Phillip Levy of the American Enterprise Institute thinks so. Leaders at the summit released a statement, vowing to “continue the process of recovery” by:

This morning, President Obama, President Sarkozy and Prime Minister Brown issued statements on the news that Iran has been secretly building a second nuclear enrichment facility underground. Here is the text of their comments.

His remarks are almost two times as long as Sarkozy and Brown’s. But, what was his message?

I read through the remarks, searching for the strongest language used by each leader.

This is what I took to be President Obama’s strongest articulation:

“Through this dialogue, we are committed to demonstrating that international law is not an empty promise; that obligations must be kept; and that treaties will be enforced.”

President Sarkozy:

“I repeated my conviction that Iran was taking the international community on a dangerous path.

We cannot let the Iranian leaders gain time while the motors are running. If by December there is not an in-depth change by the Iranian leaders, sanctions will have to be taken.”

Prime Minister Brown:

“As President Obama and President Sarkozy have just said, the level of deception by the Iranian government, and the scale of what we believe is the breach of international commitments, will shock and anger the whole international community, and it will harden our resolve.”

Notice a pattern? In the order I’ve posted the comments above (which is the same order they were presented in), the firmness with which each leader reacts to Iran’s duplicitous actions gets progressively stronger — with President Obama’s statement being the most mellow.

With all that’s on the line and the real possibility of Israel attacking Iran preemptively, President Obama needs to get tougher on Iran and bolder in his language, not just because they have explicitly defied the UN, but even more importantly, because they have repeatedly provoked the US on the international stage.

A gratuitous note/personal opinion:
As a lawyer, I can vouch for the fact that law school and the practice of law teach and require you to communicate in an unnatural voice, constantly qualifying the arguments you make. That may work in a brief or in a court room when you’re appealing to a judge and want your argument to come across strongly, but moderately enough to not tick the judge off. President Obama’s background is rooted in this balancing act, but as President, that kind of rhetoric won’t cut it. Especially not in the face of the danger of nuclear weapons landing in the hands of anti-American, anti-Israeli, anti-capitalist and generally, anti-Western fundamentalists.

Israel’s Prime Minister Netanyahu schooled the UN yesterday in a speech that reminded us all of the climate in which the UN itself was created. Unlike President Obama, he was unequivocal and unapologetic about protecting his country.

The contrast between his speech and President Obama’s speech is striking. Our President started off his speech like a campaign speech, spending too much time talking about himself, apologizing for America’s past and showcasing the changes he’s made, strongly implying that America is ready to take its relations with the rest of the world seriously now, as if this wasn’t the case before.

Here’s the text of Netanyahu’s speech posted by Michael Goldfarb over at The Weekly Standard’s blog.

Here’s the President’s speech from earlier this week.

You decide.

It’s been seven months since the stimulus bill was passed. Just shortly after his inauguration, President Obama issued this statement.

“There are many numbers in this plan…It will put billions of dollars in immediate tax relief into the pockets of working families.

But out of all these numbers, there is one that matters most to me: this recovery plan will save or create more than 3 million new jobs over the next few years. “

Despite this promise, unemployment today stands at 9.7%, the highest it’s been since 1983. The broader unemployment rate is a staggering 16.8%. Last month, unemployment surged in 27 states.

For the most part, there seems to be a consensus that unemployment is a lagging indicator, meaning its rise is delayed until after other segments of the economy have already improved. Even so, since the recession began in December 2007, 7.4 million jobs have been lost. 4 million of those have been shed since December of 2008, just a month before President Obama’s official transition to power. As of last month, 9.1 million people had accepted part-time work, unable to find full-time, permanent employment.

In fact, job creation as a result of the stimulus has been limited to government jobs. USA Today reports:

“Fourteen of the top federal agencies responsible for spending under the American Recovery and Reinvestment Act say they’ve hired about 3,000 workers with stimulus money. That’s helped fuel the continued growth of the federal government, which increased by more than 25,000 employees, or 1.3%, since December 2008, according to the latest quarterly report.”

It gets even worse. Not only has the stimulus failed to create private sector jobs, but the administrative structures created to implement and oversee the stimulus are depleting the emergency funds they were created to oversee.

“Thirteen agencies that report stimulus-related administrative expenses separately on their weekly spending reports say they’ve spent $186.8 million so far on salaries and other overhead. Those agencies have reported spending $46.1 billion in stimulus funds overall.”

