On Friday, May 10, President Obama ventured into Ohio to give a Mother's Day defense of the sagging fortunes of his signal achievement, the misnamed Patient Protection and Affordable Care Act. The law, the President assures us, "is here to stay"--a comment that is best regarded as a threat and not a promise. His conclusion was not coincidental; support for the ACA has dropped from 42 percent to 35 percent between November 2012 and April 2013. -- Richard Epstein
UPDATE: QOTD2 -- that is some lazy-ass blogging!
This is an exceptional and important article. Epstein clearly, concisely -- and fairly -- demolishes ObamaCare's implementation. It would be easy to ignore this during the administration's multi-scandal defensive. But don't -- this one is a keeper.
The President can still stop the train wreck that is his signature piece of legislation and legacy. All he has to do is -- make a speech! He's awesome at that!
Dr. Ezekiel Emanuel, "senior fellow at the Center for American Progress, is vice provost for global initiatives at the University of Pennsylvania and a former health-care adviser to President Obama." And today's guest editorialist at the WSJ. Emmanuel concedes that enrolling "young invincibles" is required to keep this monstrous ship afloat. A less charitable blogger than me would point out that the plan's fiducial framework is built on those who will pay for services they do not use. But Dr. Emmanuel is undaunted:
Fortunately, there are solutions. First, young people believe in President Obama. They overwhelmingly voted for him. He won by a 23% margin among voters 18-29--just the people who need to enroll. The president connects with young people, too, so he needs to use that bond and get out there to convince them to sign up for health insurance to help this central part of his legacy. Every commencement address by an administration official should encourage young graduates to get health insurance.
Second, we need to make clear as a society that buying insurance is part of individual responsibility. If you don't have insurance and you need to go to the emergency room or unexpectedly get diagnosed with cancer, you are free- riding on others. Insured Americans will have to pay more to hospitals and doctors to make up for your nonpayment. The social norm of individual responsibility must be equated with purchasing health insurance.
Which brings me to another belief I should update. Three years ago, after Obamacare passed, I predicted that Obamacare would not result in significant reductions in mortality. I now think that this is more likely to be right than I did before. A number of people have been out there saying that the study vindicates their belief in the health benefits of insurance. I would like to hear them say, in clear and simple language, "After seeing the results from Oregon, I now believe that the US mortality rate will fall even farther than I expected, to . . . " with a number, not a hedge about statistically significant studies, attached. -- Megan McArdle
Jonathan Chait responds by dismissing the significance of the Oregon study--based not on facts but on an emotional appeal which leads off with a bizarre and unintelligible comparison about "throwing puppies out of skyscraper windows."
If a study found that puppies survive steep falls at a higher rate than expected, then you could say the case for throwing puppies out of skyscraper windows has marginally weakened, but would remain extremely strong. Indeed, data notwithstanding, either throwing puppies out of skyscrapers or throwing people off Medicaid are both acts of sadism.
Take that, Republicans, you puppy-killing sadists!
Ophthalmologists from across the country walked out of a session on Obamacare Sunday during a national conference being held in San Francisco.
Twitchy reported ophthalmologist Dr. Kris Held sent live-tweets from the "Government relations" session on "implementing and complying with Obamacare," saying virtually all the physicians walked out of the speech in disgust.
First the Unions jump ship. Now, "a key architect" dares to caution against the impending "train wreck."
[Sen. Max] Baucus, the chairman of the chamber's powerful Finance Committee and a key architect of the healthcare reform law, said he fears people do not understand how the law will work.
"I just see a huge train wreck coming down," he told Health and Human Services Secretary Kathleen Sebelius at a Wednesday hearing. "You and I have discussed this many times, and I don't see any results yet."
Baucus pressed Sebelius for details about how the Health Department will explain the law and raise awareness of its provisions, which are supposed to take effect in just a matter of months.
"I'm very concerned that not enough is being done so far -- very concerned," Baucus said.
This underreported story is a key element of Michal Cannon's "50 Vetoes" [Review Corner]: the law is buckling under its own bureaucratic weight, and implementing the less popular and more difficult portions affords many opportunities to trim it back or clamor for its repeal.
UPDATE: Karl "Darth" Rove is on the case in today's WSJ Ed Page:
In congressional testimony last week, Health and Human Services Secretary Kathleen Sebelius blamed Republican governors for her department's failure to create a "model exchange" where consumers could shop for health-insurance coverage in states that don't set up their own exchange.
Nice try, but GOP governors aren't the problem. Team Obama's tendency to blame someone else for its shortcomings is tiresome. The Affordable Care Act requires HHS to operate exchanges in states that won't operate their own. Since the act became law in March 2010, it has been abundantly clear that the agency would have to deploy a model exchange. It is Ms. Sebelius's fault there isn't one.
There is more to this failure. Even exchanges organized by Democratic and Republican governors may not be functioning by the health-law's Oct. 1 deadline, because HHS has been slow with guidance and approvals.
Almost as if the whole thing was not completely thought through...
UPDATE: Jim Geraghty's Morning Jolt includes this pic:
I'm slacking on you yet again. This week's "book" is a white paper. You can download "50 Vetoes: How States Can Stop the Obama Health Care Law" from Cato, or you can get it all pretty and packaged up for Kindle® from Amazon for $3.49. Spendthrift that I am, I dropped the $3,49 like it was nothin' and enjoyed it on the couch.
A few pages in and one asks "I wonder if this ObamaCare® was really a good idea?" Cannon enumerates the flaws and consequences -- intended and unintended -- of what he dutifully calls PPACA. Because the law diverted some control to the states to get the famous 60 votes, and because the Feds are woefully behind and outclassed in its implementation, Cannon says that the States have a real opportunity to upend the law -- and that they should.
Collectively, states have the power to block that spending and to reduce federal deficits by $ 1.7 trillion by refusing to implement Exchanges and the Medicaid expansion. So far, 34 states, accounting for roughly two-thirds of the U.S. population, have refused to establish an Exchange, while 16 have refused to implement the Medicaid expansion. Those states have reduced federal deficits by hundreds of billions of dollars.
Cannon destroys the concept that the state exchanges are actually autonomous examples of Federalism:
The Act thus empowers the secretary to require state-funded Exchanges to operate exactly as she would operate a federal Exchange. One example is the Act's "navigator" program, in which groups that help consumers select an insurance plan-- a role traditionally performed by insurance agents and brokers-- receive funding from Exchanges. Some states have enacted laws requiring navigators to obtain a license. Yet the secretary has prohibited states from requiring navigators to be licensed agents or brokers, or to carry insurance typically carried by agents and brokers. She has also prohibited navigators from receiving any compensation from health plans either inside or outside an Exchange. If the secretary later decides to prohibit insurance agents and brokers from serving as navigators, or likewise to require state-funded Exchanges to exclude certain health plans, state-funded Exchanges will have to obey. What the secretary declares bound in Washington shall be bound in the states; what she declares loosed in Washington shall be loosed in the states.
Even states expecting to proceed with creating exchanges find that the Feds have no plan, no documentation -- not even a Web site.
"We have gotten little bits of information here and there about how the federal exchange might operate," said Linda J. Sheppard, a senior official at the Kansas Insurance Department. "I was on a panel at Rockhurst University here, and I was asked, 'Where is the Web site for the federal exchange?' I chuckled. There really isn’t any federal exchange Web site."
Kathleen Sebelius, the secretary of HHS, has repeatedly emphasized that "states have to meet a standard of transparency and accountability." A state exchange must have "a clearly defined governing board,” and the board must hold regular public meetings. . . . By contrast, federal officials have disclosed little about their plans, are vague about the financing of the federal exchanges and have refused even to divulge the "request for proposals" circulated to advertising agencies.
I know. The ThreeSources community is shocked at government opacity, arrogance, and incompetence. Most of the arguments will be familiar to ThreeSourcers: "The Act's 'community rating' price controls force insurers to sell coverage to the sick far below cost, and to the healthy far above cost. In that environment, an insurer that provides the highest-quality care to the sick will attract all the sickest patients, and will quickly go bankrupt, as healthy people avoid that carrier's higher premiums. In this way, the Act's community-rating price controls literally punish health plans that provide the most attractive coverage to the sick."
But the enumeration, collection, and strict documentation of the arguments is well worth your three-fifty. I do not suppose there is much chance in the newly Communist People's Republic of Colorado -- but there are real opportunities to avoid and perhaps repeal this wicked law.
A critical mass of states could force Congress to repeal the law. To some, it is unimaginable that Congress and President Obama would do so-- just as it was once unimaginable that 34 states would refuse to establish Exchanges, or that 16 states would refuse to expand Medicaid, or that congressional Republicans and President Obama would join together to repeal the CLASS Act. The PPACA is weaker, and the path to repeal is clearer, than it has ever been.
The study found that women who took off their bras for good experienced a 7mm lift in their nipples each year they didn't wear a bra. Researchers also found that bra-less women developed firmer breasts and saw their stretch marks fade.
For the metrically-challenged, that's over a quarter inch.
After years of often bitter debate, health care reform--a.k.a. the Affordable Care Act, or if you prefer, Obamacare--will take full effect January 1, 2014. How will it affect your company? Good question. Like Tolstoy's unhappy families, every business will be made unhappy in a different way by the new law. -- Adam Bluestein, Inc Magazine
The report, which examined conditions at Stafford Hospital in Staffordshire over a 50-month period between 2005 and 2009, cites example after example of horrific treatment: patients left unbathed and lying in their own urine and excrement; patients left so thirsty that they drank water from vases; patients denied medication, pain relief and food by callous and overworked staff members; patients who contracted infections due to filthy conditions; and patients sent home to die after being given the wrong diagnoses.
The NYTimes, that right wing rag, is clearly printing these lies to try and discredit the president's agenda.
"I mislabeled a sandwich, but with good behavior, I might be out in three to five..."
Citizens or subjects? One must admit ObamaCare® moves the dial toward the latter.
The proposed regulation would require store owners to label prepared, unpackaged foods found in salad bars and food bars, soups and bakery items. Erik Lieberman, regulatory counsel at the Food Marketing Institute, said testing foods for nutritional data will require either expensive software or even more costly off-site laboratory assessments.
Lieberman said failure to get it right comes with stiff penalties: "If you get it wrong, it's a federal crime, and you could face jail time and thousands of dollars' worth of fines."
Supermarket managers could go to jail if they accidentally mislabel a rotisserie chicken or a salad or a sandwich..
I know, that's FOX News so it's probably completely made up. I won't bother sharing it with my Facebook friends until it is confirmed on MSNBC, Al-Jazeera or some other actual news outlet.
President Obama attended the annual National Prayer Breakfast this morning and heard a "surprise guest speaker" deliver the keynote address. Yahoo Finance quoted the speaker, Reknowned pediatric neurosurgeon Dr. Ben Carson, in this article.
"I wanted to emphasize the roles faith, values and principles have played in the success of our nation."
"E pluribus unum means 'out of many one,'" said Carson. "At this critical time in our nation's history, we must remember that 'a house divided against itself cannot stand'. If we learn from the past, we can stand tall in the future."
America the Beautiful calls citizens to use their "God-given talents to improve our lives, our communities, our nation and our world," said Carson. "And I pray that God used my opportunity to reach our entire government for His glory."
But I am not a media mouthpiece so I have no reluctance to cite alternative sources to PR Newswire. Glenn Beck's The Blaze, for example.
The speech took an interesting turn when the doctor cautioned that moral decay and fiscal irresponsibility can have dire consequences — even for powerful countries like America. Here, he became even more pointed and impassioned.
“I think particularly about ancient Rome. Very powerful — nobody could even challenge them militarily…they destroyed themselves from within,” Carson continued. “Moral decay. Fiscal irresponsibility.”
While he said America’s issues are dire, he was positive that the nation can fix its ways, as there are bright and innovative people who simply need to come together to address the problems at hand.
“And one of our big problems right now…our deficit is a big problem,” he said, as Obama watched him intently. ”Think about it — and our national debt — $16 and a half trillion dollars.”
But even this doesn't do it justice. You just have to watch it yourself.
UPDATE: Here is the entire event, running some 82 minutes in length. Dr. Carson begins at 35:00, with an introduction starting 1 minute prior.
I have not yet done so but I encourage a full viewing. 26 minutes. But the bit I want to highlight begins around 16:30, and gets really interesting around 19:00. Don't stop before you reach 22:00. (And don't forget to watch the President's reactions.)
On the original flat tax, the tithe:
"He didn't say if your crops fail, don't give me any tithe. He didn't say if you have a bumper crop give me triple tithe. So there must be something inherently fair about proportionality. You make ten billion dollars, you put in a billion. You make ten dollars, you put in one. (...) Now some people say, 'Now that's not fair because it doesn't hurt the guy who made ten billion dollars as much as it hurts the guy who made ten.' Where does it say you have to hurt the guy? He just put a billion dollars in the pot! You know, we don't need to hurt him."
Health-insurance premiums have been rising--and consumers will experience another series of price shocks later this year when some see their premiums skyrocket thanks to the Affordable Care Act, aka ObamaCare.
The reason: The congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing. Premiums will soon reflect that disregard--indeed, premiums are already reflecting it. -- Merrill Matthews and Mark E Litow
Dr. Peter Weiss has a superb column on the "free annual exam" we all get thanks to ObamaCare®.
Obama won, Obamacare is the law, and, as my wife says, I will just have to learn to dance to a new song.
Now, don't get me wrong, Obamacare is awful. Forget all the "free stuff" it provides. Children covered on their parents' plan until 26 years of age? A scam, making young adults -- excuse me, children -- pay for complete, comprehensive health insurance when all they need and should pay for is major catastrophe insurance. Then there is the "annual " or "preventative" exam, which according to Obamacare is "free."
You gotta love this stuff. I wish I had the chutzpah of the people who wrote Obamacare. What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum.
(Some) Folks thought Doctor/Senator Rand Paul over the top when he pointed out that "if you have a right to health care, you have the right to enter my home and force me to care for you." Are we very far from that, when the government gets to give away "free" stuff that others have to produce?
I'll save you the search, ThreeSourcers, I read it an hour before I read Weiss's column. Here is the quote you are looking for:
"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything-- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it." -- Rand, Ayn (2005-04-21). Atlas Shrugged: (Centennial Edition) (p. 744). Penguin Group. Kindle Edition.
Senator Evan Bayh of Indiana was my favorite Democrat for a while. May still be. He has a guest editorial in the WSJ today opposing the medical device tax provision on ObamaCare. The former senator is eloquent, unequivocal, and correct. This industry creates jobs and wealth by improving lives.
The adverse effect of this confiscatory level of taxation on traditional device makers is already clear. In my state of Indiana alone, Cook Medical has canceled plans to build one new U.S. facility annually in each of the next several years, and Zimmer plans to lay off 450 workers, while Hill-Rom expects to lay off 200. Stryker, based in Michigan, anticipates having to lay off 1,000 workers.
As a result of the looming device tax, production is moving overseas, good jobs are going to Europe and Asia, and cutting-edge medical devices will now be produced elsewhere for import into the U.S.
Meanwhile, the impact on the quality of care is incalculable but no less real. Thirty billion dollars must be taken out of operations or R&D. Who knows what lifesaving devices that might have been developed will fall victim to this tax?
Here is the part of the blog post where I wish that Sen. Bayh more consistently used these principles on other industries -- maybe even some not prevalent in the Hoosier State.
It's by Dr. Barbara Bellar, a motor-scooter-riding animal lover, Army veteran and Republican attorney who's taking on a massive challenge of the Chicago political machine for a state Senate seat to combat the fiscal insanity in Barack Obama's adopted home state, which isn't an easy job, as you might imagine, so she made this hilarious homemade video that captures the colossal stupidity of ObamaCare in one (very long) sentence, like this one.
With all the usual caveats about the reliability of "scientific studies" here is another datapoint in the marijuana debate.
Prof Moffitt said adolescent brains appeared "more vulnerable to damage and disruption" from cannabis than those of fully mature adults.
Reliable figures on cannabis usage among today's British teens and twentysomethings are hard to come by.
But Prof Moffitt said there was growing concern in the US that cannabis was increasingly being seen as a safe alternative to tobacco.
"This is the first year that more secondary school students in the US are using cannabis than tobacco, according to the Monitoring the Future project at the University of Michigan," she noted.
"Fewer now think cannabis is [more] damaging than tobacco. But cannabis is harmful for the very young."
The news article, by UK Telegraph medical correspondent Stephen Adams, quotes study contributor Professor Terrie Moffitt on the cascading effects of an 8-point IQ diminishment:
"Research has shown that IQ is a strong determinant of a person's access to a college education, their lifelong total income, their access to a good job, their performance on the job, their tendency to develop heart disease, Alzheimer's disease, and even early death," she said.
"Individuals who lose eight IQ points in their teens and 20s may be disadvantaged, relative to their same-age peers, in most of the important aspects of life and for years to come."
The WSJ has a comprehensive editorial on "Cheesecake Factory Medicine." One could not do better for an intelligent comparison of free markets versus top-down bureaucracy in any field. In something as important as health care, it is damming.
"Fifteen unelected bureaucrats" has become a GOP talking point. Maybe people get what the IPAB is, but I suspect most do not.
The longer-run danger is that Mr. Orszag's cost board starts to decide what types of care "work" for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan's market proposal is rejected, then government a la Orszag will do it by brute political force.
A murderer's row of liberal health-care gurus--Zeke Emanuel, Neera Tanden, Don Berwick, David Cutler, Uwe Reinhardt, Steve Shortell, Mr. Orszag, many others--recently acknowledged as much in the New England Journal of Medicine. They conceded that "health costs remain a major challenge" despite ObamaCare. That would have been nice to know in, oh, 2009 or 2010.
Anyhow, their big idea is the very old idea of price controls that are "binding on all payers and providers," much as post-RomneyCare Massachusetts is already doing. When that strategy fails as it always has, and the public denies further tax increases, the Orszag payment board will then start to ration or prohibit access to medical resources that it decides aren't worth the expense.
Yeah, price controls. That'll work.
The entire piece is superb This link should work for seven days without respecting Rupert's property rights.
Such explosive growth in debt can't go on forever, and it won't. Yet our current leaders and their apologists insist that the problem will magically solve itself. Last year's deficit came in slightly below forecasts, and we've had one quarter of good economic growth -- see, we'll grow out of the deficit!
Let's hope that works -- but hope is not a plan.
Just as the federal government is in no immediate danger of running out of money, our forces in Iraq are in no danger of outright defeat. But in both cases, current policies appear to be unsustainable: we can't go on like this indefinitely. And things that can't go on forever, don't.
As a leading expert on the Massachusetts health care system, candidate Romney is in an excellent position to explain why the health plan he helped create for Massachusetts (quite different from what he would have done without his "partners" in the Democrat-controlled state legislature) was a failure. Here's the message:
So "Obamacare" is not only now "Obamatax" it's also "Obamasityourassdownandshutup."
Jonah Goldberg steps in to help an NPR journalist with a difficult question:
Someone in the audience asked NPR health-policy correspondent Julie Rovner this question: "Today’s decision is a positive decision for the estimated 50 million uninsured Americans. Who are the losers today?"
Rovner seemed to struggle to find losers. She came up with insurance companies that want the so-called individual mandate -- now a punitive tax, according to the Supreme Court -- to be much more punitive. After thinking through her answer, she later added that another group of losers might be the citizens of states whose governors opt to not participate in the law's expansion of Medicaid.
So, Obamacare creates no losers except where it fails to tax people sufficiently and where GOP governors fail to accept the wisdom of the law. In short, the only thing wrong with Obamacare is that it isn't even more punitive, more mandatory, and more intrusive.
For those of us who oppose the Affordable Care Act as a policy matter, this is a bad day. For those of us in this fight to preserve the limits of constitutional government, this is not a bad day. -- Randy Barnett
The quote is pulled out of an Ezra Klein piece of all things. The juicebox mafiosi has the unfortunate task of explaining to the left that Chief Roberts is an evil genius and that they have all been had.
I'd give it more credence if he did not make two errors in the lead paragraph. It's Charles EvanS Hughes -- and I don't know that being called a politician would be such an affront to the 1916 Republican Presidential Nominee.
Hat-tip: Paul Rahe who brings an interesting point I heard in passing on Kudlow last night.
There, let me add, is one other possibility. The version of Obamacare that became law originated in the Senate. The Constitution stipulates that all tax bills must originate in the House. Were I Randy Barnett, I would file another suit arguing that the mandate is unconstitutional because the Senate cannot originate tax bills.
Whatever one thinks of the substance of Bush v. Gore, it did affect the reputation of the court. Roberts seems determined that there be no recurrence with ObamaCare. Hence his straining in his ObamaCare ruling to avoid a similar result — a 5-4 decision split along ideological lines that might be perceived as partisan and political.
National health care has been a liberal dream for a hundred years. It is clearly the most significant piece of social legislation in decades. Roberts' concern was that the court do everything it could to avoid being seen, rightly or wrongly, as high-handedly overturning sweeping legislation passed by both houses of Congress and signed by the president.
I left the detailed explanation to the professional.
"Change absolutely starts with each of us, as individuals, taking responsibility for ourselves and our families because we know that our kids won't grow up healthy until our families start eating right and exercising more. That's on us," she said. "We know that we won't close that education gap until we turn off the TV, and supervise homework, attend those parent-teacher conferences, and serve as good role models for our own children."
Taken entirely as a stand-alone, without ad hominem: I agree.
Now let's apply this standard to everyone, all the time. I think if you're on government assistance, they should shut your television down.
So the president was ready for the Court to break right or break left. But instead, Chief Justice Roberts juked. He agreed with the challengers that the mandate couldn't be justified under the Commerce Clause or even the Necessary and Proper Clause -- thereby reinforcing the narrative that the Democratic Congress overreached in passing the bill. His opinion -- though not the result -- may provide much help in the future to judicial conservatives, as it suggests that, with the dissent, five justices are in favor of a more aggressive role for the Court in policing the bounds of the Commerce Clause (and the Spending Clause, which was at issue in the Medicaid legislation). And while Roberts ultimately voted to uphold the Act, he did so on a ground that, for Obama, plays terribly: that it's a tax.
