The latest meteor crossing thru the GOP presidential race firmament is Herman Cain, the Godfather of pizza.
Only in America.
As difficult as it may be, I’m actually going to attempt to take Cain seriously. Leaving aside his bizarre tax plan, one that would actually dramatically increase taxes on consumption smack dab in the middle of an economic recovery, (that’s been adequately eviscerated by others far more knowledgeable than I in the implications of tax policy) I’ll examine Cain’s rather thin health care resume and policy plans.
That said, one should note that the 9-9-9 is just an interim step in Cain’s three-step process, which concludes with a flat 30% tax on all goods and services – and no other taxes of any kind.
Cain does have a long track record on health care issues – he led the National Restaurant Association back in the early nineties and was a vocal opponent of the Clinton reform efforts. That said, his website and other public statements are long on sound bites and short on substance.
He advocates:
– treating employer and individual contributions for health insurance the same for tax purposes
– repealing the Accountable Care Act and replacing it with expanded tax credits for personal savings accounts for health care
– tort reform
– switch from the current Medicare system to some type of voucher for Medicare – how this works is uncertain as there are precious few details, but when you end payroll taxes, you end Medicare…
So what would happen with Cain as President?
Well, health care services and products and procedures and treatments would be taxed at nine percent. Yep, everything from appendectomies to pills, proctological exams, psychological counseling, and PET scans.
Next, Medicare would disappear to be replaced by some form of voucher, where people would try to by coverage from private insurers on the free market. How this would work is…uncertain. I’m not sure how many private insurers would jump at the chance to provide coverage to senior citizens with Alzheimer’s, cancer, heart disease, or osteoporosis…
What did I just write?
I should have said NO private insurers…
That’s about all we can conclude at this point. Until – or rather unless – we get more detail from the Godfather of Pizza, there’s just not enough substance to his soundbites.

The announcements this week that the United States Preventive Services Task Force has decided healthy men shouldn’t get the P.S.A. blood test is long overdue, but nonetheless very welcome news.
The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don’t.
Seventy percent of positive PSA tests are false positives; the patient does not have prostate cancer. Worse, these false positive tests often result in more tests and treatments that then result in impotence and incontinence and in some cases, premature death. According to the chair of the Task Force, “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”
Over a twenty year period, about a million men got prostate surgery, radiation, or a combination as a result of a PSA test. Of those, about 5000 died soon after surgery, and from 10,000 to 70,000 suffered serious complications, and 200,000 to 300,000 were incontinent, impotent, or both. The dimension of the problem was starkly illustrated when the test’s developer called its widespread use “a public health disaster.”
There are passionate and dedicated folks who will argue vehemently that PSA tests are necessary and save lives. Unfortunately, many have become part of a campaign financed almost entirely by the pharmaceutical industry. I engaged in a dialogue for some time with one of them, and despite my best efforts, his conclusion is that the test saved his life and therefore others should get it as well.
It’s one thing to talk population health and an entirely different thing when one is talking about the health of one’s family or self. Unfortunately, well-meaning people often confuse the two – and this is what has led them to advocate for a test that is:
– costly (PSA tests range in cost from $70 – $200, plus the office visits, or about $3 billion a year just for the tests in the US);
– results in surgery that kills about five thousand men over a twenty year period and
– causes impotence and/or incontinence in 20% to 30% of patients
Some will argue that more recent developments in surgery have delivered better results – I’d say it’s too early to tell, which is why the Task Force used a database that would allow them to see effects over the long term.
What’s the net?
PSA testing is a great example of business masquerading as good medicine, funded by businesses who profit from the test, who arguably, are partially responsible for the deaths and suffering of thousands of men.
It’s also a great lesson on why we need more science education in our schools, so so many of us would actually understand what a disaster the PSA test has become.

Exactly what role should government have in health care? What does Rick Perry think? And more importantly, what has Perry done?
There’s a good deal of evidence that Perry used his position and influence to award millions in taxpayer dollars to his financial supporters, even when those awards were not in keeping with conservative ideology or didn’t make much business sense.
According to a lengthy and well-researched piece [sub req] in the New Republic, Perry’s been a big supporter of health care ventures, especially when those ventures are tied to people who’ve been big supporters of Perry. That’s not unusual: politicians help those who help them.
What may be a bit unusual is the extent of Gov. Perry’s use of taxpayer funds to support selected health care entrepreneurs, and the abysmal performance of several of those lucky entrepreneurs. A couple of examples (there are more) are instructive.
Perry awarded $50 million of taxpayer funds to the Texas Institute for Genomic Medicine (TIGM) at his alma mater, Texas A&M. Most of the $50 million went to supplies and software from Lexicon Genetics – a company in which one of his major contributors was an investor. After several years, the TIGM has little, if anything, to show for the investment; it has ten (10) employees who appear to spend much of their time doing not much. (When the President of Texas A&M complained about the ongoing annual $2 million expense, she was summarily dismissed by the Perry-controlled Board of Regents)
Another $50 million went into the National Institute of Therapeutics Manufacturing (again at the direction of Perry and his associates, and also at Texas A&M). The NITM is still in development, and is closely allied with several of Perry’s financial supporters.
Then there’s the furor over Perry’s support for mandatory HPV vaccines for Texas’ girls, a furor generated in part because Perry’s former chief of staff was lobbying for Merck, the vaccine’s manufacturer and direct contributor of some thirty thousand dollars to Perry over the years plus perhaps a few hundred thousand more via other channels. http://www.washingtonpost.com/politics/perry-has-deep-financial-ties-to-maker-of-hpv-vaccine/2011/09/13/gIQAVKKqPK_story.html
Finally, one would do well to remember that Perry, who advocates repeal of the health reform bill and leaving reform to the states, presides over the state with the highest percentage (28%) of people without health insurance. Over a quarter of the state’s population has no coverage.
That’s eleven points higher than the national average.
So, what?
Perry doesn’t seem to be a conservative as much as a politician of the old school; rewarding friends and financial backers and hammering enemies regardless of their political ideology.