The Neville Awards
Home | The Liberals' Corner | Hypocrisy Watch | Recommended Media | The Butcher's Bill |
Obama's Daily March To Socialism & Surrender | The Obama Gallery | Videos

ObamaCare -- Some of You Will Have to Die

By Gary Starr for the Neville Awards
Originally Posted June 14, 2009

Neville Healthcare Article

Neville Healthcare Article Updates

Oct.16, 2009, Robert Reich on Healthcare -- "It's too we're going to let you die."
June 16, 2009-Obamacare Extravaganza on ABC
June 26, 2009-Withholding Care From the Elderly
July 18, 2009-You Can't Keep Your Current Plan
July 21, 2009-(1) Obama's scheme to "save money" and fix social security at the same time!
July 21, 2009-(2) Senate & House Bills Dissected
July 21, 2009-(3) Fascism on Display-Who's Advising Obama on Healthcare
July 22, 2009-House Bill Dissected Pt 2
August 6, 2009-Obama Wants You to Snitch On Your Friends
August 10, 2009-Healthcare Bill is Huge Giveaway to ACORN
Sept. 18, 2009, Senate Healthcare Bill Bombs
Sept. 26, 2009, No Healthcare? -- Go to Jail
Oct.16, 2009, Robert Reich on Healthcare -- "It's too we're going to let you die."
Mar. 26, 2010, ObamaCare: the Beginning of America's Dark Ages and Decline?
Merry Christmas 2010, ObamaCare is Unconstitutional -- For Now
ObamaCare: This Is What Healthcare Rationing Looks Like
ObamaCare: More Unpopular Than Ever: Two Reports

Related Articles:

How ObamaCare Guts Medicare

Who Pays for ObamaCare?-What Donald Berwick and Joe the Plumber both understand.

You're losing your plan -- ObamaCare's true face emerges

Obamacare: Why the AMA Wants to Muzzle Your Doctor

ObamaCare and the Constitution - If Congress can force you to buy insurance, Article I limits on federal power are a dead letter.

ObamaCare Passes House by 219-212, Smaller Margin than in November

Slaughter House Rules-How Democrats may 'deem' ObamaCare into law, without voting.

Paul Ryan v. the President - The Republican dissects ObamaCare's real costs. Democrats stay mute.

Democrat Controlled Senate Passes Healthcare -- Merry Christmas

Compare the House and Senate Healthcare Plans

Senate Healthcare bill-Change Nobody Believes In

ObamaCare and the Liberal Obsession

Worse Than the Public Option-Harry Reid's Medicare Gambit

ObamaCare Keeps Falling in the Polls-A business ad campaign could turn the tide even in the House.

What the Pelosi Health-Care Bill Really Says

Pelos's Healthcare Bill is 'The Worst Bill Ever'

Ezekiel Emanuel-Obama's Health Rationer-in-Chief White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.

ObamaCare Is All About Rationing -- Overspending is far preferable to artificially limiting the availability of new procedures and technologies.

Obama's Senior Moment-Why the elderly are right to worry when the government rations medical care.

Drug Dealers-The White House buys Big Pharma's silence.

ObamaCare's Real Price Tag

Obamacare in Retreat -- Don't Get Complacent

ObamaCare in Trouble

GovernmentCare's Assault on Seniors

Their Own Medicine-Senators prefer the insurance they have

A Reckless Congress

Parsing the Health Reform Arguments-Some of the shibboleths don't make much sense.

Healthcare: How Washington Rations

Why the Health Care Rush? The Bill Can't Stand Scrutiny

Canada's ObamaCare Precedent

ObamaCare Sticker Shock-A $1.6 trillion deficit boost, and the uninsured will still be with us.

Massachusetts Universal Healthcare Doesn't Add Up

Neville Healthcare Article

Back to Top

Health-care reform "will not be pain free" and seniors should be "more accepting of the conditions that come with age instead of having them treated."

-- Former Sen. Tom Daschle (D)

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project, most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it. Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We have an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this.

-- Ronald Reagan 1961

We've got to have national health care!!! So cry the liberals since the time of FDR. They want to take the Cadillac of health care systems and turn it into an Edsel.

Never mind that it hasn't worked in Great Britain or Canada for the last 20 years.

Never mind that it gets the government involved in 20% of the economy.

Never mind that no one other than the left is clamoring for it.

Our Fraudinator-in-Chief, as usual, is in a hurry. He doesn't want you to know what's in the bill or the fact that the details can't stand the light of day. He also knows that if he can't get it done by summer's end he won't be able to get it done until after the 2010 midterms... if he doesn't lose Democratic seats in Congress. 2011 is too late because we are aready into the next presidential election cycle. It's got to be done NOW!!!

Our Fraudinator-in-Chief and the Democrats were in a hurry to pass the $787 billion stimulus package. They told us that without the stimulus package unemployment would rise to 8%. No one read the bill...there just wasn't enough time. Congress passed it and unemployment is now at 9.4%.

Our Fraudinator-in-Chief and the Democrats were in a hurry to bail out Chrysler and GM. They told us that without the bailout money Chrysler and GM would go into bankruptcy. No one bothered with the details when it came time to vote for the bailout funds. Chrysler and GM went bankrupt anyway. Chrysler is now owned by Fiat, profitable dealerships are closing across the country, the bondholders are getting screwed and the unions and the government now hold a larger ownership stake than the shareholders. But Obama doesn't want to run the auto industry.

So now comes national healthcare.

The White House has "strongly suggested" that Senate Democrats, bracing for what they expect will be a huge price tag connected with this healthcare boondoggle, bypass the Congressional Budget Office (CBO) cost estimate in favor of the White House Office of Management and Budget (OMB).

In other words they will cook the books by lowering the expected cost of national health care. OMB's projected numbers are rosier than the CBO's.

It's not about health care, it's about health care rationing and population control or, more exactly, control of you and your health choices.

Nancy Pelosi: "Every aspect of our lives must be subjected to an inventory..."

Obama: "We can't drive our SUVs and, you know, eat as much as we want and keep our homes on, you know, 72 degrees at all times..." (Obama keeps the Oval Office at 78 degrees at all times)

And finally our tax cheating ex-Senator, almost Sec. Of Health and Human Services until he got caught, Tom Daschle, in his book "Critical: What We Can Do About The Health Care Crisis" says health-care reform "will not be pain free" and that seniors should be "more accepting of the conditions that come with age instead of having them treated." First of all Tom...what healthcare crisis? There's always a crisis with the libs and the problems exist in the first place because of half-baked liberal social engineering policies.

We at Neville wonder if Daschle and our "boomer" congressional Politburo members will themselves "be more accepting of the conditions that come with age" and just take it like the proletariat. Or will we qualify for the "Double Secret Congressional Healthcare Plan" that only our glorious legislators currently get?

Sorry Grandma and Grandpa. No pacemakers for you. No cancer operations for you. All you boomers with arthritic hips, high blood pressure and/or high cholesterol. Live with it!! No hip replacement surgery. No bypasses or stents. Forget the tummy-stitch surgery you fatty slobby boomer slug. Generic drugs only. No cutting edge medicine allowed and no surgical procedures allowed. Too expensive. Take two aspirine and don't call me in the morning.

Per Dick Morris on June 6, 2009

Health care providers trooped out of the White House and trumpeted their goal of saving $1.7 trillion of costs over the next decade in health spending. Now these drug companies, hospitals, insurance companies, medical device manufacturers, labor unions and doctors have laid out their plans in more detail.

And right there, in plain print, is the beginning of medical care rationing. Now that the cameras have been put away and the media is no longer watching, their secret emerges: They are going to cut medical costs by cutting medical care. Right now, they cite four targets. They plan to:
  • Cut diagnostic imaging tests like MRIs and CAT scans.
  • Reduce the use of antibiotics.
  • Perform fewer Caesarean sections.
  • Cut care for management of chronic back pain
These decisions will not be medical but financial. They will not be based on a doctor's opinion of what his or her patient needs, but a bureaucrat's and an accountant s opinion of what the new health care system can afford.

And you will not be able to bypass their rulings and pay for this care yourself. The rules laid down must be followed and private payments will not be permitted to override them. What we now call a private fee for service will metastasize into a bribe.

But this is just the very beginning of rationing. The total of health care spending now runs about $2.3 trillion a year in the United States. Over ten years, that's likely to reach $30 trillion. So a cut of $1.7 trillion is a mere drop in the bucket.

More rationing is coming, and coming soon.

So some of you will have to get out of the way, stop clogging up the system and die. We've got waves and waves of young healthy children and adults both legal and illegal we need to take care of. We need to control them by bribing them with "free" healthcare. You oldsters just cost too much. And some of you still remember the old ways of health care choices and [SHOCK!!] individual freedom.

Obama on his grandmother:

THE PRESIDENT: ...I actually think that the tougher issue around medical care - it's a related one - is what you do around things like end-of-life care -

INTERVIEWER: Yes, where it's $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I've told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she's in the hospital, and the doctor says, Look, you've got about - maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that - you know, your heart can't take it. On the other hand, if you just sit there with your hip like this, you're just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just - you know, things fell apart.

I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life - that would be pretty upsetting.

And it's going to be hard for people who don't have the option of paying for it.

THE PRESIDENT: So that's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

INTERVIEWER: So how do you - how do we deal with it?

THE PRESIDENT: have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now.

In other words, faceless bureaucrats in Washington will decide whether your grandparents live or die.

So thank you, white liberal guilt-ridden boomers who just had to have a black president to ease your pathetic, self-indulgent and self-loathing signed all of our death warrants.

Neville Healthcare Article Updates

Back to Top

ObamaCare: More Unpopular All The Time -- Two Articles

Back to Top

From Investors Business Daily:

Caving On ObamaCare

OCTOBER 18, 2011

Remember when Nancy Pelosi promised that Americans would fall in love with ObamaCare once it was the law of the land? Turns out barely half of Democrats now like it.

The Kaiser Family Foundation has tracked public support for ObamaCare since the law was passed. It's never been very popular, but now support has hit a new low of 34% due in part to erosion in Obama's own party. The month ObamaCare passed, more than three of four Democrats approved of it. Now, just over half do, and only one in five has a "very favorable" view. Even worse, just 27% of Democrats think the law will make them and their families better off.

But how can this be, loyalists ask, when ObamaCare is already helping people? Just ask any "adult child" on his parents' health plan, or all those small businesses benefiting from the insurance premium tax credit?

But as each month brings new Obama-Care failures, fewer Democrats seem to be buying such baloney.

Thanks to "reform," for example, insurance premiums shot up 9.5% this year, reversing a decade-long trend toward lower annual increases. Just a few days ago, the White House was forced to abandon the law's long-term care insurance provision because it was financially unworkable. And it's had to pass out more than 1,500 waivers to prevent millions from losing coverage. The temporary "high risk" pools meant to help those with pre-existing conditions are a bust.

And we haven't even mentioned the pernicious and wildly unpopular centerpiece of ObamaCare — the mandate that everyone buy insurance or else. This is scheduled to start in 26 months, unless the Supreme Court finds it unconstitutional.

Every Republican presidential candidate has called for repealing this mess before it can do any more damage. Repeal will never happen, though, as long as Obama sits in the White House. And should the GOP fail to win the next election, by 2017 it will be all but impossible to unscramble the ObamaCare egg.

Fortunately, the more the public understands the stakes involved, the more likely Obama will be safely back in Chicago in 2013, while a Republican president happily flushes ObamaCare down the drain.

From the Wall Street Journal:

Less Popular All the Time -- 'ObamaCare' has become the great unmentionable. .

OCTOBER 29, 2011

Good policies are sometimes unpopular, and everybody knows that bad ones are too often very popular, which helps explain the habits of modern Washington. So it's more than a little gratifying when the political class's worst choices earn the public scorn they deserve, as seems to be the case with President Obama's health-care plan.

Yesterday the Kaiser Family Foundation released its October tracking poll and found that only 34% of respondents have a favorable view of the Affordable Care Act, down from 41% in September. Notably, the decline was due to losing Democratic supporters, who dropped to 52% support from 65% month to month. Meanwhile, 51% of the public is opposed to the vast new government health-care entitlement, up from a prior 2011 average of 45%.

These results show the lowest support ever in the Kaiser survey and they're remarkable because the research outfit has long been an outlier, showing more support overall for the law, or for this or that provision, than other pollsters have been able to detect. This report is more in line with the national trend. The current Real Clear Politics average of all health polling puts opposition at 50.6% and support at 38.4%, down from a summer high of 41.5%.

Such hostility was evident when Democrats were writing the bill and ramming it through Congress almost two years ago, but the liberal political theory was that the plan would gradually gain support over time as partisan temperatures cooled. That was the historic path of all other entitlements, which built their own constituencies once the supposedly free benefits began.

In this case, the major insurance subsidies don't start to flow until 2014. Democrats would have begun the free lunch immediately, but they needed to delay it to make their gusher of new spending look better as part of Washington's 10-year budget scoring. However, ObamaCare was also front-loaded with all kinds of provisions that were supposed to build support in the meantime and especially leading to the 2012 election, such as small-business tax credits and temporary government coverage for people with pre-existing conditions.

Many Americans also no doubt recall the partisan and abusive manner in which the law passed. Reforms of this magnitude have historically been grounded in a rough social consensus, so ObamaCare lacks a measure of democratic legitimacy. Democrats have also been running away from it, as shown by their recent demand that Members of Congress not be able to refer to "ObamaCare" in their government-paid mail to constituents. You can bet that if it were popular, they'd be embracing the term.

The durable and growing opposition is above all due to the bill's results. The most important question Kaiser asked was whether national health care would leave Americans better or worse off. Some 44% said worse off, a 10 percentage-point jump from September, while only 18% believed they would better off.

In other words, Americans heard the President's promises, over and over again, most of all that the bill would lower insurance costs. Those costs are rising as fast as ever, more so in some places as insurers and providers anticipate the price controls and other regulation to come.

The Beltway wisdom now is that ObamaCare will never be repealed. Entitlements are forever, they say. Maybe not this one.

ObamaCare: This Is What Healthcare Rationing Looks Like

Back to Top

By Gary Starr for The Neville awards

Oct. 24, 2011

In November of 2009 an "independent" panel of experts at Arizona State University in Phoenix, and the U.S. Preventive Services Task Force (USPSTF) updated breast cancer screenings recommendations to say that most women don't need to get mammograms until they reach age 50. Under Obamacare far fewer women will undergo the breast cancer screenings. And more women will get breast cancer.

The timing of this change is suspect in that it contravenes 25 years of studies that say screenings should be done every year or two for women beginning at age 40. The new report said women this age should simply talk to their doctors about the benefits and risks. The group also says there's no benefit to performing breast self-exams.

We are assured, however, the new recommendations won't affect women at high risk, such as those with strong family histories of cancer. The task force also says older women don't need as many mammograms and women ages 50 to 74 should be screened only every other year, not annually, as currently recommended.

Really!?! This is the beginning of healthcare rationing that opponents of Obamacare, which passed in March 2010, were warning about. The bottom line is that government healthcare will simply not want, nor be able, to pay for preventative cancer screenings when the law is fully implemented in 2014. How do we know this? One only need look north to the Canadian healthcare system and the across the ocean to the British National Health Service. Deaths from cancer are consistently higher under these two nationalized systems.

Not wanting to be accused of gender bias, in October 2011 the same USPSTF issued a report draft saying that healthy men do not need to be screened for prostate cancer, and discouraged the use of PSA screening, saying there was not enough evidence to determine the value of screening. The recommendation applies only to symptom-free men regardless of age, race or family history.

The obvious catch-22 is how does one determine the health of the prostate……WITHOUT PERFORMING A PSA TEST!!!!

Again, this is healthcare rationing pure and simple.

Finally, in a slightly unrelated Obamacare (a.k.a. "The Patient Protection & Affordable Care Act") development, the long-term care provision of the law known as CLASS has been scrapped because the government can't afford it.

From the Wall Street Journal:

ObamaCare Starts to Unravel: The real story behind the Class program failure, and what to do now.

OCTOBER 17, 2011

Now that one of ObamaCare's major new benefit programs has been scrapped, liberals are trying to make stone soup by claiming that the Obama Administration merely committed an act of "good government." They claim that when this long-term care insurance program proved to be unworkable, the Administration conceded as much, and now it's gone. So let's review the evidence, not least because it so perfectly illustrates the recklessness that produced the Affordable Care Act.

When Democrats were pasting it together in 2009 and 2010, the immediate attraction of the program known by the acronym Class was that its finances could be gamed to create the illusion that a new entitlement would reduce the deficit. Ending the complicated Class budget gimmick erases the better part of ObamaCare's purported "savings," but it's also worth focusing on the program's long-run political goals.

For decades Democrats have been trying to put government on the hook for middle-class costs like home health services ($1,800 a month on average) and nursing homes ($70,000 to $80,000 per year). On paper, Class was supposed to be like normal insurance, funding benefits through premiums with no subsidy. But since the budget gimmick and the program's larger structure meant that premiums could never cover benefits, Democrats were trying to force a future Congress to prevent a Class bankruptcy using taxpayer dollars.

As the costs to the federal fisc continued to climb, the Democratic gambit was that Class would gradually morph into another part of Medicare. Insurance depends on younger, healthier people signing up to cross-subsidize the older and sicker, but under the Class program as written almost all of its enrollees would soon also be beneficiaries.

So to fix this "adverse selection," the plan was for Congress to eventually make participation mandatory, with the so-called premiums converted into another payroll tax and the benefits into another entitlement. Former White House budget director Peter Orszag has been writing that the long-term care insurance market can't function without a mandate, while HHS Secretary Kathleen Sebelius declined to rule one out at a Senate hearing in February. Now they tell us.

The only reason the Health and Human Services Department pre-emptively called off this scheme is that former New Hampshire Senator Judd Gregg succeeded in inserting a proviso that required the Class program's reality to match Democratic promises as a matter of law. If HHS couldn't provide "an actuarial analysis of the 75-year costs of the program that ensures solvency throughout such 75-year period," it couldn't be legally implemented.

In other words, HHS had to prove that the Class program wouldn't go broke the way it was designed to-and actuarial analysis is a matter of math, not politics. In a 48-page report that HHS submitted to Congress Friday, the department concedes that it is literally impossible to create any kind of long-term care program under the law's statutory text in which revenues match expenditures. Such a plan would cost as much as $3,000 per month, which no one would ever buy.

The HHS gnomes even considered "features deviating from or going beyond a plain reading of the statutory language" that its lawyers didn't think could pass legal muster, and they still couldn't avoid violating the known laws of mathematics despite 19 months of trying. HHS lawyers also said the government would have to warn enrollees that the promised benefits weren't contracts and could be abrogated to "dispel any claims that the Class program had misled the public or had encouraged reliance on its programs under false pretenses."