Supporters of the stimulus would argue that distributing the funds and creating jobs costs money. And, to a certain extent, that is true for any government action aimed at creating growth. Tax cuts also cost money — in theory — in decreased revenue for the government. But, they don’t drain the government of funds set to up to increase jobs, funds that are borrowed and upon which interest accrues.

Back in January, The Heritage Foundation pointed out that if the stimulus created 3.675 million jobs, each job would cost $217,000. I wonder if their figure included all the various administrative costs required to create the jobs in the first place. Or to oversee the distribution of the funds.

Presumably, there are some stimulus projects that have gotten underway. Road paving projects for one — because they are faster to get off the ground than construction projects that have numerous environmental hurdles to overcome. But, we now have seven months worth of data and no evidence that the stimulus has created any jobs — save for government jobs. As for saving jobs that would otherwise have been eliminated, I have yet to see anything that offers up a method of calculating this shaky proposition.

So, seven months into the program, unemployment is climbing, and jobs that were promised to Americans if only they trusted Washington to pass the biggest spending bill in U.S. history, are nowhere in sight.

In the statement quoted earlier, the President also promised:

“I can also promise that my administration will administer this recovery plan with a level of transparency and accountability never before seen in Washington. Once it is passed, every American will be able to go the website recovery.gov and see how and where their money is being spent.”

In addition to calling the stimulus bill a jobs bill, the President and his administration promised an unprecedented level of transparency related to the stimulus funds. Recovery.gov is a website that became all too familiar to Americans (well, except to Vice President Biden who famously blanked on the ‘number’ during a live TV spot). Yet, here we are seven months later, and recovery.gov offers nothing more than a very general overview of how stimulus funds have been distributed by state and department.

But, we now have a firm date for the new site, October 1. State and local contractors and other entities will have 10 days each quarter to provide specific information identifying the funds they received, how they were spent and how many jobs were created out of those funds.

But, even this is not without it’s problems. BusinessWeek reports:

“Put another way, without careful auditing, the government will have little way of judging whether all those tens of thousands of stimulus funds recipients are accurately relaying where they spent the money and how many jobs were truly created.”

Seven months in and unemployment is rising, job losses of 550,000 per week are nothing out of the norm, consumer spending is low despite the rebates included in the stimulus, and with Democrats’ health care reform and cap-and-trade proposals still on the table, the spending spree may not be over.

It’s time for Washington to come to terms with the fact that the stimulus is not working. Perhaps they should listen to the 60% of Americans who doubt that the feds will use the stimulus funds as promised on infrastructure or to the 75% of voters who do not believe that the stimulus has helped the economy.

The right thing to do is to cancel the stimulus and regroup. But, as Democrats have made clear with health care, their biggest fear is that they do not have time on their side. So, they refuse to tear up the old plans and start anew; instead, they’ll continue to pull numbers out of the air like ‘the stimulus has saved 1 million jobs.’ And sadly, in another 7 months, things might not look that different than they do today.

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The Vice President is scheduled to jump in on the health care debate today in a speech to the National Association of Insurance Commissioners. Ironically, his speech to this group of insurance regulators is set to focus on “rising health insurance rates.”

The WSJ reports:

“The vice president will present new White House findings that “health insurance premiums in states have gone up between 90-150% over the last decade,” according to speech excerpts released by the White House.

“This new state by state data is astounding and makes the case for nationwide reform. From Alaska — where premiums increased 145% while wages grew just 35% — to Florida, where premiums increased 121% while wages increased 43% — even, to Michigan, where the 37% gap between premiums and wages is actually the smallest — all around the country, we see these gaps widening,” Mr. Biden is expected to say.

Mr. Biden will use the appearance to press for ground rules for all insurance companies “to restore stability and security to our health-care system.” The rules, which Mr. Obama has called for frequently, would ban insurers from refusing to cover people based on gender, pre-existing conditions or dropping the policies of those who become seriously ill. The rules would also expand coverage for young people and ban insurers from charging “exorbitant” out-of-pocket deductibles or co-pays, or placing annual or lifetime caps on coverage.”