His decision was a disappointment to those, including this columnist, who are anxious to be rid of this monstrous law. That will require legislative action. But on the most important question of constitutional doctrine, Roberts handed a big defeat to the legal left.
UPDATE II: Yet William Jacobson @ Legal Insurrection is not feelin' the love!
To paraphrase Joe Biden, I have just four words for you:
BIG —— DEAL
If this were some other more narrow law, if this was not a monumental takeover of the most private aspects of our lives, if this monstrosity would not cause such long term damage to our health care system, if this law was not Obamacare ….
I might be inclined to agree with you.
But it is Obamacare, it is the takeover of a substantial portion of our economy which empowers the federal government to write tens of thousands of pages of regulations telling us how to live and how to die.
This was the hill to fight on for any conservative Justice of the Supreme Court.
Yet because the conservative Chief Justice sided with the liberal Justices on the result, we have Obamacare.
A good friend of this blog sends a link, suggesting "You asked for this type of debate. Here it is:"
This presidential election is "a choice," Romney said. "You can choose whether you want to have a larger and larger government, more and more intrusive in your life -- separating you and your doctor -- whether you're comfortable with more deficits, higher debt that we pass onto the coming generations. Whether you're willing to have the government put in place a plan that potentially causes you to lose the insurance that you like or whether instead you want to return to a time when the American people will have their own choice in healthcare. Where consumers will be able to make their choices as to what kind of health insurance they want."
"This is the time of choice for the American people," Romney said.
Fellow freedom advocates, do not panic. Step back from the ledge. By a single vote the Supreme Court has avoided a catastrophic expansion of the Commerce Clause. The rest, as they say, is politics. Including Chief Justice Roberts' ruling:
"If an individual does not maintain health insurance, the only consequence is that he must make an additional payment to the IRS when he pays his taxes," Roberts writes. He adds that this means "the mandate is not a legal command to buy insurance. Rather, it makes going without insurance just another thing the Government taxes, like buying gasoline or earning an income."
Hmmm, that's pretty thin Jim. The minority counters:
Justice Anthony Kennedy, usually the court's swing vote, dissented, reading from the bench that he and three conservative justices believe "the entire Act before us is invalid in its entirety." In a 65-page dissent, he and Justices Antonin Scalia, Clarence Thomas and Samuel Alito dismissed Roberts' arguments, writing that there is a "mountain of evidence" that the mandate is not a tax. "To say that the Individual Mandate merely imposes a tax is not to interpret the statute but to rewrite it," they write.
Very persuasive. So my conclusion is that Roberts just didn't want to be villified as an "unelected emperor" who "took away America's free [unearned] health care." I agree with Yahoo News' Oliver Knox who writes-
But while Obama initially kept quiet, the early response from the law's main supporters and detractors showed that the court's ruling had essentially offered the Affordable Care Act only a reprieve, and that the law's fate was entwined with the results of the presidential election.
Finally, does anyone suppose that news outlets are falling all over themselves to get the "Obamacare Constitutional" message out as quickly as possible?
No mention of the name of that tenth justice.
UPDATE: As of 11:57 am EDT that headline has been changed to: Individual mandate survives a 5-4 vote with Roberts voting to keep it
I've been a shill and a stooge for Big Pharma since I started blogging. Sad to see that I was also a rube.
I did a smaller post on this a couple weeks back, but the WSJ Ed Page has exposed the cronyism to a larger extent than I feared.
On Friday House Republicans released more documents that expose the collusion between the health-care industry and the White House that produced ObamaCare, and what a story of crony capitalism it is. If the trove of emails proves anything, it's that the Tea Party isn't angry enough.
Over the last year, the Energy and Commerce Committee has taken Nancy Pelosi's advice to see what's in the Affordable Care Act and how it passed. The White House refused to cooperate beyond printing out old press releases, but a dozen trade groups turned over thousands of emails and other files. A particular focus is the drug lobby, President Obama's most loyal corporate ally in 2009 and 2010.
The business refrain in those days was that if you're not at the table, you're on the menu. But it turns out Big Pharma was also serving as head chef, maitre d'hotel and dishwasher. Though some parts of the story have been reported before, the emails make clear that ObamaCare might never have passed without the drug companies. Thank you, Pfizer.
After that, the gloves come off and they get a bit angry. It is a lengthy column that will anger a sentient reader several times but it should be read. In full.
If you want less of something, tax it. So who ordered fewer innovative medical devices?
So though it is destined to die in the Democratic-run Senate, GOP leaders plan to push legislation through the House this week to repeal an excise tax on the makers of medical devices sold in the U.S. sales.
Democrats say the growing medical device industry can afford the 2.3 percent tax due to take effect next January. They describe the tax as part of the price device manufacturers and other providers agreed to pay in exchange for the tens of millions of new customers they will get through the sweeping 2010 health care law’s expansion of health insurance coverage.
That's not the view of Republicans or the medical device industry, which has lobbied Congress heavily to kill the tax before it takes hold. GOP lawmakers have named their legislation the Protect Medical Innovation Act, and insist it is not aimed at dismantling Obama's health care law.
"That’s not part of my agenda," said chief sponsor Rep. Erik Paulsen, R-Minn., whose state is one of the centers of the nation's $130 billion-a-year medical device industry. He said the tax would eat up dollars that otherwise might go toward research and development -- and jobs.
Yo! Crony capitalist Democrats! It was not innovators and creators of tomorrow's life saving devices that "agreed to pay in exchange for the tens of millions of new customers they will get." That was the existing manufacturers who like the status quo.
Newly released emails give an inside look at how the White House struck a deal with the pharmaceutical industry in 2009 to get support for the health bill that ultimately passed the next year.
Drug makers and their lobbyists believed they got a good bargain, the emails show. As The Wall Street Journal and others reported at the time, the companies escaped price controls and forced the president to back down on his 2008 campaign promise to allow the reimportation of cheaper drugs from other countries.
In May 2009, after the administration was hit by negative stories about the rising costs of its proposed health care overhaul, a drug industry lobbyist emailed colleagues, "Perfect timing to cut our deal w the White House as this is swirling."
Adam Smith nailed it in 1776.
[Interest] in any particular branch of trade or manufactures, is always in some respects different from, and even opposite to, that of the public...The proposal of any new law or regulation of commerce which comes from this order, ought always to be listened to with great precaution, and ought never be adopted till after having been long and carefully examined, not only with the most scrupulous, but with the most suspicious attention.
And Milton Friedman -- centuries later -- reminds that the interest of the corporation is to increase its asset value. And yet, this deal with the devil seems rather short-sighted. Even wicked guitar skills last a lifetime once bestowed. Government regulation will pull this "industry benefit" away the first chance it gets.
Obama also has made the dubious claim that preventive care "saves money for families, for businesses, for government, for everybody." Problem: It's not true. Congressional Budget Office Director Doug Elmendorf warned in 2009, "Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall." Elmendorf cited a 2008 New England Journal of Medicine article that reported that less than 20 percent of preventive services save money, whereas the rest drive up costs.
Politicians will disappoint, yet there are also surprises to the upside. My Junior Senator, Michael Bennet, and neighboring Utah's Orrin Hatch (leans-RINO UT), don't enjoy many fulsome huzzahs from ThreeSources. And yet they are taking on the FDA on an important incursion into a new field they aim to destroy, viz., medical tracking software.
Something as simple as an iPhone app to record your glucose readings is not too small for the great thinkers at the FDA to spend ten years approving. After all, people might die!
A handful of mobile apps read data streams transmitted by medical devices implanted in patients, but one that tracks your pacemaker or blood sugar isn't the same as software embedded in medical devices that are cut into your body and then generate data. In its regulatory grab, the FDA is pretending not to be able to tell the difference.
The result could be the worst regulatory mismatch possible. An FDA process that takes years cannot possibly be applied to technologies that run on our phones or iPads and get updated on a regular basis.
Sens. Michael Bennet (D., Colo.) and Orrin Hatch (R., Utah) have introduced an amendment that puts a moratorium on the FDA's power grab while Congress studies how to build a modern regulatory framework suited to these new software tools. There's good reason why apps that support doctor and patient decisions might merely need to meet certain specifications (regarding ease of use, for example, or reproducibility of performance) to earn government approval, rather than undergo the time-consuming and costly premarket clearance that the FDA demands for other kinds of products.
The Bennet-Hatch amendment--which a bipartisan group of senators is trying to insert into a bill expected to pass Congress this week (the Prescription Drug User Fee Act, which helps fund the FDA's operations)--asks for the different government agencies that already have a stake in this software technology to work together on developing proposals for regulating these new tools.
I'd seen something on this, but my pal Harsanyi explodes it. The Administration proposes a "pilot" program to delay the budget-cut side of ObamaCare® until next year.
If the law had been followed as written, Obamacare should have slashed the popular market-oriented Medicare Advantage program this year. The cuts are needed to divert funding to a Medicaid expansion that will provide coverage to millions of uninsured -- the central case for the creation of Obamacare.
It's no surprise that Medicare's most market-focused program pushes down premiums and enrollment up. So rather than allow millions of enrollees in vital swing states, such as Florida, to experience a major benefit cut right before an election, the administration founded an $8.3 billion pilot program. This year, for example, the program offsets about 70 percent of the cuts in Advantage. The cost will be paid from the Medicare trust fund (which had a $288.3 billion shortfall this year). The consequences will be put off, conveniently, until after the election.
But the health care law's troubles shed some further light on the crisis of American progressivism and the blue social model it has built. Those who believe in the blue model and want to extend it have lost their touch; the dream machines of the blue social engineers don't sail serenely across the azure sky anymore. Think of the various carbon exchanges and environmental planetary schemes; think of high speed rail proposals like California's $100 billion train to bankruptcy; think of Obamacare. These days the experts, "social entrepreneurs" and smart young blue twenty somethings fresh out of the Ivy League whomp up social programs with as much verve and dedication as their New Deal and Great Society predecessors, but the new Dreamliners don't take off. At most they roll around the runway, emitting clouds of noxious smoke; wings fall off, windows pop out, turbines misfire and the tires go flat. -- Walter Russell Mead (Whole thing read must!)
Hat-tip Insty. In an Instavision interview, Professor Mead admits he voted for President Obama, which surprised me because he has been consistently critical.
The Affordable Care Act is not merely a "law" that the Supreme Court argued over this week. It is a massive Rube Goldberg contraption. Its 2,700 pages include every pipe, whistle and valve that the nation's academic health-care economists and doctors have soldered together from infinite studies of hospital data. The new machine even has its own boiler-room crew, the 15 health-care academics of the Independent Payment Advisory Board, who will monitor and adjust the flow of medicine through the national health-care pipelines.
They say their magnificent machine will work for everyone in America only if everyone in America is inside of it. This was Solicitor General Donald Verrilli's argument before the Supreme Court on behalf of the law's mandate. This is what the Catholic hospitals discovered when the ACA's designers pulled the sheet off the new machine. -- Dan Henninger. We're not France, Yet!
It could be, if victory in the sport of Constitution Deconstitution goes in favor of the Progressives. Then we Yanks could also find ourselves having to make rationing choices between septuagenarians and "obese 30-somethings." The UK Telegraph's Christina Odone concludes, "Age should not be a barrier to optimum care; but bad habits should be."
I have a different perspective. Neither group deserves such blanket discrimination. Instead, everyone deserves the quality and quantity of healthcare he is willing to prioritize high enough in his budget to be able to purchase. Those who spend their healthcare insurance premiums on cigarettes and Mars bars deserve a different fate than those who do the opposite.
I'm drawn to Madison for his powerful intellect and his understanding that the exact structure of government defines it and suggests consequences both intended and not. Knowing him more from his essays in the Federalist, I was surprised by Gutzman's account of the Philadelphia Convention, from Madison's notes -- and others -- on how many significant Constitutional issues in which "The Father" of the Constitution did not get his way. Yet he took the challenge up to pen the Federalist essays -- as a New Yorker, no less -- providing a full-throated, fulsome defense of each clause.
The timing is propitious [I thought you said fortuitous...?] for me because of the opening of oral arguments in the ObamaCare suit. Even though my man Madison seeks a much stronger Federal (all but National) government, I am confident from his strong devotion to enumerated powers would carry the day, had we not strayed so far from the concept of limited government. Gutzman includes his assertion that the General Welfare Clause does not open the door wider that the gents in Philadelphia wanted:
"For what purpose could the enumeration of particular powers be inserted," he asks, "if these and all others were meant to be included in the preceding general power? Nothing is more natural or common than first to use a general phrase, and then to explain and qualify it by a recital of particulars." To read the section in the critics' way, he says, "is an absurdity."
I'm about halfway through and find it very enlightening.
Like myself, Boulder's [Democrat] District Attorney Stan Garnett doesn't understand why the Obama Justice Department is so tough on the medical marijuana business. After all, aren't Democrats and weed activists fellow travelers? And, perhaps because I had dinner with the man 12 days ago (well, actually, different tables in the same Boulder burger joint) I agree verbatim with General Garnett on this sentence from his letter to United States Attorney John Walsh:
"The people of Boulder County do not need Washington, D.C., or the federal government dictating ..." WAIT! Stop right there.
But he continued, "how far dispensaries should be from schools or other fine points of local land use law," Garnett wrote.
I don't think Garnett helped his effort by suggesting what the US Attorney's priorities should be, but that probably won't be what makes or breaks the G-Men's "prosecutorial discretion."
In the "things that make you say, hmmm" department: The article also says that Boulder has an estimated 12 dispensaries within 1000 feet of a school.
Politics breaks hearts. But when the "Big Pharma" firms lined up to support ObamaCare against what I thought was their long-term interests, it was particularly upsetting.
Peter Schweitzer of the Hoover Institute has an eye-opening piece in The Daily Beast today. He suggests the contraception debate should be viewed under the Crony Capitalism lens, more than religious liberty or morality. I think he nails it:
Completely ignored is the more fundamental problem: this mandate is not only about the bedroom, it's about the boardroom. You've heard of crony capitalism? Well this is America's first example of crony contraceptives. Forget for a minute the religious question and look at who wins big here: Big Pharma. This mandate is not really about condoms or generic versions of "the pill," which are available free or cheap in lots of places. This is about brand-name birth control drugs and other devices that some consumers swear off because they are too expensive. The Health and Human Services (HHS) mandate requires health-insurance companies provide contraceptive coverage for all "FDA approved contraceptive methods." It does not insist on generics. And it does not offer any cost containment. . . . It's important to point out that among President Obama's biggest financial backers are precisely the Big Pharma companies who benefit from the mandate.
I fired this broadside at my infamous FacebookFriends™ today. I have had to sit through a hundred stupid MoveOn.org and "We Survived Bush, You'll Survive Obama" photos pushing this debate as a GOP plot to return to a pre-Griswold America. I think it makes quite a bit more sense in this context.
I'm too political, I tell myself. I need to capture the spirit of Matt Welch and The Jacket's superb "Declaration of Independents" that I touted. I need to back off a little.
For instance, The National MS Society. These guys are in my corner, n'est ce pas? Helping families, funding research, sharing information, raising awareness, advocating for socialism... Yes, I was going to let it go and be casually supporting of other endeavors and forgiving of their misguided but probably good hearted support for health care initiatives.
Then I got the Colorado-Wyoming chapter's email newsletter. Fourth item:
MS and Healthcare--Tell Us Your Stories!
In order to educate legislators, policy-makers, funders, consumer advocates, the media and others, we're hoping you will tell us about issues which directly affect you--before MS and with MS. Our Chapter is a member of Colorado Consumer Health Initiative and we are gathering information for education and outreach related to the health benefits exchange. Therefore, we want to get real stories about people impacted by healthcare reform. Are you/have you:
Been unable to receive preventative care because Medicare did/does not cover it?
Saving money by the shrinking of the "donut hole" in Medicare Part D prescription drug coverage?
Impacted by annual and/or lifetime coverage limits in private insurance?
Filed for personal bankruptcy due to medical costs?
Had a negative experience(s) with Cover Colorado insurance?
Involved in another issue which is important for others to know?
Please contact Matt Pfeifer at [number] or [email] to share your issue(s). You may remain anonymous if you'd like.
So, share your stories -- providing that your story reinforces our agenda for more and more government involvement in health care! Was it just me, or did none of the story suggestions include "How was your life enriched by a private Pharma company's developing an effective treatment?" "Did you ever get good care from a provider paid for by private insurance?"
I'm foolish to think those people would write in (though I will). The folks who want and expect more from the government certainly will. But what MS patients need is a gorram cure -- and that will be less likely if their society's crusade is successful.
Here's a good mandate: Let's mandate that every time a government official says that the government is going to "help" some category of voter, he or she has to say who they are going to hurt in the same sentence. Because it has to be someone. -- John Cochrane
I hope I shall not be thought less of for posting this Ann Coulter takedown from American Spectator, so long as I don't suggest Newt Gingrich as the best Romney antidote (which, I'm learning, he is not.)
Yet Coulter, once the scourge of such malleable "moderates," has gone through some sort of transformation that has rendered her blind to Romney's cheap opportunism. And if the primary voters are foolish enough to follow her advice, they will rue the day they listened to her and the establishment Republicans with whom she has now made common cause. As Coulter herself pointed out last year when she spoke at CPAC, Barack Obama will be reelected in 2012 if the Republican Party nominates Mitt Romney for President.
I linked this previously in a comment but I've repeated it so often to so many folks it deserves a post of its own.
If only the Democrats had decided to socialize the food industry or housing, Romneycare would probably still be viewed as a massive triumph for conservative free-market principles -- as it was at the time.
Yeah, like that "conservative free-market principle" that says if someone can't afford something the government will give it to them free of charge, just as long as it's really really important, like a house or something.
Sorry Ann, you're so in the tank for Romney you're misleading even yourself.
The Denver Post reports that Colorado ranks #2 in vaccination "opt outs" for vaccines among kindergartners. Seven percent of Centennial State parents of kindergartners chose not to vaccinate their children for common diseases. According to the article, most such parents site the risk of serious complications from vaccines or a philosophy toward "natural" immunization. (i.e., Let them catch the disease and hope they don't die).
However, according to the Center for Disease Control (if you can believe those guys), only one death between 1990 and 1992 can possibly be related to a vaccination. The chances of complications from a vaccination range from 1:1000 to 1:1,000,000 or more. Most "complications" are sore arms or fever. The study linking autism to vaccinations has been largely discredited. Furthermore, 10 children died in 2010 in California alone from pertussis (whooping cough).
So here's the analogy: you go to Las Vegas and approach the table. There is a 99.9% chance that the next roll will be red and .1% chance that it will be black. Which color do you bet on? Let's just say that 7 percent of Colorado parents should stay the hell out of Las Vegas.
On the other hand, even wise and necessary Reform may, in some respects, impede and complicate Recovery. For it will upset the confidence of the business world and weaken their existing motives to action, before you have had time to put other motives in their place. It may over-task your bureaucratic machine, which the traditional individualism of the United States and the old "spoils system" have left none too strong. And it will confuse the thought and aim of yourself and your administration by giving you too much to think about all at once.
Or, "for cryin' out loud, don't pass ObamaCare® in the middle of a recession, dude!"
Actually, the president in question was FDR and, in the long run, Lord Keynes was still alive. But Professor Mankiw suggests it might apply.
The Administration's Friday afternoon bad news dump this week had a toothsome tidbit. The CLASS Act is unsustainable:
But a central design flaw dogged CLASS. Unless large numbers of healthy people willingly sign up during their working years, soaring premiums driven by the needs of disabled beneficiaries would destabilize it, eventually requiring a taxpayer bailout.
After months insisting that could be fixed, Health and Human Services Secretary Kathleen Sebelius, finally admitted Friday she doesn't see how.
"Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time," Sebelius said in a letter to congressional leaders.
After months of insisting that it could be fixed...admitted she didn't see how. Now, that's a quote for our times.
Also of interest is that this little piece of subterfuge was part of the claim that ObamaCare® would lower the deficit.
The demise of CLASS immediately touched off speculation about its impact on the federal budget. Although no premiums are likely to be collected, the program still counts as reducing the federal deficit by about $80 billion over the next ten years. That's because of a rule that would have required workers to pay in for at least five years before they could collect any benefits.
The AARP, unsurprisingly, is displeased. We were well on the way to long-term nursing home and home care as a federal entitlement.
Last week JK wrote about the FDA's anti-prosperity ruling on the clinical use of Avastin to treat breast cancer. Two days later, American Spectator's Robert M. Goldberg wrote in FDA Decision Dooms Cancer Patients some background on the individuals at FDA who were responsible.
Goozner -- who has no medical background -- was appointed to an FDA advisory committee on pharmaceutical science. Two senior Public Citizen operatives, Peter Lurie and Larry Sasich, now set policy for the FDA. Fran Visco, the head of the National Breast Cancer Coalition, applauded the FDA decision after lobbying for it over the past year. Visco, a Democrat, is also on Experts Advisory Panel for the Universal Health Insurance Program at the New America Foundation, a left-wing think tank supporting Obamacare. The NBBC also supported the administration's decision not to cover mammograms for women under 50 though many breast cancers grow faster and earlier in African-American women.
Goldberg goes on to predict that Medicare and some other health plans will try to stop paying for Avastin, but he also makes this prediction:
To these groups, the FDA decision was a triumph. But their effort to manipulate the FDA will backfire. The EMA and every major group of cancer providers support Avastin's use. Cancer patients moblilized spontaneously to keep Avastin's label. They will take on the anti-innovation establishment and the FDA with greater intensity and vigor.
WASHINGTON -- President Barack Obama's health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.
The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services department.
Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps.
Medicare chief actuary Richard Foster says the situation keeps him up at night.
"I don't generally comment on the pros or cons of policy, but that just doesn't make sense," Foster said during a question-and-answer session at a recent professional society meeting.
John Goodman at Health Affairs Blog (his picture does not look like the beloved comedic actor who plays Walter in "The Big Lebowski") has some bad news and some bad news about the epidemic of drug shortages.