Those pretenses have been obvious all along, with outside analysts and internal Administration experts saying Class wasn't viable. President Obama was a mask of indifference with no response when Paul Ryan took Class apart at the 2010 White House health summit. Democrats included it anyway, but now that the Administration itself has vindicated its critics, Republicans have a new political opportunity to make real health-care legislative progress.

At a minimum the GOP could begin by repealing the Class program altogether, since its legal authority is still intact. "One should never leave a partly loaded gun on the table, even if most of the chambers are empty or just house blanks," writes the American Enterprise Institute's Tom Miller. He also suggests attaching a few of the more destructive provisions and forcing Democrats to defend them, such as Mr. Orszag's Independent Payment Advisory Board of 15 political appointees who have broad unaccountable powers to control health-care markets and health care.

Our suggestion is for a Gregg-like amendment that applies to the entire health law and not simply Class. If reality can't match the rhetoric that accompanied the bill-about fiscal responsibility, bending the cost curve, keeping your health care if you like your health care and all the other false promises-then, legally, it should be repealed like Class. Call it a truth-in-advertising clause. ObamaCare would collapse in a heartbeat.

Merry Christmas 2010: ObamaCare is Unconstitutional -- For Now

Back to Top

By Gary Starr for The Neville awards

Dec. 15, 2010

Obamacare hit its first major legal roadblock, when U.S. District Judge Henry E. Hudson ruled that the heart of the sweeping legislation is unconstitutional.

In a 42-page ruling, Judge Henry Hudson declared that ObamaCare's core enforcement mechanism known as the individual mandate-the regulation that requires everyone to purchase health insurance or else pay a penalty-exceeds Congress's authority to regulate the lives of Americans.

"An individual's personal decision to purchase - or decline to purchase - health insurance from a private provider is beyond the historical reach of the Commerce Clause," said Hudson, a 2002 appointee of President George W. Bush.

"The unchecked expansion of congressional power to the limits suggested by the Minimum Essential Coverage Provision [the individual mandate] would invite unbridled exercise of federal police powers. 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."

Judge Hudson further argues that the nut of the case is the Commerce Clause. Justice can't now claim that the mandate is "really" a tax when the bill itself imposes what it calls a "penalty" for failing to buy insurance and says the power to impose the mandate is vested in interstate commerce. Recall that President Obama went on national television during the ObamaCare debate to angrily assert that the mandate "is absolutely not a tax increase."

Moreover, Judge Hudson says that no court has ever "extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market."

Liberals immediately attacked Judge Hudson because he was appointed by George W. Bush as an activist. Interestingly enough they don't attack the (Republican) judge in California that threw out Prop 8, the law that made gay marriage illegal. So the judiciary is officially if it hasn't been for years.

Liberals were also crowing that even if the mandate is eventually declared illegal, it's no big deal because the rest of ObamaCare's new system would remain intact. Yet they've argued for years that the mandate is essential to health reform, because the mandate is at the heart of the regulatory machine. They also said that not having a public option was no big deal while privately seething that it was left out of the legislation. Each new day is a chance for liberals to re-write history.

Hopefully the new congress will have the cojones to de-fund this monstrosity and tear it apart piece by piece

This case will now move to the Supreme Court where sanity and the Constitution, hopefully, will prevail.

Waivers and Exemptions -- Some are more equal than others

Meanwhile the list of companies, insurers and unions winning exemptions from the new health reform legislation has grown to 222, doubling since early November and up from just 30 in the month of October.

Companies and unions that provide health coverage for more than 1.5 million people now don't have to abide by health reform changes for one year beginning January 1. That includes 34 unions with more than 140,000 members.

Many unions had fought hard for health reform and were dismissive about fears that companies would simply dump their coverage if health reform passed. Now they want out. A true profile in courage.

“[ObamaCare's] march to the sea is only beginning and the trail of destruction will grow. The last six months have seen 2011 premium increases as high as 9% due to ObamaCare; multibillion-dollar corporate writedowns by Verizon, AT&T, Caterpillar and others; disruption in the insurance markets leading to the erasure of child-only policies and other types of specialty coverage as shown in the McDonald’s imbroglio; the Administration beginning to impose price controls on premiums; insurers withdrawing private options from Medicare Advantage; and Democratic protection of a 1099 tax reporting mandate that will slam small businesses. Republicans should be repeating all of these tangible harms in a litany, while predicting the damage to come.” –The Wall Street Journal

Approved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711 as of December 3, 2010


Neville Health Care Update Mar. 26, 2010, ObamaCare: the Beginning of America's Dark Ages and Decline?

Back to Top

A couple of days after our very own Leftist Junta (Obama, Reid Pelosi for those of you still in denial) did their little victory lap, our Fraudinator-in-Chief was out on the campaign trail trying to sell the new law (he never did sell it us) to the American people. There was something about a "nice day on the mall", "the ground didn't open up" and some other feel-good bromides about how all of this really good for us. After all, Pelosi said we would find how great Obamacare was after they passed it.

What is interesting is that, even after all of the bribes, union carve outs, arm-twisting and finally the Stupak sellout, this bill passed by one vote less than the original house bill in November 2009. The real principles of the Junta's machine were articulated by Democratic Congressman Alcee Hastings who was impeached and removed from the bench as a federal judge, before being elected to the House when he said ""There ain't no rules here, we're trying to accomplish something. . . .All this talk about rules. . . .When the deal goes down . . . we make 'em up as we go along."

Obama has shown just how unserious he is about healthcare, and how this was always about his ego. By trying to soft-pedal the bill on the road he hopes to deflect attention away from the fact that the real problems don't begin until 2011 and 2014 when the post election triggers kick in, including the unconstitutional mandate that everyone have health insurance enforced by the IRS. Those clever Dems.

By the end of the week alarm bells were starting to go off in big business.
  • Caterpillar Inc. said the health-care overhaul legislation would increase the company's health-care costs by more than $100 million in the first year alone.
  • More Fortune 500 firms followed with similar write-down announcements: Valero Energy ($20 million), Deere & Co. ($150 million), 3M ($90 million) and AK Steel ($131 million).
  • In an employee notice, Verizon warned about the 40% tax on high-end health plans, though that won't take effect until 2018. "Many of the plans that Verizon offers to employees and retirees are projected to have costs above the threshold in the legislation and will be subject to the 40 percent excise tax." These costs will start to show up soon, and, as we repeatedly argued, the tax is unlikely to drive down costs. The tax burden will simply be spread to all workers-the result of the White House's too-clever decision to tax insurers, rather than individuals.
  • AT&T announced that the bill will cause a reevaluation of their employees' healthcare benefits, calling it an "additional tax burden." AT&T stated that it will take a $1 billion non-cash charge this quarter because of changes to the Medicare-subsidy tax treatment.
From the Heritage Foundation:

The leftist majorities in Congress were incensed that America's employers would dare warn their investors about the costs of Obamacare at the same time as the Obama administration's national sales pitch was set to begin. So using the full force of the federal government to bully and harass America's job creators, House Energy and Commerce Committee Chairman Henry Waxman (D-CA) sent letters to the CEOs of Deere, Caterpillar, Verizon, and AT&T demanding all documents "from January 1, 2009, through the present" regarding "any analyses related to the projected impact of health care reform" and "any documents, including e-mail messages, sent to or prepared or reviewed by senior company officials related to the projected impact of health care reform." Waxman intends to haul these CEOs in front of the Subcommitte on Oversight and Investigations, which just happens to be chaired by Rep. Bart Stupak (D-MI), for a hearing April 21st.

While it is unfortunate that the left in Congress believes our nation's business leaders' time is best spent being browbeaten by congressmen for not doing more to support their policy preferences, the American public should look forward to these hearings. The more information the American public is given about Obamacare, the more they will oppose it. The more they oppose it, the easier it will be to repeal it. We have a long road ahead of us, but eventually the Obamacare nightmare will end.

The Democrats who passed this turkey and their cheerleaders in the media also tipped their hand. It was about wealth redistribution and population control all along.

Sen. Max Baucus declared the "healthcare bill" to be "an income shift, it is a shift, a leveling to help lower income middle income Americans." Baucus continued, "[t]oo often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America." This is how Marxists think so this would make Baucus a communist.

Rep. John Dingle in an interview with Detroit WJR News/Talk 760 host Paul W. Smith - 3/22/10: "Let me remind you this [Americans allegedly dying because of lack of universal health care] has been going on for years. We are bringing it to a halt. The harsh fact of the matter is when you're going to pass legislation that will cover 300 [million] American people in different ways it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people."

Fascists and communists always feel the need to control the people.

And finally Dave Leonhardt in Pravda, err, The New York Times

For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago.

Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.

Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform's effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan.

...Since Mr. Obama began his presidential campaign in 2007, he has had a complicated relationship with the Reagan legacy. He has been more willing than many other Democrats to praise President Reagan. "Reagan's central insight - that the liberal welfare state had grown complacent and overly bureaucratic," Mr. Obama wrote in his second book, "contained a good deal of truth." Most notably, he praised Mr. Reagan as a president who "changed the trajectory of America."

But Mr. Obama also argued that the Reagan administration had gone too far, and that if elected, he would try to put the country on a new trajectory. "The project of the next president," he said in an interview during the campaign, "is figuring out how you create bottom-up economic growth, as opposed to the trickle-down economic growth."

Folks, it was never about healthcare.

Our friends across the pond are none too fond. Nile Gardiner writes in the London Telegraph:

Congress health care vote: a dark day for freedom in America

The passage last night of Barack Obama's health care reform bill through the House of Representatives is yet another blow to freedom in America inflicted by the Obama administration. The legislation, which comes at a staggering cost of $940 billion, will hugely add to the already towering national debt, now at over $12 trillion. It is yet another millstone round the necks of the American people, already faced with the highest levels of unemployment in a generation.

It is also a great leap forward by the United States towards a European-style vision of universal health care, which will only lead to soaring costs, higher taxes, and a surge in red tape for small businesses. This reckless legislation dramatically expands the power of the state over the lives of individuals, and could not be further from the vision of America's founding fathers. It has also been rushed through Congress without proper scrutiny, in the face of overwhelming public opposition, and with not an ounce of bipartisan support.

Above all the health care bill is a thinly disguised vanity project for a president who is committed to transforming the United States from the world's most successful large-scale free enterprise economy, to a highly interventionist society with a massive role for centralized government. The United States has thrived as a nation for over 230 years precisely because of its love for freedom and its belief in free markets.

What we have just witnessed is a massive slap in the face for limited government and the principle of individual responsibility. Its net result will be the erosion of freedom in America, and a further undermining of the country's economic competitiveness. This may be a political victory for the president and his supporters in Congress, but it is in reality a defeat for America as a great power, and another Obama-led step towards US decline.

Finally the saddest part of Obamacare will happen over the next twenty to forty years. Since the end of World War II Europe and Canada have built massive social welfare, cradle to grave societies at the expense of maintaining there own security. That job fell on the United States. Europe has sort of thrived under our nuclear umbrella, all the while spitting in our face for being the world's policeman.

Well, after forty years the worker's paradise party is over...they are running out of money for the socialist utopia. Greece and Spain are broke…there are riots in the streets of France and Greece and everyone is running around in circles trying to figure out if they should bail out Greece with worthless Euro bucks.

The same scenario will unfold here if Obamacare entrenches itself. Mark Steyn writing in National Review: of the first things that middle-rank powers abandon once they go down this road is a global military capability. If you take the view that the U.S. is an imperialist aggressor, congratulations: You can cease worrying. But, if you think that America has been the ultimate guarantor of the post-war global order, it's less cheery. Five years from now, just as in Canada and Europe two generations ago, we'll be getting used to announcements of defense cuts to prop up the unsustainable costs of big government at home. And, as the superpower retrenches, America's enemies will be quick to scent opportunity.

Can you say Russia?, China?, Iran?

Max Boot Writing in the Wall Street Journal:

ObamaCare and American Power The lesson of Europe is that the U.S. can't fund a health entitlement and maintain superpower status.
MARCH 25, 2010

A lot has been written about the impact of ObamaCare on health care and the economy. I am worried about its impact on our global power.

The United States currently spends roughly as much on defense ($661 billion in fiscal year 2009) as the rest of the world combined. But that's a pittance compared to what we spend on three major entitlement programs-Social Security, Medicare and Medicaid. Combined, they cost $1.38 trillion or almost 35% of the budget, compared with 17% for defense. And entitlements will only grow dramatically. The current unfunded liability for Social Security and Medicare, according to the 2009 Social Security and Medicare Trustees Report, is nearly $107 trillion-seven times the size of our economy.

It's hard to remember now, but there was a time when the federal government spent most of its money on the armed forces. In 1962, the total federal budget was $106 billion of which $52 billion-almost half-went for defense. It wasn't until 1976 that entitlement spending exceeded defense spending. Since then the totals have been getting more lopsided-more for social programs, less, in relative terms, for defense.

In 1935, Franklin Roosevelt assured the public that the new Social Security system would not lead to runaway spending. In 1965, Lyndon Johnson pledged that the fiscal impact of Medicare would be minimal. And now Barack Obama cites a Congressional Budget Office estimate claiming that the vast new health-care entitlement will actually reduce the deficit.

Count me as skeptical. Odds are great that the cost-containment provisions will never be rigorously implemented while the promised subsidies will prove more costly than projected.

In other words, ObamaCare will likely continue the trend already evident during the first year of the administration-when, thanks to the bank bailout and stimulus bill, federal spending as a share of GDP soared to 24.7%, unprecedented in peacetime. If you add in state and local spending, the government as a whole consumes 37.5% of GDP, up from 34.7% in 2008. Prepare for those figures to climb further as government takes on new health-care obligations.

To consider the implications for defense, look at Europe. Last year government spending in the 27 European Union nations hit 52% of GDP. But most of them struggle to devote even 2% of GDP to defense, compared to more than 4% in the U.S.

When Europeans after World War II chose to skimp on defense and spend lavishly on social welfare, they abdicated their claims to great power status. That worked out well for them because their security was subsidized by the U.S.

But what happens if the U.S. switches spending from defense to social welfare? Who will protect what used to be known as the "Free World"? Who will police the sea lanes, stop the proliferation of weapons of mass destruction, combat terrorism, respond to genocide and other unconscionable human rights violations, and deter rogue states from aggression? Those are all responsibilities currently performed by America. But it will be increasingly hard to be globocop and nanny state at the same time. Something will have to give.

President Obama's budget projects that "core" defense spending (excluding supplemental appropriations for wars) will fall as a percentage of GDP to 3% in 2019 from 3.9% in 2010. Assuming the economy keeps growing, that will still deliver more defense spending in absolute terms-but economic growth may well be endangered by the higher taxes needed to fund ObamaCare. Even if defense spending stays steady, it will be increasingly hard to replace aging weapons systems such as Bradley Fighting Vehicles, Abrams tanks and Black Hawk helicopters, which were purchased during the Reagan defense buildup.

The Air Force, which is responsible for maintaining air and space superiority-a sine que non of American power-faces a particularly big budget crunch. Its aircraft are aging and need to be replaced (KC-135 tankers and B-52 bombers are more than 40 years old), but each new plane is much costlier than its predecessor.

The Navy faces a similar problem. It now has only 283 ships-the smallest number since 1916. Granted, each of those vessels is much more capable than earlier models. But at some point quality cannot substitute for a crippling lack of quantity.

The crunch will not come anytime soon. The U.S. will remain strong for years to come. But if we are looking at major threats to our global standing, we should not look at China, Iran or Russia. We have met the enemy and he is us-specifically, our insatiable demand for entitlement spending, which ObamaCare will only exacerbate.

Mr. Boot is a senior fellow in National Security Studies at the Council on Foreign Relations and author most recently of "War Made New: Technology, Warfare, and the Course of History, 1500 to Today" (Gotham, 2006).

Neville Health Care Update Oct.16, 2009, Robert Reich on Healthcare -- "It's too we're going to let you die."

Back to Top

Rep. Alan Grayson of Florida had it only partially right when he said the following:

Actually it's the Democrats who want you out of the way if only they would speak truthfully. Obama advisor Robert Reich did just that in a September 2007 speech to an audience at the UC Berkeley. Reich revealed what he believes an honest liberal presidential candidate would say about health care:

Transcript from the audio:

"Thank you so much for coming this afternoon. I'm so glad to see you and I would like to be president. Let me tell you a few things on health care. Look, we have the only health care system in the world that is designed to avoid sick people. And that's true and what I'm going to do is that I am going try to reorganize it to be more amenable to treating sick people but that means you, particularly you young people, particularly you young healthy're going to have to pay more.

"And by the way, we're going to have to, if you're 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 another couple of months. It's too we're going to let you die."

"Also I'm going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid---we already have a lot of bargaining leverage---to force drug companies and insurance companies and medical suppliers to reduce their costs. What that means, less innovation and that means less new products and less new drugs on the market which means you are probably not going to live much longer than your parents. Thank you."

Thank you, Robert Reich, for revealing the brutal truth about what liberals ultimately have in store for the public with their health care plan. Remember, this is Reich presenting what an honest liberal presidential candidate would say aloud if he weren't worried about being elected.

Has state controlled media covered this? Of course not...they are too busy calling Rush Limbaugh a racist for the trillionth time and actively preventing him from engaging in a legitimate business deal.

Neville Health Care Update Sept. 26, 2009 -- No Healthcare?-- Go to Jail

Back to Top

On September 20th on ABC's This Week Obama abd George Stephanopoulos got into it over the definition of a tax:

Stephanopoulos: "Under this mandate, the government is forcing people to spend money, fining you if you don't. How is that not a tax?".

Obama: "No, but -- but, George, you -- you can't just make up that language and decide that that's called a tax increase."

Stephanopoulos: "I don't think I'm making it up. Merriam-Webster's dictionary: 'Tax, a charge, usually of money, imposed by authority on persons or property for public purposes."

Obama: "No. That -- that's not true, George. The -- for us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase."

Sorry is a tax and page 29 of the Baucus bill calls it an excise tax. In fact it is the type of tax that can get you thrown in jail and fined up to $25,000.

During the markup sessions for the bill Sen. John Ensign (R-Nev.) received a handwritten note from Joint Committee on Taxation Chief of Staff Tom Barthold confirming the penalty for failing to pay the up to $1,900 fee for not buying health insurance.

Violators could be charged with a misdemeanor and could face up to a year in jail or a $25,000 penalty, Barthold wrote on JCT letterhead. He signed it "Sincerely, Thomas A. Barthold."

So there it is. If you do not buy insurance under ObamaCare you may go to jail, go directly to jail, do not pass go, and do not collect $200.

The House and Senate, working on separate bills have also indicated they do not want the pesky public to be able to see the final bill 72 hours before the legislation comes up for a vote.