So the White House’s answer to rising insurance costs continues to be to extend coverage to more people while at the same time limiting the amount those people pay in to the system. More people, less money coming in, and this is supposed to curb our health care problems. Apparently, Americans’ insistence this summer that this formula doesn’t make sense to them hasn’t resonated with the White House, which is continuing its push for reform with the same old, broken talking points.

In the excerpt from Biden’s speech, he specifically calls out Alaska, Florida and Michigan. What if, rather than using these states as strategic pawns to push their plans for health care, the administration steps back and commits to taking a closer look at those states in an attempt to determine what is contributing to high health care premiums on the ground there?

And, how about instead of just focusing on states with high costs, it also looks at states that are faring well, with low premiums, an abundance of doctors, low liability rates for doctors and multiple insurers competing for business?

Instead, the administration thinks that singling out states with high premiums will automatically convince Americans that we need their health care reforms and we need them now.  Never mind that they are overlooking that the government and its regulations are part of the problem, so simply adding more to the mix will not be a cure-all.

Why not look at states like Texas and Missouri that had serious health care problems, with doctors in short supply, sky-high liability rates for medical professionals and a dwindling number of insurers willing to do business in the state? At one point, this was the case for both Texas and Missouri.

By passing tort reform in the way of limiting non-economic damages and venue shopping, these states were able to turn their situations around. By implementing these reforms, they lowered the number of malpractice suits thereby lowering the costs of medical malpractice insurance. This in turn, gave doctors and insurers a reason to return to their states to practice medicine and compete for business. Insurance premiums decreased, making insurance available to more people.

What better proof is there that the new system worked than an article like this one from the ABA mourning the loss of work for trial lawyers in Texas post-tort reform?

In Texas, the number of lawsuits filed between 2002 and 2005 fell by 55%. In Missouri, lawsuits fell by 91% after enacting reforms. Missouri Gov. Barbour says,

“It’s mysterious to me that the administration and the leadership of Congress talk about health care reform and the goal of reducing costs, and yetrefuse to put tort reform into the legislation,” he said. “I believe $200, $250 billion a year in health care costs is caused by litigation. It may be more than that. But this is the lowest hanging fruit, this ain’t rocket science. If they want a demonstration project, come down to Mississippi, and I’ll show you a demonstration project.”

I won’t hold my breath waiting for the White House to take Barbour up on his offer. But, if they are truly serious about making a dent in our health care problems, they must lay their old talking points to rest and start studying state programs — those that work and don’t work — before they start imposing blanket reforms on the whole country.

*Originally published September 22, 2009 on the American Issues Project Blog, here.

President Obama continued his sales pitch for health care reform this weekend, making the rounds of the Sunday talk show circuit. During an interview with George Stephanopoulos that aired today, Obama said, “We’re not going to have other people carrying your burdens for you.” To say this was an unexpected sentiment coming from this President would be an understatement. Praising personal responsibility, meeting obligations and self-sufficiency have not been trademark items for this President who so famously touted the benefits of ‘spreading the wealth around’ on the campaign trail.

His statement was in regard to the “$900, on average — our families [pay] in higher premiums because of uncompensated care.” The President’s position is to regulate behavior and force everyone to either carry insurance or pay a fine.

“The — for us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase. What it’s saying is, is that we’re not going to have other people carrying your burdens for you anymore.“

As I wrote last week here on AIP, this assertion that we are all collectively picking up the tab for the uninsured to the tune of $900 to $1100 a year per family, is false. Unfortunately, the media has been slow to fact-check the President’s talking points on health care reform. The WSJ picked up the story about Otto Raddatz just last week when I wrote about it on AIP almost a month ago. Perhaps now that the President has repeated this fallacious claim about the uninsured a few more times, the media will cast some sunlight on the truth.

But, the President’s flawed data isn’t the only issue. It’s the sentiment he expressed in defending his plan, that we’re not going to have some people carry the burden for others. For today only, and only when it comes to this topic of the uninsured and their effect on premiums, the President positioned himself as against pinning the burden on one segment of society for the benefit of another.

But, isn’t this what his Presidency is based on? On all of us being each other’s keepers? How many times has he told reporters that successful people like him should pay more in taxes than the waitress struggling to make ends meet (an example he took a liking to on the campaign trail)?

Yet today, by the President’s logic, he expressed that when people don’t shoulder their responsibilities, when they expect for everyone else to carry them, everyone else pays the price. The collective suffers. And, this time, President Obama finds this unacceptable.