First the bad news:
Doctors at the Johns Hopkins cancer center are rationing cytarabine, a drug used to treat leukemia and lymphoma. They are literally deciding who will live and who will die.
About 90 percent of all the anesthesiologists in the country report they are experiencing a shortage of at least one anesthetic
Currently, there are about 246 drugs that are in short supply and as the chart shows, the number has been growing for some time.
Hospitals are scrambling to make up the shortfall, in some cases rationing medications, postponing surgeries and using alternative drugs.
What's the problem? Supply-chain? We can fix that. Shortages in transportation or labor? That can be fixed. The FDA? Oh crap. And that's the bad news:
The Federal Food and Drug Administration (FDA) has been stepping up its quality enforcement efforts -- levying fines and forcing manufacturers to retool their facilities both here and abroad. Not only has this more rigorous regulatory oversight slowed down production, the FDA's "zero tolerance" regime is forcing manufacturers to abide by rules that are rigid, inflexible and unforgiving. For example, a drug manufacturer must get approval for how much of a drug it plans to produce, as well as the timeframe. If a shortage develops (because, say, the FDA shuts down a competitor's plant), a drug manufacturer cannot increase its output of that drug without another round of approvals. Nor can it alter its timetable production (producing a shortage drug earlier than planned) without FDA approval.
Emphasis added, which I rarely do, but the emphasized statement is utterly gobsmacking.
Why doesn't the Administration simply outlaw shortages?
Ilya Shapiro reports from the ObamaCare Constitutional challenge. And the news is pretty good:
ATLANTA -- In the most important appeal of the Obamacare constitutional saga, today was the best day yet for individual freedom. The government's lawyer, Neal Katyal, spent most of the hearing on the ropes, with the judicial panel extremely cautious not to extend federal power beyond its present outer limits of regulating economic activity that has a substantial aggregate effect on interstate commerce.
As the lawyer representing 26 states against the federal government said, "The whole reason we do this is to protect liberty." With those words, former solicitor general Paul Clement reached the essence of the Obamacare lawsuits. With apologies to Joe Biden, this is a big deal not because we're dealing with a huge reorganization of the health care industry, but because our most fundamental first principle is at stake: we limit government power so people can live their lives the way they want.
In 2002, InterMune ran a large trial to seek Food and Drug Administration approval to sell the drug explicitly for this second disease. That study didn't meet its primary goal: showing that the drug slowed progression of lung fibrosis. But the results did suggest that patients with "mild to moderate" fibrosis lived longer.
There were plausible reasons why the drug might work only in patients with mild disease and not those with advanced fibrosis. Yet some of the analysis that led to this conclusion was nonetheless "retrospective"--meaning statisticians had selectively mined the data to find that positive benefit.
Since the study didn't set out to test the drug in only mild patients, the finding wasn't firm enough to satisfy FDA. So when Dr. Harkonen subsequently issued a press release that publicized the study's findings, the Justice Department says he committed the crime of wire fraud.
These abstractions of liberty stories are also starting to hit home. I am researching travel to Costa Rica to continue the effective experimental MS treatment I have been on. It has drastically slowed progression of symptoms with negligible side effects. I'd like to stay on it, but I don't want anybody to go to jail. (Yeah, six months of home confinement and a $20,000 fine for this guy, but Dr. Waksal went to jail for curing Cancer.)
Although not specifically mentioned by name in the rate review rules finalized last Thursday by the Department of Health and Human Services (HHS), the rule that exempts Medigap insurance providers is clearly designed to benefit the largest seller of such policies and the biggest lobbyist for ObamaCare -- the American Association of Retired Persons.
So you can add AARP to the list of favored unions, corporations, former Speaker Nancy Pelosi's constituents and even entire states such as Senate Majority Leader Harry Reid's Nevada that have received exemptions or waivers from various requirements of ObamaCare.
The amount AARP will gain from ObamaCare, with cost-effectiveness mandates that will lead to rationed care, less medical innovation and health care decisions made by bureaucrats rather than doctors and patients, is staggering.
Equally staggering is the brazenness exhibited by the Obama administration and the beneficiaries of what can only be called crony health care.
I don't wish to rekindle the Quantum Theory debate, but it is interesting to speculate on counterfactuals and how the world would have been if... The BBC Show Red Dwarf suggested that if Quantum Theory holds true, there would be a universe "where Ringo was a really good drummer."
And there might be one where President George Bush pursued his domestic agenda without the exigencies of 9/11. This, admittedly, could be a utopian or dystopian tale...
But lost for all time was the campaign coinage "tollbooths to the middle class." I don't know if a domestic W would have fixed them, but it is an important concept that is ignored in progressive politics. It is swell to give $1,000 to everybody who makes less than 10,000, but the marginal rate on a worker making 9,999 is roughly, negative-eleven-billiondy-one per cent. Which is what economists call "a lot."
Professor Daniel P. Kessler details the effects of ObamaCare® on this:
Fixing the notch is not so easy. To phase out the subsidy smoothly for families with incomes of 134% to 400% of poverty, the law would have to take away $22,700 in subsidies as a family's income rose to $93,700 from $31,389. In other words, for every dollar earned in this income range, a family's subsidy would have to decline by 36 cents. On top of 25% federal income taxes, 5% state income taxes, and 15% Social Security taxes, this implies a reward to work of less than 20 cents on the dollar--in economists' language, an implicit marginal tax rate of over 80%. Although economists may differ on the effect of taxes on work effort, it is hard to fathom how anyone could argue that this will not reduce economic activity.
It gets worse. There are also subsidies to cover the deductibles and copayments of insurance policies purchased through an exchange--and like the premium subsidies, these subsidies also phase out with income. There is also the likelihood that federal and state income taxes on upper-middle income families will have to be raised above current levels to finance the cost of the subsidy, the Medicaid expansion, and other provisions of the new law. Both of these effects exacerbate the law's negative work incentives.
And this is just new legislation. These pernicious effects are layered on top of welfare, food support, housing subsidies, and all the other tollbooths Governor Bush highlighted in 1999.
I'm lazy tonight and just copying titles for my posts. This one answers the question:
What types of factors make it more likely a non-married couple will be together one year later?
a) A joint gym membership
b) Living together
c) Having a baby together
d) Making payments on each others credit cards
And the obvious answer is, a combination of a and d.
In one of these studies we have in the pipeline (accepted for publication) we found that all sorts of things make it more likely that a non-married couple will remain together. Things as serious as signing a lease together or sharing finance as well as less serious things like having vacation plans or a gym membership. But do you know what didn’t predict which couples would remain together? (Um, I just gave you a pretty huge clue, right?) Yes, having a baby together didn’t affect the odds of the relationships continuing. By the way, were talking about a very large national data set here of non-married people in serious romantic relationships who are generally in their 20s and early 30s. Yes, having a baby together is not one of the things that is associated with being together a year later (and we’ll be checking in the future out to two and three and four years later).
Yet another reason why so many young people want the government to provide free health care for them and their families, since their family can't even commit to being a family.
I cannot imagine another response to the WSJ Ed Page's devastation of President Obama's Independent Payment Advisory Board.
It sounds absurd, but there the President was last week, gravely conceding Mr. Ryan's analysis of Medicare's balance sheet and then claiming that the solution is to give a lot more political power to an unelected board to control health costs. Democrats believe this board will play doctor and actuary and allocate health resources better than markets, so allow us to fill in some of the details of this government-planned future.
Mr. Ryan has been lambasted for linking his "premium support" Medicare subsidies to inflation, not the rate of health cost growth. But if that's as unrealistic as the liberal wise men claim, then Mr. Obama's goals are even more so. Medicare grew 2.1 percentage points faster between 1985 and 2009 than Mr. Obama's new GDP target. At least Mr. Ryan is proposing a workable model for bringing costs down over time by changing incentives.
Mr. Obama, by contrast, is relying on the so far unidentified technocratic reforms of 15 so far unidentified geniuses who are supposed to give up medical practice or academic research for the privilege of a government salary. Since the board is not allowed by law to restrict treatments, ask seniors to pay more, or raise taxes or the retirement age, it can mean only one thing: arbitrarily paying less for the services seniors receive, via fiat pricing.
Other than that, Mr. President, the idea is awesome.
Striking NFL athletes under 26 can get on their parents' insurance, thanks to ObamaCare®:
I said, "Man, this is awesome. I'm a professional athlete and I am getting on my parent's insurance." I got lucky on that, but some of the guys have families and children, and they are having to pay for their own health insurance now. It's just the little small things that you are having to pick up now in this uncertainty that you wouldn't have had to worry about before.
Really coming through for America's less fortunate! I'm reconsidering my opposition. Hat-tip: Taranto
UPDATE: This is also WSJ's Notable & Quotable today.
As we prepare to add 32 million members to Medicaid or to a similarly reimbursing program, John Goodman wonders Is Medicaid Real Insurance? At the risk of a spoiler, enrollment rates show it to be "not worth the effort it takes to fill out the enrollment papers" to one in six eligible.
Both anecdotal and scholarly reports from Massachusetts are consistent with this prediction. The wait to see a family doctor in Boston is now longer than in any other US city. More people are going to emergency rooms for their care in the state than before Massachusetts enacted its health reform. A Boston cab driver went through a list of twenty doctors (a list Medicaid gave her!) before she found a doctor who would see her. A preliminary report on the state as a whole found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. Further, state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer.
Hat-tip: The Everyday Economist, who highlights the sentence: "Here's my bottom line: after we get through spending our $1 trillion under ObamaCare, there is no convincing reason to believe that the bottom half of the income distribution will have more care, better care, or better access to care than they have today."
Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived.
The infant was rushed to another hospital where a surgeon performed a procedure at 1 a.m. that saved her life. Eight months later, when her heart was the size of a small plum, an incredibly dedicated and skilled team of medical professionals surgically reconstructed it. Twenty-seven years later, the young woman is now a nurse in a neonatal intensive care unit where she is studying to become a nurse practitioner.
She wasn't saved by a bureaucrat, and no government mandate forced her parents to purchase the coverage that saved her. Instead, her care was provided under a run-of-the-mill plan available to every employee of an Oshkosh, Wis., plastics plant.
I don't think it's the height of spoilerdom if I tell you the girl is his daughter.
I like to argue facts and philosophy. And it bothers me to no end that, in the House debates, every Democrat's speech started with a story. "Old Mamie Rodgerpickle, of Asbury Heights can't get insurance and has a terminal hangnail..." But sometimes you have to bring it home to people.
Johnson's daughter, my darling bride. Saturday will be six years since her stroke. I have always been amazed, like Johnson, at the full tilt boogie, failure is not an option care that a middle class couple in a small city in Colorado received. And, like Johnson, neither of us has ever had a doubt that she would not have survived in a socialist medical system.
The first hospital could not save her. It would have been easy to say that nothing could be done. Instead, a helicopter took her to a different hospital. There, it would have been easy to say that the damage was too extensive. But three and a half hours of surgery, twelve weeks of ICU and rehab hospitalization, and -- mostly -- six years of determined dignity, have brought her back.
Perhaps little good is served from personalizing the debate. But I vow to do what I can to leave that particular blessing of liberty to posterity.
House Democrats held a birthday party last week for passage of the health-care law. Just as we looked at Senate Minority Leader Mitch McConnell's floor speech noting the milestone, we will now examine some of the claims made by Democrats.
McConnell framed his speech in negative terms, citing data to back up his language. Both Democrats and Republicans can pick and choose numbers and studies to make their case, but we found that generally McConnell did not exaggerate or use bogus figures. In fact, he correctly described a Congressional Budget Office analysis suggesting a potential reduction in employment of 800,000 jobs (technically, one-half of 1 percent of household employment in 2021) that other Republicans have misrepresented.
By contrast, House Democrats appear to show little hesitation about repeating claims that previously have found to be false or exaggerated. So let’s take a tour through the numbers.
It's a Health Care Edition of the Internet Segue Machine...
I almost linked young Ezra Klein on his own yesterday. He is concerned that Dems' capitulation on an obscure clause of ObamaCare® could "undermine the Affordable Care Act." You should read the whole thing, not as an example of uplifting prose, but to experience the level of nonsense Klein is willing to tolerate before admitting that there's a problem. In the bill to repeal the bipartisanly-hated 1099 provision, eeevil Republicans are tweaking the prorating of partial years' poverty:
Under their proposed policy, a family with income at 225 percent of the poverty line who needed subsidies for the first half of the year but canceled them mid-year when the husband got a better job could get a bill for more than $4,500 at the end of the year.
A more worrying example goes the other way: Imagine a family where the breadwinner makes much more than 400 percent of poverty, but loses his job late in the year. He tries to apply for subsidies so the family can keep getting health insurance but is told that he shouldn’t bother -- because his total income that year will still be above 400 percent of poverty, he'll get a bill at the end of the year forcing him to pay back the money.
The Affordable Care Act, unfortunately, already includes a "payback" policy along these lines -- the House Republicans are just proposing to make it much, much worse.
Klein cannot see how ludicrous this new "tollbooth to the middle class" is. His concern is that it will "make people hate the Affordable Care Act for bait-and-switching them, and keep people from entering the exchanges because they've heard horror stories of huge bills."
Lemme get this straight, Ezra, other than this, you see no problem with the complexity and perverse incentives of the underlying program? If we make people from Louisiana and Nebraska exempt from these paybacks, it's okay?
A segue you were promised, and a segue you shall have. On a more reasonable side of the debate we have Professor Bainbridge and the WSJ Ed Page. Again they're, if I may mix metaphors, picking at a mote in somebody's eye when the house is on fire.
The concern is the new rules of flex reimbursements. Because those have been cut back, patients are exploiting a loophole, viz., if you get a prescription for that hangover medicine you can get reimbursed.
The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies.
"It drives up the cost of health care as opposed to reducing it," says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine. ...
I cannot quibble with Bainbridge who closes with "It's clear that Obamacare was seriously botched. We need to repeal the damned thing and start over with a more modest, incremental, and carefully vetted alternative." I quibble with the flex account.
I have one of these and it makes the mohair subsidy look well thought out. I predict my outside of insurance medical bills at the start of the benefit year, and 1/26th is deducted from each paycheck. I then apply for reimbursement from the program manager, submitting receipts and filling out the form. In return, that sum escapes Federal income taxation.
That makes it worthwhile, but I cannot help see VP Albert A. Gore's face every time I fill out the form. He and President Clinton loved to talk about "targeted tax cuts." Chopping the marginal rate would take they and their cohorts out of power -- but I would not have to fill out a form and my company pay an administering firm so that I could get my own money back.
Yet all of this nonsense is accepted as the price of having government, or in lieu of a plague of boils, or something. The entire scheme (one of VP Gore's favorite words, if memory serves) of social control through the tax code must be undone.
The program in question, the CLASS Act or Community Living Assistance Services and Support Act, is a massive long-term elderly care entitlement program that was quietly tucked into Obamacare and never got anywhere near the attention it deserves.
Sen. Kent Conrad, North Dakota Democrat, called the CLASS Act "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of." And then he voted for it. I suspect Bernie Madoff would be proud of Kent Conrad. -- Milton R. Wolf, M.D.
... at least until a court higher than Vinson's says otherwise.
Here's something that I missed on the day of the ruling, and that JK and even the Washington Examiner missed when the former declared Judge Clyde Roger Vinson "our hero." (I agree, by the way. If his ruling survives higher court scrutiny he could be as great a hero to individual self-government as was George Washington in his day.)
The Examiner concluded: "Ultimately, these issues will likely be decided by the nine justices of the Supreme Court -- unless the 112th Congress beats them to it."
But Vinson himself has already beaten them to it. The media makes much of the fact that in its short life the Obamacare law has been ruled in favor of by two judges (Democrats) and against by two others (Republicans.) But the judiciary is not a democracy (usually.) It only takes one court to invalidate a law (ask California voters) if its ruling is sufficiently broad. With the severability issue, the wizards of smart who wrote Obamacare behind closed doors gave Vinson the power to do exactly that.
Judge Vinson found that there was no need for an injunction, since the declaratory judgment that the entire law was invalid was sufficient. In effect, there is nothing left to enjoin, since no part of the law survived. By contrast, in the ruling in Virginia last year invalidating the mandate, the Judge severed the mandate from the rest of the law (but denied an injunction preventing the rest of the law from taking effect).
Here is the key language from the Order showing that Judge Vinson expects the federal government to obey the declaration that the law is unenforceable in its entirety:
"...there is a long-standing presumption “that officials of the Executive Branch will adhere to the law as declared by the court. As a result, the declaratory judgment is the functional equivalent of an injunction.” See Comm. on Judiciary of U.S. House of Representatives v. Miers, 542 F.3d 909, 911 (D.C. Cir. 2008); accord Sanchez-Espinoza v. Reagan, 770 F.2d 202, 208 n.8 (D.C. Cir. 1985) (“declaratory judgment is, in a context such as this where federal officers are defendants, the practical equivalent of specific relief such as an injunction . . . since it must be presumed that federal officers will adhere to the law as declared by the court”) (Scalia, J.) (emphasis added).
There is no reason to conclude that this presumption should not apply here. Thus, the award of declaratory relief is adequate and separate injunctive relief is not necessary."
In this sense, this decision is far more sweeping than the Virginia case, and presents a greater problem for the Obama administration which arguably does not have authority to implement any aspect of Obamacare.
Vinson said the government even conceded that its interpretation of the Commerce Clause to support the individual mandate "breaks new legal ground" and is "unprecedented." He concluded, "If it has the power to compel an otherwise passive individual into a commercial transaction with a third party ... it is not hyperbolizing to suggest that Congress could do almost anything it wanted. It is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place."
More fundamentally, the resources available for caring for the sick or injured will still be treated as a commons, in the tragic sense. Every consortium will be obligated not to exceed its budgets in the course of a fiscal year, and it's all too easy to imagine the rush of procedures as doctors kick off the period in April flush with cash, along with the anxious moments in midwinter as budgets run low. "Don't get sick in March" could be the gallows humor coming to a doctor's office near you.
Nice. Perhaps there is some lesson we can learn from the cradle of liberty?
More than anything else, the Cameron government's reforms reflect an acknowledgment that only price signals of some sort can act as a check on the demand for, and cost of, supposedly free health care. The reformed NHS would put a price on almost everything the NHS offers or does—while maintaining the myth for consumers themselves that, when it comes to their health, money is no object.
House Minority Whip Steny Hoyer (D-Md.) acknowledged Tuesday that his party has not succeeded in selling the public on the benefits of the national health care overhaul, noting that polls indicate that opinion remains divided on the law.
"Apparently, none of us did a good enough job," Hoyer, the number-two House Democrat, said at his weekly pen-and-pad briefing when asked whether the White House had succeeded in selling one of its signature legislative agenda items.
If only they had a rilly rilly good speaker in the White House. Then, he could have made a few rilly rilly good speeches.
It boggles the mind that they still blame the packaging. But that is not why I excerpted. I just thought ThreeSourcers would enjoy the phrase "House Minority Whip Steny Hoyer."
If you're not enjoying the 112th Congress, you're not paying attention!
Providing for consideration of H.R. 2, to repeal the job-killing health care law and health care-related provisions in the Health Care and Education Reconciliation Act of 2010; and providing for consideration of H.Res. 9, instructing certain committees to report legislation replacing the job-killing health care law
UPDATE: Felecia Sonmez of the WaPo calls it "a mostly party line vote" while Jim Hoft @ Gateway Pundit is dancing in the streets to get four D's.
UPDATE II: Two Republicans vote "present."
The rule passed 236-181-2, a key test vote of next Wednesday's scheduled vote to repeal President Obama's bill.
Update, 12:06 p.m.: It turns out that the pair to vote present were the two lawmakers who missed their own swearings-in on Wednesday: Reps. Pete Sessions (R-Texas) and Mike Fitzpatrick (R-Pa.).
Not all my Facebook friends are Communists. One posts a link to David Harsanyi today:
To this point, we've authorized Washington to micromanage our "economic activity" per the commerce clause -- which, technically speaking, means everything. We've permitted government to set up elaborate bureaucracies to keep us safe from drop-side cribs and artificial sweeteners. From our investment decisions to the snacks we're allowed to feed our kids in the schools we're forced to enroll them in, government makes choices for us in the name of the public good. What we haven't done is force people to buy stuff.
This should be a comment to Brother jg's scoop on the Virginia challenge to ObamaCare®, but I am posting to enjoy better links and blockquotes...
Richard Epstein says that this decision will be tough to wish away, and details how it got around every freedom lover's bete noire, Wickard:
The key successful move for Virginia was that it found a way to sidestep the well known 1942 decision of the Supreme Court in Wickard v. Filburn, which held in effect that the power to regulate commerce among the several states extended to decisions of farmers to feed their own grain to their own cows. Wickard does not pass the laugh test if the issue is whether it bears any fidelity to the original constitutional design. It was put into place for the rather ignoble purpose of making sure that the federally sponsored cartel arrangements for agriculture could be properly administered.
At this point, no District Court judge dare turn his back on the ignoble and unprincipled decision in Wickard. But Virginia did not ask for radical therapy. It rather insisted that "all" Wickard stands for is the proposition that if a farmer decides to grow wheat, he cannot feed it to his own cows if a law of Congress says otherwise. It does not say that the farmer must grow wheat in order that the federal government will have something to regulate.
It is just that line that controls this case. The opponents of the individual mandate say that they do not have to purchase insurance against their will. The federal government may regulate how people participate in the market, but it cannot make them participate in the market. For if it could be done in this case it could be done in all others.
He even ends with a boxing metaphor:
So how does it stand? If you know which way Justice Kennedy will vote, you have a pretty good shot of getting the final outcome. But if one plays the odds, this is a 12 round fight. As of today, ObamaCare is losing on rounds.
No, we can't yet quip, "Down goes Frazier!" but today's federal ruling in the Virginia Obamacare case was a necessary foundation for the defense of western civilization.
In his 42-page opinion, Judge Hudson wrote that "at its core, this dispute is not simply about regulating the business of insurance -- or crafting a scheme of universal health insurance coverage -- it's about an individual's right to choose to participate."