Neville Health Care Update Sept. 18, 2009 -- Senate Healthcare Bill Bombs

Back to Top

Sen. Max Baucus' Senate version of the Healthcare bill is DOA. Even the Democrats hate it.

From the Wall St. Journal:

Finance Chairman Max Baucus finally unveiled his health-care plan yesterday to a chorus of bipartisan jeers. The reaction is surprising given that President Obama all but endorsed the outlines of the Baucus plan last week. But the hoots are only going to grow louder as more people read what he's actually proposing.

The headline is that Mr. Baucus has dropped the unpopular "public option," but this is a political offering without much policy difference. His plan remains a public option by other means, imposing vast new national insurance regulation, huge new subsidies to pay for the higher insurance costs this regulation will require and all financed by new taxes and penalties on businesses, individuals and health-care providers. Other than that, Hippocrates, the plan does no harm.

The plan essentially rewrites all insurance contracts, including those offered by businesses to their workers. Benefits and premiums must be tailored to federal specifications. First-dollar coverage would be mandated for many services, and cost-sharing between businesses and employees would be sharply reduced, though this is one policy that might reduce health spending by giving consumers more skin in the game. Nor would insurance be allowed to bear any relation to risk. Inevitably, costs would continue to climb.

Everyone would be forced to buy these government-approved policies, whether or not they suit their needs or budget. Families would face tax penalties as high as $3,800 a year for not complying, singles $950. As one resident of Massachusetts where Mitt Romney imposed an individual mandate in 2006 put it in a Journal story yesterday, this is like taxing the homeless for not buying a mansion.

The political irony here is rich. If liberal health-care reform is going to make people better off, why does it require "a very harsh, stiff penalty" to make everyone buy it? That's what Senator Obama called it in his Presidential campaign when he opposed the individual mandate supported by Hillary Clinton.

To sum up, the Baucus-Obama plan would increase the cost of insurance and then force people to buy it, requiring subsidies. Those subsidies would be paid for by taxes that make health care and thus insurance even more expensive, requiring even more subsidies and still higher taxes. It's a recipe to ruin health care and bankrupt the country, and that's even before liberal Democrats see Mr. Baucus and raise him, and then attempt to ram it all through the Senate.

More importantly forcing people to buy anything against their will is unconstitutional. The most idiotic retort is that people have to buy car insurance....if they have a car!!

Attorneys David Rivken and Lee Casey, who toiled in the Reagan and Bush I Justice Department wrote in the Wall St. Journal:

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.

These are mostly found in Article I, Section 8, which among other things gives Congress the power to tax, borrow and spend money, raise and support armies, declare war, establish post offices and regulate commerce. It is the authority to regulate foreign and interstate commerce that—in one way or another—supports most of the elaborate federal regulatory system. If the federal government has any right to reform, revise or remake the American health-care system, it must be found in this all-important provision. This is especially true of any mandate that every American obtain health-care insurance or face a penalty.

Neville Health Care Update August 10, 2009

Back to Top

Healthcare Bill is Huge Giveaway to ACORN

The reason ACORN and SEIU are now showing up to the Healthcare townhalls is simple...the bill is a huge giveaway to both.

First it was the stimulus bill that didn't create jobs for average Americans but was instead a big payoff to groups like ACORN. Then, there was the auto bailout deal with turned over the auto companies to the unions. That was another windfall worth billions.

Now, health care bills in both the House and the Senate mandate even more payola to ACORN
  • PG 65 Sec 164 is a payoff subsidized plan 4 retirees and their families in Unions & community orgs (ACORN).
  • Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps 2 sign up indiv. for Govt HC plan.
  • Pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required. Can u say ACORN?!!
  • Pg 469 - Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Svcs here!!?
  • Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment 2 a community-based org. Like ACORN?
From CNS News:

Washington ( - Sen. Christopher Dodd (D-Conn.), the man who is shepherding the health-care reform bill through the Senate, says he doesn't know for sure, but the controversial Association of Community Organizations for Reform Now (ACORN) could qualify to receive health-care grants under a provision of the bill that provides money for groups that are members of a "national network of community based organizations."

The grants are designed to fund groups that will "measure" people's health-related behavior on the community level, including whether they are gaining or losing weight, eating the right foods, getting exercise, using tobacco, or engaging in other personal behaviors targeted for federal monitoring by the secretary of health and human services.

[...] These grantees will be charged with carrying out a "community transformation plan," and the targets of their activities will include local schools, infrastructure and restaurants.

The bill specifically directs organizations receiving the grant money that they must "with respect to residents in the community, measure -- (i) decreases in weight; (ii) increases in proper nutrition; (iii) increases in physical activity; (iv) decreases in tobacco use prevalence;(v) other factors using community specific data from the Behavioral Risk Factor Surveillance Survey; and(vi) other factors as determined by the Secretary."

Neville Health Care Update August 6, 2009

Back to Top

August 6, 2009-Obama Wants You to Snitch On Your Friends

The Democrats have run into a buzzsaw of protest at the healthcare townhalls...ah those pesky angry citizens employing their constitutional rights.

For their efforts the Democrats have been painted the protestors as 'angry mobs' bought and paid for by the "K Street Lobbyists" and the evil insurance companies. Very odd coming from the party that invented community organizing.

Consider this bit of Big Lie propaganda from the Democratic National Comittee on August 4, 2009:

Statement from DNC Communications Director Brad Woodhouse on the Republican Party and Allied Groups’ Mob Rule:

The Republicans and their allied groups – desperate after losing two consecutive elections and every major policy fight on Capitol Hill – are inciting angry mobs of a small number of rabid right wing extremists funded by K Street Lobbyists to disrupt thoughtful discussions about the future of health care in America taking place in Congressional Districts across the country.

However, much like we saw at the McCain-Palin rallies last year where crowds were baited with cries of 'socialist,' 'communist,' and where the birthers movement was born – these mobs of extremists are not interested in having a thoughtful discussion about the issues – but like some Republican leaders have said – they are interested in ‘breaking’ the President and destroying his Presidency.

These mobs are bussed in by well funded, highly organized groups run by Republican operatives and funded by the special interests who are desperately trying to stop the agenda for change the President was elected to bring to Washington. Despite the headline grabbing nature of these angry mobs and their disruptions of events, they are not reflective of where the American people are on the issues – or the hundreds of thousands of thoughtful discussions taking place around kitchen tables, water coolers and in homes.

The right wing extremists’ use of things like devil horns on pictures of our elected officials, hanging members of Congress in effigy, breathlessly questioning the President's citizenship and the use of Nazi SS symbols and the like just shows how outside of the mainstream the Republican Party and their allies are. This type of anger and discord did not serve Republicans well in 2008 – and it is bound to backfire again.

'K Street Lobbyists' attending Health Care Town Halls in Philly and NY:

The Tim Bishop (D) NY Variety Pack:

The Kathleen Sebelius and Arlen Spector (fake D) Pennsylvania Variety Pack August 2, 2009:

Do these people look like K Street Lobbyists to you?

The White House, in the meantime, is asking people to email any conversations on Healthcare that seem 'fishy'...shades of Nazi Germany. What's next...little daily missives like 'Arbeit Macht Frei'?

We at Neville wonder what happened to 'Dissent is patriotic'. I guess when it's organized ACORN rallies and Democratic talking points it's fine. Just don't question The One.

Opponents of health insurance reform may find the truth a little inconvenient, but as our second president famously said, "facts are stubborn things."

Scary chain emails and videos are starting to percolate on the internet, breathlessly claiming, for example, to "uncover" the truth about the President's health insurance reform positions.

In this video, (to see the b.s. video you will have to the White House website) Linda Douglass, the communications director for the White House's Health Reform Office, addresses one example that makes it look like the President intends to "eliminate" private coverage, when the reality couldn't be further from the truth.

For the record, the President has consistently said that if you like your insurance plan, your doctor, or both, you will be able to keep them. He has even proposed eight consumer protections relating specifically to the health insurance industry.

There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can't keep track of all of them here at the White House, we're asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to

White House web page screen shot:

Oops...these videos refute the White House propaganda...the Fraudinator-in-Chief in his own words:

And from the guy who brought you ACORN and SEIU, Obama is asking his drones via email and 'Organize for America' telling them to once again, get in people's faces, knock on doors, and attend "thousands" of planned healthcare rallies in August. But there is no organizing going on here. It's just those damn rich Republicans and the insurance companies causing all the problems...

And the Democrats on Capitol Hill are gearing up as well to smear the Republicans:

Lee Fang of the Center for American Progress's ThinkProgess blog snarls: ThinkProgress reported today on the growing number of angry right-wing activists viciously harassing Democratic, as well as moderate Republican, members of Congress on health care reform. Jonathan Cohn wrote that these tactics represent "classic astroturf organizing, in some cases bankrolled by the health care industry." The insurance industry is sending staff members to over 30 states to "confront" lawmakers about health care reform. Simultaneously, Cohn writes, the health care industry will use the August recess to "flood the airwaves with ads picking apart reform legislation." Indeed, AHIP, the lobbying juggernaut for the health insurance industry, has promised to change its tone and begin running negative ads on reform soon.

Dick Durbin sounds off about Democrats getting "sucker punched".

"These health insurance companies and people like them are trying to load these town hall meetings for visual impact on television. They want to show thousands of people screaming 'socialism' and try to overcome the public sentiment, which now favors health care reform. That's almost like flooding the switchboards on Capitol Hill. It doesn't prove much other than the switchboards have limited capacity, so we want to have a balanced approach that allows members of Congress to hear both sides of the story, rather than be sucker-punched, or sidetracked by these tactics."

Nanci Pelosi calls the protests 'astroturf' (code for not really grassroots protests)

"I think they're Astroturf," Pelosi said Tuesday. "You be the judge. "There is no question that people want to know what's in the legislation, want to know how it is paid for and know what it means to them. And that is why we have town meetings, either electronically or personally. Just because someone opposes their understanding of what this health care is, that's not a bad thing. But some of what is orchestrated to prevent the opportunity of presenting the plan, that's a different story. These members are members of Congress. They know how to handle it. They're OK. They're OK. But they do have to know the difference between grassroots and Astroturf."

Actually many of these Democrats look like deer caught in the headlights.

Barbara Boxer wringing her hands over the protests:

Rep. Lloyd Doggett's office is calling the protesters who swarmed him in Austin over the weekend a "mob," and blaming the chaos on the local libertarian and Republican activists.

"This mob, sent by the local Republican and Libertarian parties, did not come just to be heard, but to deny others the right to be heard. And this appears to be part of a coordinated, nationwide effort. What could be more appropriate for the "party of no" than having its stalwarts drowning out the voices of their neighbors by screaming "just say no!"

Neville Health Care Update July 22, 2009

Back to Top

House Bill dissected Part 2

With the public’s trust in Obama's handling of health care tanking (50%-44% of Americans disapprove), the White House has launched a new phase of its strategy designed to pass Obamacare: all Obama, all the time. As part of that effort, Obama hosted a conference call with leftist bloggers urging them to pressure Congress to pass his health plan as soon as possible. During the call, a blogger from Maine said he kept running into an Investors Business Daily article that claimed Section 102 of the House health legislation would outlaw private insurance. He asked: “Is this true? Will people be able to keep their insurance and will insurers be able to write new policies even though H.R. 3200 is passed?” President Obama replied: "You know, I have to say that I am not familiar with the provision you are talking about."

Portions of the House Bill as read on the Mark Levin Show. To hear the audio go to and click on "AUDIO" on the top toolbar, then click on Tuesday, July 22...segment starts at the bottom of the second hour.

The most egregious stuff is highlighted in red.
  • Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!
  • Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benes u get
  • Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED!!!
  • Pg 42 of HC Bill - The Health Choices Commissioner will choose you're HC Benefits for you. You have no choice!
  • Pg 50 Section 152 in HC bill - HC will be provided to ALL non US citizens, illegal or otherwise
  • Pg 58HC Bill - Govt will have real-time access to individual's finances & a National ID Healthcard will be issued!
  • Pg 59 HC Bill lines 21-24 Govt will have direct access to your banks accts for electronic funds transfer
  • Pg 65 Sec 164 is a payoff subsidized plan 4 retirees and their families in Unions & community orgs (ACORN).
  • Pg 72 Lines 8-14 Govt is creating an HC Exchange to bring priv HC plans under Govt control.
  • Pg 84 Sec 203 HC bill - Govt mandates ALL benefit pkgs for priv. HC plans in the Exchange
  • Pg 85 Line 7 HC Bill - Specs for of Benefit Levels for Plans = The Govt will ration you're Healthcare!
  • Pg 91 Lines 4-7 HC Bill - Govt mandates linguistic appropriate servics. Example - Translation: illegal aliens (Calif already has this)
  • Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps to sign up indiv. for Govt HC plan
  • Pg 85 Line 7 HC Bill - Specs of Benefit Levels for Plans. #AARP members - Your Health care WILL be rationed
  • Pg 102 Lines 12-18 HC Bill - Medicaid Eligible Indiv. will be automatic enrolled in Medicaid. No choice
  • Pg 124 lines 24-25 HC No company can sue GOVT on price fixing. No "judicial review" against Govt Monopoly
  • Pg 127 Lines 1-16 HC Bill - Doctors/AMA - The Govt will tell YOU what you can make.
  • Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE
  • Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.
  • Pg 149 Lines 16-24 ANY Emplyr w/payroll 400k & above who does not provide public option pays 8% tax on all payroll
  • pg 150 Lines 9-13 Biz w payroll btw 251k & 400k who doesn't provide public option pays 2-6% tax on all payroll
  • Pg 167 Lines 18-23 ANY individual who doesnt have acceptable HC according to Govt will be taxed 2.5% of income
  • Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from indiv. taxes. (Americans will pay)
  • Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will have access 2 ALL Americans finan/pers recs
  • Pg 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax" Yes, it says that
  • Pg 239 Line 14-24 HC Bill Govt will reduce physician servics for Medicaid. Seniors, low income, poor affected
  • Pg 241 Line 6-8 HC Bill - Doctors, doesnt matter what specialty you have, you'll all be paid the same
  • Pg 253 Line 10-18 Govt sets value of Dr's time, professional judgment, etc. Literally value of humans.
  • Pg 265 Sec 1131 Govt mandates & controls productivity for private HC industries
  • Pg 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs
  • Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
  • Pg 280 Sec 1151 The Govt will penalize hospitals for what Govt deems preventable readmissions.
  • Pg 298 Lines 9-11 Drs, treat a patient during initial admission that results in a re-admission-Govt will penalize you.
  • Pg 317 L 13-20 PROHIBITION on ownership/investment. Govt tells Doctors what/how much they can own.
  • Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand
  • Pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required. Can you say ACORN?!!
  • Pg 335 L 16-25 Pg 336-339 - Govt mandates estab. of outcome based measures. HC the way they want. Rationing
  • Pg 341 Lines 3-9 Govt has authority 2 disqual Medicare Adv Plans, HMOs, etc. Forcing folks into Govt plan
  • Pg 354 Sec 1177 - Govt will RESTRICT enrollment of Special needs applicants
  • Pg 379 Sec 1191 Govt creates more bureaucracy - Telehealth Advisory Cmtte.
  • Pg 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life
  • Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory! (CLUE as to what they have in store for YOU at age 65)
  • Pg 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding you in death
  • Pg 427 Lines 15-24 Govt mandates program for orders end of life. The Govt has a say in how your life ends
  • Pg 429 Lines 1-9 A mandatory "adv. care planning consult" will be used frequently as patients health deteriorates
  • Pg 429 Lines 10-12 "adv. care consultation" may incl an ORDER for end of life plans. AN ORDER from GOV
  • Pg 429 Lines 13-25 - The govt will specify which Doctors can write an end of life order.
  • Pg 430 Lines 11-15 The Govt will decide what level of treatment you will have at end of life
  • Pg 469 Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Services here!!?
  • Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment to a community-based org. Like ACORN?
  • Pg 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt into YOUR marriage
  • Pg 494-498 Govt will cover Mental Health Services including defining, creating, rationing those svcs
...And we haven't even gotten to the second half of this 1018 pg. monster yet.

Neville Health Care Update (3) July 21, 2009

Back to Top

Fascism on Display-Who's Advising Obama on Healthcare

The two doctors advising Obama on universal healthcare represent a throwback to the Dr. Josef Mengele/Margaret Sanger/Nazi Party eugenics approach to medical experimentation. Prepare to be astonished:

Dr. Ezekiel Emanuel
Head of the Department of Bioethics
The Clinical Center of the National Institutes of Health

Dr. Emanuel, the brother of white house chief of staff Rahm Emanuel, has written extensively of the benefits of "comparative effectiveness research." This concept is keystone in socialized health care policies, such as those in Canada and the UK. In essence, comparative effectiveness research promotes devoting health care resources to those who have the most time left to benefit from them. To put it another way, those who are considered too old or too sick to truly reap the benefits from expensive treatments would be denied such care. Can this be where medicine is heading?

Dr. Emanuel sees the Hippocratic Oath as one factor driving "overuse" of medical care. He is a policy adviser in the Office of Management and Budget (OMB) and a brother of Rahm Emanuel, the president's chief of staff.

Dr. Emanuel argues that "peer recognition goes to the most thorough and aggressive physicians." He has lamented that doctors regard the "Hippocratic Oath's admonition to 'use my power to help the patient to the best of my ability and judgment' as an imperative to do everything for the patient regardless of the cost or effects on others."

Contact Information

Department of Bioethics
National Institutes of Health
10 Center Drive, Building 10, Room 1C118
Bethesda, MD 20892-1156
Phone: 301.496.2429
Fax: 301.496.0760

Dr. David Blumenthal
Department of Health and Human Services
National Coordinator for Health Information Technology

Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get.

Dr. Blumenthal has been given the responsibility of developing a nation-wide medical monitoring system, which will "oversee" the choices your doctor makes when it comes to your health. Diagnoses, treatments, and recommendations will all be recorded in this system and analyzed by the government. If you doctor refuses to be a "meaningful user" of the system, he or she can expect to be penalized starting in 2014.

"Government controls are a proven strategy for controlling health care expenditures," he argued in the New England Journal of Medicine (NEJM) in March 2001.

Blumenthal conceded there are disadvantages:

"Longer waits for elective procedures and reduced availability of new and expensive treatments and devices."

Yet he called it "debatable" whether the faster care Americans currently have is worth the higher cost.

"If electronic health records are to save money," he writes, doctors will have to take "advantage of embedded clinical decision support" (a euphemism for computers instructing doctors what to do).