Surprised? Why the change from his normal philosophy of fairness — that is, taking from one group to pay for another because it’s the fair, socially just thing to do? What are we missing? What happened today?

The answer is that this is a good for today only, health-care specific policy he’s carved out. There is no reconciling his statement today with his belief that ‘spreading the wealth around’ is the only way to success.

Charles Krauthammer wrote an excellent article this weekend on President Obama’s shaky relationship with the truth. He writes, “Obama doesn’t lie. He merely elides, gliding from one dubious assertion to another.” When one tactic doesn’t work, he moves on to the next ploy. Krauthammer perfectly sums up Obama’s approach to his health care pitch. If you like your insurance, you can keep it — didn’t work. The public option is just an option — didn’t work. I will not sign a plan that adds a dime to the deficit — didn’t work. Illegal immigrants will not be covered under our plan — didn’t work.

So, our salesperson-in-chief moved on to his next gambit. Is it to obfuscate? To sound conservative? I’m not sure. What I do know is that President Obama’s policies embrace a philosophy that is completely opposed to the one he peddled today. But, with his health care proposals remaining unpopular, I guess he’ll try anything to sell his plan — including throwing a little conservative philosophy in there.  Many including Karl Rove and George Will have pointed out that when the President talks about health care, the poll numbers go down. This week’s numbers will tell whether this new untrustworthy sales tactic worked.

*Originally published September 20, 2009 on the American Issues Project Blog, here.

Yesterday, CBS’s Declan McCullagh reported on documents obtained from the Treasury Department under a FOIA request by the Competitive Enterprise Institute. The documents provide an internal overview and analysis of the cap-and-trade scheme. The first memo contains this disclosure.

“In his February 24, 2009 Joint Session address, President Obama called for a greenhouse gas cap-and-trade program, underscoring his commitment to domestic climate policy. While such a program can yield environmental benefits that justify its costs, it will raise energy prices and impose annual costs on the order of [REDACTION] dollars. At the same time, given the Administration’s proposal to auction all emission allowances, a cap-and-trade program could generate federal receipts on the order of $100 to $200 billion annually.”

So there you have it, from an internal Treasury Department document that cap-and-trade could generate federal receipts, i.e. tax revenue, in the range of $100 to $200 billion a year. McCullagh reports that at the upper end of that range, cap-and-trade would cost every American household an extra $1,761 a year.

Does that cost sound familiar to you? The Heritage Foundation has long predicted that:

“The annual cost of emissions permits to energy users will be at least $100 billion by 2012 and could exceed $390 billion by 2035.”

“Economic costs will likely be on the order of 1% of GDP, making them equal in scale to all existing environmental regulation.”

That’s another prediction offered up without any details as to timeline or the effects of this scheme, not just on increased costs for families but on businesses and job losses.

These internal memos confirm what the Heritage Foundation, the Brookings Institution and the National Black Chamber of Commerce (NBCC) all agree on — that cap-and-trade will produce “significant losses in employment and gross domestic product.”

According to Heritage:

“The Heritage Foundation’s Center for Data Analysis found that, for the average year over the 2012-2035 timeline, job loss will be 1.1 million greater than the baseline assumptions. By 2035, there is a projected 2.5 million fewer jobs than without a cap-and-trade bill. The average GDP lost is $393 billion, hitting a high of $662 billion in 2035. From 2012 to 2035, the accumulated GDP lost is $9.4 trillion (in 2009 dollars). The average of the climate tax revenue–what the government gets to spend or give away–is $236 billion from 2012 through 2035 and adds up to $5.7 trillion in tax collections.”

Brookings concluded:

“The Brookings analysis of the Waxman-Markey bill finds loss in personal consumption of $1-2 trillion in present value. The more stringent carbon targets in subsequent years produce even higher costs. Brookings projects that an additional 8 percent cut in carbon dioxide emissions increases costs 45 percent. GDP in the United States would be lower by 2.5 percent in 2050, and unemployment would be 0.5 percent higher (1.7 million fewer jobs) in the first decade below the baseline or without cap and trade. The total allowance revenue (tax revenue) generated by 2050 would be $9 trillion.”

