUND THAT MEDICARE ULTIMATELY SAVES $2.06 FOR EVERY DOLLAR IT SPENDS ON MEDICINES.

33. DRUG COMPANIES ARE GOUGING THE PUBLIC CLAIM REALITY DRUG PRICES ARE TOO HIGH ! BUT GETTING AN EFFECTIVE DRUG TO MARKET IS AN EXPENSIVE ENDEAVOR. 99.9% FAIL.

34. A DIFFERENT PERSPECTIVE ON DRUG COSTS CLAIM REALITY DRUG PRICES ARE TOO HIGH ! BUT A LONGER TERM VIEW SHEDS SOME ADDED INSIGHT THINK ABOUT THE HISTORY OF ARTIFICIAL LIGHT. UNTIL THOMAS EDISON INVENTED THE ELECTRIC LIGHT IN THE LATE 19th CENTURY, PEOPLE SPENT MONEY ON WOOD, OIL, AND CANDLES TO LIGHT THEIR HOMES. ONE COULD SAFELY SAY THAT ELECTRICITY ACCOUNTED FOR ZERO COST %. BUT AS THE BENEFIT BECAME CLEAR, PEOPLE WERE HAPPY TO SPEND $$ FOR NIGHT TIME LIGHT. THE WIDESPREAD MYTH THAT DRUGS ARE RESPONSIBLE FOR HIGH HEALTH CARE COSTS IS NOT HARMLESS . IT HAS LED TO A SURREAL SITUATION IN WHICH POLITICIANS ARE ATTEMPTING TO PUNISH A COST REDUCER .

36. DO OTHER HC SYSTEMS REALLY DO BETTER ? CLAIM REALITY - - LIFE EXPECTANCY KNOW WHAT’S IN THE STATISTICS ! JUST COMPARE SOME KEY HEALTH DATA FOR VARIOUS NATIONS . OK. BUT LET’S LOOK AT THE DATA CARE-FULLY ! INDICATORS LIKE LIFE EXPECTANCY DON’T JUST REFLECT THE QUALITY OF A HEALTH CARE SYSTEM. THEY ALSO REFLECT A NATION’S HOMICIDE RATE, THE NUMBER OF ACCIDENTS, AND MUCH MORE. ACCORDING TO THE U.S. DOJ, AMERICA’S HOMICIDE RATE WAS 5.9 PER 100,000 INHABITANTS IN 2004. IN CONTRAST, IT WAS 1.95 IN CANADA, 1.64 IN FRANCE, AND 0.98 IN GERMANY. THE UNITED STATES ALSO HAS MORE CAR ACCIDENTS. ACCORDING D.O.T., AMERICA HAD 14.24 FATALITIES PER 100,000 PEOPLE FROM AUTO ACCIDENTS IN 2006. IN CANADA, THE NUMBER WAS 9.25. IN FRANCE, 7.4. IN GERMANY, JUST 6.19 PER 100,000. AS HARVARD ECONOMIST GREG MANKIW HAS NOTED, “MAYBE THESE DIFFERENCES HAVE LESSONS FOR TRAFFIC LAWS AND GUN CONTROL, BUT THEY TEACH US NOTHING ABOUT OUR SYSTEM OF HEALTH CARE.”

37. DO OTHER HC SYSTEMS REALLY DO BETTER ? CLAIM REALITY - - WAITING FOR CARE JUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS . OK. BUT LET’S LOOK AT THE DATA CARE-FULLY ! IT’S NOT JUST DRUG RATIONING THAT HASTENS THE DEATHS OF THE ILL AND THE ELDERLY. SOCIALIZED SYSTEMS RATION SERVICES ACROSS THE WHOLE RANGE OF MEDICAL CARE. CANADA TODAY, WITH 33 MILLION PEOPLE, HAS MORE THAN 800,000 CITIZENS CURRENTLY ON WAITING LISTS FOR SURGERY AND OTHER NECESSARY TREATMENTS . 15 YEARS AGO THE AVERAGE WAIT BETWEEN A REFERRAL FROM A PRIMARY CARE DOCTOR AND TREATMENT BY A SPECIALIST WAS AROUND 9 WEEKS. TODAY THAT WAIT IS MORE THAN 18 WEEKS.

38. DO OTHER HC SYSTEMS REALLY DO BETTER ? CLAIM REALITY - - WAITING FOR CARE JUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS . OK. BUT LET’S LOOK AT THE DATA CARE-FULLY ! FACED WITH THE PROSPECT OF WAITING A YEAR FOR A HIP REPLACEMENT, CANADIAN GEORGE ZELIOTIS TRIED TO ARRANGE WITH HIS SURGEON, DR. JACQUES CHAOULLI, TO PAY PRIVATELY. BUT HE WAS TOLD THAT WOULD HAVE BEEN ILLEGAL. SO HE WENT TO COURT, LOSING IN TWO QUEBEC PROVINCIAL COURTS, BUT THE CANADIAN SUPREME COURT AGREED TO HEAR HIS APPEAL—AND FINALLY, IN JUNE 2005, THE COURT RULED IN HIS FAVOR.