Contact Information
Office of the National Coordinator for Health Information Technology
Department of Health and Human Services
200 Independence Ave. SW
Suite 729-D
Washington, DC 20201
Phone: 202-690-7151
Fax: 202-690-6079

Neville Health Care Update (2) July 21, 2009

Back to Top

Senate and House Bills dissected

As Compiled by Betsy McCaughey at

To here Betsy McCaughey interviewed on the Mark Levin Show go to and click on "AUDIO" on the top toolbar, then click on Friday, July 17...Betsy's segment starts immediately.
  • The price tag for this legislation is a whopping $1.04 trillion to $1.6 trillion (Congressional Budget Office estimates). Half of the tab comes from tax increases on individuals earning $280,000 or more, and these new taxes will double in 2012 unless savings exceed predicted costs (House bill, p. 199). The rest of the cost is paid for by cutting seniors' health benefits under Medicare.
  • And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).
  • When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).
  • Legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone's consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.
  • House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."
  • For a health plan to count as "qualified," it has to meet all the restrictions listed in the legislation and whatever criteria the Secretary of Health and Human Services imposes after the bill becomes law. You may think you're in a "qualified" plan, but the language suggests that only plans with managed-care controls such as the "medical home" will meet the definition (sections 3101 and 2707).
  • "Medical home" is this decade's version of HMO-style insurance, according to the Congressional Budget Office, with a primary-care provider to manage your access to costly services such as visits to specialists and diagnostic tests. Medical home providers in "qualified" plans, states the Kennedy bill, will have a "payment structure" based on "incentives" rather than payments for each doctor visit or procedure (section 3101, pp. 57-58).
  • According to the terms of the Kennedy bill, you must enroll in a "qualified" plan or face a fine, even if you and your employer are paying the entire cost of the plan you already have (section 161, pp. 111-115).

Neville Health Care Update (1) July 21, 2009

Back to Top

Obama's scheme to "save money" and fix social security at the same time!

Looks like Obama and his cohorts have taken a page right out of the famous 1970's science fiction movie Logan's Run described as: "An idyllic sci-fi future has one major drawback: life must end at 30."


They're going to begin with denying specific procedures and medications to "people over 65," but if you understand how socialized medicine works, that age limit will soon slip to 55, probably to 50 and will surely include ALL of the seriously infirm (regardless of age), children and fetuses with defects. Shades of the Nazi Party! In other words, they only want "quality health care" for the already healthy (who don't need health care). The "savings" will come from cutting short the lives of millions of utterly defenseless sick, weak and elderly Americans. Clever way to (1) save money on healthcare (after, of course, spending trillions to nationalize it), and (2) thin out that pesky Social Security herd of useless old folks.

From the Wall St. Journal

One by one, President Obama's health-care promises are being exposed by the details of the actual legislation: Costs will explode, not fall; taxes will have to soar to pay for it; and now we are learning that you won't be able to "keep your health-care plan" either.

The reality is that the House health bill, which the Administration praised to the rafters, will force drastic changes in almost all insurance coverage, including the employer plans that currently work best. About 177 million people-or 62% of those under age 65-get insurance today through their jobs, and while rising costs are a problem, according to every survey most employees are happy with the coverage. A major reason for this relative success is a 1974 federal law known by the acronym Erisa, or the Employee Retirement Income Security Act.

Erisa allows employers that self-insure-that is, those large enough to build their own risk pools and pay benefits directly-to offer uniform plans across state lines. This lets thousands of businesses avoid, for the most part, the costly federal and state regulations on covered treatments, pricing, rate setting and so on. It also gives them flexibility to design insurance to recruit and retain workers in a competitive labor market. Roughly 75% of employer-based coverage is governed by Erisa's "freedom of purchase" rules.

Goodbye to all that. The House bill says that after a five-year grace period all Erisa insurance offerings will have to win government approval-both by the Department of Labor and a new "health choices commissioner" who will set federal standards for what is an acceptable health plan. This commissar-er, commissioner-can fine employers that don't comply and even has "suspension of enrollment" powers for plans that he or she has vetoed, until "satisfied that the basis for such determination has been corrected and is not likely to recur."

In other words, the insurance coverage of 132 million people-the product of enormously complex business and health-care decisions-will now be subject to bureaucratic nanomanagement. If employers don't meet some still-to-be-defined minimum package, they'll have to renegotiate thousands of contracts nationwide to Washington's specifications. The political incentives will of course demand an ever-more generous "minimum" benefit and less cost-sharing, much as many states have driven up prices in the individual insurance market with mandates. Erisa's pluralistic structure will gradually constrict toward a single national standard.

So when Mr. Obama says that "If you like your health-care plan, you'll be able to keep your health-care plan, period. No one will take it away, no matter what," he's wrong. Period. What he's not telling the American people is that the government will so dramatically change the rules of the insurance market that employers will find it impossible to maintain their current coverage, and many will drop it altogether. The more we inspect the House bill, the more it looks to be one of the worst pieces of legislation ever introduced in Congress.

Neville Health Care Update July 18, 2009

Back to Top

Obamacare is like the Sword of Damocles, hovering over everyone, ready to swoop in and enslave us to the state. In recent days we've found some very unpleasant facts about this the 1,018-page monstrosity.

Director of the Congressional Budget Office Douglas Elmendorf said that Obamacare could actually worsen the problem of rapidly escalating medical spending:

"We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. On the contrary, the legislation significantly expands the federal responsibility for health-care costs."

In other words, the President has been lying to us.

The president also said we would all be able to keep our current insurance. Not so fast. As reported by Investors Business Daily: Page 16 of the House bill:

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.

So you can keep your coverage, except you won't be able to keep your coverage if life actually intervenes: If you have private individual coverage you won't be able to change it. If you leave a company to work for yourself you won't be free to buy individual plans from private insurers.

This bill will effectively kill the market for private individual coverage by not letting new policies be written after the public option becomes law. And the government can also, initially, undercut the costs of any attempts by private carriers to compete.

In other words, the President has been lying to us.

One more tidbit... by putting private insurance out of business thousands of people who work at these companies will lose their jobs.

There is no precedent for a major power grab like this in a free society and there may be no Constitutional authority as well.

The authority to outlaw private markets in which parties voluntarily participate is the stuff of marxists and totalitarians. The ability to enter into contracts without interference by a third party is fundamental to freedom and liberty.

Of course who ever said Obama and the Marxists in Congress were about freedom and liberty?

Neville Health Care Update June 26, 2009

Back to Top

Obama's Health Future -- Rationing and withholding care from the elderly.

President Obama's TV health-care forum on Wednesday evening was useful, because revealing. Namely, Mr. Obama shared more than he probably intended about the kind of rationing that his health plan will inevitably impose.

At one point in the town hall, broadcast from the East Room by ABC news, a woman named Jane Sturm told the story of her 105-year-old mother, who, at 100, was told by an arrhythmia specialist that she was too old for a pacemaker. She ended up getting a second option, and the operation, for which Ms. Sturm credits her survival.

"Look, the first thing for all of us to understand that is we actually have some -- some choices to make about how we want to deal with our own end-of-life care," Mr. Obama replied. After discussing ways "we as a culture and as a society [can start] to make better decisions within our own families and for ourselves," he continued that in general "at least we can let doctors know and your mom know that, you know what? Maybe this isn't going to help. Maybe you're better off not having the surgery, but taking the painkiller."

What Mr. Obama is describing is his preferred health-care future. If or when the Administration's speculative cost-cutting measures under universal health care fail to produce savings, government will start explicitly limiting patient access to treatments and services regarded as too expensive. Democrats deny this eventuality, but health planners will have no choice, given that the current entitlement system is already barreling toward insolvency without adding millions of new people to the federal balance sheet.

Earlier, a physician asked Mr. Obama if he would subject his own family to the restrictions of a national health plan, even if specialists recommended treatments that weren't covered. The President was noncommittal: "And you're absolutely right that, if it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care." We suspect most Americans would agree.

Neville Health Care Update June 16, 2009

Back to Top

On June 24, 2009 ABC News will become an official propaganda arm of the Obama administration (NBC and MSNBC must not have been available that night after the NBC's Brian Williams/Obama Family "Living Large With the Top Dog" puff piece in May) when the network turns its programming over to the Administration officials to push government run health care. Can you say conflict of interest?

"Fair and Balanced" ABCNEWS "anchor" Charlie Gibson will deliver WORLD NEWS from the Blue Room of the White House and the network plans a primetime propaganda blowout -- 'Prescription for America'. The broadcast will exclude opposing voices on the debate.

Republican National Committee Chief of Staff Ken McKay fired off a complaint to the head of ABCNEWS excerpted here:

As the national debate on health care reform intensifies, I am deeply concerned and disappointed with ABC's astonishing decision to exclude opposing voices on this critical issue on June 24, 2009. Next Wednesday, ABC News will air a primetime health care reform "town hall" at the White House with President Barack Obama. In addition, according to an ABC News report, GOOD MORNING AMERICA, WORLD NEWS, NIGHTLINE and ABC's web news "will all feature special programming on the president's health care agenda." This does not include the promotion, over the next 9 days, the president's health care agenda will receive on ABC News programming.

In the absence of opposition, I am concerned this event will become a glorified infomercial to promote the Democrat agenda. If that is the case, this primetime infomercial should be paid for out of the DNC coffers. President Obama does not hold a monopoly on health care reform ideas or on free airtime. The President has stated time and time again that he wants a bipartisan debate. Therefore, the Republican Party should be included in this primetime event, or the DNC should pay for your airtime.

ABCNEWS Senior Vice President Kerry Smith's response to the RNC was basically "what's the problem...we will maintain editorial control."

These related articles sum it all up very nicely:

Healthcare: How Washington Rations--ObamaCare omen: a case study in 'cost-control.
MAY 19, 2009

Back to Top

Try to follow this logic: Last week the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years. So Democrats have decided that the way to close this gap is to create a new "universal" health insurance entitlement for the middle class.

Such thinking may be a non sequitur, but it will have drastic effects on the health care of all Americans -- and as it happens, this future is playing out in miniature in Medicare right now. Desperate to prevent medical costs from engulfing the federal budget, the program's central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.

This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.

The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.

Medicare is already the country's largest purchaser of health care. Private carriers generally adopt its rates and policies, and the virtual colonoscopy decision may run this technology out of the marketplace. Now multiply that by the new "public option" that Democrats favor, which would transfer millions of patients to a new insurance program managed by the federal government. Washington's utilitarian judgments about costs would reshape the practice of medicine.

Initially, the open-ended style of American care will barely be touched, if only for political self-preservation. Health planners will adjust at the margins, as with virtual colonoscopy. But scarcity forces choices. As the Medicare trustees note in their report, the tax increases necessary to fund merely the current benefit schedule for the elderly would cripple the economy. The far more expensive public option will not turn into a pumpkin when cost savings do not materialize. At that point, government will clamp down with price controls in the form of lines and rock-bottom reimbursement rates.

Mr. Orszag says that a federal health board will make these Solomonic decisions, which is only true until the lobbies get to Congress and the White House. With virtual colonoscopy, radiologists and gastroenterologists are feuding over which group should get paid for colon cancer screening. Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too. More than 50 Congressmen are demanding that the decision be overturned.

All this is merely a preview of the life-and-death decisions that will be determined by politics once government finances substantially more health care than the 46% it already does. Anyone who buys Democratic claims about "choice" and "affordability" will be in for a very rude awakening.

Why the Health Care Rush? Democrats don't think their bill can stand public inspection.
JUNE 3, 2009.

Back to Top

If sharks stop swimming, they sink and drown. President Obama seems to view his health-care program the same way. "If we don't get it done this year," he said in a recent pep talk to supporters, "we're not going to get it done." Well, why? If laying "a new foundation" for 18% of the economy really is as important as the President claims it is, then surely it could withstand more than fleeting inspection.

Instead, Democrats are trying to rush the largest entitlement expansion since LBJ into law with a truncated debate and as little public scrutiny as possible. At this point all they've released are the vaguest "policy options," not concrete specifics. Yet the Senate plans to begin marking up legislation next week, maybe hold a hearing or two, then have something to the floor by the end of the month, votes by the August recess and a bill to the Oval Office by Thanksgiving. On the seventh day, they will rest. Mr. Obama had 24 Senate Democrats over for a White House chat yesterday to drive the calendar ahead.

It's not hard to see why Democrats are trying to hew to this full-speed-ahead timetable. Their health overhaul will run up a 13-figure price tag at a time when spending and deficits are already at epic levels and hook up the middle class to an intravenous drip of government health subsidies for generations to come. These are not realities that Democrats want the American people to mull over for very long.

This is especially true for the majority of Americans who are generally satisfied with their coverage and doctors but worried about cost. They might get scared off if they were allowed the chance to realize that Democrats will do almost nothing to restrain rising health spending. Based on the leaks so far, this year's legislation will hone in on traditional liberal concerns of social equity -- covering the uninsured.

This shell game found its apotheosis yesterday in "The Economic Case for Health Care Reform," from the White House Council of Economic Advisors, which argues that slowing the growth rate of U.S. health costs by 1.5 percentage points would increase real GDP by more than 2% in 2020 and nearly 8% in 2030. But it presents no plan for actually slowing the growth rate of U.S. health costs. Christina Romer's study is a political argument disguised as an economic one in favor of a "reform" that doesn't even exist yet. And in any case, if we're talking about the state of the economy decades hence, why does health care absolutely have to pass this year?

Part of the need for speed comes from the fact that "stakeholders" -- doctors, hospitals, insurers, pharmaceutical and device makers, etc. -- still seem to be experiencing Stockholm Syndrome. Democrats have so far succeeded in conjuring an illusion of political inevitability, which has kept industry groups in line lest they be shut out of the negotiations. But once the policy details of Mr. Obama's new foundation are poured -- above all for a public insurance program run by the government that will run private carriers out of the market and eventually fix medical prices -- even shell-shocked CEOs might stir up their courage to resist. Democrats are of course acutely aware of how industry opposition chewed through HillaryCare in 1994.

The reality is that Democrats are contemplating the most sweeping restructuring of the health markets since Medicare in 1965, and they don't want to let the details slow them down. Or to be more precise, they don't want to let the details let others slow them down. Better to grab what they will portray as a major domestic achievement while President Obama is at the height of his popularity and before anyone understands what it will mean in practice. The consequences and the cost can be explained later.

Canada's ObamaCare Precedent
Governments always ration care by making you wait. That can be deadly
JUNE 9, 2009

Back to Top

Congressional Democrats will soon put forward their legislative proposals for reforming health care. Should they succeed, tens of millions of Americans will potentially be joining a new public insurance program and the federal government will increasingly be involved in treatment decisions.

Not long ago, I would have applauded this type of government expansion. Born and raised in Canada, I once believed that government health care is compassionate and equitable. It is neither.

My views changed in medical school. Yes, everyone in Canada is covered by a "single payer" -- the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system.

The problems were brought home when a relative had difficulty walking. He was in chronic pain. His doctor suggested a referral to a neurologist; an MRI would need to be done, then possibly a referral to another specialist. The wait would have stretched to roughly a year. If surgery was needed, the wait would be months more. Not wanting to stay confined to his house, he had the surgery done in the U.S., at the Mayo Clinic, and paid for it himself.

Such stories are common. For example, Sylvia de Vries, an Ontario woman, had a 40-pound fluid-filled tumor removed from her abdomen by an American surgeon in 2006. Her Michigan doctor estimated that she was within weeks of dying, but she was still on a wait list for a Canadian specialist.

Indeed, Canada's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery -- described by the Globe and Mail newspaper as "broken necks, burst aneurysms and other types of bleeding in or around the brain."

Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada. Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

Ironically, as the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction. In 2005, Canada's supreme court struck down key laws in Quebec that established a government monopoly of health services. Claude Castonguay, who headed the Quebec government commission that recommended the creation of its public health-care system in the 1960s, also has second thoughts. Last year, after completing another review, he declared the system in "crisis" and suggested a massive expansion of private services -- even advocating that public hospitals rent facilities to physicians in off-hours.

And the medical establishment? Dr. Brian Day, an orthopedic surgeon, grew increasingly frustrated by government cutbacks that reduced his access to an operating room and increased the number of patients on his hospital waiting list. He built a private hospital in Vancouver in the 1990s. Last year, he completed a term as the president of the Canadian Medical Association and was succeeded by a Quebec radiologist who owns several private clinics.

In Canada, private-sector health care is growing. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia. According to the New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments.

In the United Kingdom, where socialized medicine was established after World War II through the National Health Service, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones. Even in Sweden, the government has turned over services to the private sector.

Americans need to ask a basic question: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?

Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute.

ObamaCare Sticker Shock-A $1.6 trillion deficit boost, and the uninsured will still be with us.
By The Wall St. Journal
JUNE 19, 2009

Back to Top

This was supposed to be a red-letter week for national health care, as Democrats started the process of hustling a quarter-baked bill through Congress to reorganize one-sixth of the economy on a partisan vote. Instead it was a fiasco.

Most of the devastation was wreaked by the Congressional Budget Office, which on Tuesday reported that draft legislation from the Senate Finance Committee would increase the federal deficit by more than $1.6 trillion over the next decade while only partly denting the population of the uninsured. The details haven't been made public, but the short version seems to be that President Obama's health boondoggle prescribes vast new spending without a coherent plan to pay for it even while failing to meet its own standards for social equity.

Finance Chairman Max Baucus postponed the health timeline, probably until after Congress's July 4 vacation. His team will try to scale down the middle-class insurance subsidies and make other cuts to hold the sticker shock under $1 trillion. (Oh, is that all?) Mr. Baucus also claims he's committed to a bipartisan consensus, yet most Republicans have been closed out of the negotiations, and industry lobbyists have been pre-emptively warned that even meeting with the GOP will invite retribution.

Useful to emphasize amid the mayhem is that CBO's number-crunching is almost always off -- predicting too much spending for market-based policies and far too little for new public programs, especially on health care. The CBO score for a new entitlement is only the teaser rate, given that the costs will inevitably balloon as the years pass and more people mob "free" or subsidized insurance.

Mitt Romney pitched his 2006 health reform -- which Democrats view as a model for universal coverage -- as modest and affordable, yet already its public option is annihilating the Massachusetts fisc. The original cost estimate for last year was $472 million; final spending came in at $628 million. Spending this year is at least $75 million over initial budget, while projections for next year range as high as $880 million -- and even those are probably too low.

Capitol Hill's entitlement Democrats are determined too press ahead, despite this cost detour. Still, this week's lesson is that ObamaCare might not be inevitable once Americans figure out the astonishing price tag.

Massachusetts Universal Healthcare Doesn't Add Up

Back to Top
Joan Vennochi writing in the Boston Globe:

The fuzzy math behind the Massachusetts universal healthcare law is starting to add up -- just as Washington studies the law as a possible model for the nation.

Because of a recession-related drop in state revenues and a surge in enrollment by the recently unemployed, the truth is emerging at an inconvenient time. Massachusetts doesn't have enough money to pay for the coverage envisioned by the law.

In June, state officials announced they are cutting $100 million from Commonwealth Care, which subsidizes premiums for needy residents. The poorest residents, along with the newest -- legal immigrants -- will take the hit.