And, the NBCC predicted:

“The National Black Chamber of Commerce found the following adverse effects from Waxman-Markey: In 2015, GDP would be 1 percent ($170 billon) below the “no cap-and-trade bill” baseline. In 2030, GDP will be 1.3 percent ($350 billon) below the baseline, and by 2050 the study projects a reduction in GDP of 1.5 percent ($730 billion). The study also projects higher unemployment of 2.3-2.7 million jobs in each year of the policy through 2030–after accounting for “green job” creation.”

Treasury’s $100 to $200 billion a year estimate is a private admission that Heritage, Brookings and the NBCC have it right. But, the figure stops shorts of examining the widespread effects this huge tax scheme will have as it raises costs for consumers and simultaneously forces businesses to cut jobs.

“In particular, the Heritage analysis projects that by 2035 the economic impacts (in constant 2009 dollars) of this bill are:

• Gasoline prices will rise 58 percent (or $1.38);
• Natural gas prices will rise 55 percent;
• Heating oil prices will rise 56 percent;
• Electricity prices will rise 90 percent;
• A family of four can expect its per-year energy costs to rise by $1,241;
• Including taxes, a family of four will pay an additional $4,609 per year;
• A family of four will reduce its consumption of goods and services by up to $3,000 per year, as its income and savings fall;
• Aggregate GDP losses will be $9.4 trillion;
• Aggregate cap-and-trade energy taxes will be $5.7 trillion;
• Job losses will be nearly 2.5 million; and
• The national debt will rise an additional $12,803 per person ($51,212 per family of four).

The income losses, the job losses, the tax increases, and the mounting debt all get worse over the coming decades. The Waxman-Markey bill forces a bad deal on a generation that does not have the option to turn it down.

The $9.4 trillion of lost income, the 2.5 million lost jobs, the $5.0 trillion of additional national debt, and the $5.7 trillion in new taxes will buy no more than a 0.2 degree (Celsius) moderation in world temperature increases by 2100 and no more than a 0.05 degree reduction by 2050.”

Christopher Horner, the CEI scholar who requested the documents put it best, “They’re not telling you the cost — they’re not telling you the benefit, what are they telling you? They’re just talking about global salvation.”

President Obama has repeated a couple of heart-wrenching stories during his sales pitches for his health care reforms this summer. A little less than a month ago, I got curious about one of these stories — the one about the man whose insurance policy was revoked while he was in the middle of chemotherapy. According to the President, the insurance company claimed that he had lied on his application, failing to admit to a history of gallstones.

Given our President’s tendency to distort facts, I looked into the story of this Illinois man, who I found out was Mr. Otto Raddatz. And, it turned out the President’s version of what happened to Mr. Raddatz was untrue. Since then, I’ve been wondering if anyone in the media would pick up on this story, and finally, Scott Harrington did so today in the WSJ.

Below is a reposting of my original piece on the American Issues Project Blog on August 23, 2009.
—-
Debunking willful misrepresentations in the health care debate: the story of Otto Raddatz.

President Obama used his weekly address yesterday to “debunk[] some of the more outrageous myths circulating on the internet, on cable TV, and repeated at some town halls across this country.” If we’re clearing the air of falsehoods related to health care, then there is one story in particular that the President himself has referred to on a number of occasions that he should have corrected. That is the story of an Illinois businessman named Otto Raddatz.

At a town hall forum in New Hampshire on August 11, referring to Mr. Raddatz, President Obama said:

“Another [man] lost his coverage in the middle of chemotherapy because the insurance company discovered he had gall stones that he hadn’t known about when he applied for insurance. Now, that is wrong, and that will change when we pass health care reform. That is going to be a priority.”

A few days later at a town hall in Montana, the President repeated this story.

“One man from Illinois lost his coverage in the middle of chemotherapy because his insurer discovered he hadn’t reported gall stones he didn’t know about. True story. Because his treatment was delayed, he died. “

And on August 15, Obama penned an op-ed in the New York Times titled, “Why We Need Health Care Reform” where he repeated the story for a third time.

“A man lost his health coverage in the middle of chemotherapy because the insurance company discovered that he had gallstones, which he hadn’t known about when he applied for his policy. Because his treatment was delayed, he died.”

The story the President relates of this innocent person who played by the rules and maintained insurance only to have it fail him in his time of a need is indeed a powerful, persuasive story … except that it’s not entirely true.

Here’s the true story, based on testimony from Mr. Raddatz’s sister at a hearing before the House of Representatives’ on June 16, 2009.