To this obvious conclusion the statists reply like Washington and Lee University Law Professor Timothy Jost:
Washington and Lee University law professor Timothy Jost, an expert on the health-care law, said other judges who have upheld the law interpreted the Commerce Clause more broadly to cover economic decisions that are more passive -- namely, the refusal to buy insurance. Jost said that when people choose not to buy health insurance they are still making an economic decision and affecting the nation's commerce.
Yes, just like my decision not to purchase a new car every year affects the nation's commerce.
Starting to wonder whether this big health care reform package was a good idea...
The WSJ digs into the waivers that HHS has been handing out. The President said "if you like your plan, you can keep it." The legislation did not comply, so for "some" employers, exemption waivers (papal indulgences?) have been disbursed. We discussed that.
Over the last several weeks the Health and Human Services Department has granted dozens of temporary waivers to certain ObamaCare mandates so that insurers and businesses won't drop or cancel coverage. The most conspicuous went to McDonald's to protect the "mini-med" plans for some 30,000 hourly workers from a rule that prohibits annual restrictions on benefits. Mini-med policies offer modest coverage at low premiums and other low-wage fast-food chains like Jack in the Box and Denny's have been granted waivers as well.
Cigna, Aetna and a few other insurers have been given hall passes to continue selling mini-meds. Another went to the United Federation of Teachers Welfare Fund. The New York union offers city teachers supplemental drug coverage that would have been banned under the new rules.
At least this sudden regulatory flexibility is protecting the coverage that people have today, as President Obama promised. But it isn't much of an improvement if HHS retreats only after a national political blow-up. After all, the essential point of the regulations was to destroy mini-med plans and other types of coverage that Democrats claim are insufficiently generous. Democrats from Mr. Obama on down call these rules "the patients' bill of rights," but people don't regularly need exemptions from a bill of rights.
In short, if you've got a Senator on speed-dial, or gave a pile to the Democrats, you don't need to follow the rules.
And. of course, these exemptions will make the Administration's already iffy figures less likely to balance. And McDonalds employees will be tempted to quit and get gub'mint care that covers more.
But that's just numbers. The real problem is that we've taken another step to Venezuelan rule: freedom for the connected.
Actually, what the President said was "If WE like your current health insurance plan, you can keep it."
Joseph Antos suggests, in the American, that the government is regulating a business that it does not understand (viz. "Duh!") and will take away the limited care option that is the only plan some workers at McDonalds, Home Depot and Disney can afford.
McDonald’s warned that it might have to drop its health insurance plan for some 30,000 restaurant workers because of new rules imposed by ObamaCare. McDonald’s insurer spends too much money on administrative costs and not enough on health services to fit the federal standard. So in the name of consumer protection, thousands of low-wage hamburger cooks are likely to lose their health insurance starting next year. That’s the genius of healthcare reform
Three Rabbis and an Eskimo walk into a gay bar. The ostrich says "If you like your current health care plan -- you can keep it!" Ha! That one gets me everytime. AP:
WASHINGTON -- A plan by Medicare to try to make it simpler for consumers to pick drug coverage could force 3 million seniors to switch plans next year whether they like it or not, says an independent analysis.
That risks undercutting President Barack Obama's promise that people can keep their health plans if they like them.
And it could be an unwelcome surprise for many seniors who hadn't intended to make a change during Medicare's open enrollment season this fall.
To be fair, they are trying to make it easier to pick coverage. If there's only one plan...
Politico has the slide show developed to help the Democrats "sell" ObamaCare® I thought hopes for GOP Midterm Tsunamis were overblown. Until I saw this presentation.
It is critical to reassure seniors that Medicare will not be cut [Don't mention the $500 Billion cut in Medicare]
Tell non college educated women that the health care law passed, Explain what is in the law and how it will affect them. Let them know they can keep the coverage they have now. [If they didn't want to be lied to, they should have gone to college.]
Tell latinos that the health care law passed, explain what is in the law by using a personal story... [Say Jennifer Lopez is injured on the way to pick up some tortillas...that's a good one]
For Voters Under 40...Do not make grand claims about the law. Use 'improve it' language.
Slide 24 (penultimate):
-- list benefits outside of personal context;
-- say the law will reduce costs and deficit. [Ooops.]
Hat-tip: @JimPethokoukis, who summarizes "Dem strategy to change healthcare opinion by public: anecdotes, lots of anecdotes "
Shhh! Don't call them death panels, people will think you're stupid. No, it's just an occasion where a government bureaucrat not approved by the Senate decides whether the government will pay for FDA approved treatments to extend lives. Or not. Washington Examiner:
The Ovarian Cancer National Alliance explains the problem: "Medicare must cover therapies that are 'reasonable and necessary,' while the FDA is instructed to approve drugs that are 'safe and effective.' Because of the conflicting federal coverage and approval requirements, there are some non-FDA approved drugs (called off-label drugs) that are paid for by CMS. However, with respect to Provenge, it appears that CMS is arguing that while the treatment is safe and effective, it may not be reasonable and necessary. For the first time, an FDA approved anti-cancer therapy may not be covered by Medicare."
The same problem has developed on Avastin, according to the Susan G. Komen Fund, which has joined with OCNA advocating for Medicare coverage of both drugs. With respect to Avastin, Komen's founder and, CEO, Ambassador Nancy Brinker, said "We recognize the benefits of Avastin overall are modest for women with metastatic breast cancer. However, we do know that for some women, Avastin offers a greater than modest benefit. We hope that this decision will not restrict access to Avastin to all patients."
There's an old blues song that has always baffled me:
If I don't love you baby, then,
Grits ain't groceries,
Eggs ain't poultry,
And Mona Lisa was a man.
I grew up on brain teasers and tried to deconstruct these lyrics a little more than Little Milton probably intended. Though not demonstrably false, none of the negatives struck me as "2 + 2 = 4" true. Was I dissembling, or was Diminutive Milt a little less committed than he wanted to let on?
Perhaps the Obama Administration will set up an agency to tackle the grits-groceries conundrum. But by law, they will have to decide "What is Health Care?"
There will be more such what-have-they-done ObamaCare moments. Wait until the public discovers the government is now literally determining what qualifies as "health care" in America.
That isn't a typo. ObamaCare mandates that insurers spend a certain percentage of premium dollars on benefits, but Democrats never got around to writing the fine print of what counts as a benefit. So a handful of regulators are now choosing among the tens of thousands of services that doctors, hospitals and insurers offer. Few other government decisions will do more to shape tomorrow's health market, or what's left of it.
This command-and-control mechanism is the bill's mandate for insurance "medical loss ratios" (MLR) of 85% for large employers and 80% for small businesses and individuals. The MLR is an accounting statistic that measures the share of premiums paid out in patient claims ("losses"). In the individual market, MLRs typically run between 65% and 75%, and Democrats like Jay Rockefeller and Al Franken think this is evidence of excessive profits, executive pay, marketing and other supposedly wasteful overhead.
The same mentality prevails in the Administration, so it may well adopt a narrow definition of medical expenses when it issues final regulations by early fall. The insurance industry is lobbying for a less rigid standard: It will be easier to run a business and turn a profit if more of the costs are considered truly medical in nature.
Looking at other bureaucracies, I think I'd be more willing to trust Little Milton.
UPDATE: From the same editorial: "Even North Dakota's Democratic Rep. Earl Pomeroy, who voted for the bill, argues that tight MLR regulation 'could have a chilling effect on future innovative programs.' " Not that he ever considered -- for one second -- not voting for the innovation-chilling legislation. Thanks, Earl!
Got my National MS Society Newsletter in my inbox. Usually, I delete it before it has the opportunity to anger me, but there are a few interesting things. There have been a few new drugs approved lately, and this letter brings news of a new FDA Fast Track. Fast Track is where the FDA behaves as it should. They only do this in extreme circumstances, mind you, but I guess it's better than never.
But the second item was "Changes in access to health insurance and new health insurance rules are starting now with more to come this fall and next January. What does this mean to you? Our Health Care Reform team has created concise answers to the FAQs of people affected by MS."
Against my better judgment, I clicked. It's not awful, but it is a press release from the White House, repeating every lie and not questioning anything.
Q: I have MS and am uninsured. Can I now buy an individual health insurance policy?
A: Yes, if you have been without insurance for six months or more Uninsured people with pre-existing conditions will be able to buy a health plan through temporary high risk pools. In most states, they opened July 1, 2010. These pools will provide insurance until 2014. Although the temporary high risk pools are government financed, the premiums may still be high until more significant federal subsidies take effect through the National Health Benefit Exchanges in 2014. Still, these temporary pools mean no one can be refused insurance because of MS or any other condition.
Yup, it's got a lot more government -- which is better -- but over time we'll add more and more government and it will be better still.
Sadly, it is the last year they will be doing this but it is a pretty good crew. A few nurses associated with my drug trial are walking. I'll suggest supporting the "Advanced Neurology of Colorado" team. If you wanna.
In short, as a reaction to the self-destruction of Europe in World War II and the twin monsters of fascism and communism, Europeans thought they could change human nature itself through the creation of an all-caring, all-wise European Union uber-citizen. Instead of dealing with human sins, European wise men of the last half-century would simply declare them passé.
But human-driven history is now roaring back with a fury in Europe -- from Mediterranean insolvency, to the threat of radical Islam, to demographic decline, to new international dangers on the horizon.
Only one question remains: At a time when Europe is discovering that its democratic socialism does not work, why in the world is the United States doing its best to copy it?
Both are good questions, and I have a single answer for both of them: If America doesn't follow suit quickly enough the "utopian" Euro-centric systems may crumble of their own weight before we get there.
The Progressives/Marxists/Euro-socialists will, of course, tell us that once America is integrated into the collective it will suddenly become sustainable. How, exactly, they never say. Nor do they explain our lack of recourse if, once the "bill is passed," we find it undesirable.
HHS Secretary Kathleen Sebelius defends the President's choice of Dr. Donald Berwick to run the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare.
Have some compassion for the poor Secretary. I don't think I could defend him either:
The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.
...any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional."
I am romantic about the [British] National Health Service; I love it.
You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach. You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.
Clearly, the "Absolutely Right Leader At This Time."
For our new hospital! It's close, has a modern infrastructure, good security, banking system. Canada!
TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.
Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.
British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.
And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.
None of their hockey teams are very good, but we will have to make sacrifices to keep the lamps of freedom and medical innovation alive.
Sadly, I am souring on all my Central American locations for our new hospital.
But word comes of potential staff. As they are already in Texas, they won't have as far to relocate.
Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.
Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.
“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.”
But, jk, they aren't leaving medicine -- just government medicine. Check your calendar.
I added this as an update to the post below, but that wasn't cathartic enough.
Let me get this straight -- you're assessing an extra fine if I give a job to a poor person? I guess if you accept that it's okay to fine an employer for providing a job to anybody, that only makes it a bit weirder.
UPDATE: Unintended consequence of side effect: Now you have to tell your employer your family income! Privacy anyone?
Under the new law, health insurance premiums charged by employers to employees must not exceed 9.5% of their household income. As many as 38% of employers may be at risk of violating the unaffordable coverage provision, [a Mercer] study concluded…
Mercer partner Tracy Watts said, “Lawmakers did not take into account that employers don’t have access to information on employee household income. Employers question how they are going to get that information and…what happens if an employee’s total family income changes during the course of a plan year?”
We have to pass the bill so that you can find out what is in it, -- Speaker Nancy Pelosi
I'm confidant in the timelessness because this quote opens two stories today. Both James Taranto and the Washington Examiner Editorial Page see fit to open columns reminding readers of this curious phrase.
Taranto references Senator Patty Murray's concern that "An obscure part" of the law restricts abortion.
"Implementation of this reform should be about increasing access to health care and increasing choices, not taking them away," said Sen. Patty Murray, D-Wash., a member of the Senate leadership. "Health care reform is not an excuse to take rights away from women."
Taranto provides the inconvenient truth that her vote for cloture cleared the biggest hurdle to enact this bill as law. Dang.
And the Examiner uses to the Speaker's words to highlight what happens when you read Section 1334, pages 97-100,
That section gives the U.S. Office of Personnel Management — which presently manages the federal civil service — new responsibilities: establishing and running two entirely new government health insurance programs to compete directly with private insurance companies in every state with coverage for people outside of government.
Quoting the new law, former OPM director Donald Devine notes that it makes the OPM boss a health care czar, with power to set “‘profit margin premiums and other such terms and conditions of coverage as are in the interest of enrollees in such plans.’ That’s open-ended. You can do anything.” Dan Blair, another former OPM director, calls the new program “nothing but a placeholder for the public option.” Indeed, the OPM head is also given the authority to “appoint as many employees” as needed to run the program, and to spend “such sums as may be necessary” to establish and administer it.
Huh. Public option, abortion restrictions -- if only there were some way to find out what was in a bill without enacting it into law! You'd think Madison would have thought of that.
UPDATE: Don't tell Harold and Kumar! White Castle analyst points out perverse mechanism against hiring poor people. You really can't make this stuff up!
The actor will be part of the White House Office of Public Liaison, which is run by Obama senior adviser Valerie Jarrett. Penn will be primarily involved in dealing with Asian American and Pacific Islander communities and the arts community.
A new lawsuit against ObamaCare® takes a more expansive view of its unconstitutionality.
In the complaint, the material about the interstate commerce power and the tax power is fairly standard. What makes the lawsuit significance is a well-developed argument (subject, of course, to the caveat that a complaint is not a brief) on medical privacy issues. Primarily, that the compelled disclosure to insurance corporations and insurance agents of private medical information (as well as urine or DNA samples and so on) is a violation of Fifth Amendment liberty, and of the constitutional right of privacy. Further, coercing individuals to associate with insurance companies and insurance agencies is a violation of the right of association, a right derivative of the First Amendment, but, as developed in later case law, not at all limited to classic First Amendment associations such as political or expressive organizations.
Maybe there is too much sarcasm around ThreeSources lately. But when you see this, how can you avoid it?
Health overhaul law potentially costs $115B more
WASHINGTON – President Barack Obama's new health care law could potentially add at least $115 billion more to government health care spending over the next 10 years, congressional budget referees said Tuesday.
If Congress approves all the additional spending called for in the legislation, it would push the ten-year cost of the overhaul above $1 trillion — an unofficial limit the Obama administration set early on.
The Congressional Budget Office said the added spending includes $10 billion to $20 billion in administrative costs to federal agencies carrying out the law, as well as $34 billion for community health centers and $39 billion for Indian health care.
The costs were not reflected in earlier estimates by the budget office, although Republican lawmakers strenuously argued that they should have been. Part of the reason is technical: the additional spending is not mandatory, leaving Congress with discretion to provide the funds in follow-on legislation — or not.
In addition to the cost, states are worried about the strings attached to the program. In a conference call with state officials last week, HHS officials weren't able to answer specific questions about federal mandates that will be placed on participating states. That's discomforting because HHS will draft the program's rules only after states decide whether to sign up. -- Grace Marie Turner
From a great editorial in the WSJ, looking at States' decision to sign up for high-risk pools that are scheduled to run out of money "next year or in 2012."
But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.
It's a worrisome assessment for Democrats.
In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.
Hat-tip: Megan McArdle who asks Who could possibly have predicted this shocking and totally unexpected turn of events?
Now that the world is belatedly waking up to the fact that President Obama lied his face off about the fiscal impacts of health care reform, maybe it's an appropriate time to point out that he's lying his face off about financial reform as well:
JK just highlighted the press "discovery" of the impending doctor shortage and treatment delays and degradation under Obamacare. But Obamacare's big selling points were affordability and accessibility. We'll get improvements in those areas by mandating that everyone have coverage, right? Wrong.
In June 2002, Washington Policy Center published a study showing how state-imposed mandates add to the cost of health insurance. Since then state lawmakers have added new mandates, and the cost of insurance has continued to rise.
Yes I realize that the verb 'mandate' acts on different objects in the comparative cases, but the idea is that when government interferes in the marketplace only bad things happen.
Taken together, however, mandates impose significant cost on the health insurance market. State-imposed mandates carry the force of law, and they interfere directly in the voluntary relationship between buyer and seller. Mandates mean people are forced to pay for coverage they may not otherwise choose. This leads to a “crowding out” effect – coverage customers prefer is not available because insurers must offer the mandated benefits instead.
In Washington state, where this report was produced, the state mandates some 57 different conditions, providers, and beneficiaries be included in every health insurance policy. Included among these is "port wine stain removal." Imagine that not being covered. Oh, the humanity!
I don't think they're even factoring in Doctor Galts (Henderson, was it?) But "experts" on the WSJ News pages are discovering what real experts on the WSJ Editorial Page were screaming for months: we won't have enough doctors without ObamaCare®, ObamaCare® makes it worse, and ObamaCare® does nothing positive to alleviate the shortage.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
This is so weird. Government controls the price. And then there's a shortage. Somebody should do a study and see if there is some correlation...
If you like your plan, you can keep it: Whoops - Congress Eliminates Own Health Care Plan via Obamacare http://bit.ly/c2W08d #tcot #hcr -- @bdomenech (Ben Domenech)
UPDATE: Same topic, diff'rent pundit:
Good luck with that, guys. Are congressmen really going to pass legislation to rectify the harm ObamaCare did to them, while continuing to subject everyone else to this awful, hated law? Leaving the law in place isn't a politically attractive option either, for the reason National Review's Yuval Levin points out: "If you had your own research service to help you figure out what the law will do to your insurance, the answer would likely be just as confusing and discouraging." The CRS's findings are a powerful reminder that ObamaCare likely holds horrible surprises for everyone. -- James Taranto
In the 25th comment under JK's "That's Not Me" post lamenting the "God and Values and Country" flavor of the organized TEA Party Express bus tour JK expressed that "giving" a right to individuals which, in turn, takes away the rights of other individuals to "define my own law" is an unusual bargain. Maybe I'm being too cavalier but I believe that's what America has always been about. In the 26th comment I made a layman's case for a supportive Constitutional interpretation:
I contend that our difference of opinion arises from two different interpretations of the Ninth Amendment:"The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."
I submit that these unenumerated rights are those of individual people. I read you as insisting that what is not explicitly prohibited by the Constitution any majority of people may impose upon all individual people. I say the latter interpretation de facto turns the ninth amendment on its head.
It's an interesting topic worthy of its own post. And the original thread rolled off the page today. Something tells me that commenters aren't yet finished.
UPDATE: An extension of the excerpt from my own comment (in response to jk's first comment below).
The ninth amendment is to protect the rights of individuals, of minorities, from all levels of government, not of states from the Feds. By my reading the tenth amendment does not give the states power to abrogate the right of individual people "to be secure in their persons..."
This is the nature of my "parasite" argument. That clinical term does not imply benefit or harm, but the state of being conjoined as one person in the eyes of the Constitution. No, you won't find this in the text. But you will find numerous prohibitions that threaten Obamacare or "the right to receive uncompensated medical care from my neighbor."
If you say to an average person: "What would you rather have: Free health care or an un-trampled Constitution," people are going to pick free health care because people like free stuff. They also like rainbows, puppies and therapeutic massage and, one day, we will all have a right to those too — I hope. Which is why we had the Constitution to begin with: To protect us from ourselves. -- Greg Gutfield.
Gutfield is respecting Rep Phil Hare's candor "I give him credit for saying what no one else on his side is saying: This entitlement means more to us than the principles on which our country was founded." We're stupefied hearing him say he doesn't care about the Constitution (and them of course, conflating it with the Declaration -- the depredating that.
But Gutfield is sadly right. My newfound Facebook Communists don't see why some old piece of paper should keep them from getting free stuff.
UPDATE: Heh. Blog Brother ac posts Gutfield's "politically-incorrect" iPad review.
Obamacare was supposed to provide unicorns and rainbows: How can it possibly be hurting companies and killing jobs? Surely there's some sort of Republican conspiracy going on here!
More like a confederacy of dunces. Waxman and his colleagues in Congress can't possibly understand the health care market well enough to fix it. But what's more striking is that Waxman's outraged reaction revealed that they don't even understand their own area of responsibility - regulation -- well enough to predict the effect of changes in legislation. -- Glenn Reynolds in an Examiner editorial with bonus Hayek references,
The president is "frustrated" that Republicans did not support these ideas that they had actually proposed in the past.
Mister president, have you forgotten that the Republicans were VOTED OUT OF OFFICE FOR THE POLICIES THEY PROPOSED IN THE PAST? Instead of trying to please congressional Republicans, try pleasing the voters.
Investors.com editorial page explains how national health bills have been repealed in the past and can be again.
Once before there were "angry mobs" reacting to government expansion of and into health care. They once greeted former House Ways and Means Chairman Dan Rostenkowski over the Medicare Catastrophic Coverage Act of 1988, which expanded Medicare benefits and funded it with a supplemental tax.
Unlike the current legislation, which was barely passed through a combination of deals such as the Cornhusker Kickback and the Louisiana Purchase (along with a worthless executive order on federal funding of abortion services), the earlier bill passed the House in June 1988 by a vote of 328-72. It passed the Senate by 86-11.
In a precursor to the Tea Party movement, the natives, particularly seniors, rebelled over its provisions and the supplemental tax.
Legislation to repeal was introduced in the House on Nov. 7, 1989, and passed by a voice vote.
There's still time for repeal. House Minority Leader John Boehner says the election of a Republican House and Senate in 2010 would make possible the de-funding of ObamaCare. A victory at the presidential level in 2012 would seal the deal.
It can be done. It has been done. It must be done. To paraphrase Joe Biden, it's a big deal.
I thought 10 p.m. to 11 p.m. Sunday night in Washington was the Republican Party's finest hour in a long time. When the voting stopped, the screen said the number of Republicans voting for Mr. Obama's bill was zero. Not one. Nobody. -- Dan Henninger
I'm going to try and take the advice of two very smart people. Nicholas Nassim Taleb suggested, in The Black Swan, that everybody [jk] should read more books and less news. A good friend of mine and this blog sent a private email suggesting that my jest of "putting down the keyboard" was actually a pretty good idea.