39. DO OTHER HC SYSTEMS REALLY DO BETTER ? CLAIM REALITY - - LIMITING ACCESS JUST COMPARESOME KEY HEALTH DATA FOR VARIOUS NATIONS . OK. BUT LET’S LOOK AT THE DATA CARE-FULLY ! A BRITISH GOV’T AGENCY, THE NAT’L INST. FOR HEALTH AND CLINICAL EFFECTIVENESS ( NICE ), DETERMINES WHICH TREATMENTS THE HEALTH CARE SYSTEM COVERS. IN EARLY 2008, NICE REFUSED TO APPROVE ABATACEPT, SOLD IN THE U.S., AND ONE OF VERY FEW DRUGS CLINICALLY PROVEN TO IMPROVE SEVERE RHEUMATOID ARTHRITIS. NICE DECIDED THAT “ABATACEPT COULD NOT BE CONSIDERED A COST EFFECTIVE USE OF NATIONAL HEALTH RESOURCES.” IN 2008, NICE MADE A SIMILAR DECISION ABOUT THE LUNG CANCER DRUG TARCEVA , DESPITE NUMEROUS STUDIES SHOWING THAT THE DRUG SIGNIFICANTLY PROLONGS THE LIFE OF CANCER PATIENTS .

43. EXPANDING RETAIL CLINICS THE PROBLEM? WHAT TO DO ? UNTIL RECENTLY, IF YOU NEEDED MEDICINE FOR A SORE THROAT OR AN EARACHE, YOU HAD TO SCHEDULE A DR’S APPTMT. IF YOU HAPPENED TO GET SICK AFTER BUSINESS HOURS OR DURING THE WEEKEND, OR HAD NO INSURANCE, YOUR ONLY OTHER OPTION WAS TO WAIT FOR HOURS IN AN EMERGENCY ROOM. RETAIL CLINICS TYPICALLY CHARGE AROUND $50 PER VISIT, DON’T REQUIRE AN APPTMT, AND ARE GENERALLY OPEN 24/7. THIS IS THE ULTIMATE IN PRICE TRANSPARENCY TO THE CONSUMER. IN SOME STATES, LAWMAKERS ARE PUSHING FOR THE GOVERNMENT TO MANDATE A LOW NURSE-PRACTITIONER-TO-DOCTOR RATIO. A BEST PRACTICES, CONSUMER-DRIVEN APPROACH SHOULD SUPPORT THE GROWTH OF RETAIL HEALTH CLINICS BY RESISTING CALLS TO PROTECT DOCTORS FROM LOWER-PRICED COMPETITION.

44. ENACTING TORT REFORM THE PROBLEM? WHAT TO DO ? ANY MEANINGFUL HEALTHCARE REFORM MUST BRING MALPRACTICE LAWSUITS UNDER CONTROL, AS THE CURRENT SYSTEM IS COSTING PATIENTS DEARLY. EACH YEAR, ONE OUT OF EIGHT PHYSICIANS GETS HIT WITH A MEDICAL MALPRACTICE LAWSUIT. MALPRACTICE INSURANCE CAN COST SPECIALTY PHYSICIANS AS MUCH AS $240,000 PER YEAR , AND IS DRIVING DOCTORS OUT OF SPECIALTIES LIKE OBSTETRICS AND NEUROSURGERY. THESE LIABILITY CONCERNS PROMPT PHYSICIANS TO ORDER MORE PROCEDURES AND TESTS THAN THEY WOULD OTHERWISE, HENCE ADDING FURTHER COSTS. POLICYMAKERS MUST PUT AN END TO THE LAWSUIT LOTTERY. SENSIBLE REFORMS INCLUDE CAPPING NON-ECONOMIC DAMAGE AWARDS SUCH AS IN CALIFORNIA UNDER ITS MICRA LAW AND IN TEXAS: ALLOWING DEFENDANTS TO PAY LARGE AWARDS IN PERIODIC PAYMENTS; MOVING TO A SYSTEM OF BINDING ARBITRATION; AND PLACING REASONABLE LIMITS ON ATTORNEYS’ FEES. SUCH REFORMS WOULD SIGNIFICANTLY REDUCE HIDDEN LITIGATION COSTS AND HELP PREVENT A SHORTAGE OF MEDICAL SPECIALISTS IN STATES WITH EXPENSIVE MEDICAL MALPRACTICE INSURANCE

45. ADDITIONAL HEALTHCARE ETHICS - - THE REAL PROBLEM OF ALLOCATING SCARCE RESOURCES

47. Ref to SOME MEDICAL ETHICS RESOURCES

48. Principles For Allocating Scarce Resources - - Pt 1

49. Principles For Allocating Scarce Resources - - Pt 2

50. NO “DEATH PANEL EVER” “ DEATH PANEL” IS ALWAYS NEEDED FOR THE TOTAL GOOD C L WEIGHING THE RIGHTS OF SOCIETY vs THE INDIVIDUAL

52. A HORRIBLE HOBSON’S CHOICE

54. WEIGHING THE RIGHTS OF SOCIETY vs THE INDIVIDUAL THE SAME DIFFICULT CHOICE - - BROADER APPLICATION [ ] INDIVIDUAL ALWAYS [ ] INDIVIDUAL MOSTLY [ ] ABOUT EVEN [ ] SOCIETY MOSTLY [ ] SOCIETY ALWAYS C L

55. NO “DEATH PANEL EVER” “ DEATH PANEL” IS ALWAYS NEEDED FOR THE TOTAL GOOD C L ? ? ? ?

63. THE END