This outcome is not surprising, but it is instructive as President Obama pushes for a national healthcare plan.

On the day that Republican Governor Mitt Romney, for once, made Bay State Democrats happy, by signing the sweeping new healthcare bill into law, the Globe headline said it all: "Joy, worries on healthcare. As Romney signs bill, doubts arise about revenues.''

In Massachusetts, the numbers never added up, as everyone involved in crafting the new law understood. But for a variety of reasons, ranging from Romney's presidential aspirations to Senator Edward M. Kennedy's longstanding commitment to healthcare reform, everyone smiled for the cameras and hoped for the best out of this noble experiment.

Parsing the Health Reform Arguments-Some of the shibboleths don't make much sense. JULY 2, 2009

Back to Top

The health-care debate continues. We have now heard from nearly all the politicians, experts and interested parties: doctors, drug makers, hospitals, insurance companies, even constitutional lawyers (though not, significantly, from trial lawyers, who know full well "change" is not coming to their practices). Here is how one humble economist sees some of the main arguments, which I have paraphrased below:

- "The American people overwhelmingly favor reform."

If you ask whether people would be happier if somebody else paid their medical bills, they generally say yes. But surveys on consumers' satisfaction with their quality of care show overwhelming support for the continuation of the present arrangement. The best proof of this is the belated recognition by the proponents of health-care reform that they need to promise people that they can keep what they have now.

- "The cost of health care rises two to three times as fast as inflation."

That's like comparing the price of hamburger 30 years ago with the price of filet mignon today and calling the difference inflation. Or the price of a 19-inch, black-and-white TV 30 years ago with the price of a 50-inch HDTV today. The improvements in medical care are even more dramatic, leading to longer life, less pain, fewer exploratory surgeries and miracle drugs. Of course the research, the equipment and the training that produce these improvements don't come cheap.

- "Health care represents a rising proportion of our income."

That's not only true but perfectly natural. Quality health care is a discretionary, income-elastic expense -- i.e. the richer a society, the larger the proportion of income that is spent on it. (Poor societies have to spend income gains on food and other necessities.) Consider the alternatives. Would we feel better about ourselves if we skimped on our family's health care and spent the money on liquor, gambling, night clubs or a third television set?

- "Shifting funds from health care to education would make for a better society." These two services have a lot in common, including steadily rising cost. What is curious is that this rise in education costs is deemed by the liberal establishment smart and farsighted while the rise in health-care costs is a curse to be stopped at any cost. What is curiouser still is that in education, where they always advocate more "investment," past increases have gone hand-in-hand with demonstrably deteriorating outcomes. The rising cost in health care has been accompanied by clearly superior results. Thus we would shift dollars from where they do a lot of good to an area where they don't.

- "Forty-five million people in the U.S. are uninsured."

Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?

- "The cost of treating the 45 million uninsured is shifted to the rest of us."

So on Monday, Wednesday and Friday we are harangued about the 45 million people lacking medical care, and on Tuesday and Thursday we are told we already pay for that care. Left-wing reformers think that if they split the two arguments we are too stupid to notice the contradiction. Furthermore, if cost shifting is bad, wait for the Mother of all Cost Shifting when suppliers have to overcharge the private plans to compensate for the depressed prices forced on them by the public plan.

- "A universal plan will reduce the cost of health care."

Think a moment. Suppose you are in an apple market with 100 buyers and 100 sellers every day and apples sell for $1 a pound. Suddenly one day 120 buyers show up. Will the price of the apples go up or down?

- "U.S. companies are at a disadvantage against foreign competitors who don't have to pay their employees' health insurance."

This would be true if the funds for health care in those countries fell from the sky. As it is, employees in those countries pay for their health care in much higher income taxes, sales or value-added taxes, gasoline taxes (think $8 a gallon at the pump) and in many other ways, effectively reducing their take-home pay and living standards. And isn't it odd that the same people who want to lift this burden from businesses that provide health benefits also (again, on alternate days) want to impose this burden on the other firms that do not offer this benefit. What about the international competitiveness of these companies?

- "If you like your current plan you can keep it."

In other words, you can keep your current plan if it (and the company offering it) is still around. This is not a trivial qualification. Proponents have clearly learned from the HillaryCare debacle in the 1990s that radical transformation does not sell. What we have instead is what came to be dubbed "salami tactics" in postwar Eastern Europe where Communist leaders took away freedoms one at a time to minimize resistance and obscure the ultimate goal. If nothing else, a century of vain attempts to break the Post Office monopoly should teach us how welcoming Congress is to competition to one of its high-cost, inefficient wards.

- "Congress will be strictly neutral between the public and private plans."

Nonsense. Congress has a hundred ways to help its creation hide costs, from squeezing suppliers to hidden subsidies (think Amtrak). And it has even more ways to bankrupt private plans. One way is to mandate ever more exotic and expensive coverage (think hair transplants or sex-change operations). Another is by limiting and averaging premiums and outlawing advertising. And if all else fails Congress can always resort to tax audits and public harassment of executives -- all in the name of "leveling the playing field." Then, in the end, the triumphal announcement: "The private system has failed."

- "Decisions will still be made by doctors and patients and the system won't be politicized."

Fat chance. Funding conflicts between mental health and gynecology will be based on which pressure group offers the richer bribe or appears more politically correct. The closing (or opening) of a hospital will be based not on need but which subcommittee chairman's district the hospital is in. Imagine the centralization of all medical research in the country in the brand new Robert Byrd Medical Center in Morgantown, W.Va. You get the idea.

- "We need a public plan to keep the private plans honest."

The 1,500 or so private plans don't produce enough competition? Making it 1,501 will do the trick? But then why stop there? Eating is even more important than health care, so shouldn't we have government-run supermarkets "to keep the private ones honest"? After all, supermarkets clearly put profits ahead of feeding people. And we can't run around naked, so we should have government-run clothing stores to keep the private ones honest. And shelter is just as important, so we should start public housing to keep private builders honest. Oops, we already have that. And that is exactly the point. Think of everything you know about public housing, the image the term conjures up in your mind. If you like public housing you will love public health care.

Mr. Newman is an economist and retired business executive.

A Reckless Congress
Democrats want to ram through one of the greatest raids on private income and business in American history.
JULY 17, 2009

Back to Top

Say this about the 1,018-page health-care bill that House Democrats unveiled this week and that President Obama heartily endorsed: It finally reveals at least some of the price of the reckless ambitions of our current government. With huge majorities and a President in a rush to outrun the declining popularity of his agenda, Democrats are bidding to impose an unrepealable European-style welfare state in a matter of weeks.

Mr. Obama's February budget provided the outline, but the House bill now fills in the details. To wit, tax increases that would take U.S. rates higher even than most of Europe. Yet even those increases aren't nearly enough to finance the $1 trillion in new spending, which itself is surely a low-ball estimate. Meanwhile, the bill would create a new government health entitlement that will kill private insurance and lead to a government-run system.

Hyperbole? That's what people said when we warned about this last fall in "A Liberal Supermajority," but even we underestimated the ideological willfulness of today's national Democrats. Consider only a few of the details:

A huge new income surtax. The bill's main financing comes from another tax increase on top of the increase already scheduled for 2011 under Mr. Obama's budget. The surtax starts at one percentage point for adjusted gross income above $350,000 in 2011, rising to two points in 2013; a 1.5 point surtax at incomes above $500,000, rising to three in 2013; and a whopping 5.4 percentage points in 2011 and beyond on incomes above $1 million.

This would raise the top marginal federal tax rate back to roughly 47% or 48%, if you include the Medicare tax and the phase-out of certain deductions and exemptions. With the current top rate at 35%, this would be the largest rate increase outside the Great Depression or world wars.

The average U.S. top combined state-federal marginal tax rate would hit about 52%. This would be higher than in all but three (Denmark, Sweden, Belgium) of the 30 countries measured by the OECD. According to the nearby table compiled by the Heritage Foundation, taxpayers in at least five U.S. states would pay higher marginal rates even than Sweden. South Korea, which Democrats worry is stealing American jobs, would be able to grab even more as its highest rate is a far more competitive 38.5%.

House Democrats say they deserve credit for being honest about the tax increases needed to fund their ambitions. But then they also claim that this surtax would raise $544 billion in new revenue over 10 years. America's millionaires aren't that stupid; far fewer of them will pay these rates for very long, if at all. They will find ways to shelter income, either by investing differently or simply working less. Small businesses that pay at the individual rate will shift to pay the 35% corporate rate. When the revenue doesn't materialize, Democrats will move to soak the middle class with a European-style value-added tax.

Phony numbers. Democrats will have to come up with something, because even the surtax puts their bill at least $300 billion short of honest financing. The public insurance "option" doesn't even begin until 2013 and the costs are heavily weighted toward the later years, but the tax hikes start in 2011. So under Congress's 10-year budget window, the House bill is able to pay for seven years of spending with nine years of taxes. Andy Laperriere of the ISI Group estimates the bill would add $95 billion to the deficit in 2019 alone.

Then there's yesterday's testimony, from Congressional Budget Office (CBO) Director Doug Elmendorf, that ObamaCare's cost "savings" are an illusion. Mr. Obama claims government can cover more people and pay less to do it. But Mr. Elmendorf told the Senate Finance Committee that "In the legislation that has been reported we don't see the sort of fundamental changes that would be necessary to reduce the trajectory of federal spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health-care costs."

Further on the public plan: "It raises the amount of activity that is growing at this unsustainable rate."

No matter, Speaker Nancy Pelosi is whisking the bill through House committees even before CBO has had a chance to score it in detail. As Wisconsin Republican Paul Ryan put it to us, "We will not have read it, and we will not have a score of it, but we will have passed it out of committee."

A new payroll tax. Unemployment is at 9.5% and rising, but Democrats will nonetheless impose a new eight percentage point payroll tax on employers who don't provide health insurance for employees. This is on top of the current 15% payroll tax, and in addition to a new 2.5-percentage point tax on individuals who don't buy health insurance. This means that any employer with more than $400,000 in payroll would have to pay at least 25% above the salary to hire someone. Result: Many fewer new jobs, with a higher structural jobless rate, much as Europe has experienced as its welfare states have expanded.

Other new taxes, including an as yet undetermined levy on private health plans. This tax, which Democrats say could raise $100 billion or so, would make it even harder for private plans to compete with the government plan, which would already benefit from government subsidies and lower capital costs. For good measure, the House bill also gets the ball rolling on tax increases on foreign-source corporate income.

We could go on, and we will in coming days. But the most remarkable quality of this health-care exercise is its reckless disregard for economic and fiscal reality. With the economy still far from a healthy recovery, and the federal fisc already nearly $2 trillion in deficit, Democrats want to ram through one of the greatest raids on private income and business in American history. The world is looking on, agog, and wondering why the United States seems intent on jumping off this cliff.

Their Own Medicine-Senators prefer the insurance they have
JULY 18, 2009

Back to Top

In the health debate, liberals sing Hari Krishnas to the "public option" -- a new federal insurance program like Medicare -- but if it's good enough for the middle class, then surely it's good enough for the political class too? As it happens, more than a few Democrats disagree.

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Republican Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. Yet all Democrats -- with the exceptions of acting chairman Chris Dodd, Barbara Mikulski and Ted Kennedy via proxy -- voted nay.

In other words, Sherrod Brown and Sheldon Whitehouse won't themselves join a plan that "will offer benefits that are as good as those available through private insurance plans -- or better," as the Ohio and Rhode Island liberals put it in a recent op-ed. And even a self-described socialist like Vermont's Bernie Sanders, who supports a government-only system, wouldn't sign himself up.

Of course, they also qualify now for generous Congressional coverage. Most Americans won't have the same choice. Some will be transferred to the new entitlement as it uses its taxpayer bankroll to dominate insurance markets. Others work for businesses that will find it easier to dump their policies and move employees to the federal rolls. Democrats also know that the public option will try to control health spending by squeezing payments made to doctors and hospitals, and by not paying for treatments that Washington decides are too expensive, which will result in inferior care.

No doubt Mr. Dodd acceded to the Coburn amendment to blunt such objections, and in any case he'll strip it out later in some backroom. Judd Gregg was the only GOP Senator to oppose it, on humanitarian grounds. As he told us in an interview, the public option "will be so bad that I don't think anyone should be forced to join."

GovernmentCare's Assault on Seniors
JULY 23, 2009
By Betsy McCaughey

Back to Top

Since Medicare was established in 1965, access to care has enabled older Americans to avoid becoming disabled and to travel and live independently instead of languishing in nursing homes. But legislation now being rushed through Congress-H.R. 3200 and the Senate Health Committee Bill-will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years.

The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare. This cut will come just as baby boomers turn 65 and increase Medicare enrollment by 30%. Less money and more patients will necessitate rationing. The Congressional Budget Office estimates that only 1% of Medicare cuts will come from eliminating fraud, waste and abuse.

The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient's age. Economists are familiar with the formula, where the cost of a treatment is divided by the number of years (called QALYs, or quality-adjusted life years) that the patient is likely to benefit. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.

When comparative effectiveness research appeared in the stimulus bill, Rep. Charles Boustany Jr., (R., La.) a heart surgeon, warned that it would lead to "denying seniors and the disabled lifesaving care." He and Sen. Jon Kyl (R., Ariz.) proposed amendments to no avail that would have barred the federal government from using the research to eliminate treatments for the elderly or deny care based on age.

In a letter this week to House Speaker Nancy Pelosi, White House budget chief Peter Orszag urged Congress to delegate its authority over Medicare to a newly created body within the executive branch. This measure is designed to circumvent the democratic process and avoid accountability to the public for cuts in benefits.

Driving these cuts is the misconception that preventative care can eliminate sickness. As President Obama said in a speech to the American Medical Association: "We have to avoid illness and disease in the first place." That would make sense if most diseases were preventable. But the two most prevalent diseases of aging-cancer and heart disease-are largely caused by genetics and their occurrence increases with age. Your risk of being diagnosed with cancer doubles from age 50 to 60, according to the National Cancer Institute.

The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process (pp. 660-686). In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner.

"Study after study shows that cardiologists adhere to guidelines better than primary care doctors," according to Jeffrey Moses, a heart specialist at New York Presbyterian Hospital. Adds Jeffrey Borer, chairman of medicine at SUNY Downstate Medical Center: "Seldom do generalists have the knowledge to identify the symptoms of aortic valve disease, even though more than 10% of people over 75 have it. After valve surgery, patients who were too short of breath to walk can resume a normal life into their 80s or 90s."

While the House bill being pushed by the president reduces access to such cures and specialists, it ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it (pp. 425-446). In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.

The harshest misconception underlying the legislation is that living longer burdens society. Medicare data prove this is untrue. A patient who dies at 67 spends three times as much on health care at the end of life as a patient who lives to 90, according to Dr. Herbert Pardes, CEO of New York Presbyterian Medical Center.

What is costly is when seniors become disabled. In a 2007 Health Affairs article, researchers reported that surgeries to unclog arteries and replace worn out hips and knees have had a major impact on steadily reducing disability rates. And nondisabled seniors use only one-seventh as much health care as disabled seniors. As a result, the annual increase in per capita health spending on the elderly is less than for the rest of the population.

Nevertheless, Medicare is running out of money. The problem is the number of seniors compared with the smaller number of workers supporting the system with payroll taxes. To remedy the problem, the Congressional Budget Office has suggested inching up the eligibility age one month per year until it reaches age 70 in 2043, or asking wealthy seniors to pay more.

These are reasonable solutions-reducing access to treatments and counseling seniors about cutting life short are not. Medicare has made living to a ripe old age a good value. ObamaCare will undo that.

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.

ObamaCare in Trouble
JULY 22, 2009
by Karl Rove

Back to Top

Polls are turning against President Barack Obama's health-care plan. The political calendar is, too.

On Monday, the Washington Post/ABC poll reported that 49% of Americans approve of his handling of health care while 44% disapprove. What many people missed is that those who strongly disapprove of the president's approach on health care now outnumber those who strongly approve by 33% to 25%. That presages further decline. Already, 49% of independents disapprove of the president's approach, up from 30% in April, a staggering shift in 11 weeks.

Mr. Obama is also slipping on the economy. Those who strongly disapprove now outnumber those who strongly approve of his handling of the economy (35% to 29%), of deficits (38% to 19%), and of unemployment (31% to 26%). On Tuesday, Gallup showed Mr. Obama's personal approval was 55%, down from more than 60% a few weeks ago and lower than the 56% George W. Bush had at this point in his first term.

The polls are crumbling because of a flood of bad news about Mr. Obama's health-care proposals. One batch of such news came from a July 17 study by the Lewin Group that was commissioned by the Heritage Foundation. It projects that if the House bill becomes law, 83.4 million people-nearly half of those with private coverage-will lose private insurance as employers drop their plans. Mr. Obama's promise that you can keep your plan is being left on the cutting room floor with nary a peep from the president.

Another batch of bad news came this week as Democratic governors from Colorado, Tennessee, New Mexico and Washington joined GOP colleagues at the National Governors Association summer meeting to blast the administration for plans to shift millions of families into Medicaid. That could stick states with $440 billion in new costs over the next decade.

But the most damaging news came from Congressional Budget Office (CBO) Director Douglas Elmendorf, who said last week that the White House's health-care proposals would not "reduce the trajectory of federal health spending by a significant amount." This shattered the central claim Mr. Obama has been making: that his health-care plan controls costs. In a July 17 letter, Mr. Elmendorf added that the House's health-care bill would result in a "net increase in the federal budget deficit of $239 billion" over 10 years. That's likely a low-ball estimate because it assumes that Congress will increase taxes by $583 billion over the next decade.

Ways and Means Committee Chairman Charlie Rangel says he'll pay for the Obama health proposal by raising taxes on Americans making $280,000 a year ($350,000 for couples). Most of those stuck with higher taxes will be small business owners. Even Democrats don't like that approach: 21 of 39 freshmen House Democrats penned a letter opposing the tax hike. Many are among the 66 Democrats from districts that either Mr. Bush or John McCain carried in recent presidential elections. Mr. Obama shrugged off the letter by saying that the surtax would only force some to pay "a little bit more."

The Democratic National Committee is now running ads pressuring Democrats to vote for the president's health-care plans, including new ads in the districts of House Ways and Means Committee Democrats who have raised questions about the health-care bill. It is hard to think of a more obvious sign of weakness than attacking members of your own party.

Team Obama was rushing to pass health care before the August recess out of fear that allowing members to go home for an extended spell before voting on the bill would give them an opportunity to hear from their constituents. They fear that the 300 protestors who showed up at a town hall meeting in Panama City, Fla. held June 30 by Democrat Rep. Allen Boyd shortly after he voted for the cap and trade energy tax) are only the start of a larger backlash.