My work has me wired in and using three Internet connected computers, so I won't stop hitting F5 on ThreeSources, but in that spirit I did decide that the best reaction to my liberty-ignoring friends was no reaction.
Another good friend who has right to be far more disappointed than me pointed out the folly of repeal. "We're gonna take away your free stuff" is not really a campaign winner. ObamaCare is here to stay, All we can do [close your ears ThreeSourcers, he's gonna say it again] is fight at the margins.
It's a Brave, New, Darkly Dystopian world -- and Soma® isn't even legal.
AND YET, I still have to link to Holman Jenkins's outstanding editorial today "Now Can We Have Health Care Reform?"
We'll let Angela Braly, CEO of insurer WellPoint, take the story from here. She was recently hauled before Congress to justify her company's proposed 39% rate hike in California. She explained the source was two-fold: rising medical costs and healthier customers dropping their coverage, forcing the sick to pick up the tab.
Now this sounds like two problems, but for WellPoint and other insurers it's really only one problem. Once everyone is required by government mandate to buy insurance, the industry's survival is no longer threatened: It can just pass its skyrocketing costs along to customers.
Once customers can no longer refuse to buy the industry's product, the problem of costs won't be fixed, but it no longer is the insurance industry's problem.
There, in that one sentence, we give you the failure of ObamaCare, the failure of the congressional health-care debate, the failure of health-care politics in this country.
He ends with a dare for us to open our hospital. Judging from my email, a lot of health professionals are ready to join us:
A world-class hospital in India does heart surgery the equal of any heart surgery in America, but does so at one-tenth the cost (and increasingly attracts a world-wide clientele). The reason is not what you think: low-paid doctors and nurses. The reason is that competition works in medicine as it does in everything else when the patient cares about getting value for money. This is the great low-hanging fruit of health-care reform. It continues to hang.
Just as the housing bubble can be traced to the Community Reinvestment Act, the American health care 'crisis' can be traced to EMTALA. This act, part of the 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA) is the origin of the treatment-on-demand mandate on American hospitals. The stick that makes hospitals comply is continued receipt of Medicare reimbursements. So why can't a private hospital choose to stop treating Medicare patients and, as an added bonus, indigent patients?
As with the CRA, EMTALA was made worse by subsequent amendments. Like this one:
"Though patients treated under EMTALA may or may not be able to pay or have insurance or other programs pay for the associated costs, they are legally responsible for any costs incurred as a result of their care under civil law. Patients whose advance intention it is to receive medical care and fail to pay cannot be held criminally liable unless they intentionally and knowingly provide false identifying information to dodge billing."
And yet, as amended...
"The patient cannot receive a negative credit mark for failure to pay the hospital or any related services, or any third-party agent collecting on their behalf."
Jon Caldera is collecting signatures for a ballot initiative to amend the Colorado Constitution to protect health care choice.
We at the Independence Institute refuse to watch this atrocity corrode the quality of healthcare in Colorado. For months we have been at work bringing forward an amendment to the Colorado Constitution to preserve as a basic human right our “Right to Health Care Choice.” It is my goal to make Colorado a sanctuary state for quality healthcare.
This citizens’ initiative is very close to the petition stage. Soon we will need as many volunteer petition gatherers as possible. We will also need funding to wage this battle. I ask you, right now, to donate to our fight. I desperately need your talents, your time, and your resources to protect Colorado from this affront coming from DC. We can stop Washington.
Follow the links to read the amendment (in lovely, non-selectable PDF...)
-- I am proud of the GOP
-- I am proud of my State:
DENVER (AP) — Colorado is joining at least nine other states in suing to block federal health care legislation.
Republican Attorney General John Suthers said Monday he will join the suit, despite the objections of Democratic Gov. Bill Ritter.
Suthers said the bill's requirement that most Americans buy health insurance or be subject to fines is an unconstitutional expansion of the federal government's powers. He says Congress has the right to control interstate commerce but can't force people to participate in commerce.
Suthers said his decision isn't politically motivated. Republican state lawmakers urged him to join the lawsuit earlier in the day but Suthers said he didn't meet with them to reach his decision.
The editors of National Review sensibly counsel conservatives, in the wake of last night’s victory for Obamacare: “‘Nil desperandum’--never despair.” I agree, though I’m more inclined to the mock-Latin motto of the Harvard band: “Illegitimi non carborundum”--don't let the bastards get you down. -- Bill Kristol
"I quit when medicine was placed under State control some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I could not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun.
I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything - except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but 'to serve.'
That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards - never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind - yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce.
Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it - and still less safe, if he is the sort who doesn't."
-- Ayn Rand, from Atlas Shrugged, published in 1957
I've never been prouder to be a Republican. The party's Congressional leaders have fought this battle to the end on behalf of the American people--with intelligence, toughness, persistence and good humor. The contrast between the parties has never been starker than in today's debate. If any intelligent Democrats were watching--there must be some left--they had to be embarrassed for their party.--John Hinderocker, looking for silver linings on a day of dark-ass clouds.
Beyond that, it's doubtful that opposition to the measure will ever again be as high as it is now. Fox News polling found that 45 percent of voters would favor repeal, while 47 percent say leave the reforms alone or add to them. With the big insurance subsidies years away, the initial changes stemming from the legislation would be relatively modest -- and that should come as a surprise to an American public told by Republican foes of the legislation to expect a socialist takeover of the United States.
There will certainly be ads this fall saying Republican Congressman X voted against tax breaks for small business and voted to deny Junior his life-saving treatments. These modest changes to the health system probably wouldn't be widespread and noticeable enough to limit Democratic losses at a time of 10 percent unemployment. But, at the very least, voters would see nothing to justify the Republicans' apocalyptic predictions.
Yet repeal still holds appeal, even to the likes of Mitt Romney, who as governor of Massachusetts created what the New Republic's Jonathan Chait calls "the closest thing to Obamacare in the United States." A poll by the Boston Globe and Harvard last fall found that only one in 10 Massachusetts residents favors a repeal of that program.
AP/OBAMA Newswire - "Medicare fix would push health care into the red"
Betsy Markey based her vote on the CBO deficit reduction number. Now AP (not the Washington Times, not the Heritage Foundation ... the 'in-the-tank, Associated Press) reports:
The Congressional Budget Office said Friday that rolling back a programmed cut in Medicare fees to doctors would cost $208 billion over 10 years. If added back to the health care overhaul bill, it would wipe out all the deficit reduction, leaving the legislation $59 billion in the red.
Obama, Biden, Pelosi, Markey and the entire Subvert Constitutional Procedure Caucus have been hailing deficit reduction as the justification for destroying the best part of Canada's health care system - the American system. Now this AP report, citing CBO blows that claim out of the water.
I'm really curious why our more liberal blog brothers been completely silent through all of this. Do they believe ObamaCare will cut the deficit, or do they think it's "benefits" are worth a bit more deficit spending?
This is cool! Tania Gail of PAWaterCooler.com is going to the Capitol rally today and she's posting live video clips to her website via cell phone. If you click on the image it links to her qik.com page which shows a google map of her location when the video was recorded.
11 minutes ago she posted this clip."Holy cow, people are coming!"
Professor Mankiw suggests a warning label for CBO scores:
In the discussion of out and out lies and gimmickry used to game the CBO numbers, both Larry Kudlow and Mankiw remind that the CBO by definition scores statically (their Laffer Curve is flat). They can score an increase in taxes to 110% as revenue and not account for any loss from people who would prefer not to pay to go to work every day.
Indeed, to be very wonkish about it, these tax changes could have especially large GDP effects. Some people like to argue that taxes have small GDP effects because income and substitution effects offset each other. But if you give someone a subsidy and then phase it out, both the income and substitution effects work in the direction of reducing work effort.
Why does CBO assume no change in GDP? It is not because the CBO staffers necessarily believe that result. Rather, it is just one of the conventions of budget scoring.
Those of us paying attention knew it was true, but now someone within the Democrat ranks has leaked proof:
“As most health staff knows, leadership and the White House are working with the AMA to rally physicians for a full SGR ["sustainable growth rate" for medicare reimbursements to doctors] repeal later this spring. However, both health and communications staff should understand we do not want that policy discussion discussed at this time, lest (it) complicate the last critical push to pass health reform,” according to the memo.
The memo helps explains why the American Medical Association has supported reform even though their top legislative priority, the doc fix, was left out. The group is working behind the scenes with Democratic leadership and the White House to fix the cuts later this year.
And in the prior paragraph of the memo was this astonishingly honest statement:
"The inclusion of a full SGR repeal would undermine reform's budget neutrality."
According to the Politico piece, SGR repeal would increase the deficit another $371 ba-billion.
Gee, it's a good thing Rep. Betsy Markey made sure that the CBO scored the legislation as "deficit reducing." I guess she didn't get the memo, addressed to "Democratic Health and Communications Staff."
Has there ever been a political spectacle like the final throes of ObamaCare? We can't recall one outside of a banana republic, or, more accurately, Woody Allen's 1971 classic "Bananas." Capitol Hill resembles nothing so much as that movie's farcical coup d'etat in San Marcos as Democrats try to assemble the partisan minimum of 216 House votes—if only for an hour or so at some point on Sunday—and no bribe is too costly, no deal too cynical, no last-minute rewrite too blatant.
Yesterday, Democrats defeated 222 to 203 a GOP resolution that would have required them to vote up-or-down on the text of the Senate's Christmas Eve bill. Big Labor hates that bill's tax on high-cost health coverage, and rank-and-file Members are so embarrassed by its kickbacks that Democrats are resorting to the procedural trick of "deeming" it passed instead. Speaker Nancy Pelosi actually told reporters this week that "nobody wants to vote for the Senate bill," but she'll do what it takes to impose it anyway.
The Commander in Chief even felt obliged to cancel his overseas trip so he could personally explain to Members why this Presidential legacy project is worth their defeat in November. Four separate workout sessions, including an Air Force One trip to hometown Cleveland, were enough to convert Dennis Kucinich. The supposedly principled Ohio liberal had opposed ObamaCare in the House's November vote because it still preserves a vestige of a private health-care industry. But a vast expansion of the welfare state as a consolation prize is now good enough for his government work.
That's only the start of the logrolling, if that's not an insult to logs. Secretary of the Interior Ken Salazar announced on Tuesday that central California would get extra public water allocations. This was apparently the price for Democrats Dennis Cardoza and Jim Costa to vote something other than their consciences. We will hear about many more in the coming days.
Also yesterday the white smoke rose up from the Congressional Budget Office, which released its cost estimates for the "reconciliation" bill and the sundry fixes without which Mrs. Pelosi can't deem the Senate bill passed. Democrats pre-emptively released the topline numbers, which by themselves took weeks of tweaking to game the CBO's accounting conventions and officially stay under $1 trillion in spending for 10 years. (The real cost over a decade once all the spending kicks in: $2.4 trillion.)
CBO Director Doug Elmendorf was thus obliged to release a "preliminary estimate," having "not thoroughly examined the legislative language." Mr. Elmendorf said at a hearing that his health-care staff members were close to burning out under "the almost round-the-clock schedule" of unrelenting Democratic demands about the budgetary effects of this or that provision. And all for a bill whose subsidies don't begin until 2014.
By the way, to make the deficit numbers "work," Democrats decided at the 11th hour to increase their new tax on investment income to 3.8% from 2.9%. Congratulations.
White House budget director Peter Orszag quickly declared that "The CBO score today should leave no doubt that we are operating in a new fiscal era," and no kidding. One thing the score also made clear, however, is that Mrs. Pelosi's reconciliation fixes could easily be blown to pieces in the Senate. While the Democratic strategy is already a wholesale abuse of the traditional reconciliation process, it now bids to violate the actual rules of reconciliation as well.
In a carom shot if there ever was one, the excise tax on gold-plated health coverage has received one last tweak. It is expected to fund ObamaCare as employees take more of their compensation in wages rather than health insurance, thus exposing more income to ordinary taxes. The House demand to delay that tax until 2018 from 2013 in the Senate bill—to appease the likes of AFL-CIO president Richard Trumka, who met one-on-one with Mr. Obama on Wednesday—therefore reduces Social Security payroll tax revenues. But reconciliation expressly forbids such changes to Social Security, and CBO says this change will drain some $53 billion from the program's trust fund.
Senate Republicans will therefore be entitled to raise a budget "point of order" against the entire reconciliation bill if it does arrive in the upper chamber. That will let them strip out the offending provision—which will offend the labor movement, to say the least—or even send the entire bill back to the House, forcing another round of agony on the gullible rank-and-file.
North Dakota Senator Kent Conrad admitted the risks yesterday, asking rhetorically if he expected that some GOP "challenges will be upheld? Yeah. I do." By the way, Mr. Conrad and his House North Dakota colleague Earl Pomeroy are getting a special provision that exempts a state-owned North Dakota bank from the unrelated private student loan takeover that Democrats have included as part of ObamaCare. That multibillion-dollar baby was added to further rig the budget numbers and win over conflicted Members.
Even the political panic over the 2008 Troubled Asset Relief Program, amid an incipient financial collapse and a Presidential election, looks like regular order compared to this ObamaCare mayhem. That the White House and Mrs. Pelosi are still running into such resistance after a year of pleading reveals what an historic blunder ObamaCare really is.
This is what happens when a willful President and his party try to govern America from the ideological left, imposing a reckless expansion of the entitlement state that most Americans, and even dozens of Democrats in Congress, clearly despise.
Despite what meager effort I and my family and those I emailed in CO-4 could make, today's fake CBO report gave Betsy Markey the cover she wanted to commit political suicide in this traditionally conservative district. I hope voters remember the "Markey Mistake" for a long, long time.
Markey's decision to vote in favor of the bill will almost certainly become a dominant issue for Republicans as they try to oust her in November. Markey in 2008 became the first Democrat in 36 years to win the 4th Congressional District seat, and national Republicans have made ousting her a top priority this year.
Two recent polls released by business groups opposed to the Democrats' health care bill showed a majority of district residents were against the bill.
Markey said her decision to support the bill was about policy, not politics.
"I'm not a career politician and I've said this before, this is not a stepping stone for another career. I'm not here as a place to retire," she said.
First, I don't believe that Obamacare would lead to 31 million more patients. I believe they're all receiving care when they need it already but I went with it for a snappy title. Investor's Business Daily surveyed some 25,000 doctors last summer (about 1400 of whom responded) and reported that 45% said they'd close their practice or retire early if Obamacare passed. And they opposed the measure two to one. The left-stream media slammed this as "ludicrous."
Yesterday IBD reported a similar survey by a physician's job placement firm, reported in the New England Journal of Medicine, with similar findings:
This poll, conducted by the Medicus Firm, a physician search and consulting outfit, found that 29.2% of the nearly 1,200 doctors it queried said they would quit or retire early if a health overhaul were passed into law. That number jumped to 45.7% — nearly identical to our own — if a public option were included.
In the end, it's clear: A health care overhaul, as it's now being pushed, could lead to a precipitous drop in the number of doctors.
"Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases," wrote Kevin Perpetua, managing partner of the Medicus Firm, summing up his findings.
I just called my congressperson, U.S. Representative Betsy Markey of CO-4. Her website touts a report that she is one of the most centrist and independent members of congress. The House Switchboard number was busy so I called her office directly and got right through.
I asked if the congresswoman had decided how she intends to vote on the Health Care bill. Her staffer told me that she is waiting for a cost analysis by the CBO and has not yet made a decision. I said, "I am her constituent, residing near Fort Lupton, and I would like to encourage her to vote NO. I think if she votes yes then this won't be the United States of America any more and if she votes no she will become one of a handful of national heroes."
I was asked for my name and contact information, which I gave. (Not that they couldn't have guessed I'm a registered Republican anyway.)
Things are looking up for our Mexican Health Care venture! Insty links to this NEJM Survey of physicians who might "Go Galt" if ObamaCare® passes. There's some up and down and the leftist slant of NEJM's readership shows through in spots ("0.8% feel income will 'improve dramatically' with a public option." -- kinda hope that's not my doctor...)
But the money quote for us is:
Health Reform and Primary Care Physicians
* 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.
To which I say "Don't Go Galt, Go Kranz!" Join us in sunny Puerto Viarta at a free market hospital serving North America and the world.
We all have a favorite kind of story or blog post. I'll readily confess mine is exposing the huckster prop in a Democratic "feel their pain" pitch.
I suppose it goes back farther, but it all started for me with Grame Frost the 12-year-old poster boy for SCHIP. Way back in 2007, mean ol' President George W Bush vetoed the expansion of SCHIP (I do enjoy reminding right-wing Bush haters of this). So the Democrats chose young Grame to deliver their radio response. He pulled the heartstrings as he was recovering from a serious accident and his medical bills were affecting his parents.
Well, Dad turns out to be a hyper-partisan and a loser. He quit a good job to start his own woodworking business. The more one looked, the less sympathetic the family appeared.
I invoked their name on these pages in July of 2008. The Nunez family, in George Bush's Evil Amerikkka, could not afford meat. They were highlighted on an NPR story. But the 'R' is for radio, and once people saw the extremely obese family, sympathy rolled off a bit.
Today, FOXNews via Gateway Pundit brings us Natoma Canfield. She was President Obama's prop in Ohio -- follow the link to hear the President say "I am here for Natoma."
Natoma has cancer and is dying in the street without care after being kicked out of her home for failure to pay her medical bills and has nothing to eat or wear or...no....wait a minute, this just in: No, it appears she is in a top flight cancer center receiving care after 12 years of not working and dropping her insurance. She will get financial aid and will not lose her house:
Lyman Sornberger, executive director of patient financial services at the Cleveland Clinic, said "all indications" at the outset are that she will be considered for assistance.
"She may be eligible for state Medicaid … and/or she will be eligible for charity (care) of some form or type. … In my personal opinion, she will be eligible for something," he said, adding that Canfield should not be worried about losing her home.
"Cleveland Clinic will not put a lien on her home," he said.
Last Friday, Jack Calfee asked if health insurance profits are so healthy, why weren't large firms like Walmart, Microsoft and the like diving in. I mean, who would miss a chance to bilk an unsuspecting public out of -- wait for it -- $66?
Mark Perry at The American links to the Calfee piece and adds the $66 figure to the discussion:
Using the industry profit margin of 2.2 percent last year, it means that insurance companies make only about $66 on average per policy in profits for individual coverage, and less than $140 in profits for each family policy.
Wow! Two-point-two percent profit! Man, why doesn't every business give up the stupid things they do and hop into this lucrative pool?
America has the finest health care delivery system in the world. Let's not forget that and put it at risk in the name of reform. Desperate souls across the globe flock to our shores and cross our borders every day to seek our care. Why? Our system provides cures while the government-run systems from which they flee do not. Compare Europe's common cancer mortality rates to America's: breast cancer - 52 percent higher in Germany and 88 percent higher in the United Kingdom; prostate cancer - a staggering 604 percent higher in the United Kingdom and 457 percent higher in Norway; colon cancer - 40 percent higher in the United Kingdom.
Look closer at the United Kingdom. Britain's higher cancer mortality rate results in 25,000 more cancer deaths per year compared to a similar population size in the United States. But because the U.S. population is roughly five times larger than the United Kingdom's, that would translate into 125,000 unnecessary American cancer deaths every year. This is more than all the mothers and fathers, aunts and uncles, cousins and children in Topeka, Kan. And keep in mind, these numbers are for cancer alone. America also has better survival rates for other major killers, such as heart attacks and strokes. Whatever we do, let us not surrender the great gains we have made. First, do no harm. Lives are at stake. -- Dr. Milton R. Wolf, Barack Obama's second cousin once removed.
I have been meaning to ask whether any reproductive-rights ThreeSourcers had found new respect for pro-life legislators since they became the best chance to kill ObamaCare® and keep the last vestige of freedom in these United States.
But then I saw this, and I am laughing too hard to type:
That's especially true given yesterday's report indicating that at least seven of Stupak's faction have confirmed they will not vote for a reform bill without a change in the abortion language.
Another single-issue conflict with a different House faction also reared its head: The Hispanic Caucus is now publicly threatening to torpedo reform because of the Senate bill's ultra-restrictive language prohibiting illegal immigrants from buying health insurance through the state-run insurances exchanges that would be set up. At least one high-profile former yes vote, Illinois Rep. Luis Gutierrez, has said that he'll switch his vote to no if the immigrant restrictions aren't changed. (For more detail on this conflict, see the Reason Foundation's Shikha Dalmia.)
I hadn't seen this before. It's from last October and even if you've seen it, watch it again. Among other things the judge explains how federal government lawyers act to prevent unconstitutional laws from being judged so in court.
UPDATE (3/15): For those who didn't listen, and just because I want to see it in print, here is one of those other things the judge said: [closing minute]
"These gatherings are more important than anything you can imagine. Because in the long history of the world, only a few generations have been granted the role of defending freedom in its maximum hour of danger. You are that generation! This is your role! Now is that time! Freedom must be defended from every assailant in every corner of this country, from outside the country, from inside the country, and especially from the government that wants to take it away from us. [applause] God bless you."
Not only insurers, but all producers who greedily refuse to supply persons who don't pay should be set aright. Now I'm sure that YOU don't ration the supply of the books you write according to any criteria as sordid as requiring people actually to pay for them. But our society is full of people less enlightened than you.
For example, the typical worker rations his labor services according to who pays and who doesn't. That must stop. Oh, and supermarkets! Every single one rations groceries according to who pays. Likewise with restaurants, clothing stores, home-builders, furniture makers, even lawyers! You name it, rationing is done according to who pays. Indeed, my own county government has been corrupted by this greedy attitude: if I don't pay my taxes, the sheriff takes my house ... Preposterous!
I look forward to your changing this selfish and unfair system of rationing that for too long now has kept Americans impoverished.
Liberals don't think the middle-class insurance subsidies are large enough. Big Labor hates the "Cadillac tax" on high-cost health coverage because extremely generous benefits typically come out of collective bargaining. The pro-life Democrats led by Michigan's Bart Stupak can't abide federal funding for abortion. Everyone detests the enveloping corruption, such as the Nebraska Medicaid bribe for Ben Nelson, which has become so politically toxic that the opponents now include Ben Nelson. -- WSJ Ed Page
Gray's thesis is this: "It may be that the president believes the inalienable rights of "We the People" come from government, not from God. Driven by this worldview, the attempt to place health care under government control will continually re-emerge."
