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July 29, 2009

Frederic G. MarksPacific Palisades, California

Senator Max Baucus511 Hart Senate Office Bldg.Washington, D.C. 20510Re:Health Care “Reform”Dear Senator Baucus:I am writing to you because as Chairman of the Senate Finance Committee you areworking to prepare legislation to “reform” health care.Please stop! Please reconsider the false premises of your effort, as set forth onyour website, athttp://baucus.senate.gov/issues/healthcare.cfm New physicians take an oath: physician, first do no harm. The same should applyto legislators: whatever you do, first do no harm. The legislation now being developed inyour Committee would do a great deal of harm.Commenting on President Obama’s proposals, eminent journalist Robert J.Samuelson said recently: “It's hard to know whether President Obama's health-care ‘re-form’ is naive, hypocritical or simply dishonest. Probably all three.” See “Wrong Way onHealth Reform,”

Washington Post

, June 15, 2009.One version of health care “reform” legislation being prepared by SenatorKennedy's staff and the Senate Health, Education, Labor and Pensions Committee spe-cifically exempts members of Congress and federal employees. If such legislation is goodfor other Americans, why does it include an exemption for members of Congress?Financially driven controls on medical practice have already caused many physi-cians to question whether they would encourage their own children to go to medicalschool. If the type of legislation you are working on becomes law, physicians of my ac-quaintance predict that in the future very few Americans will choose the medical profes-sion as a career.The following is a list of reforms that can be enacted by Congress at relativelylittle or no cost to the federal government that would help to reduce health care costs.

July 29, 2009Page 2

Provide the same income tax deductions whether people get insurance throughtheir employer or on their own.

Require the states to allow individuals and companies to shop nationwide forhealth care insurance.

Reduce the legal expenses of physicians and other providers by reforms de-scribed below.The most basic false premise of the legislation your committee is working on is that 45.7million people lack insurance for health care because they cannot afford it. The truth isthat not 45.7 million, but about 8 million people don't have health care insurance be-cause they cannot afford it according to analysis of Census Bureau data by Sally C. Pipesin her book

The Top Ten Myths of American Health Care

(2008), chapter three.Ms. Pipes summarized the data in a recent interview as follows: “Of the almost46 million Americans counted as uninsured by the U.S. Census Bureau, 14 million ofthem are eligible for existing government programs but have not signed up. [In her bookMs. Pipes adds that “more than ten million . . . aren’t U.S. citizens,” and I would add thatmany of these may be here illegally.] Another 17 million of [the uninsured] are earningover $50,000 a year but do not buy insurance because they feel it is too expensive. Two-thirds are young people between 18 and 31 who consider themselves ‘invincible.’ Theywould buy insurance if it were cheaper and available to cover catastrophes, which iswhy one has insurance. Because 64 percent of Americans get their insurance throughtheir employer and insurance is not portable, many of the uninsured are just between jobs and hence counted as uninsured, even if they are only uninsured for a short periodof time.

There are only about 8 million uninsured that need some assistance

.” [Em-phasis added.]http://article.nationalreview.com/?q=MmYwNjgyMDQ0NW-MxZTdhZmZkNzY4ZjcwMTUyMmI1ZDY=&w= MA==These 8 million could be provided with health care insurance at far less cost thanthe current proposals in Congress. They could all be given vouchers on the U.S. Treasurygood for the purchase of major medical (catastrophic expense) insurance, at a cost ofprobably no more than $4,000 per year per household, for a total federal outlay of lessthan $15 billion a year. In comparison, the Congressional Budget Office has stated thatthe current proposals in Congress would cost at least $100 billion a year, and probablymuch more. Remember, both Medicare and Medicaid ended up costing a multiple of theoriginally estimated costs.Those among the eight million who would otherwise be uninsurable because ofpre-existing medical condition could be apportioned among insurance companies viathe "assigned risk" approach widely used with auto insurance for high-risk drivers.

July 29, 2009Page 3

If Congress wants real reform, start by eliminating Medicare as we know it, andinstead give means tested subsidies to the elderly poor via vouchers to buy privatehealth insurance as suggested above. The elderly who are not poor could buy their owninsurance absent competition from the government via Medicare.The 8 million needy and uninsured people amount to less than 3% of the U.S.population of 300 million. Since they can be provided insurance as indicated above, whyshould we wreck our existing system of health care for the other 97% of the population by adopting the bureaucratic monstrosities now being prepared in Congress? After all,the finest health care in the world is available to Americans now, and Americans can buyinsurance against the cost of catastrophic expense due to serious illness or injury.In his news conference of July 22, President Obama said a big reason for his re-form proposals is to reduce the impact of rising health care costs on the federal deficit.This is a bogus claim. It is not private sector health care costs that are driving up federaldeficits. It is the costs of Medicare which already require large and growing paymentsfrom general revenues to supplement Medicare payroll taxes. See Social Security andMedicare Boards of Trustees, Summary of 2008 Annual Reports, page 1.http://www.so-cialsecurity.gov/OACT/TRSUM/trsummary.html Furthermore, Medicare per-patient costs are up 34% more than private per-pa-tient costs since 1970, according to a recent study. See “Medicare Costs Have Risen FarMore than the Costs of Private Health Care,” by Jeffrey H. Anderson, Ph.D., Senior Fel-low, Health Care Studies, Pacific Research Institute.http://liberty.pacificresearch.org/docLib/20090608_HPPv7n06_0609.pdf According to a former Chief Actuary of Social Security, Haeworth Robertson,“the average cost of medical care has increased nearly twice as fast as the general cost ofliving since Medicare was adopted in 1965—

a predictable consequence of providinggenerous medical benefits, but making someone other than the recipient responsiblefor paying the bill.”

[Emphasis added]President Obama demands that Congress create a "competing" governmenthealth insurer to provide "a better range of choices, make the health care market morecompetitive, and keep the insurance companies honest." In reality, equal competition between a public plan and private plans would be impossible. Initially, the public planwould have a lower cost to the insured, because the government does not have some ofthe expenses of private sector insurers. Therefore, the public plan would inexorablycrowd out private plans, leading to a single-payer system. That is how Canada’s single-payer system evolved, by first permitting then outlawing private health care insurance.When health care, like anything else, is provided without cost to the consumer,rationing becomes the only way to hold down costs. Therefore, government-run healthcare in America would ultimately lead to the kind of rationing of health care experi-enced under single-payer systems in other countries, where treatments available in the