Democratic leaders, including the president, are now backing away from a vote on health care before August. But that's not likely to decrease voter angst. Americans for Prosperity and others are already organizing voters to attend public meetings with members of Congress this summer. My guess is that members of Congress are about to hear a lot from their voters on the government takeover of health care, new energy taxes, the failed stimulus, record deficits, and growing joblessness.

Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.

ObamaCare in Retreat -- Don't get Complacent
JULY 31, 2009
by Charles Krauthammer

Back to Top

WASHINGTON -- Yesterday, Barack Obama was God. Today, he's fallen from grace, the magic gone, his health care reform dead. If you believed the first idiocy -- and half the mainstream media did -- you'll believe the second. Don't believe either.

Conventional wisdom always makes straight-line projections. They are always wrong. Yes, Obama's aura has diminished, in part because of overweening overexposure. But by year's end he will emerge with something he can call health care reform. The Democrats in Congress will pass it because they must. Otherwise, they'll have slain their own savior in his first year in office.

But that bill will look nothing like the massive reform Obama originally intended. The beginning of the retreat was signaled by Obama's curious reference -- made five times -- to "health-insurance reform" in his July 22 news conference.

Reforming the health care system is dead. Cause of death? Blunt trauma administered not by Republicans, not even by Blue Dog Democrats, but by the green eyeshades at the Congressional Budget Office.

Three blows:

(1) On June 16, the CBO determined that the Senate Finance Committee bill would cost $1.6 trillion over 10 years, delivering a sticker shock that was near fatal.

(2) Five weeks later, the CBO gave its verdict on the Independent Medicare Advisory Council, Dr. Obama's latest miracle cure, conjured up at the last minute to save Obamacare from fiscal ruin, and consisting of a committee of medical experts highly empowered to make Medicare cuts.

The CBO said that IMAC would do nothing, trimming costs by perhaps 0.2 percent. A 0.2 percent cut is not a solution; it's a punch line.

(3) The final blow came last Sunday when the CBO euthanized the Obama "out years" myth. The administration's argument had been: Sure, Obamacare will initially increase costs and deficits. But it pays for itself in the long run because it bends the curve downward in coming decades.

The CBO put in writing the obvious: In its second decade, Obamacare significantly bends the curve upward -- increasing deficits even more than in the first decade.

This is obvious because Obama's own first-decade numbers were built on arithmetic trickery. New taxes to support the health care plan begin in 2011, but the benefits part of the program doesn't fully kick in until 2015. That excess revenue is, of course, one time only. It makes the first decade numbers look artificially low, but once you pass 2015, the yearly deficits become larger and eternal.

Three CBO strikes and you're out cold. Though it must be admitted that the White House itself added to the farcical nature of its frantic and futile cost-cutting when budget director Peter Orszag held a three-hour brainstorming session with Senate Finance Committee aides trying to find ways to save. "At one point," reports The Wall Street Journal, "they flipped through the tax code, looking for ideas." Looking for ideas? Months into the president's health care drive and just days before his deadline for Congress to pass real legislation? You gonna give this gang the power to remake one-sixth of the U.S. economy?

Not likely. Whatever structural reforms dribble out of Congress before the August recess will likely not survive the year. In the end, Obama will have to settle for something very modest. And indeed it will be health-insurance reform.

To win back the vast constituency that has insurance, is happy with it, and is mightily resisting the fatal lures of Obamacare, the president will in the end simply impose heavy regulations on the insurance companies that will make what you already have secure, portable and imperishable: no policy cancellations, no pre-existing condition requirements, perhaps even a cap on out-of-pocket expenses.

Nirvana. But wouldn't this bankrupt the insurance companies? Of course it would. There will be only one way to make this work: Impose an individual mandate. Force the 18 million Americans between 18 and 34 who (often quite rationally) forgo health insurance to buy it. This will create a huge new pool of customers who rarely get sick but will be paying premiums every month. And those premiums will subsidize nirvana health insurance for older folks.

Net result? Another huge transfer of wealth from the young to the old, the now-routine specialty of the baby boomers; an end to the dream of imposing European-style health care on the U.S.; and a president who before Christmas will wave his pen, proclaim victory and watch as the newest conventional wisdom reaffirms his divinity.

ObamaCare's Real Price Tag-The funding gap is a canyon by year 10
AUGUST 6, 2009, 8:46 A.M. ET.

Back to Top

As ObamaCare sinks in the polls, Democrats are complaining that the critics are distorting their proposals. But the truth is that the closer one inspects the actual details, the worse it all looks. Today's example is the vast debt canyon that would open just beyond the 10-year window under which the bill is officially "scored" for cost purposes.

The press corps has noticed the Congressional Budget Office's estimate that the House health bill increases the deficit by $239 billion over the next decade. But government-run health care won't turn into a pumpkin after a decade. The underreported news is the new spending that will continue to increase well beyond the 10-year period that CBO examines, and that this blowout will overwhelm even the House Democrats' huge tax increases, Medicare spending cuts and other "pay fors."

In a July 26 letter, CBO director Douglas Elmendorf notes that the net costs of new spending will increase at more than 8% per year between 2019 and 2029, while new revenue would only grow at about 5%. "In sum," he writes, "relative to current law, the proposal would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window." (The House bill has changed somewhat in the meantime, but not enough to alter these numbers much.)

The nearby chart shows this Grand Canyon between spending and revenue, including CBO's long-term predictions. While these are obviously very coarse estimates, there's also a projection of a $65 billion deficit in the 10th year-and "deficit neutrality in the 10th year is . . . the best proxy for what will happen in the second decade."

That's not our outlook. That's what White House budget director Peter Orszag told the House Budget Committee in June. He added that "If you're not falling off a cliff at the end of your projection window, that is your best assurance that the long-term trajectory is also stable." The House bill falls off a cliff.

And the CBO score almost surely understates this deficit chasm because CBO uses static revenue analysis-assuming that higher taxes won't change behavior. But long experience shows that higher rates rarely yield the revenues that they project.

As for the spending, when has a new entitlement ever come in under budget? True, the 2003 prescription drug benefit has, but those surprise savings derived from the private insurance design and competition that Democrats opposed and now want to kill. The better model for ObamaCare is the original estimate for Medicare spending when it was passed in 1965, and what has happened since.

That year, Congressional actuaries (CBO wasn't around then) expected Medicare to cost $3.1 billion in 1970. In 1969, that estimate was pushed to $5 billion, and it really came in at $6.8 billion. House Ways and Means analysts estimated in 1967 that Medicare would cost $12 billion in 1990. They were off by a factor of 10-actual spending was $110 billion-even as its benefits coverage failed to keep pace with standards in the private market. Medicare spending in the first nine months of this fiscal year is $314 billion and growing by 10%. Some of this historical error is due to 1970s-era inflation, as well as advancements in care and technology. But Democrats also clearly underestimated-or lowballed-the public's appetite for "free" health care.

ObamaCare's deficit hole will eventually have to be filled one way or another-along with Medicare's unfunded liability of some $37 trillion. That means either reaching ever-deeper into middle-class pockets with taxes, probably with a European-style value-added tax that will depress economic growth. Or with the very restrictions on care and reimbursement that have been imposed on Medicare itself as costs exploded.

On the latter point, the 1965 Medicare statute explicitly stated that "Nothing in this title shall be construed to authorize any Federal official or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided." Yet now such government management of doctors and hospitals is so pervasive in Medicare that Mr. Obama can casually wonder in a recent interview with Time magazine how anyone could oppose the "benign changes" that he supports, such as "how the delivery system works." Oh, is that all?

Democrats will return in the fall with various budget tweaks that will claim to make ObamaCare "deficit neutral" over 10 years. But that won't begin to account for the budget abyss it will create in the decades to come.

Drug Dealers-The White House buys Big Pharma's silence.
AUGUST 7, 2009

Back to Top

Democrats are trying to explain opposition to ObamaCare as a sinister conspiracy controlled by the hidden hand of the health-care industry. Psychologists call this projection. Why bother with a new conspiracy when you've already clinched a secret deal with the President?

Part of the Obama health strategy has been to assiduously co-opt the key health "stakeholders," primarily with the leverage that legislation was inevitable so they might as well negotiate. Doctors, hospitals, insurers and the drug makers bought it-or perhaps it is more accurate to say were bought. This week it emerged that the pharmaceutical industry's supposedly voluntary peace offering to cut drug costs by $80 billion to help finance ObamaCare was an explicit quid pro quo in exchange for White House protection.

After the industry trade group PhRMA announced the plan in the Rose Garden in June, liberals on Capitol Hill promptly declared that they were "not bound" by it, as Henry Waxman and Nancy Pelosi repeatedly put it. If the industry could do Mr. Obama the favor of $80 billion, liberals wanted it to eat $100 billion in cuts, or $160 billion, or more.

"The President made the agreements he made," Mrs. Pelosi said. "And maybe we'll be limited by that. But maybe not." Sure enough, the House health bill pockets the money and then imposes price controls in Medicare and other "rebates" from manufacturers, much like Medicaid requires now.

Chief pharma lobbyist Billy Tauzin's clients were probably wondering about the return on their investment. Then, lo, Mr. Tauzin disclosed this week in a page-one story in the New York Times that, yes, the concessions were capped at $80 billion, no further. "We were assured: 'We need somebody to come in first. If you come in first, you will have a rock-solid deal,'" Mr. Tauzin said. "Adding other stuff changes the deal." The White House confirmed Mr. Tauzin's account.

It's astonishing to watch the press corps pass all this off as just another day at the Oval Office. During the Bush years, even eye contact with a business, CEO or lobbyist was treated as prima facie evidence of corruption. There was the furor over Dick Cheney's "secret energy task force," and even the Iraq war was engineered to benefit Halliburton, Blackwater and Big Oil. But apparently having corporate America dictate public policy is fine as long as it's the largest expansion of the welfare state since the Great Society.

As for Mr. Tauzin's gambit that playing nice would spare his industry, he evidently missed the sign hanging above Congress's chambers: "Abandon all hope, ye who enter here." Mr. Waxman responded, "PhRMA would like to see if they can get a bargain. I think that PhRMA should contribute more than PhRMA wants to contribute." Senator Dick Durbin chimed in that "I don't think any, if many, of us feel bound by any understanding or agreement along those lines."

What this Abbott and Costello routine exposes is the industry folly of thinking that liberals could be appeased. By now it is beyond obvious that Democrats view whole segments of the health-care industry as expendable. After all, what do insurers really do, besides bilk consumers? Government already pays Medicare bills; it can handle the under-65 crowd too. Over time doctors can be transferred into the civil service, but if they're good sports maybe at a higher pay grade than the DMV. As for drug research and development, the National Institutes of Health can fill in-and as a bonus, all those government-funded professors won't care about profits either. For the Democrats running Congress, merely allowing a business to continue to exist is a concession.

Even if Mr. Tauzin's strategy works this time around, it will only push his clients deeper into Mr. Waxman's embrace as government pays for the majority of American medicine. If ObamaCare is defeated, it will be due to the common sense of the American people, not to the health-care lobbies that have become its political partners.

Obama's Senior Moment-Why the elderly are right to worry when the government rations medical care.
AUGUST 14, 2009

Back to Top

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about. Allow us to referee. While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France—which has a mix of public and private medicine—has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force—either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation—and usually all three.

A lot of talk has centered on what Sarah Palin inelegantly called "death panels." Of course rationing to save the federal fisc will be subtler than a bureaucratic decision to "pull the plug on grandma," as Mr. Obama put it. But Mrs. Palin has also exposed a basic truth. A substantial portion of Medicare spending is incurred in the last six months of life.

From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?

In Britain, the NHS decides, and under its QALYs metric it generally won't pay more than $22,000 for treatments to extend a life six months. "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."

Before he got defensive, Mr. Obama was open about this political calculation. He often invokes the experience of his own grandmother, musing whether it was wise for her to receive a hip replacement after a terminal cancer diagnosis. In an April interview with the New York Times, he wondered whether this represented a "sustainable model" for society. He seems to believe these medical issues are all justifiably political questions that government or some panel of philosopher kings can and should decide. No wonder so many seniors rebel at such judgments that they know they could do little to influence, much less change.

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonsocopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes—and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more.

It's striking that even the AARP—which is run by liberals who favor national health care—has been backing away from support for Mr. Obama's version. The AARP leadership's Democratic sympathies will probably prevail in the end, perhaps after some price-control sweeteners are added for prescription drugs. But AARP is out of touch with its own members, who have figured out that their own health and lives are at stake in this debate over ObamaCare. They know that when medical discretion clashes with limited government budgets, medicine loses.

ObamaCare Is All About Rationing -- Overspending is far preferable to artificially limiting the availability of new procedures and technologies.
AUGUST 19, 2009

Back to Top

Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.

The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."

The president has emphasized the importance of limiting services to "health care that works." To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama's original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.

In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive."

One reason the Obama administration is prepared to use rationing to limit health care is to rein in the government's exploding health-care budget. Government now pays for nearly half of all health care in the U.S., primarily through the Medicare and Medicaid programs. The White House predicts that the aging of the population and the current trend in health-care spending per beneficiary would cause government outlays for Medicare and Medicaid to rise to 15% of GDP by 2040 from 6% now. Paying those bills without raising taxes would require cutting other existing social spending programs and shelving the administration's plans for new government transfers and spending programs.

The rising cost of medical treatments would not be such a large burden on future budgets if the government reduced its share in the financing of health services. Raising the existing Medicare and Medicaid deductibles and coinsurance would slow the growth of these programs without resorting to rationing. Physicians and their patients would continue to decide which tests and other services they believe are worth the cost. There is, of course, no reason why limiting outlays on Medicare and Medicaid requires cutting health services for the rest of the population. The idea that they must be cut in parallel is just an example of misplaced medical egalitarianism.

But budget considerations aside, health-economics experts agree that private health spending is too high because our tax rules lead to the wrong kind of insurance. Under existing law, employer payments for health insurance are deductible by the employer but are not included in the taxable income of the employee. While an extra $100 paid to someone who earns $45,000 a year will provide only about $60 of after-tax spendable cash, the employer could instead use that $100 to pay $100 of health-insurance premiums for that same individual. It is therefore not surprising that employers and employees have opted for very generous health insurance with very low copayment rates.

Since a typical 20% copayment rate means that an extra dollar of health services costs the patient only 20 cents at the time of care, patients and their doctors opt for excessive tests and other inappropriately expensive forms of care. The evidence on health-care demand implies that the current tax rules raise private health-care spending by as much as 35%.

The best solution to this problem of private overconsumption of health services would be to eliminate the tax rule that is causing the excessive insurance and the resulting rise in health spending. Alternatively, Congress could strengthen the incentives in the existing law for health savings accounts with high insurance copayments. Either way, the result would be more cost-conscious behavior that would lower health-care spending.

But unlike reductions in care achieved by government rationing, individuals with different preferences about health and about risk could buy the care that best suits their preferences. While we all want better health, the different choices that people make about such things as smoking, weight and exercise show that there are substantial differences in the priority that different people attach to health.

Although there has been some talk in Congress about limiting the current health-insurance exclusion, the administration has not supported the idea. The unions are particularly vehement in their opposition to any reduction in the tax subsidy for health insurance, since they regard their ability to negotiate comprehensive health insurance for their members as a major part of their raison d'être.

If changing the tax rule that leads to excessive health insurance is not going to happen, the relevant political choice is between government rationing and continued high levels of health-care spending. Rationing is bad policy. It forces individuals with different preferences to accept the same care. It also imposes an arbitrary cap on the future growth of spending instead of letting it evolve in response to changes in technology, tastes and income. In my judgment, rationing would be much worse than excessive care.

Those who worry about too much health care cite the Congressional Budget Office's prediction that health-care spending could rise to 30% of GDP in 2035 from 16% now. But during that 25-year period, GDP will rise to about $24 trillion from $14 trillion, implying that the GDP not spent on health will rise to $17 billion in 2035 from $12 billion now. So even if nothing else comes along to slow the growth of health spending during the next 25 years, there would still be a nearly 50% rise in income to spend on other things.

Like virtually every economist I know, I believe the right approach to limiting health spending is by reforming the tax rules. But if that is not going to happen, let's not destroy the high quality of the best of American health care by government rationing and misplaced egalitarianism.

Mr. Feldstein, chairman of the Council of Economic Advisers under President Ronald Reagan, is a professor at Harvard and a member of The Wall Street Journal's board of contributors.

Ezekiel Emanuel-Obama's Health Rationer-in-Chief White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.
AUGUST 26, 2009

Back to Top

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (, Jan. 31, 2009).

To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . ." He writes that one drug "used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy." (JAMA, June 13, 2007).

Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom's rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.

Dr. Emanuel's assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: "The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name."

This is untrue, though sadly it's parroted at town-hall meetings across the country. Moreover, it's an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel's views.

Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

Is this what Americans want?

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.

Pelosi's Healthcare Bill is 'The Worst Bill Ever'
Nov 1, 2009
By The Wall Street Journal

Back to Top

The Worst Bill Ever -- Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all
Nov 1, 2009

Speaker Nancy Pelosi has reportedly told fellow Democrats that she's prepared to lose seats in 2010 if that's what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone," may well be the worst piece of post-New Deal legislation ever introduced.

In a rational political world, this 1,990-page runaway train would have been derailed months ago. With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time. Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.

Yet at this point, Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level-for the health-care system, for the country's fiscal condition, and ultimately for American freedom and prosperity.

The spending surge The Congressional Budget Office figures the House program will cost $1.055 trillion over a decade, which while far above the $829 billion net cost that Mrs. Pelosi fed to credulous reporters is still a low-ball estimate. Most of the money goes into government-run "exchanges" where people earning between 150% and 400% of the poverty level-that is, up to about $96,000 for a family of four in 2016-could buy coverage at heavily subsidized rates, tied to income. The government would pay for 93% of insurance costs for a family making $42,000, 72% for another making $78,000, and so forth.

At least at first, these benefits would be offered only to those whose employers don't provide insurance or work for small businesses with 100 or fewer workers. The taxpayer costs would be far higher if not for this "firewall"-which is sure to cave in when people see the deal their neighbors are getting on "free" health care. Mrs. Pelosi knows this, like everyone else in Washington.

Even so, the House disguises hundreds of billions of dollars in additional costs with budget gimmicks. It "pays for" about six years of program with a decade of revenue, with the heaviest costs concentrated in the second five years. The House also pretends Medicare payments to doctors will be cut by 21.5% next year and deeper after that, "saving" about $250 billion. ObamaCare will be lucky to cost under $2 trillion over 10 years; it will grow more after that.

Expanding Medicaid, gutting private Medicare All this is particularly reckless given the unfunded liabilities of Medicare-now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to "pay for" universal coverage. While Medicare's price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.