This is likely correct, but it better explains why Obama won't give upon reform, not why he can't. The latter reason, it seems to me, is that he expects large numbers of Democrats to be flushed down the electoral toilet at every opportunity given voters to pull the chain. They may as well have something consequential to show for it when their 60-vote majority is a distant and infamous memory.
But looking deeper into Gray's analysis I couldn't ignore the following passage.
Sen. Harkin's statement reflects the worldview behind the French Declaration of the Rights of Man of 1789, not the American Declaration of Independence of 1776.
The last sentence of the opening paragraph of the French Declaration of the Rights of Man reads: "Therefore the National Assembly recognizes and proclaims, in the presence and under the auspices of the Supreme Being, the following rights of man and of the citizen."
By appealing to an unknowable, deistic Supreme Being, the rights of man rested on the generosity of the State. A change in political power opens the door to a change in the rights of man. Man cannot confer inalienable rights.
In stark contrast, the American Declaration of Independence appealed to a knowable, personal God — the Creator of life itself. "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness."
According to the Declaration of Independence, inalienable rights do not arise from men, but from God.
Maybe it takes a non-theist to notice this but what exactly is the difference between "the Supreme Being" and "God?" According to Gray's analysis, the entire defense of an individual's right to his own life rests on this difference. If it arises from the "knowable" and "personal" God the question becomes, knowable and personal to whom? This is no more concrete and objective than the French Rights of Man he rightly criticizes, for it rests on the opinion of the democratic majority and gives no defense to heterodox individuals.
But where in the Declaration of Independence does the word "God" appear? The word I see is "Creator." The beauty of that word is that it makes no difference whatsoever who or what an individual's creator is because the fact of his existence is de facto proof that he has one. In essence, "I am, therefore I have rights." Magister dixit.
I certainly agree that this structure raises costs, but if you have a simple problem like this, you fix it, you do not say "hey, let's try communism."
Did anyone watch Obama's Health Care Summit? Did any of the geniuses there point this out? Didn't think so. Not in so many words, anyway.
CA's 'Health Care Mythology' is well structured for emailing to our "innumerate" (good word CA) relatives but I couldn't find a direct link to the individual essay. Maybe someone can help me here. In closing, I enjoyed the hockey references and erudite humor but alas, found it sadly lacking in Heinlein quotes. [Be patient -it's in there.]
Nope, I am thinking of a Mexican Mayo Clinic (or perhaps Costa Rica) that will be an Atlas Shrugged facility for health care. We'll take money and we'll sell real Clifford Asness insurance. We'll hire providers who did not go to Med school to be GS-7 Government employees, or who don't want to join AFSCME.
Whatever happens up here it's gonna be bad. The full brunt of ObamaCare may or may not be avoided but look at Massachusetts:
Last month, Democratic Governor Deval Patrick landed a neutron bomb, proposing hard price controls across almost all Massachusetts health care. State regulators already have the power to cap insurance premiums, which Mr. Patrick is activating. He also filed a bill that would give state regulators the power to review the rates of hospitals, physician groups and some specialty providers. Those that are deemed too high "shall be presumptively disapproved."
Mr. Patrick ad-libbed that he had "a whole bunch of pals here who are in the health-care field, and I saw the color drain out of their faces." Little wonder. The administered prices of Medicare and Medicaid already shift costs to private patients while below-cost reimbursement creates balance-sheet havoc among providers. Now the governor wants to import these distortions to save the state's heavily subsidized insurance program as costs explode.
The feds will enact some pieces, more states will do more. And pretty soon -- if not now -- you'll be able to staff a whole hospital in a sunny modern hotspot with disaffected staff. I am guessing, like Atlas, that you will attract the best in every category.
Affluent Canadians go south to avoid the privations of socialism. I wondered where Americans would go. Why not South? I believe there is already quite a bit of medical tourism in Costa Rica for specialty items like dental reconstruction and joint replacements. Why not a whole hospital?
ThreeSources and Heritage.org have just saved you SEVEN HOURS! Now you can catch up on all that Curling footage you Tivoed...
Senator Grassley has an awesome sound bite in there that opponents should pick up on. "Unconstitutional" doesn't mean anything to anybody who doesn’t read ThreeSources. His explanation of the unprecedented nature of government forcing you to buy something is very strong.
Lookit me, cheering on Sen. Grassley, I guess I am a pragmatist!
Ignoring pre-existing conditions might sound compassionate, but it is equivalent to declaring that a fire-insurance company must charge the same amount for a modern house with smoke detectors and interior fireproofing as for a century-old, wooden-frame former stable, complete with some hay left over, and a basement full of painting supplies.
The desire to help those with pre-existing conditions is laudable. The way to do this is to help. If someone needs more medical care than he or she can pay for, direct state subsidy is far more efficient than making insurance companies pretend that the patient isn’t ill or at high risk of becoming ill. We can separately debate the degree of generosity of this subsidy, but it is efficient and honest. Making insurance companies play “don’t ask, don’t tell” with health status is neither.
Wait a doggone minnit - this Asness character is an investment banker! Never mind. Say, how much was HIS bonus last year?!
Well, if Hitler, Hennessey and Hoyer are right, then in a couple of months the partisans on the left are going to be ramping it up from angry to screaming mad, after they are teased, led on, and frustrated all over again. -- Jim Glass at Scrivener.net
You are victims. You are helpless against the wiles of big corporations and insurance companies and you need protection. You need the government to take over and do things you cannot do for yourself.
That is the thinking of what David Brooks calls "the educated class" that favors the Democrats' health care bills. Members of this elite spout tales of woe of people denied coverage or care with the implication that there but for the grace of government go you. So sign on and the government will take care of everything.
We try to distill arguments down to their original essence around here. Michael Barone is good at this (as well as many other things). His "Hard Amerce, Soft America" is just such a distillation.
I'm glad to see him call out David Brooks in the second 'graph here. Many are looking for politicians to exhibit purer principle, I'd like to see some of the elitist establishment conservative pundits like George Will, David Brooks and Peggy Noonan take down a peg or 16.
She's not only merely dead, she's really most sincerely dead!
With apologies to EY Harburg, who would have championed government health care, the lyrics seem apt: Rep Steny Hoyer is breaking the news.
AP: WASHINGTON – Democratic congressional leaders confronted the reality Tuesday that they may not be able to pass the comprehensive health care overhaul sought by President Barack Obama. Republican leaders prepared to do everything in their power to make sure they can't.
Democrats saw the sweeping health bill that Obama unveiled ahead of a bipartisan health care summit Thursday as their last, best chance at a top-to-bottom remake of the nation's health care system that would usher in near-universal health coverage. But some were clear-eyed about the difficulties after a year of corrosive debate and the loss of their filibuster-proof supermajority in the Senate.
"The President's Proposal," as the 11-page White House document is headlined, is in one sense a notable achievement: It manages to take the worst of both the House and Senate bills and combine them into something more destructive. It includes more taxes, more subsidies and even less cost control than the Senate bill. And it purports to fix the special-interest favors in the Senate bill not by eliminating them—but by expanding them to everyone. -- WSJ Ed Page
UPDATE: Professor Mankiw is not really on board either:
Very, very strange. You would think that all those future Nobel-prize-winning economists working for the President would explain to him the history and economics of government price controls. Imposing price controls certainly wasn't President Nixon's finest hour.
Maybe President Obama should instead follow in President Ford's footsteps and start wearing a WHINE button on his lapel, for Whip Healthcare Inflation Now, Egads!
Feckless would be one step better than counterproductive.
If you didn't have enough reasons to dislike President Nixon (EPA, anybody?) -- he had a peculiar take on the laws of supply and demand.
President Nixon signed the CON law because he thought America had too many hospitals. He thought decreasing the number would lower health care costs. But that was ridiculous economics. Limiting the number of suppliers raises costs.
This is from a nice John Stossel post explaining that we don't really have a free market in health care at all. To build a hospital, you have to prove need.
Don't make the mistake of believing the Health Care Bill is dead. They're still trying to give us the same problems that Canadians have. But in Canada they're way ahead of us. They're already figuring out innovative ways around the socialized medicine scheme, with its 4 month waits for an MRI and 8 month waits to remove a brain tumor as shown in this YouTube video. KOA Radio's Jon Caldera, he of the Colorado Constitutional Reform Initiative, interviewed [audio link] Canadian Rick Baker of Canada's Timely Medical Alternatives and they discussed a specific case with the wait times I mentioned earlier. The conclusion they reached was that, while Canada has Universal Health Care Coverage the U.S. has Universal Health Care Treatment. This is because in Canada it is against the law to pay for private medical treatment - so many of them come here to spend their money. And it's damned affordable to boot. Baker quoted the customary price for a heart bypass procedure in the U.S. when billed to an insurer at $80,000 to $120,000. His cash client paid $16,000. Mister President! Mister President!
Here are the latest fees and wait times published on Timely's home page-
John Stossel's suggestion. I would never speak to the President in such tones.
Stossel links to Peter Suderman's Reason piece with the less imperative headline:
"Here, Obama, Let Me Google Some Health-Care Reform Alternatives For You"
Suderman provides links to a few good alternative suggestions on health care reform. For a President who said "If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know."
WASHINGTON – Speaker Nancy Pelosi said Thursday that she lacks the votes to quickly move the Senate's sweeping health overhaul bill through the House, a potentially devastating blow to President Barack Obama's signature issue.
Insty links to Boston Conservative Talk Show Host (and you thought you had a rough job!) Michael Graham's blog post "Brown Supporters: The Most Motivated Voters Ever?" I corrected the spelling in my title to provide regional flair.
I ran campaigns for six years, and I’ve been watching campaigns for years more, and I’ve never seen the “We’ve got to win this race” attitude from regular voters like I’m seeing for Scott Brown.
In a typical campaign, the hardest part is getting people to actually do things—show up at events, make phone calls, etc. They all talk a good game, but what you usually end up with is a hard core group of activists begging folks just to put a sign in their yards. That’s why money is so important—so campaigns can pay people to do the work. Even Obama had to use money to get his “community activist” campaign off the ground in early 2008.
Scott Brown is having the opposite problem. People are begging for stuff to do, and the campaign can’t keep up with the demand. On Saturday, driving between Ashland and Littleton, I saw more people displaying home made signs than printed ones.
I'm daring to believe. A squeaker, we must remember, is a strong signal to legislators with purpler constituencies. A win would be the biggest stand for freedom since they tore town the Berlin Wall.
Jimmy P suggests, not so well, lining to Igor Volsky:
- Ways and Means Chairman Charlie Rangel (D-NY): “Normally you’re just dealing with the Senate and they talk about 60 votes and you listen to them and cave in, but this is entirely different,” he said. “I’m telling you that never has 218 been so important to me in the House.”
- Rep. Anthony Weiner (D-NY): “We keep hearing them squeal like pigs in the Senate that they had a tough time getting to 60,” Weiner said. “Well, it wasn’t particularly a picnic for us to get to 218. Generally speaking, the Senate kabuki dance has lost its magic on those of us in the House.”
- Rep. Pete Defazio (D-OR): “They only got two votes to spare in the House. I think this will be a tougher negotiation than they think.”
The normally solidly Democratic Denver Post Ed Page:
Despite repeated promises of transparency by Obama and Democratic leaders, the House and Senate will forgo the usual approach of combining bills through a conference committee, which would allow for floor debate and television coverage, and instead craft a compromise behind closed doors.
Democrats say Republicans, who have rejected the plan, could otherwise filibuster the process, delaying negotiations and the legislation.
But Democratic leaders even rejected a request from C-SPAN to allow cameras to capture the important negotiations. That's an outrage
Yup, everybody's posting this, and yup, I did not bother to watch because I have seen it before. But Allahpundit says " Lies this shameless, especially from the lips of our modern-day Lincoln-Jesus, must be cherished." And he has got a point.
Bonus, web-only feature. Follow the Hot Air link to see Robert Gibbs actually face some tough questions on this.
"Call off the Dogs!" says the deeply deliberative Senator Ben Nelson. Who stood up to his own party in a matter of deep conscience until the Senate Bill made provisions about Federal funding of abortions gave his State $100 Million. You know the guy I'm talking about -- another Damn Webster if I ever saw one!
The "dogs" in this instance being 13 state attorneys general who were suing against the "Cornhusker Kickback." Senator Webst -- I mean Nelson, said that it would be fixed.
How would the kickback be fixed? The memo explains: "Senator Nelson said it would be 'fixed' by extending the Cornhusker Kickback (100% federal payment) on Medicaid to every state."
In no time, we'll all be drinking free bubble up and eatin' rainbow stew!
Sprint showed us what it would look like "If Firefighters Ran the World."
Senators Harry Reid, Charles Schumer, Richard Durbin and Christopher Dodd show us what would happen "If the Mafia Ran the World."
Problem is, the Sprint ad was hypothetical and the Senate's actions are all too real. It can legitimately be argued that the Democrat party has become a full-fledged criminal syndicate. Just listen to Judge Napolitano.
Is what we are seeing today much different than if a majority of Mafioso had been elected to Congress?
Am I racist to post this because this particular, brain-dead, corrupt Union thug happens to be of African descent? You decide.
The teamsters are blockading blood donations at the Red Cross in Philadelphia (home to a certain football team). But, compassionate lot that dey is, dey did allow one shipment to go through to save the life of a two-year old. But the rest of youse? Dey got grievances!
I cannot even continue. Read Liberty Chick's post on BigGovernment (from whence I lifted the picture), then John Stossel's take.
When we have a union disgruntled over a pay freeze that has resorted to blocking a blood donation delivery, on its way to save the life of a 2-year old child, from reaching a hospital, we have a problem. When we have unions that control the majority of health care, home care, nursing home care, child care, pharmacy, radiology, and public workers in this country, we will have a catastrophe. -- Liberty Chick
I know you're all shocked. Stick with me a minute.
In a superb guest editorial in the WSJ, Dr, Scott Gottlieb provides a comprehensive enumeration of reasons that the current Senate bill is bad for physicians and providers. Most will not be a surprise, but I had not seen this little gem before:
Next, the plan creates financial incentives for doctors to consolidate their practices. The idea here is that Medicare can more easily apply its regulations to institutions that manage large groups of doctors than it can to individual physicians. So the Obama plan imposes new costs on doctors who remain solo, mostly by increasing their overhead requirements—such as requiring three years of medical records every time a doctor orders routine medical equipment like wheelchairs.
The plan also offers doctors financial carrots if they give up their small practices and consolidate into larger medical groups, or become salaried employees of large institutions such as hospitals or "staff model" medical plans like Kaiser Permanente. One provision, laid out in Section 3022, allows doctors to share with the government any savings to the government they achieve by delivering less care—but only if physicians are part of groups caring for more than 5,000 Medicare patients and "have in place a leadership and management structure, including with regard to clinical and administrative systems."
Round 'em all up so they are easier to control! These are Doctors we are talking about.
Consolidation has a great track record in business and is important. But no serious person ever claimed it improved innovation. Our new medical overlords are so considered somebody will discover a new treatment that costs money.
Politico’s Mike Allen and Alexander Trowbridge have some bad news for Democrats, especially in the Senate, where Harry Reid has kept the chamber locked in battle over ObamaCare for weeks in an attempt to hit the finish line by Christmas. Barack Obama plans to put the health-care overhaul on the back burner until after the State of the Union address, pushing any conference between the House and Senate off until February. Instead, Obama plans a “hard pivot” towards jobs and the economy.
Let him screw up jobs and teh economy for awhile, that sounds far less dangerous.
James Pethokoukis points out: "On this double-counting issue, I dont know if this will pan out. But if it does, boom goes the dynamite."
The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund.
One tires of saying it but: if they did this at Enron, there'd be jail time...
Duquesne Light carries extra weight here because health-insurance industries are far from natural monopolies, so that regulating their rates calls for an extra dollop of judicial scrutiny. At this point, the Reid bill is on a collision course with the Constitution. I take it for granted that, constitutionally, the federal government could not just require all private health insurers to liquidate tomorrow, without compensation. -- Richard Epstein
Lining up at the trough after the slop has been poured -- are they not?
Nelson Says More Senators Seeking Special Treatment in Light of Nebraska Deal
Nebraska Sen. Ben Nelson, who has faced a heap of criticism for appearing to trade his vote on health care for millions in federal Medicaid money, said he's considering asking that the Nebraska deal be stripped from the bill. But he said other senators are looking for special treatment in light of his success.
Coals to Newcastle. But I break my Facebook pledge against politics again with this comprehensive argument against the Health Care bill and current partisan tactics.
I highly recommend everybody's sharing it with a few people who will dislike it.
I'll even give them a Quote of the Day:
Even in World War I there was a Christmas truce.
The rushed, secretive way that a bill this destructive and unpopular is being forced on the country shows that "reform" has devolved into the raw exercise of political power for the single purpose of permanently expanding the American entitlement state. An increasing roll of leaders in health care and business are looking on aghast at a bill that is so large and convoluted that no one can truly understand it, as Finance Chairman Max Baucus admitted on the floor last week. The only goal is to ram it into law while the political window is still open, and clean up the mess later.
Thanks to Senator Sheldon Whitehose for giving the opposition a viable plan:
Senator Sheldon Whitehouse (D-R.I.) today took shots at those who are not supporting the health care legislation. During a floor speech, he excoriated Senate GOP members for up holding the pending health care bill and accused their supporters of being birthers and fanatics in right-wing militia and Aryan support groups. He started off by citing an editorial from the Manchester Journal Inquirer, which used insults like "lunatic fringe.":
Likely past time. But Senator Cornyn offers a site that allows you send an email to seven Senators -- including my illustrious Senator Bennet.
I sent the mails and made a small gift. If any ThreeSources felt they could join me:
Your message was sent to:
Senator Blanche Lambert Lincoln
Senator Michael F. Bennet
Senator Evan Bayh
Senator Byron L. Dorgan
Senator Ben Nelson
Senator Arlen Specter
Senator Jim Webb
I have Multiple Sclerosis and my wife is recovering from a stroke.
Both of us need advances in treatment and therapy that will be severely impeded by this bill.
I would support interstate purchase of insurance, normalization of tax status between employers and individuals, and would consider a well structured plan to aid those who cannot acquire or afford insurance.
The current package does none of this. It will drive up government costs and taxes -- and make future health care worse.
Please vote NO! (I especially urge Senator Bennet because I live in Colorado).
Kim Strassel notes that "Barack Obama emerged from his meeting with Senate Democrats this week to claim Congress was on the 'precipice' of something historic." (Roger Kimball suggests "precipice" instead of "threshold" as a Freudian slip.)
The polls are bad and getting worse, but Strassel offers what I fear to be the real reason so many will jump:
So why the stubborn insistence on passing health reform? Think big. The liberal wing of the party -- the Barney Franks, the David Obeys -- are focused beyond November 2010, to the long-term political prize. They want a health-care program that inevitably leads to a value-added tax and a permanent welfare state. Big government then becomes fact, and another Ronald Reagan becomes impossible. See Continental Europe.
The entitlement crazes of the 1930s and 1960s also caused a backlash, but liberal Democrats know the programs of those periods survived. They are more than happy to sacrifice a few Blue Dogs, a Blanche Lincoln, a Michael Bennet, if they can expand government so that in the long run it benefits the party of government.
Should I congratulate them for principle? Strassel compliments my backbencher freshman Senator: "In Colorado, where 55% of voters oppose a health bill, appointed Democratic Sen. Michael Bennet told CNN he'd vote for a bill even if it "cost him his job." Give the freshman credit for honesty."
Yes, Senator, you've got to break some eggs to make an omelet, don't you?
Sanctimonious progressives ridicule social conservatives for refusing to acknowledge the validity of the theory of evolution. Too bad they are too dense to see the obvious parallel with their refusal to acknowledge the lessons of history. But IBD's Michael Ramirez sees it.
Tipping point? Status Quo was a pejorative term last week: NBC/WSJ Poll:
As the Senate sprints to pass a health-care bill by Christmas, the latest NBC News/Wall Street Journal poll finds that those believing President Obama's health-reform plan is a good idea has sunk to its lowest level.
Just 32 percent say it's a good idea, versus 47 percent who say it's a bad idea.
In addition, for the first time in the survey, a plurality prefers the status quo to reform. By a 44-41 percent margin, respondents say it would be better to keep the current system than to pass Obama's health plan.
This last-minute, back-room ploy shows again that Democrats are simply winging it as they rush to pass something—anything—that can get 60 votes by Christmas. President Obama praised the proposal as "a creative new framework," while Finance Chairman Max Baucus told the Washington Post, "If there's 60 Senators who can reach agreement, I'm for it." Now there's a model standard to use for reordering 17% of the U.S. economy. --- WSJ Ed Page
Title: Nicholas Kristof, Obamacare, and the Broken Window Fallacy
Don't forget to hat-tip: Professor Reynolds...
UPDATE: If you don't have time, Michelle Malkin (jk links to Michelle Malkin -- mark the date!) does a great job, awarding Kristof the prize for "Quite possibly the crappiest NYTimes column for Obamacare ever."
Bainbridge gets points for the Bastiat reference, but what Malkin grabs is that the object of pity in this ObamaCare paean already qualifies for government healthcare, but (don't laugh, this gentleman is truly suffering) he cannot secure the services of a physician because the reimbursement rates are too low!
I'm aware that not all ThreeSourcers share my appreciation of Megan McArdle. But she has written a gem that demands linkage. McArdle is unimpressed with the argument that we may as well do ObamaCare. because Medicare is going to bankrupt us anyway:
Anyone who has dated a manic-depressive has heard some version of this argument. "I can barely make ends meet now, so I might as well use my tax refund check to buy a boat! After all, if I can't figure out a way to fix my budget, I'm going to go bankrupt anyway."
The premise is fun. The serious treatment she gives to an American bankruptcy is a bit disturbing in its casualness.