Mr. Raddatz was a restaurant owner in Illinois who purchased an individual insurance policy for himself and his wife in 2003. On the original insurance application, he indicated that he had a history of kidney stones and was a smoker. A year into the policy, at the age of 59, Mr. Raddatz found himself losing weight rapidly and sought medical attention. It was then that he was diagnosed with stage four non-Hodgkins type lymphoma, a cancer of the immune system. After undergoing a series of chemotherapy and drug treatments, he was referred to a specialist for high-dose chemotherapy and a stem cell transplant.

At that time, he was informed by his insurer that his insurance was being cancelled due to his failure to disclose material information about his medical history – namely that he had a history of gall stones and an aneurysm. As it turns out, Mr. Raddatz was unaware of this diagnosis, having never been given the test results this information came from.

This happened just as Mr. Raddatz was told that he only had a 3-4 week window in which to get the stem cell transplant he needed. With his insurance rescinded, he could not afford to pay for the procedure out-of-pocket. His sister, Peggy Raddatz, reached out to the Illinois Attorney General’s office who reviewed the situation and sent two letters to the insurance company arguing that Mr. Raddatz had not lied to the insurance company since he had been unaware of the test results and had in fact, never received any treatment for either of those issues.

The insurance company reinstated his insurance policy. He went on to receive the stem cell transplant, “which was extremely successfully” and enabled him to live for three and a half more years. He passed away when, while being scheduled to have a second transplant, his donor suddenly died.

Now in President Obama’s version of the story, Mr. Raddatz died because his treatment was delayed. That is a lie. Mr. Raddatz’s story is powerful in terms of illustrating problems with the insurance industry. It is particularly relevant that he was self-insured, given the problems with the individual insurance market, the low numbers and high turnover of participants and the lack of tax benefits which make it less attractive to individuals. All of this makes the pool of participants amongst which claims can be distributed even smaller, resulting in higher costs to individuals and the insurance companies themselves.

But, that wasn’t the President’s point. He didn’t tell this story to promote reforms in the individual insurance market, to make it equitable with employer-based insurance by giving it the same tax benefits or allowing people to purchase insurance from any state they’d like. Instead, this was a story, much like the cases of tonsil-removing, foot-amputating doctors, that was meant to vilify the insurance industry and exploit people’s emotions given the tragic ending Mr. Raddatz faced at the hands of his evil insurance company under President Obama’s made-up version of the story. If, as he said this weekend, President Obama really wants to open a new chapter, “not one dominated by willful misrepresentations and outright distortions”, then perhaps he should start leading by example.

In support of his health care plan, President Obama often refers to the ‘hidden taxes’ insured families pay on behalf of the uninsured. On multiple occasions, he’s stated, “the average family pays a thousand dollars in extra premiums to pay for people going to the emergency room who don’t have health insurance.” Factcheck.org did a little investigating and determined that this claim comes from a 2005 report by Families USA. Obama uses this assertion to support his argument that if these people were insured, unnecessary ER visits would stop, thereby eliminating these hidden costs. It turns out that his numbers are wrong, and his claim that the uninsured overuse the ER is also inaccurate.

A 2008 study by the Urban Institute for the Kaiser Family Foundation looked at the 2005 study and concluded:

“[W]e are highly skeptical that the high and growing cost of private insurance is strongly related, if at all, to the amount of uncompensated care delivered by private providers or to the growing number of uninsured people.

Jack Hadley, the lead researcher on the KFF study, [told Factcheck.org] that to assume that the insured end up paying for all uncompensated care is “clearly an exaggeration.” According to KFF, the amount of uncompensated care that providers could shift to the privately insured is much less, only $8 billion, not the $42.7 billion Families USA said could be passed on to premium payers in 2008. The KFF number is less than 19 percent of Families USA’s, and by [Factcheck.org's] figuring that implies a per-family increase in health insurance premiums of less than $200 a year, not $1,000.“

As for the President’s argument that the uninsured overuse emergency rooms, a study by the University of Michigan found the exact opposite to be true. In a study published in the Journal of the American Medical Association their team concluded that:

“The uninsured do not make up a disproportionate share of ER patients, because they are the only group that faces the full cost of care…Although it challenges some of the most-repeated mantras about the uninsured and ER care, the study does confirm that solid evidence exists for many of the things that Americans have come to believe about the uninsured and emergency care.