As for Medicaid, the House will expand eligibility to everyone below 150% of the poverty level, meaning that some 15 million new people will be added to the rolls as private insurance gets crowded out at a cost of $425 billion. A decade from now more than a quarter of the population will be on a program originally intended for poor women, children and the disabled.

Even though the House will assume 91% of the "matching rate" for this joint state-federal program-up from today's 57%-governors would still be forced to take on $34 billion in new burdens when budgets from Albany to Sacramento are in fiscal collapse. Washington's budget will collapse too, if anything like the House bill passes.

European levels of taxation All told, the House favors $572 billion in new taxes, mostly by imposing a 5.4-percentage-point "surcharge" on joint filers earning over $1 million, $500,000 for singles. This tax will raise the top marginal rate to 45% in 2011 from 39.6% when the Bush tax cuts expire-not counting state income taxes and the phase-out of certain deductions and exemptions. The burden will mostly fall on the small businesses that have organized as Subchapter S or limited liability corporations, since the truly wealthy won't have any difficulty sheltering their incomes.

This surtax could hit ever more earners because, like the alternative minimum tax, it isn't indexed for inflation. Yet it still won't be nearly enough. Even if Congress had confiscated 100% of the taxable income of people earning over $500,000 in the boom year of 2006, it would have only raised $1.3 trillion. When Democrats end up soaking the middle class, perhaps via the European-style value-added tax that Mrs. Pelosi has endorsed, they'll claim the deficits that they created made them do it.

Under another new tax, businesses would have to surrender 8% of their payroll to government if they don't offer insurance or pay at least 72.5% of their workers' premiums, which eat into wages. Such "play or pay" taxes always become "pay or pay" and will rise over time, with severe consequences for hiring, job creation and ultimately growth. While the U.S. already has one of the highest corporate income tax rates in the world, Democrats are on the way to creating a high structural unemployment rate, much as Europe has done by expanding its welfare states.

Meanwhile, a tax equal to 2.5% of adjusted gross income will also be imposed on some 18 million people who CBO expects still won't buy insurance in 2019. Democrats could make this penalty even higher, but that is politically unacceptable, or they could make the subsidies even higher, but that would expose the (already ludicrous) illusion that ObamaCare will reduce the deficit.

The insurance takeover A new "health choices commissioner" will decide what counts as "essential benefits," which all insurers will have to offer as first-dollar coverage. Private insurers will also be told how much they are allowed to charge even as they will have to offer coverage at virtually the same price to anyone who applies, regardless of health status or medical history.

The cost of insurance, naturally, will skyrocket. The insurer WellPoint estimates based on its own market data that some premiums in the individual market will triple under these new burdens. The same is likely to prove true for the employer-sponsored plans that provide private coverage to about 177 million people today. Over time, the new mandates will apply to all contracts, including for the large businesses currently given a safe harbor from bureaucratic tampering under a 1974 law called Erisa.

The political incentive will always be for government to expand benefits and reduce cost-sharing, trampling any chance of giving individuals financial incentives to economize on care. Essentially, all insurers will become government contractors, in the business of fulfilling political demands: There will be no such thing as "private" health insurance.

All of this is intentional, even if it isn't explicitly acknowledged. The overriding liberal ambition is to finish the work began decades ago as the Great Society of converting health care into a government responsibility. Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today. One reason Mrs. Pelosi has fought so ferociously against her own Blue Dog colleagues to include at least a scaled-back "public option" entitlement program is so that the architecture is in place for future Congresses to expand this share even further.

As Congress's balance sheet drowns in trillions of dollars in new obligations, the political system will have no choice but to start making cost-minded decisions about which treatments patients are allowed to receive. Democrats can't regulate their way out of the reality that we live in a world of finite resources and infinite wants. Once health care is nationalized, or mostly nationalized, medical rationing is inevitable-especially for the innovative high-cost technologies and drugs that are the future of medicine.

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.

From Congressman Mike Rogers

From the Heritage Foundation
The House Health Care Bill: A $700 Billion Tax Hike
October 29th, 2009

The New House Health Care Plan has several tax increases that will cost taxpayers $700 billion in the next ten years. Several of these taxes are new and were not in the earlier House bills.

The Surtax

The new Pelosi plan establishes a 5.4% surtax on joint filers with over $1 million in adjusted gross income or $500,000 for single filers. This is a single rate, which is different from the earlier House bills that had surtaxes at lower income levels. This surtax is not based on final adjusted gross income, but instead modified gross income. Thus the effective rate of the surtax is higher than just increasing marginal tax rates by 5.4%.

This surtax is also not indexed to inflation. This will cause more and more taxpayers to be hammered by the surtax even as their real income does not increase. This is one of the reasons that the Joint Tax Committee expects the cost of the surtax to more than double in year 10 of its estimate to $68.4 billion from $30.9 billion in 2011. The Joint Tax Committee estimates that taxpayers will be forced to pay $460.5 billion in higher taxes due to this provision. This is a larger tax increase than the 1993 Clinton income tax increase provisions that created a new tax bracket for high income taxpayers, increased the AMT, limited deductions and exemptions for high income earners.

Business Taxes

Businesses could pay a penalty of 8% on the average wage of their employees if they do not offer qualified health insurance. Small businesses with less than $500,000 in total payroll will be exempt from the business. Businesses with total payroll from $500-$750,000 will pay less than the full 8% depending on their total payroll size.

Business Rate Table
  • Does not exceed $500,000 ………………………….0 percent
  • Exceeds $500,000, but does not exceed $585,000 2 percent
  • Exceeds $585,000, but does not exceed $670,000 4 percent
  • Exceeds $670,000, but does not exceed $750,000 6 percent
Copying Baucus

The House bill copies the Baucus framework of having several small tax increases in an effort to raise additional income. For example, the House bill now also limits Flexible Spending Accounts to $2500 and limits the ability of FSA or HSAs to purchase goods by excluding over the counter drugs.

Here is a full list of the additional House tax increase items and their cost:
  1. Health Savings Account Tax: Increases tax on health savings account funds not used for medical purposes from 10% to 20%. ($1.3 billion)
  2. Flexible Spending Arrangement Cap: Caps contributions to flexible spending accounts at $2,500. ($13.3 billion/ ten years)
  3. Medical Devices Excise Tax: Imposes 2.5% excise tax on sale of medical devices. ($20 billion/ ten years)
  4. Self-Insured Health Fee: Imposes fee on insured and self insured health plans.
  5. Itemized Deductions Definition: Conforms the definitions of medical expenses from employer-provide health insurance, merging flexible spending arrangements, health reimbursement arrangements, health savings accounts and archer MSAs to the definition of itemized deduction. ($5 billion/ ten years)
  6. Medicare Part D: Eliminates deduction for expenses that can be allocated to the Medicare Part D subsidy. ($3 billion/ ten years)
  7. Payments to Corporations: "Requires information reporting on payments to Corporations" ($17.1 billion/ ten years)
  8. Worldwide Interest Allocation: Delays implementation of interest allocation. ($26.1 billion/ ten years)
  9. Treaty Benefits Limit: Limits the treaty benefits for some deductible payments. ($7.5 billion/ ten years)
  10. Economic Substance Payments: Codifies economic substance doctrine and imposes penalties for underpayments. ($5.7 billion/ ten years)

What the Pelosi Health-Care Bill Really Says -- Here are some important passages in the 2,000 page legislation.
Nov 7, 2009

Back to Top

The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

What the government will require you to do:
  • Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.
  • Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.
On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.
  • Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice-basic, enhanced and premium levels-but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.
  • Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.
  • Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.
Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.
  • Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.
  • Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.
  • Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.
  • Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
  • Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."
Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.
  • Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.
  • Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.
  • Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."
  • Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.
For the text of the bill with page numbers, see

Summary of Medicare Cuts in H.R. 3962

Back to Top

Democrats' health bill will slash Medicare by more than one-half trillion dollars
  • $170 billion in cuts to Medicare Advantage (MA) which currently provides benefits to more than 11 million seniors. o The
  • $170 billion in cuts to Medicare Advantage (MA) which currently provides benefits to more than 11 million seniors.
  • The Congressional Budget Office (CBO) predicts these cuts "could lead many plans to limit the benefits they offer, raise their premiums, or withdraw from the program."
  • CBO also predicts 3 million seniors will lose the plan they currently have and the non-partisan Medicare Payment Advisory Commission (MedPAC) predicts these cuts will result in 1 in 5 seniors no longer having access to an MA plan;
  • $143.6 billion in across-the-board cuts by instituting a new, permanent "productivity adjustment" to reimbursement rates for all hospitals, Ambulatory Surgery Centers (ASCs), skilled nursing facilities (SNFs), hospice, clinical laboratories, and durable medical equipment (DME);
  • $56.7 billion in cuts to home health agencies by freezing payment rates in 2010, applying the productivity adjustment, and other reimbursement changes;
  • $42.3 billion in cuts to the Medicare prescription drug program (Part D) by imposing government price-controls for drugs. As a result, CBO predicts seniors' premiums will increase by at least 20%;
  • $23.9 billion in additional cuts to SNFs by freezing their payment rates in 2010;
  • $14.3 billion in provider reimbursement cuts by reallocating Medicare funding nationally;
  • $10.3 billion in additional cuts to hospitals by slashing reimbursements designed to cover uncompensated care;
  • $9.3 billion in yet further cuts to hospitals that have a high rate of readmitted patients;
  • $8.2 billion in undisclosed cuts determined by the new, unelected "Center for Medicare Innovation;"
  • $5.3 billion in cuts to inpatient rehabilitation facilities cuts by freezing payment rates in 2010;
  • $3 billion in reimbursement cuts to providers who use imaging equipment (MRI, CT scans, etc);
  • $1 billion cut to physician-owned hospitals, effectively legislating these hospitals out of existence. In some communities, physician-owned hospitals are the only hospital in the community.
  • $800 million in additional DME cuts (power wheelchairs); and
  • Plus, $14.5 billion in additional miscellaneous cuts to the Medicare program.

ObamaCare Keeps Falling in the Polls-A business ad campaign could turn the tide even in the House.
Dec 10, 2009

Back to Top

The Senate's compromise bill on health care was announced on Wednesday to much fanfare. But there's not much there for moderate Democrats to write home about. It waters down a provision creating a "public option," but it also expands (to include people over 55) Medicare, a program already expected to go bankrupt in 2017.

The Senate bill is so unwieldy that the health-care system it will create will almost certainly break apart and force us into Canadian-style care. As Rep. Anthony Weiner (D., N.Y.) said in a statement, the Medicare expansion "would perhaps get us on the path to a single payer model." That grim prospect means there's still a chance to defeat or reshape the health-reform effort.

Opponents of ObamaCare will be aided by polls showing that it is even less popular than HillaryCare was a year into the Clinton presidency. Back in December 1993, Gallup found that 47% of voters backed HillaryCare, with 32% opposed. Today, an average of health-care surveys at shows support for ObamaCare at 38.8%, with 51.4% against.

The difference is that in 1993 and 1994, ads pointing out the weaknesses of HillaryCare were ubiquitous on TV. This time the White House has bullied the health-care industry into silence or sullen support.

But the falling poll numbers tell us anyone who tries to force a full health-care debate that pushes a vote past the holidays will not suffer politically. One reason the Democrats are frantic for a vote before Christmas is that they fear what will happen if senators have to go home and talk with constituents before voting.

Even if the Senate passes something before Christmas, House Speaker Nancy Pelosi (D., Calif.) says the bill will likely have to go to a conference committee. There differences between The Senate version and the bill that has already passed the House must be reconciled.

Mrs. Pelosi says "we'd do almost anything" to finish the bill this year. But it is unlikely the House will be able to vote on a final bill until January. That delay gives opponents time to raise money for a campaign aimed at House members who were dragooned into voting for the Pelosi bill in November.

That legislation only passed 220 to 215. There will be new pressures on members for a second vote. Louisiana Rep. Anh "Joseph" Cao, the lone Republican to vote for the bill, may not be able to support it again without strong limits on funding abortions—and several Democrats might feel compelled to join him.

Meanwhile, the new Quinnipiac poll reports that 63% of Americans believe covering the uninsured will increase their own costs, and that includes 44% of Democrats. Voters by 48% to 46% believe extending coverage to the uninsured would decrease the quality of their own care—including a majority of independents and 26% of Democrats. A full 74% of people don't believe the president's claim that health reform won't add to the deficit, including 53% of Democrats.

There is also the issue of jobs. The unemployment rate is 10% and a new study by the National Federation of Independent Business estimates that mandating that employers provide health care will cost 1.6 million jobs by 2013.

These are all potent issues if TV ads and grass-roots activism can be directed into the districts of House Democrats vulnerable to defeat in 2010. Fourteen Blue Dog Democrats who voted to pass health-care reform last month represent districts rated as leaning Republican by the Cook Political Report. Another nine Democrats hail from districts that are only slightly Democratic. Pressure will be put on the 39 Democrats who voted no the first time to switch their vote, but they will be hard to budge. There are enough votes among the three groups to make it agonizingly difficult to pass health care a second time.

Speaker Pelosi has told her members that health-care reform is so important she is willing to lose 20 seats next year if that is what it takes to get it. Polls showing Republicans leading in the generic vote for Congress make some Democrats worry that she is seriously lowballing the risk. She may not mind if some members lose their seats, especially if they are moderates who are possible future votes against her in a leadership contest. The Blue Dogs who are the subject of her political science experiment may decide they'd rather not be her guinea pigs.

Worse Than the Public Option-Harry Reid's Medicare Gambit
Dec 11, 2009

Back to Top

It's hard to imagine a better illustration of the panic and recklessness stringing ObamaCare along in the Senate than the putative deal that Harry Reid announced this week. The Majority Leader is claiming that a Medicare "buy-in" for people from ages 55 to 64 has overcome the liberal-moderate impasse over the "public option." But if anything, this gambit is an even faster road to government-run health care.

The public option—an insurance program open to everyone, financed by taxpayers and run like Medicare—is intended as a veiled substitute for "single-payer" Canada-style insurance. Under the cover of "choice" and "competition," the entitlement would quickly squeeze out private insurance as people gravitated to "free" coverage and the government held down costs via price controls the way Medicare does now.

Mr. Reid's buy-in simply cuts out the middle man. Why go to the trouble of creating a new plan like Medicare when Medicare itself is already handy? A buy-in is an old chestnut of single-payer advocate Pete Stark, and it's the political strategy liberals have tried since the Great Society: Ratchet down the enrollment age for Medicare, boost the income limits to qualify for Medicaid, and soon health care for the entire middle class becomes a taxpayer commitment.

In the case of Medicare, this means expanding a program that is already going broke. Medicare reimburses doctors and hospitals at rates 70% to 80% below those of private insurers, which means below the actual treatment costs in many cities and regions. Providers either eat these losses—about half of U.S. hospitals are running a deficit or close to it—or they raise prices for private payers. This cost-shifting isn't dollar for dollar, but all empirical research shows that it adds tens of billions of dollars to consumer health bills, and this will accelerate if several million new patients are added to Medicare. That means higher prices for health insurance.

Adverse selection will also be a big problem, as the people who choose to join will inevitably be higher risk or in poorer health. Mr. Reid hasn't released any details on his plan, if they even exist, but would the sub-65 uninsured who join Medicare be subsidized? If so, in what sense is this one-hand-subsidizes-the-other taxpayer self-dealing a "buy-in"? It sounds simply like a huge Medicare expansion, especially if employers decide to drop coverage for anyone older than 55.

As for costs, how does adding new beneficiaries square with Democratic promises that they will cut Medicare spending on paper by two percentage points a year for the next two decades—just as the baby boomers retire and health costs continue to climb?

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.

The latest polls show public support for the Senate plan falling into the mid-30%-range. The remaining supporters must not be paying attention.

ObamaCare and the Liberal Obsession
Dec 17, 2009
by Dan Henninger

Back to Top

If President Obama's health-care initiative fails, there is no longer a rationale for being a liberal in the United States. Everything else on liberalism's to-do list is footnotes.

Passing national health insurance has obsessed every Democratic president since Franklin Roosevelt. Even Harry Truman, for some conservatives a model of "moderate" Democratic politics, wanted it. Looking back, Truman wept and warned: "I've had some bitter disappointments as President, but the one that has troubled me most, in a personal way, has been the failure to defeat the organized opposition to a national compulsory health insurance program. But this opposition has only delayed and cannot stop the adoption of an indispensable federal health insurance plan."

No other issue has consumed more political energy in the U.S. than "health-care reform." Congress's half-year preoccupation with health care is only the latest blip in the Democrats' long march to a public option.

As we head to the final act, one element of this history stands out: The liberals' repeated failure to get it done.

The Democratic Mecca—a real national health insurance system available to all—has always encountered stiff resistance in Congress, notably as now from moderate Democrats. In the 1960s, Senate Finance Chairman Russell Long (of Mary Landrieu's Louisiana) railed publicly against Medicare's costs but as now, questions about cost were obliterated.

Frustrated at the failure to pass their "National Health Insurance" bill during the presidency of Dwight Eisenhower, the Democrats ratcheted back from the Euro-style idea of FDR and Truman to a plan that would cover only Social Security beneficiaries, the elderly. This was Medicare.

Medicare failed all its initial votes in 1960. A compromise known as Kerr-Mills, which limited federal coverage to the "indigent" elderly, passed the Senate by a vote of 91-2. Many said then that Kerr-Mills addressed the U.S.'s main problem, which was medicine for the poor. Ronald Reagan supported Kerr-Mills, arguing that people "worth millions of dollars" shouldn't be getting health care paid for by government.

For Democratic liberals, a lot is never enough. With John Kennedy's election, they resubmitted Medicare for the elderly regardless of income.

The Democrats still couldn't pass a health-care entitlement on the scale of Social Security. The politics they threw into the effort was massive. They put 20,000 elderly in Madison Square Garden to hear JFK's oratory. Rallies were held in 45 cities. Organized labor ran campaigns against members of the Ways and Means Committee in their home districts. For all this, in July 1962 the Senate voted 52-48 against Medicare. JFK denounced the vote on TV.

It is a familiar story that Lyndon Johnson got Medicare passed as part of the Kennedy legacy. But for LBJ in 1965, the political planets were in perfect alignment. He had an overwhelming victory in the 1964 presidential campaign and huge congressional majorities. He had a robust economy, the gift of JFK's tax cut passed in early 1964. Also, no House hearings were held on the 296-page bill, which Democratic Sen. Philip Hart of Michigan complained was the "one of the most complex set of social security amendments ever brought before this body."

Oh, and let us not overlook the party's concurrent quest for money transfers. In a moment of glee over the 1965 bill, Rep. Phil Burton of California, a member of the liberal pantheon, intoned: "All in all, our fair state and its people in the first year will be favored to the tune of some $550 million, a not modest sum." (Norms of spending "modesty" have changed since.)