Professor Reynolds suggested reading the whole thing. Do what you want.
On the wild chance somebody doesn't know this joke, here's the Cliff's Notes® version (best in a Groucho Marx voice...):
He: "Would you sleep with me for a million dollars?"
She: "A million dollars, I'd have to think about that..."
He: "Would you sleep with me for $20?"
She: "No, you think I am some kind of whore?"
He: "We know what you are, now we're haggling over price!"
Take Louisiana Democrat Mary Landrieu, who claims to have grave concerns about the bill's cost. Those worries became less pressing when Majority Leader Harry Reid added language on page 432 of the 2,074-page opus that would raise the bill's cost by increasing federal Medicaid subsidies for "certain states recovering from a major disaster." Guess which state is the only one that would qualify under that wording?
This political gratuity was quickly reported as costing $100 million, but Senator Landrieu made clear after her floor speech that her vote couldn't be bought that cheaply. "I will correct something. It's not $100 million, it's $300 million, and I'm proud of it and will keep fighting for it," she told reporters.
WASHINGTON – When it comes to paying for a health care overhaul, Americans see just one way to go: Tax the rich.
That finding from a new Associated Press poll will be welcome news for House Democrats, who proposed doing just that in their sweeping remake of the U.S. medical system, which passed earlier this month and would extend coverage to millions of uninsured Americans.
UPDATE: JammieWearingFool suggests that other results from the poll are not quite so encouraging (to the collectivists).
So now the mandate is like a tax? Which is it? I'm not exactly sure what's untrue about Rep. [Dave] Camp's statement. If you don't pay your taxes, what exactly happens? You go to jail. You don’t get prosecuted “in theory.” Men with guns come to your home and take you away. -- John Stossel
I don't know how many commercials are in this series; this is the second that Instapundit has posted. The first subject ended up coming to America for care, this woman got treatment after begging doctors for two years:
There's a BB King tune, he sings "Went down to the welfare office to get myself some grits and stuff. The woman said you ain't been around long enough! Everybody wants to know why I'm singin' the blues..." I cannot imagine hearing "you have not suffered long enough -- others have been on the list longer."
But of course that will not happen here: we Americans are so much kinder and more generous than Canadians and our government is so much more efficient than theirs -- no doubt our version of socialized medicine will rock!
The lead editorial in the WSJ today captures it pretty well:
The bill is instead a breathtaking display of illiberal ambition, intended to make the middle class more dependent on government through the umbilical cord of "universal health care." It creates a vast new entitlement, financed by European levels of taxation on business and individuals. The 20% corner of Medicare open to private competition is slashed, while fiscally strapped states are saddled with new Medicaid burdens. The insurance industry will have to vet every policy with Washington, which will regulate who it must cover, what it can offer, and how much it can charge.
We've lost our liberty and privacy, we've demolished the greatest engine of innovation for improving quality-of-life ever created, and we've signed up for complete middle-class serfdom. But THANK GOD for the work of those brave blue dog Democrats who stood tough and stripped out abortions!
I guess I am still enough of a partisan hack that I can at least appreciate the possible bloodbath for the Democrats in 2010. But this has come one step closer than I thought. I figured something would pass the House (the old line was "you could pass a ham sandwich in the House") but I did not expect anything this bad to pass.
On to the Senate. I am thinking of writing Senator Bennet today with a pledge to donate $1000 to his opponent if he votes for it. Good idea?
JCT Confirms Failure to Comply with Democrats’ Mandate Can Lead to 5 Years in Jail
Friday, November 06, 2009
Today, Ranking Member of the House Ways and Means Committee Dave Camp (R-MI) released a letter from the non-partisan Joint Committee on Taxation (JCT) confirming that the failure to comply with the individual mandate to buy health insurance contained in the Pelosi health care bill (H.R. 3962, as amended) could land people in jail. The JCT letter makes clear that Americans who do not maintain “acceptable health insurance coverage” and who choose not to pay the bill’s new individual mandate tax (generally 2.5% of income), are subject to numerous civil and criminal penalties, including criminal fines of up to $250,000 and imprisonment of up to five years.
No surprise to ThreeSources, all government mandates are ultimately enforced by guns and jail time. I wonder that some enterprising 527 could not make a good TV commercial by juxtaposing this with footage of Then-Senator Obama ridiculing rival candidate Clinton for mandates.
Hat-tip: Ann Althouse who asks "Is this what the Democrats mean to inflict on the unsuspecting public that believes it is getting health care? What chaos lies ahead?"
We have not had too much good news, I will make the most of it.
Blue Dogs would be dog-foolish to ignore the off year elections. Now, Leader Reid says they'll debate health care while looking down the barrel of midterms.
WASHINGTON – In a blow to the White House, the Senate's top Democrat signaled Tuesday that Congress may fail to meet a year-end deadline for passing health care legislation, leaving the measure's fate to the uncertainties of the 2010 election season.
UPDATE II: Michael Barone underscores that the results imperil health care legislation:
I cannot imagine that Congressmen Nye, Perriello, Connally and Boucher have not already accessed the websites which have shown the position of their constituents in a contest which, while like all governorship contests has its own specific features, was also in its contrast on issue positions reasonably congruent with those prevailing on national issues. And I can certainly respond with sympathy if any or all of these incumbents responded to these numbers with a two-word comment of which I will relay only the first word which is, “Oh.”
The 2009 election results are certainly not going to make it easy for Speaker Nancy Pelosi to round up the needed 218 votes for Democrats’ health care bills.
He also mentions Westchester County, a race that brought a cautiously optimistic email from Perry.
"The health bill [Speaker Pelosi] unwrapped last Thursday, which President Obama hailed as a 'critical milestone,' may well be the worst piece of post-New Deal legislation ever introduced." So begins a long and thoughtful editorial in the Wall Street Journal today -- and it does not let up from there.
The editors enumerate its flaws and suggest -- rightfully -- that the flaws are features, not bugs: the goal is to complete FDR's vision.
Mr. Obama rode into office on a wave of "change," but we doubt most voters realized that the change Democrats had in mind was making health care even more expensive and rigid than the status quo. Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated.
Full of choir preachin' for ThreeSourcers, but if you are looking for a serious article to share with someone in the other side, this one is very very good.
The health-care debate is part of a moral struggle currently being played out over the free enterprise system. It will be replayed in every major policy debate in the coming months, from financial regulatory reform to a cap-and-trade system for limiting carbon emissions. The choices will ultimately always come down to competing visions of America's future. Will we strengthen freedom, individual opportunity and enterprise? Or will we expand the role of the state and its power? -- AEI Chief Arthur Brooks in a great guest editorial on health care in the WSJ
What if the entire healthcare reform debate rested on a false premise? (It does.) What if a prominent and respected thought leader on the "government option" side of the debate made a public statement that exposed the false premise and he was videotaped to prove it? (He has.) Alas, probably nothing but I'll shout it from the rooftop anyway.
The existing "treat on demand" mandate for American hospitals is based on the premise that "we can't let sick people die" just because they can't pay for their care. Somebody should remind Robert Reich, who said:
And by the way, we are going to have to, if you are very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for a couple of months. IT'S TOO EXPENSIVE SO WE'RE GONNA LET YOU DIE. [1:15]
"It's too expensive, so we're gonna let you die." These nine words are so important to the future of the free world that they mark my first EVER use of bold underlined italic all-caps. EVER!
So the obvious question for Mister Reich and every other hypocritical, disingenuous mouthpiece for healthcare "reform" and "compromise" is this:
"If we can let old people die then why can't we let sick people be sick? Even if it means they might die?"
If it is acceptable for the government to deny medical treatment to patients with no fault other than their advanced age (even if they would have had the means and the will to pay for their own care before you "fixed" the healthcare system) why isn't it acceptable for hospitals to deny medical treatment to patients who can't pay for it (even though the public and private means to be prepared for those costs are ubiquitous and could be made even more so?)
I had a blog post brewing in my head when I woke up this morning. Curiously, Blogging God James Taranto has thieved it:
British health care, it seems, resembles American elementary and secondary education, in that the government has a monopoly but there is an expensive private opt-out--and many of those who run the monopoly avail themselves of the private system. If you like the public schools, you'll love ObamaCare!
Taranto is following up on a story that British Heath Care workers will be given taxpayer-financed private care. Else, socialized medicine will kill all the providers. Beautiful, isn't it?
But I had two thoughts on education (all my family members are teachers, I'm a dead man if one of them ever stumbles on ThreeSources). The first is the title: public education is the ultimate public option. No, there's no law to keep us from opening up the ThreeSources Academy of Reason and Civics and Advanced PE, but all of our students will have to pay for both public education and our inflated tuition. The government will regulate how many days are taught and have great influence on our curricula. Lastly, if we do well and attract attention, we can be denied building permits, accreditation, fire code clearances, &c.
We can swim but they completely own the pool. A serious person cannot help but see that health care would be just like that. Crappy substandard care for all, and an escape of quality and innovation that only the rich could afford. Progressive, indeed!
The other point is that innovation in a sector is frozen to the time government takes over. The highly subsidized and regulated passenger railways are frozen at WWII technology, British Health Care in 1975 all the time. And American education has not progressed an inch since Wilson was President (most would say it has fallen). In spite of communications, Internet, advances in access to books and information, and ubiquitous, inexpensive computers, schools have seen no improvement.
Medicine has made startling gains, but it might be 2009 forever. Shame
Is President Obama disingenuous? I've been searching for evidence of this to share with a dear cousin who believes that Sarah Palin is, but Barack Obama is not. My handicap is that her chosen news sources are all on television: FOX, KERA, ABC, CBS.
Most astounding of all is what this Congress is willing to do to struggling middle-class families. The bill would impose nearly $400 billion in new taxes and fees. Nearly 90% of that burden will be shouldered by those making $200,000 or less.
Somewhere between $360,000,000,000 and "one dime" is a broken campaign promise. Unfortunately, it was in a newspaper. Worse yet, on the opinion page.
Hard to pick from two choices in one WSJ Editorial. The Ed Page chides industry lobbying groups for trying to appease Congress and only now seeing that ObamaCare will not be a great deal for them. Choice one is "and we thought you had to be smart to get into med school," but I think I'll have to go with:
All of these lobbies should have known better. The insurers have been especially foolish, given that ObamaCare has all along been about converting them into public utilities. Washington will design benefits and set prices—and now there's even talk in the House of a windfall profits tax. The CEOs of Aetna, WellPoint, UnitedHealthcare and the rest deserve to be sued for destroying shareholder value through political malpractice. If nothing else, this exercise provides an object lesson in the wisdom of the Washington adage that "if you're not at the table, you're on the menu." The industry is "at the table"—as the main course.
UPDATE: A belated QOTD on the same topic yesterday:
The AMA goes to bed with the Obama administration, and predictably wakes up with fleas. -- Don Luskin
Halfway through our victory lap and the starter's gun puts a .38 into our thigh.
Sorry for the tortured metaphor, but I really believed that citizen activism had killed socialized medicine in the United States. We had a great August recess and I thought that reason was going to prevail.
We had August; President Obama has four years. And it's over. Rasmussen polls last week showed support for reform returning, and the new CBO numbers are a death knell. People who are watching Katie Couric instead of reading ThreeSources are hearing that we can cover the uninsured and cut the deficit. Damn, that Obama really is a wiz.
The WSJ headline (again news pages) took me aback: "New Math Boosts Health Plan." I thought that was "new math" as in "if math were a color..." or "how does this differential equation make you feel?" But no, they were talking about the new CBO numbers.
Crisis averted! Our brave legislators have found a way to tax us enough to give us all health care hooray!
UPDATE: Our friends at Heritage are not impressed:
Enter Senate Finance Committee Chair Max Baucus (D-MT) who was determined to manipulate the CBO’s scoring system as best he could and deliver a deficit neutral version of Obamacare. After months of working directly with CBO staff, Baucus scored a victory for Obamacare yesterday when the CBO released a preliminary analysis purporting to show that the Baucus bill would reduce deficits by a total of $81 billion over the next decade. The New York Times awarded Baucus with the headline that the White House has been searching for since the debate first began: “Health Care Bill Gets Green Light in Cost Analysis.” But this headline and the accompanying article are fundamentally dishonest. As the Politico reported yesterday: “While the media and lawmakers often shorthand a CBO letter as a “score” or “cost estimate,” today’s CBO letter is neither. Because the bill is still in “conceptual,” or layman’s terms, CBO’s letter today was a “preliminary analysis.” For it to be an official cost estimate, the bill has to be translated into legislative language.”
Okay, so now everybody who follows @Heritage (27,913) are against it and everybody who reads the New York Times...
Robert E. Moffit of the Heritage Foundation provides: a good look at the freedom implications of an individual mandate, versus its efficacy in "At What Cost To Freedom?: Obama's Individual Mandate Is a Bad Idea."
Meanwhile, Sen. Max Baucus (D., Mont.) has unveiled a Senate Finance Committee draft that also has an individual mandate. It would levy a penalty of up to $3,800 on families for what the president calls "irresponsible behavior," by which he means health-care choices of which he disapproves. In Obama's usage, "personal responsibility" is selective; it doesn't extend to the question of taking responsibility for one's health care. That's the government's job. Of course, federal officials will have outside help in deciding for the rest of us. Powerful special-interest groups and health-industry lobbyists will do all they can to make sure that their favored medical treatments, procedures, drugs, and devices are part of the "bare minimum" that every plan must include.
The only argument the left has for ObamaCare is the idea of near universal coverage. I would not trade quality, innovation and privacy for it, mind you, but it is compelling to suggest that most every American would be covered.
Well, except for 25 million. WSJ (News pages, not my wingnut buddies)
The Congressional Budget Office estimated that an earlier version of the Senate Finance bill would ensure health insurance for 91% of Americans -- leaving about 25 million people without coverage. The CBO's estimates for the latest version of the bill are due out this week; it is expected to cover fewer people. About 85% of Americans currently have health insurance.
The industry concerns illustrate one tension at the heart of the latest Senate bill. Key industries bought into the measure -- and agreed to absorb cuts in reimbursements -- on the expectation that millions of new customers would be brought into the health-care system. The weaker the mandate to buy insurance, the fewer the new customers.
In addition, if the bill leaves many Americans without coverage, that would undermine President Barack Obama's goal of bringing near-universal health insurance to the U.S.
The thesis of the article is that many of the industry players who went along because they stood to gain from universal coverage are now realizing that they get the full pro quo without so much of the quid.
I don't think any ThreeSourcer will cry as the rent-seekers are hoisted on their own petard (ow!). But I suggest that the supporters are losing their only convincing argument. We are going to go from 40 million to 25 million uninsured -- and this is worth destroying the whole system?
Referencing Paul Krugman's astonishment that Ronald Reagan "was a fierce opponent of Medicare's creation, warning that it would destroy American freedom. (Honest.)" I would turn your attention to a WSJ Editorial today: The War on Specialists.
My friends continually tell me my fears are overblown and "nobody is talking about a government takeover." Umm, what do you call this then?
The chunks Team Obama took out of cardiology RVUs are especially drastic. The basic tools of heart specialists—echocardiograms (stress tests) and catheterizations—are slashed by 42% and 24%, respectively. Jack Lewin, who heads the American College of Cardiology, said in an interview that the crackdown will cause "a horrible disruption" that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services.
Cancer doctors get hit because the Administration believes specialists order too many MRIs and CT scans. Certain kinds of diagnostic imaging lose 24%.
These are Medicare changes right out of the Baucus bill. Senators will decide, and in the wisdom of the world's most deliberative body, Cancer and Heart Disease are clearly the best places to cut costs.
– 37 percent understand the president’s plan
– 17 percent believe the plan is deficit neutral
– 20 percent believe funding will come from a fine on the wealthy.
– 32 percent actually support the president’s plan
– 40 percent have no idea how is being paid for
– 34 percent think everyone other than Congress will be pushed into public plan
I assume that the CBO is going to score all these largely imaginary savings, and that this will make it very hard to keep the bill from passing, because legislators are, natch, more concerned about the appearance of fiscal rectitude than actual conservative budgeting. Conservatives can, and should, raise the reasons to believe that hits bill will cost more than its CBO score allows. But frankly, the public is probably going to accept the CBO numbers.
I think that ramming through the bill on a party line vote makes it very likely that the Democrats will lose the house in 2010; the American public doesn't like uniparty votes, especially on something this controversial. A lot of liberals have gotten angry at me for saying this, but it's not a normative statement; it's an observation.
Rasmussen reports 56% of likely voters now oppose the reforms President Obama is threatening to push upon them, and when you look at the "Strongly Oppose"(44%) vs. "Strongly Favor"(24%) the picture is even bleaker in terms of public support for this broad, governmental takeover of the health sector. Still, this is not the time to get complacent, because His Royal Self is going to flood the weekend airwaves with his toothy smile and reassuring rhetoric, appearing on five Sunday morning network shows (excluding FOX) and then Letterman on Monday night
Me? I share McArdle's fear that the Democrats are completely "all in" and they have the votes. ObamaCare it is -- I just hope they pay the hefty price. I guess that makes your ThreeSources optimist more pessimistic than the other three. Of course, McArdle is not cheered by a 2010 House turnover. It would be a bad trade for ObamaCare, but it would be something.
I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it they expect to depend on, when they lie on an operating table under my hands? ... Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't. -- Ayn Rand, in an obscure novel call Atlas Shrugged.
In a family email dialog about healthcare reform my brother asked a first cousin once removed: "I can't believe that you would be supportive of socialized medicine - are you?"
The cousin replied,
"Generally speaking yes I am. Although I don't think any of the proposals on the table are perfect.
But you shouldn't be worried. Even if a perfect bill was drafted, it won't pass. Politicians are incapable of getting tough things done."
What follows is my contribution to the thread. It's important to first note that the cousin and his wife (the first cousin not-removed) both happen to work in the airline industry.
You know, it's interesting that you say that. I happen to support socialized air travel. I think that everyone should be able to get the same access to free jet trips whenever they need them, regardless of their ability to pay. I believe that air travel is a right and that people who provide it should not make such an obscene profit! I am sure that airfares would be much lower if there was a single payer system so that efficiencies and economies of scale could come into play. In addition, it is absolutely unconscionable that the super rich can fly in first-class comfort simply because they happen to have so much more money than anyone else. I think that first-class service should be abolished so that coach will be available for more flyers at the same total cost. And who on earth thinks that the elderly should be flying? Those people have lived full and rich lives already. We need to leave the thrill and growth opportunities that flying offers for younger people who will get more “adventure memory years” from each flight than those geriatrics would.
And before you ask, no, I don't support socialized engineering services. Engineers are highly trained professionals who have taken the individual initiative to learn the specialized skills and principles that they apply to important needs of society. By taking away the right of individual engineers to offer their services on a free market at the highest price that any customer is willing to pay him the excellent engineers will have no incentive to work harder and more ingeniously than the sad-sack chair-warming engineers do. The result would be that the engineering profession as a whole, and all of the productive enterprises that depend on engineering excellence would be crippled with mediocrity and malaise.
Fortunately I am quite certain that the politicians in Washington, responding to the clear and complete understanding of the distinctions between air travel and engineering, would never dream of applying the same centralized government control over the wages and careers of engineers that I am advocating for airline corporations and their money grubbing employees. Yeah, just them ... and the doctors. Leave us engineers - and the lawyers - alone.
I posted last week that it was ingenious for the health care reform bill to stop innovation so that it would not have to pay for it when the bills are going to the people that passed it. A Wall Street Journal editorial shows "How Max Baucus knifed the medical devices industry."
Supposedly the Senate’s version of ObamaCare was written by Finance Chairman Max Baucus, but we’re beginning to wonder if the true authors were Abbott and Costello. The vaudeville logic of the plan is that Congress will tax health care to subsidize people to buy health care that new taxes and regulation make more expensive.
Look no further than the $40 billion "fee" that Mr. Baucus wants to impose on medical devices and diagnostic equipment. Device manufacturers would pay $4 billion a year in excise taxes, divvied up among them based on U.S. sales. This translates to an annual income tax surcharge anywhere from 10% to 30%, depending on the corporation.
I'll do something I criticize others for. I'm sick of the town hall criers who personalize every issue and cry on candidates' shoulders to get promises of help in (usually collectivist) policy.
But I will personalize this with some good news. I am in the early stages of trying a Bioness machine and early results are promising. This machine senses pressure in my heel and gives me a zap of current at the right time to walk. It might replace a clunky plastic Ankle Foot Orthotic (AFO) that I have worn since I was diagnosed with MS in 2003. Or I might wear it on my "good leg" to improve its function.
Time will tell -- but it was fun to see my foot moving on its power, even if Skynet was controlling it.
The political point is that this machine costs a kazillion dollars. My wife is looking at a hand version and, while they've been too chicken to give me a price yet, it's clear that if we both bought one it would bump up GDP a couple notches next quarter. It would be pretty tempting for government to give a guy a plastic AFO (only $600!) but it is the difference between real walking and umm, whatever it is I do. Let's not tax these guys out of existence.
Can we start an adverb of the day feature? Here's a must read guest editorial from David B. Rivkin and Lee A. Casey
Federal legislation requiring that every American have health insurance is part of all the major health-care reform plans now being considered in Washington. Such a mandate, however, would expand the federal government’s authority over individual Americans to an unprecedented degree. It is also profoundly unconstitutional.
The elephant in the room is the Constitution. As every civics class once taught, the federal government is a government of limited, enumerated powers, with the states retaining broad regulatory authority. As James Madison explained in the Federalist Papers: "[I]n the first place it is to be remembered that the general government is not to be charged with the whole power of making and administering laws. Its jurisdiction is limited to certain enumerated objects." Congress, in other words, cannot regulate simply because it sees a problem to be fixed. Federal law must be grounded in one of the specific grants of authority found in the Constitution.
The CBO scores the Baucus Plan favorably over the next decade (whereupon it spirals out of control). But the scheme of tax-for-ten to pay-for-seven fools the Congressional Budget Office.