For instance, the study shows, the number of people without insurance visiting American ERs is rising — but less quickly than the numbers of uninsured are rising. Meanwhile, patients with insurance are going to the ER more frequently.

There is also solid evidence that caring for patients — insured and uninsured — in an ER is more expensive than treating the same complaint in a doctor’s office. Uninsured people definitely have a hard time finding primary care doctors who will see them as outpatients, but even insured patients have difficulty finding primary care.

“What we found is that there is a perception that — because one of the roles of the emergency room is a safety net for the uninsured — it is the uninsured who must be causing all the problems in ER care,” says first author and emergency physician Manya Newton, M.D., MPH, M.S., a Robert Wood Johnson Clinical Scholar at the U-M Medical School.

“The crisis in emergency medicine and the problems of the growing uninsured population have been conflated,” she said. “While there’s excellent research out there on both issues, the myths about how the uninsured use the emergency department threaten to interfere with the policy-making process. The rise in ER use has much more to do with the aging of the population, the increase in chronic diseases, and the decrease in available primary care than with the uninsured. Policies based on false assumptions risk diverting energy and money from confronting the true drivers of emergency department crowding.”

At the least, Newton and her co-authors conclude from their review, ER policy solutions will need to address the lack of timely access to primary care by the uninsured and insured alike.”

So much for the uninsured monopolizing emergency rooms and increasing costs for everyone.

But, as it turns out, the President is right in pointing out that those who have private insurance do foot the bill for others who underpay. What the President got wrong is who this culprit is who underpays and leaves others having to pay the bills. Since it happens to be the government when it underpays for Medicare and Medicaid services, this is a hidden tax the President doesn’t want you to know about.

ObamaCare opponents argue that these already existing public programs add to the high cost of private insurance. More specifically, when the government imposes its own fee structure on providers, and thereby underpays them, they find ways to recoup those lost fees. And by now, you can probably guess who bears this expense — taxpaying, insured, private citizens like you and me.

A recent article by Grace-Marie Turner and Joseph Antos in the WSJ explains:

“According to Milliman, an independent actuarial firm, Medicare—and to an even greater extent, Medicaid—underpays doctors and hospitals, shifting costs to private insurers. Milliman estimates that the average family in a private PPO health plan pays an additional $1,788 a year to compensate for underpayments by Medicare and Medicaid, representing a “hidden tax” on commercial payers totaling $89 billion a year.”

Providers could not keep their doors open without the higher payments from private insurers. A recent letter to Congress from 13 leading health-care delivery organizations, including the Mayo Clinic, said “many providers suffer great financial losses associated with treating Medicare patients.” They said that if these rates were expanded to patients who currently have private insurance, the result “will be unsustainable for even the nation’s most efficient, high quality providers, eventually driving them out of the market. “That means we would say goodbye to some of the best health-care systems in the country.

Yet, as he laid out in his speech to Congress this week, President Obama’s goal is to insure everyone under a Medicare/Medicaid type system. So the critical question then becomes, who will pick up these costs if a Medicare-for-all system is implemented?

ObamaCare supporters have not answered that question. Instead, their response to critics who point out that private companies cannot compete with this government-run system is that the public option is just an option. This default response does not address the issue, and their dismissal of such an important question is one reason why they are losing the health care debate. Just last week, former Senate Majority Leader and HHS Nominee Tom Daschle mocked those who are concerned with the public option, laughing at what he sees as the illogical argument that the public option is bad because it would be so popular. Clearly, Mr. Daschle misses the point. Critics of the bill are concerned with the bill’s constraints on individuals and private businesses via mandates and on insurance companies via regulations — all of which will result in 1) increased premiums for private insurance and 2) as many as 88.1 million people being forced into the public option (see The Lewin Group’s study).

President Obama stated this week that his door is open to those with alternative proposals. The 13 health care organizations that wrote that letter to Congress actually support health care reform, just not the President’s version. If he truly cares about health care, he’d do well to start listening to them and to stop using false information, like his claim about the cost of the uninsured visiting emergency rooms, to support his program. Obama often refers to the greater good, the socially just thing to do. Well, in this case, it’s to make sure that health care providers never have to shut their doors, or else it won’t matter how many are or aren’t insured.

*Originally published September 13, 2009 on The American Issues Project Blog, here.