Mankiw provides an excerpt from the text and adds this handy translation:
Let me try to put CBO's point in a more familiar setting:
Your friend Joe, who says he want to lose weight, asks you for an extra slice of pie after dinner. Naturally, you are doubtful about the wisdom of the request.
"Ahem, Joe," you whisper, "Aren't there a lot of calories in that?"
"Yes," he says, "but the pie is part of a larger plan. I am committed not only to eating that slice of pie but also to going to the gym every day for the next week and spending at least half a hour on the treadmill. The exercise will more than work off those extra calories."
"But that's what you said last week, when you asked for an extra piece of cake. And you never made it to the gym."
"Yes, I know," Joe replies ruefully, "but this time I really mean it....Can you please pass the pie?"
That's Professor Reynolds's headline for an IBD Editorial. (If I saw brother JG with a rubber glove, I would run for the hills.)
The link was also sent to me by a physician friend, who wishes retirement were an option. "In addition to the restrictions Obamacare will impose on the level care I can provide, the deleterious effect on medical innovation, and the decrease in salary, I am sure it will also bring an avalanche of new paperwork and busywork that will make me less productive and more frustrated. A mid-life career change is sounding more appealing every day."
Disturbing that the President got the AMA on board early -- the illusion is well set that the medical community is firmly behind him. But the IBD Ed Page begs to differ:
Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.
The poll contradicts the claims of not only the White House, but also doctors' own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.
It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost.
Andrew Napolitano three-fers in the WSJ Ed Page today:
1) He questions whether ObamaCare is Constitutional. I have been driven crazy by the lack of time and space devoted to this in the commentary. But then again, with Representatives like Mister Clyburn...
Last week, I asked South Carolina Congressman James Clyburn, the third-ranking Democrat in the House of Representatives, where in the Constitution it authorizes the federal government to regulate the delivery of health care. He replied: "There's nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do." Then he shot back: "How about [you] show me where in the Constitution it prohibits the federal government from doing this?"
[dramatic pause. Repeat. "How about [you] show me where in the Constitution it prohibits the federal government from doing this?" ]
2) He preemptively demolishes the lame "Commerce Clause" response we are all expecting in the event any of them ever actually do have to defend it.
Applying these principles to President Barack Obama's health-care proposal, it's clear that his plan is unconstitutional at its core. The practice of medicine consists of the delivery of intimate services to the human body. In almost all instances, the delivery of medical services occurs in one place and does not move across interstate lines. One goes to a physician not to engage in commercial activity, as the Framers of the Constitution understood, but to improve one's health. And the practice of medicine, much like public school safety, has been regulated by states for the past century.
3) He answers my concern that I was undermining my belief in Federalism by seeking interstate trade in insurance
The same Congress that wants to tell family farmers what to grow in their backyards has declined "to keep regular" the commercial sale of insurance policies. It has permitted all 50 states to erect the type of barriers that the Commerce Clause was written precisely to tear down. Insurers are barred from selling policies to people in another state.
That's right: Congress refuses to keep commerce regular when the commercial activity is the sale of insurance, but claims it can regulate the removal of a person's appendix because that constitutes interstate commerce.
Really, I should give the Obama Administration more credit. Call it what you will (I choose "evil"), this goes beyond incompetence: paying for the new health care entitlement with a huge surtax on medical devices. You not only raise revenue, but you keep them from coming out with all those expensive new life-saving devices that cost so much. Tigerhawk:
This tax would be without regard to profitability, so it would amount to a capital tax on start-ups and a massive income tax surcharge on profitable companies, varying as net margins do. In the case of my own mid-sized company, the tax would be the equivalent of a roughly 20% surcharge on our net income (in all likelihood raising our economic tax rate well above 50%) or 50% of our research and development budget, depending on how you want to look at it.
Any way you look at it, the proposed tax is a calculated effort to divert capital from the medical technology industry to other uses in the economy, because new medical technology drives costs that are now going to be assumed by the government (or at least will be if the Senate leadership gets its way). Of course, innovative medtech also extends and saves lives, and makes them more comfortable and more productive. Which is, after all, the point of medicine.
No sir, the point of medicine is reelection and incumbency. You'd think a smart feller would figure that out...
In April I made a case for Sarah Palin to embrace her Christian morality but to denounce imposing it on everyone through the power of the state. Contemporaneously I commented on another blog, though I can't find it at present, to advise a fellow commenter that among the Christian principles she espoused, altruism is used by the statists to justify their athiestic brand of collectivism.
On the occasion of the eighth anniversary of the 9/11 terror attacks, President Barack Obama took another step toward proving me right.
We honor all those who gave their lives so that others might live, and all the survivors who battled burns and wounds and helped each other rebuild their lives; men and women who gave life to that most simple of rules: I am my brother's keeper; I am my sister's keeper.
That "most simple of rules" will come in mighty handy during debates over publicly funded health care, won't it?
No, mister president, I don't agree. To every man I meet - in my town, in my country, in the world - I can tell him I am his brother, but not his keeper. Nor is he mine.
I wondered about this remark in the President's speech last Wednesday:
If we can successfully slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
"Can that be right," wonders I? Surely the POTUS has some figures to back that up. If that's true, than the Peter Orzag scenario has some foundation.
Ed Morrissey gets a little help from King Banaian, whom he describes as "everybody's favorite economist." With all die respect, I have lots of favorite economists. But Banaian concedes this is true. Providing that your idea of long term is more than 363 years.
In a ten-year window, even if Obama delivered what he promised twice this week, it would save a grand total of $33 billion dollars — and that’s for the whole industry. If the government covered a third of the costs, the total deficit reduction over ten years drops to a mere $11 billion dollars. At that rate, how long will the “long run” need to be to save $4 trillion dollars in deficit spending? It would have to be 363 years and five months.
As John Maynard Keynes said "in the long run we'll all be dead." But who cares as your great-great-great-great-great-great-great-great-great-great-great-great-great-great-great-grandchildren cross that $4Trillion savings mark. It will be a proud day for the republic and will cement President Obama's legacy.
We’re going to pass a health care plan written by a committee whose head says he doesn’t understand it, passed by a Congress that hasn’t read it but exempts themselves from it, signed by a president that also hasn’t read it, and who smokes, with funding administered by a treasury chief who didn’t pay his taxes, overseen by a surgeon general who is obese, and financed by a country that’s nearly broke.
Sent to both today. If the President is just going to repeat his position, I don't see why I shouldn't.
I watched the President's speech last night and remain unconvinced that the current proposals for reform will have positive outcomes.
The President claims that his opponents are lying or do not understand -- yet he never concedes there are several valid objections to current proposals.
Whether the government is going into the insurance business or dictating terms for current providers (or, my fear, both at the same time), this will retard innovation in both funding and treatment.
His assertion that it can be paid for out of waste seems contrary to the history of government projects and publicly run entities.
Medical records are my most private personal documents and I do not trust government to manage them properly. The news has lately been full of incidents of compromised access to government records in passports and elsewhere.
Lastly, President Madison famously asked a legislator to "lay his finger on the part of the Constitution" that allowed the government to undertake internal improvements.
This level of intervention in our most private affairs requires such a stretch of Constitutional purviews, that the document becomes only fit for defining the minimum ages of office-holders.
Please vote against any legislation that increases government involvement in health care.
It's early yet, but this opening sentence of an Examiner Editorial is pretty solid:
President Obama’s address to Congress and the nation Wednesday evening was yet another illustration of his seemingly endless ability to soar to genuinely impressive rhetorical heights without ever landing back on truthful ground.
This thought occurred to me last week, but I can't claim to be the first: The futuristic scenario painted by the Obamacare proposal, H.B. 3200 is remarkably similar to the 1972 sci-fi film 'Soylent Green.' Rick Carpenter at "Right Wing vs. The Wingnuts" blog posted his take last month:
What is interesting to me is that in the movie, the euthenasia of old people is a government-run program. Under ObamaCare, we are starting with 'death panels'.
What is discovered about the food product Soylent Green at the end of the movie seems far-fetched, in that they used the remains of the dead to produce the food wafers. I use the word 'seems' instead of 'is', because the Obama administration has already done some things that are so far-fetched and corrupt that I can't put anything outside the boundaries of their morals (lack), their conscience (lack), their defense of the Constitution (betrayal), or their love for the sovereignty of America (hatred).
Think Rick and I are just two of the strange ones? Jonah Goldberg is nearly with us.
Now, I don’t think Soylent Green-style solutions are coming down the pike. (...) But every nationalized health-care system to one degree or another rations care based on the quality of life and number of “life years” a procedure will yield. That’s perfectly reasonable. If you put me in charge of everyone’s health care, I would do that, too. That’s a really good argument for not giving me — or anyone else — that power.
A new study published today by the National Changing Diabetes Program deals another blow to the Obamacare myth that increased preventive medical care will lead to long-term health cost savings. From the Washington Post:
Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year -- money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.
However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.
This is consistent with CBO findings reported earlier this month, says WaPo. "In its own analysis of preventive care, CBO said earlier this month that the cost of making cancer screening, cholesterol management and other services broadly available is likely to far outweigh any savings ultimately generated."
"There's no free lunch here" said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago. [No kidding!]
I enjoyed the summation of this news by FNC's Stuart Varney this morning: "It's basically saying that if you drink a pint of vodka and three packs of cigarettes a day and die at 50 your medical care will cost less than if you take care of yourself and live to 85."
So if lawmakers really want to lower overall healthcare costs they should be mandating this, which I dub - the Lee Marvin *Healthcare Plan.
* An iconic and accomplished actor - one of my all time favorites. A man's man who, though he may have been more careful in life, did more than his share of drinkin' and smokin' on the screen.
Senator Lieberman suggests that the President back off a bit.
WASHINGTON – An independent senator counted on by Democrats in the health care debate showed signs of wavering Sunday when he urged President Barack Obama to postpone many of his initiatives because of the economic downturn.
"I'm afraid we've got to think about putting a lot of that off until the economy's out of recession," said Connecticut Sen. Joe Lieberman. "There's no reason we have to do it all now, but we do have to get started. And I think the place to start is cost health delivery reform and insurance market reforms."
University of Chicago professor Charles Lipon takes up the banner of enabling a national market for health insurance. This has been one of my biggest hopes -- and it even got an endorsement of sorts from ThreeSources friend Silence Dogood.
The easiest way to see how insurance competition benefits consumers is to look at auto insurance. That's a huge, nationwide market and companies compete intensively for a share of it. Some stress their low prices, others customer service, whatever gives them an edge in the marketplace. Geico and Progressive have been especially aggressive in touting cost savings. State Farm and Allstate certainly compete on price, but they stress service after an accident. That's why Allstate says "you're in good hands," and State Farm says it will be there "like a good neighbor." Other companies, like SafeAuto, focus on drivers who want only minimum coverage to meet state license requirements. In short, auto insurance companies compete vigorously to provide what different consumers want, and they tell them so in national advertisements. Life insurance companies do the same thing. There are even companies that specialize in comparing policies for customers. Competition drives down excess profits and means better, cheaper options for consumers.
Ever see an ad touting health insurance? They are rare because the markets are small and companies don't need to compete aggressively on price or service. Introducing such competition would be good for consumers, wouldn't require another Washington bureaucracy and could be done quickly.
I have been waiting for somebody to accuse me of being a fair weather Federalist. Everybody loves States' rights, bit about everybody always seems to have an exception or two in their pocket. Hypocrisy is too pejorative and I am not suggesting a purity test or a census of pinhead-resident-angels. But I love to quote Justice Brandeis's "Laboratories of Democracy." And I salute those who have suggested that some of the facets of ObamaCare should be tried in States, where they could be abandoned after failure.
I know it would be one of the top three changes to health care that would make it accessible and affordable. I'd put it right after employer-tax bias and way in front of tort reform. Am I discarding my Federalist principles? My Tenth Amendment bona fides? What right does the Fed have to tell Vermont that they may not mandate aromatherapy coverage?
President Obama has called for a serious and reasoned debate about his plans to overhaul the health-care system. Any such debate must include the question of whether it is constitutional for the federal government to adopt and implement the president's proposals. Consider one element known as the "individual mandate," which would require every American to have health insurance, if not through an employer then by individual purchase. This requirement would particularly affect young adults, who often choose to save the expense and go without coverage. Without the young to subsidize the old, a comprehensive national health system will not work. But can Congress require every American to buy health insurance?
The authors say that even by the most aggressive commerce clause precedents -- no way. After McConnell v. FEC, I gave up on the court's saving us. But there is a chance. There is a chance.
Then again, the authors point out that nationalizing health care would work -- just not the mandate.
I am just goofy enough that I would try to plow through HB3200. Silence inquired about it, and a Facebook friend whom I consider fairly non-political told me she read it coast to coast.
I want my legislators to read it, but I confess I have no intention. Call me names, but my opposition is not to details or percentages or cost thresholds -- my objection is to Federal intrusion into the private sector. Perhaps if they had included some GOP softeners like tort reform or interstate purchases, I might be interested. But I don't think there's one thing in those thousand-plus pages that I'd like.
There are many legitimate concerns raised by these massive plans, and what you hear depends on who you ask. If you ask men, they tend to be most concerned about the legislation's cost and the long-term effect of government controlling such an enormous share of the economy.
If you ask women, they worry about the risks of delayed care and the intrusion on their choices. If you ask the elderly, it is the idea of being pushed to quietly accept the pains of old age and settle for the palliative pill rather than the new hip.
All these concerns are real and matter. But the larger point is that Democrats aren't proposing a subsidy to enable people to get the care they need. Rather they want to shift decision-making authority from the American citizen to the government bureaucrat.
These proposals are yet another manifestation of the no-growth, redistributionist mindset, combined with an elitist, authoritarian philosophy of government. To buy into them and ignore the reality they've produced elsewhere is to love humanity more than human beings, and value utopian ideals of equity over the tremendous individual costs they inflict.
In these proposals, human beings aren't individuals with freedom to contract as they see fit and make their own best judgments, but interchangeable widgets for whom rules should be fashioned and enforced based on age, or quality of life, or some other metric. Bureaucrats would evaluate whether one is young enough to warrant a pacemaker or a hip, or sufficiently long gone from a hospital to justify readmission. Medicine would become a one-size-fits-all bureaucracy, not an art, in which the physician would face real risks for deciding that the bureaucratically approved "effective treatment" isn't what works in a particular case.
Today's Latin lesson: Dirigo, meaning "I lead." It is the state motto of Maine and the name of their 2003 universal health care plan was DirigoChoice. I'll confess I thought it read "DingoChoice" as in "Dingoes Ate My Baby," but the name is even more prescient than that.
The Wall Street Journal Editorial Page reports that Dingo --er DirigoChoice has very similar elements to ObamaCare and was sold under very similar promises.
Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.
Why did this happen? Among the biggest reasons is a severe adverse selection problem: The sickest, most expensive patients crowded into DirigoChoice, unbalancing its insurance pool and raising costs. That made it unattractive for healthier and lower-risk enrollees. And as a result, few low-income Mainers have been able to afford the premiums, even at subsidized rates.
This problem was exacerbated because since the early 1990s Maine has required insurers to adhere to community rating and guaranteed issue, which requires that insurers cover anyone who applies, regardless of their health condition and at a uniform premium. These rules—which are in the Obama plan—have relentlessly driven up insurance costs in Maine, especially for healthy people.
The Maine Heritage Policy Center, which has tracked the plan closely, points out that largely because of these insurance rules, a healthy male in Maine who is 30 and single pays a monthly premium of $762 in the individual market; next door in New Hampshire he pays $222 a month. The Granite State doesn't have community rating and guaranteed issue.
Perhaps, Dirigante. (They lead? did I get it?) The good people of Maine seek to lead us into the same quagmire of unfulfilled promises, market disruptions and unending expense that they have incurred.
ATLANTA - U.S. life expectancy has risen to a new high, now standing at nearly 78 years, the government reported Wednesday.
The increase is due mainly to falling death rates in almost all the leading causes of death. The average life expectancy for babies born in 2007 is nearly three months greater than for children born in 2006.
The Internet is really one big segue machine. I wanted to blog about privacy of medical info with greater government involvement.
I took somebody to the doctor, and the patient was asked to provide a UA specimen for drug testing. It came with a questionnaire that was pretty intrusive. It turns out that neither the test nor questionnaire was required, but I couldn't help thinking that it contained several questions that I would be queaay answering.
Civil libertarians went apopleptc over a section of the Patriot Act that allowed government to snoop on library records. I can appreciate that's being problematic and feel I could take either side of that debate (I think it was pretty restricted). What I cannot accept is their telling me that library lists are unacceptable, but collecting drug use information is fine.
As they say, what could possibly go wrong? Breitbart::
WASHINGTON (AP) - A fifth State Department worker has been convicted of snooping into the passport files of famous Americans.
Kevin Young, a 22-year veteran of the State Department from Temple Hills, Md., pleaded guilty Monday to illegally accessing more than 125 confidential passport applications for celebrities, professional athletes and a politician.
An investigation began in March 2008 after officials discovered unauthorized access of the files for then-presidential candidates Barack Obama, John McCain and Hillary Rodham Clinton.
I saw MoveOn.org's "answers to five lies about health care" on Facebook last week. It should have been titled "Five fallacious answers to straw men," but I digress. It got me thinking, a few days before I attended a party that would be chock-full-o-progressives, what my five complaints about health care reform would be: a little elevator talk against HB3200 as it were.
I found it hard to get beyond limited government and enumerated powers. I know we have stretched the idea of enumerated powers around some egregious legislation in the past 100 years, but it got me to wondering whether any "four horsemen" would surface. It also made me wonder why we read so little about any Constitutionality of Federally run, Executive branch managed health care.
Well, Instapundit links to a good post: Is ObamaCare Constitutional? Author Rob Natelson compiles a good list of concerns.
A major goal of our Constitution and Bill of Rights is to limit government power, especially federal power. National health care proposals would increase that power greatly, so it is not surprising that those proposals have constitutional difficulties. Whatever the merits of federal control of health care, moving in that direction is (as former Justice David Souter might say) a change of “constitutional dimension.” The proper way to make such a change is not through an ordinary congressional bill. The proper way is by constitutional amendment.
It seems quaint to even discuss whether something is Constitutional any more (after McConnell v FEC, what could fail?) but, truly if we stretch the Constitution somehow to include this, it ceases to be a framework for limited government and becomes only a document that says how old our legislators must be to hold office.
Harry Reid: Protesters are "Evil-Mongers." Remember how Democrats and media made fun of Bush for talking about "evildoers?" But those were just terrorists, not people who, you know, opposed the Obama Administration's agenda. -- Professor Glenn Reynolds
After years of blocking legislation to require valid identification to vote and branding Republicans as "racists" for supporting it, some Democrats are apparently requiring photo ID to attend their town hall meetings.
In Texas, Rep. Gene Green's office is requiring town hall attendees to present a photo ID that proves they live in his district.
On his Web site, Green says "due to a coordinated effort to disrupt our town hall meetings, we will be restricting further attendance to residents ... and verifying residency by requiring photo identification."
Illegal aliens should be able to vote, but people angry with government should not be allowed to speak. Is this still America?
Shannon Love compares transportation costs to health care.
In 1900, most people walked to work, school, shopping and socializing. The percentage of the average household’s budget devoted to transportation was so low that the Census bureau didn’t even bother to collect data on it. Today, the average household spends 21% of its budget on transportation. It’s the second biggest single cost after housing yet people take such spending for granted and easily factor it in to their personal budgets. We do so because transportation costs rose slowly over the course of the last half century while other costs, such as food, decreased. Decade after decade we gradually became used to spending more and more for transportation till now the average middle-class family easily accepts spending several thousand dollars a year in transportation costs.
Love goes on to speculate about the governmnet action that would be required if your employer funded transportation was suddenly taken from you. Great stuff.
In this case, I think that the political logic of an expensive new health care plan will push us faster and further towards price controls on key inputs, and somewhat hamfisted "one-size-fits-all" standard-of-care recommendations. I am reinforced in this belief by the fact that many of the people pushing health care reform are also enthusiastic proponents of . . . price controls on key inputs, and national standard-of-care recommendations. I don't trust them when they ask me to focus on just this bill right here.
They shouldn't trust me either. Except they should, because I'm being right out front about this. I don't want this bill, and I don't want any other bill that increases the number of people for whom the government pays for care. I may point out why you shouldn't want this bill, and I will try to be intellectually honest about it--i.e. focus on things the bill actually is likely to do, rather than "death panels". But I wouldn't like it any more if it was more like something you want. In fact, I'd probably like it less.
I have a background thread with a family member that was launched by the McArdle post I highlighted last week. Maybe she knows my niece, but it is funny how well she has followed and countered the objections I have encountered: on time, in order.
At the end of the day, this is a first principle on which I won't budge. I do not want more government involvement, however it is structured.
UPDATE: Her rationing argument makes the WSJ "Notable & Quotable:"
Robert Wright notes that "we already ration health care; we just let the market do the rationing." This is a true point made by the proponents of health care reform. But I'm not sure why it's supposed to be so interesting. You could make this statement about any good:
"We already ration food; we just let the market do the rationing."
"We already ration gasoline; we just let the market do the rationing."
"We already ration cigarettes; we just let the market do the rationing."
And indeed, this was an argument that was made in favor of socialism. (No, okay, I'm not calling you socialists!) And yet, most of us realize that there are huge differences between price rationing and government rationing, and that the latter is usually much worse for everyone. This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they're applied to hip replacements and otitis media.
The rationing is, first of all, simply worse on a practical level: goods rationed by fiat rather than price have a tendency to disappear, decline in quality, etc. Government tends to prefer queues to prices. This makes most people worse off, since their time is worth much more than the price they would pay for the good. Providers of fiat-rationed goods have little incentive to innovate, or even produce adequate supplies. If other sectors are not controlled, the highest quality providers have a tendency to exit. If other sectors are controlled, well, you're a socialist.
And these are just some of the falsehoods and misinformation peddled by President Obama yesterday. It doesn't even include his choice to sell Obamacare as The "Post Office" of Health Care Plans. No wonder so many Americans are skeptical. -- Heritage, in a blistering and comprehensive