The Democrats' persistent problems with this issue, including the Clintons' Health Security Act in 1994, suggests a victory for ObamaCare is no sure thing.

Nearly every defeat of broad public health coverage has come amid some turbulence that scared the public or politicians.

For Truman it was the Korean War. For JFK it was a recession, Vietnam and the Cuban missile crisis. Walter Lippmann wrote of JFK that a too-confident president was exceeding the public's reach. The Social Security Administration's own history of the Kennedy effort notes, "Some experts still had doubts about the reliability of the cost estimates for the bill."

Now Democrats say this vote is about "history." No, it's about their history. As with past failures to federalize health care, the air in 2009 is full of static—high unemployment, Afghanistan, a terrorist prison in Illinois and a petulant White House. The Democrats' familiar problems with the politics of universal health care have turned the bill into one of the most degraded legislative exercises in congressional history. Left-wing Dems like Howard Dean are screaming "kill" the Senate bill, suggesting a progressive Jonestown over it. Public support is below 40%.

This is probably the final death struggle for universal health care. They may let Harry Reid's Senate seat itself go down in the bloodbath over the 70-year obsession. Anyone remotely opposed to this idea had better step forward. History says ObamaCare isn't a done deal til the fat lady votes.

Senate Healthcare bill-Change Nobody Believes In
Dec 21, 2009

Back to Top

And tidings of comfort and joy from Harry Reid too. The Senate Majority Leader has decided that the last few days before Christmas are the opportune moment for a narrow majority of Democrats to stuff ObamaCare through the Senate to meet an arbitrary White House deadline. Barring some extraordinary reversal, it now seems as if they have the 60 votes they need to jump off this cliff, with one-seventh of the economy in tow.

Mr. Obama promised a new era of transparent good government, yet on Saturday morning Mr. Reid threw out the 2,100-page bill that the world's greatest deliberative body spent just 17 days debating and replaced it with a new "manager's amendment" that was stapled together in covert partisan negotiations. Democrats are barely even bothering to pretend to care what's in it, not that any Senator had the chance to digest it in the 38 hours before the first cloture vote at 1 a.m. this morning. After procedural motions that allow for no amendments, the final vote could come at 9 p.m. on December 24.

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.

• Health costs. From the outset, the White House's core claim was that reform would reduce health costs for individuals and businesses, and they're sticking to that story. "Anyone who says otherwise simply hasn't read the bills," Mr. Obama said over the weekend. This is so utterly disingenuous that we doubt the President really believes it.

The best and most rigorous cost analysis was recently released by the insurer WellPoint, which mined its actuarial data in various regional markets to model the Senate bill. WellPoint found that a healthy 25-year-old in Milwaukee buying coverage on the individual market will see his costs rise by 178%. A small business based in Richmond with eight employees in average health will see a 23% increase. Insurance costs for a 40-year-old family with two kids living in Indianapolis will pay 106% more. And on and on.

These increases are solely the result of ObamaCare—above and far beyond the status quo—because its strict restrictions on underwriting and risk-pooling would distort insurance markets. All but a handful of states have rejected regulations like "community rating" because they encourage younger and healthier buyers to wait until they need expensive care, increasing costs for everyone. Benefits and pricing will now be determined by politics.

As for the White House's line about cutting costs by eliminating supposed "waste," even Victor Fuchs, an eminent economist generally supportive of ObamaCare, warned last week that these political theories are overly simplistic. "The oft-heard promise 'we will find out what works and what does not' scarcely does justice to the complexity of medical practice," the Stanford professor wrote.

• Steep declines in choice and quality. This is all of a piece with the hubris of an Administration that thinks it can substitute government planning for market forces in determining where the $33 trillion the U.S. will spend on medicine over the next decade should go.

This centralized system means above all fewer choices; what works for the political class must work for everyone. With formerly private insurers converted into public utilities, for instance, they'll inevitably be banned from selling products like health savings accounts that encourage more cost-conscious decisions.

Unnoticed by the press corps, the Congressional Budget Office argued recently that the Senate bill would so "substantially reduce flexibility in terms of the types, prices, and number of private sellers of health insurance" that companies like WellPoint might need to "be considered part of the federal budget."

With so large a chunk of the economy and medical practice itself in Washington's hands, quality will decline. Ultimately, "our capacity to innovate and develop new therapies would suffer most of all," as Harvard Medical School Dean Jeffrey Flier recently wrote in our pages. Take the $2 billion annual tax—rising to $3 billion in 2018—that will be leveled against medical device makers, among the most innovative U.S. industries. Democrats believe that more advanced health technologies like MRI machines and drug-coated stents are driving costs too high, though patients and their physicians might disagree.

"The Senate isn't hearing those of us who are closest to the patient and work in the system every day," Brent Eastman, the chairman of the American College of Surgeons, said in a statement for his organization and 18 other speciality societies opposing ObamaCare. For no other reason than ideological animus, doctor-owned hospitals will face harsh new limits on their growth and who they're allowed to treat. Physician Hospitals of America says that ObamaCare will "destroy over 200 of America's best and safest hospitals." • Blowing up the federal fisc. Even though Medicare's unfunded liabilities are already about 2.6 times larger than the entire U.S. economy in 2008, Democrats are crowing that ObamaCare will cost "only" $871 billion over the next decade while fantastically reducing the deficit by $132 billion, according to CBO.

Yet some 98% of the total cost comes after 2014—remind us why there must absolutely be a vote this week—and most of the taxes start in 2010. That includes the payroll tax increase for individuals earning more than $200,000 that rose to 0.9 from 0.5 percentage points in Mr. Reid's final machinations. Job creation, here we come.

Other deceptions include a new entitlement for long-term care that starts collecting premiums tomorrow but doesn't start paying benefits until late in the decade. But the worst is not accounting for a formula that automatically slashes Medicare payments to doctors by 21.5% next year and deeper after that. Everyone knows the payment cuts won't happen but they remain in the bill to make the cost look lower. The American Medical Association's priority was eliminating this "sustainable growth rate" but all they got in return for their year of ObamaCare cheerleading was a two-month patch snuck into the defense bill that passed over the weekend.

The truth is that no one really knows how much ObamaCare will cost because its assumptions on paper are so unrealistic. To hide the cost increases created by other parts of the bill and transfer them onto the federal balance sheet, the Senate sets up government-run "exchanges" that will subsidize insurance for those earning up to 400% of the poverty level, or $96,000 for a family of four in 2016. Supposedly they would only be offered to those whose employers don't provide insurance or work for small businesses.

As Eugene Steuerle of the left-leaning Urban Institute points out, this system would treat two workers with the same total compensation—whatever the mix of cash wages and benefits—very differently. Under the Senate bill, someone who earned $42,000 would get $5,749 from the current tax exclusion for employer-sponsored coverage but $12,750 in the exchange. A worker making $60,000 would get $8,310 in the exchanges but only $3,758 in the current system.

For this reason Mr. Steuerle concludes that the Senate bill is not just a new health system but also "a new welfare and tax system" that will warp the labor market. Given the incentives of these two-tier subsidies, employers with large numbers of lower-wage workers like Wal-Mart may well convert them into "contractors" or do more outsourcing. As more and more people flood into "free" health care, taxpayer costs will explode.

• Political intimidation. The experts who have pointed out such complications have been ignored or dismissed as "ideologues" by the White House. Those parts of the health-care industry that couldn't be bribed outright, like Big Pharma, were coerced into acceding to this agenda. The White House was able to, er, persuade the likes of the AMA and the hospital lobbies because the federal government will control 55% of total U.S. health spending under ObamaCare, according to the Administration's own Medicare actuaries.

Others got hush money, namely Nebraska's Ben Nelson. Even liberal Governors have been howling for months about ObamaCare's unfunded spending mandates: Other budget priorities like education will be crowded out when about 21% of the U.S. population is on Medicaid, the joint state-federal program intended for the poor. Nebraska Governor Dave Heineman calculates that ObamaCare will result in $2.5 billion in new costs for his state that "will be passed on to citizens through direct or indirect taxes and fees," as he put it in a letter to his state's junior Senator.

So in addition to abortion restrictions, Mr. Nelson won the concession that Congress will pay for 100% of Nebraska Medicaid expansions into perpetuity. His capitulation ought to cost him his political career, but more to the point, what about the other states that don't have a Senator who's the 60th vote for ObamaCare?

"After a nearly century-long struggle we are on the cusp of making health-care reform a reality in the United States of America," Mr. Obama said on Saturday. He's forced to claim the mandate of "history" because he can't claim the mandate of voters. Some 51% of the public is now opposed, according to National Journal's composite of all health polling. The more people know about ObamaCare, the more unpopular it becomes.

The tragedy is that Mr. Obama inherited a consensus that the health-care status quo needs serious reform, and a popular President might have crafted a durable compromise that blended the best ideas from both parties. A more honest and more thoughtful approach might have even done some good. But as Mr. Obama suggested, the Democratic old guard sees this plan as the culmination of 20th-century liberalism.

So instead we have this vast expansion of federal control. Never in our memory has so unpopular a bill been on the verge of passing Congress, never has social and economic legislation of this magnitude been forced through on a purely partisan vote, and never has a party exhibited more sheer political willfulness that is reckless even for Washington or had more warning about the consequences of its actions.

These 60 Democrats are creating a future of epic increases in spending, taxes and command-and-control regulation, in which bureaucracy trumps innovation and transfer payments are more important than private investment and individual decisions. In short, the Obama Democrats have chosen change nobody believes in—outside of themselves—and when it passes America will be paying for it for decades to come.

Compare the Senate and House Healthcare Bills

Back to Top
Compare the health-care bill that passed in the Senate Dec. 24 with the House's version of health legislation passed Nov. 7, as tough negotiations loom on a compromise package. Any final health care bill would have to meld proposals from the House and Senate.
  • The Congressional Budget Office estimates the bill would cost $871 billion over ten years
  • Senators added extra $10 billion for comunity health centers
  • The CBO says the bill's cost is $1.05 trillion and reduces the deficit by $132 billion over 10 years
  • The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. But after adding up a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, the cost is around $1.2 trillion
  • How it's paid for
  • $149.1 billion over seven years from a new excise tax on high-premium insurance plans, equal to 40% of premiums paid on plans costing more than $23,000 annually for families, $8,500 for an individual
  • Cuts to Medicare and Medicaid
  • A fee on employers whose workers receive government subsidies to help them pay premiums; fines on people who fail to purchase coverage
  • $54 billion over 10 years from a Medicare payroll taxes hike on couples with income of more than $250,000 a year. For those families, the levy would be raised to 1.95%, up from 1.45%
  • Customers of indoor tanning salons would pay a 10% tax (Replaces a proposed tax on cosmetic surgery)
  • $102.3 billion over ten years from fees on insurance companies, drug makers and medical device manufacturers
  • $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million -- the threshold was increased from $280,000 and $350,000, in response to lawmakers' concerns that the taxes would hit too many people and small businesses
  • More than $400 billion in cuts to Medicare and Medicaid
  • A new $20 billion fee on medical device makers
  • $13 billion from limiting contributions to flexible spending accounts
  • Fines paid by individuals and employers who don't obtain coverage and a mix of other corporate taxes and fees
  • Requirements for individuals
  • Most Americans would be required to obtain insurance
  • Those who are obligated to buy coverage and refuse could face a penalty up to $750 for an individual or $2,250 for a family
  • The maximum amount workers would be required to spend on premiums would be capped at 9.8% of income
  • Exemptions for economic hardship
  • Individuals must have insurance
  • People who fail to purchase coverage would face a tax penalty of 2.5% of income
  • People can apply for hardship waivers if coverage is unaffordable.
  • Requirements for employers
  • Companies with more than 200 employees are required to automatically enroll employees in plans
  • Companies with more than 50 full-time workers that do not offer coverage would pay a fee as high as $750 multiplied by the total size of the work force if the government ends up subsidizing employees' coverage
  • Tax credits to buy health coverage available to small employers with up to 25 workers and average wage of $50,000 or less
  • Employers must provide insurance to their employees or pay a penalty of 8% of payroll
  • Companies with payrolls under $250,000 annually are exempt and the penalty is phased in for companies with payrolls between $500,000 and $750,000
  • Businesses with 10 or fewer workers get tax credits to help them provide coverage
  • Subsidies
  • Tax credits for individuals and families likely making up to 400% of the federal poverty level, which computes to $88,000 for a family of four.
  • Individuals and families with annual income up to 400% of poverty level, or $88,200 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
  • Benefits package
  • All plans sold to individuals and small businesses would have to cover basic benefits
  • The government would set four levels of coverage: Under legislation passed by the Senate Finance Committee the least generous would pay an estimated 65% of health care costs per year; the most generous would cover an estimated 90%. Those numbers could change
  • Starting in 2010, insurers would be barred from denying coverage to children with pre-existing conditions. That provision would apply to adults starting in 2014.
  • A committee would recommend a so-called essential benefits package including preventive services
  • Out-of-pocket costs would be capped
  • The new benefits package would be the basic benefits package offered in the exchange.
  • Government-run plan
  • Democratic senators dropped a plan that would have had the government directly operate a health-insurance plan, while giving states the right to opt out
  • In place of that, the senators embraced a more limited proposal that would empower the government's Office of Personnel Management to put in place a new low-cost national health plan
  • The new national plan would be run by nonprofit entities set up by the private sector, and would be available to the public on the new insurance exchanges that would be created under the bill
  • A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services
  • Democrats originally designed the plan to pay Medicare rates plus 5% to doctors. But the final version would let the HHS secretary negotiate rates with providers
  • How you choose your plan
  • Self-employed people and small businesses could pick a plan offered through new state-based purchasing pools
  • Employees would be generally allowed to keep their work-provided coverage
  • Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers
  • It could be expanded to large employers over time
  • States could opt to operate their own exchanges in place of the national exchange if they follow federal rules
  • Changes to Medicaid and Medicare
  • Senators dropped a plan to expand Medicare coverage to some people ages 55 to 64
  • Income eligibility levels likely to be standardized to 133% of poverty ($29,327 a year for a family of four)
  • States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid
  • The federal government would pick up the full cost of the expansion for 2014 through 2016; thereafter financing will be shared through an increase in the federal medical assistance percentage (FMAP)
  • The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150% of the federal poverty level ($33,075 per year for a family of four)
  • The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 90% and states would pay 10%

  • Democrat Controlled Senate Passes Healthcare -- Merry Christmas -- Every Democrat cast the deciding health-care vote.
    Dec 26, 2009

    Back to Top

    In the post-dawn hours on Thursday the Senate passed ObamaCare 60 to 39, in the first vote on Christmas Eve since 1895 and after the longest consecutive session in Congress since World War I. We are thus heading toward the first U.S. entitlement program dragged across the finish line on a straight partisan majority, a bill that even its most fervent supporters admit is "flawed" but better than nothing.

    It is far worse than nothing. The bill itself is an unprecedented arrogation of federal power over one-seventh of the economy, and even its closest antecedents, Medicare and Medicaid, passed in 1965 with the support of both parties. Reflecting the political consensus that has always inspired durable social reform in America, those entitlements cleared the Senate with more than half of the GOP caucus voting in favor.

    It takes hard partisan work to drive off Olympia Snowe, Susan Collins, Chuck Grassley, Orrin Hatch, John McCain, Bob Bennett, Judd Gregg, Mike Enzi and the Senate's other Republican moderates or deal-makers who earlier this year were prepared to compromise. Some 18 Senate Republicans voted to more than double the size of the children's health insurance program in 2007 over the opposition of President Bush, and Mrs. Snowe and Messrs. Grassley and Hatch and others have long joined with Democrats for health-care subsidy expansions that most Republicans dislike. The GOP had no choice but to oppose this plan or completely abandon its principles.

    Mrs. Snowe in particular genuinely wanted to support reform, and she voted to send the Finance Committee version to the floor in October. Majority Leader Harry Reid promptly tacked hard to the left, trying, among other things, to resurrect the government-run "public option" that was untenable among Democratic moderates and even the White House had long ago left for dead.

    The bill Democrats approved on Christmas Eve was drafted "in the shadows, without transparency, just to garner the necessary 60 votes and nothing more," as Mrs. Snowe put it in a statement on Sunday. A law so sweeping and complex that no one can understand it but that will affect the lives of all Americans was thus rushed to passage with little real debate, and less reflection. The Senate considered only 20 of the more than 450 amendments filed.

    Those votes were revealing nonetheless, showing that certain Democrats oppose core parts of ObamaCare even as they voted for the final version. Nebraska's Ben Nelson—now justly famous for a Medicaid payoff in return for his vote—and Virginia's Jim Webb voted for the McCain amendment that would have stripped out cuts totalling more than $400 billion in future Medicare spending to fund "universal" health insurance. Along with Blanche Lincoln (Arkansas) and Evan Bayh (Indiana), the duo also supported changes that would have excluded tax increases on individuals earning under $200,000, as President Obama promised during his campaign. The tax amendment failed, 45-54.

    So these Senators were against the heart of the bill before they voted for it, as John Kerry has been known to say.

    In remarks on Monday after a crucial late night cloture vote to meet an arbitrary Christmas deadline, Mr. Obama added that "Medicare will be stronger and its solvency extended by nearly a decade." But as the Congressional Budget Office noted in a memo on Wednesday, the claim isn't true except on paper, since money taken out of the accounting gimmick of the "trust fund" to pay for subsidies today can't simultaneously be spent on Medicare benefits tomorrow. Messrs. Bayh, Nelson and Webb voted in favor of an amendment sponsored by Mr. Gregg that would have eliminated this double counting.

    These Democratic fence-sitters and Joe Lieberman ended up killing the public option, but in the end they gave Mr. Reid and the White House what they needed. We trust voters in Nebraska, Louisiana, Indiana, Virginia and elsewhere noticed that these votes ultimately ensured the passage of a bill that will increase insurance costs, retard medical innovation and sorely damage the country's fiscal position.

    And it may get worse before it becomes law. The left has thrown a faux tantrum over the Senate bill, hoping to leverage changes toward even higher costs and taxes as it now goes to House-Senate conference. Democratic leaders are already saying this won't be the usual conference, with public votes, but will be negotiated by a few barons plus White House chief of staff Rahm Emanuel in a backroom. Whatever changes they make to appease the left will be sprung on everyone else and once again rushed through both houses, a la the Senate bill.

    Every Democrat in the Senate cast the deciding vote for this spectacle, which will soon give them ownership of the U.S. health-care system.

    Paul Ryan v. the President - The Republican dissects ObamaCare's real costs. Democrats stay mute.
    Mar 4, 2010

    Back to Top

    'Every argument has been made. Everything that there is to say about health care has been said, and just about everybody has said it," President Obama declared yesterday as he urged Democrats to steamroll his plan through Congress. What hasn't been heard, however, is even a shred of White House honesty about the true costs of ObamaCare, or its fiscal consequences.

    Nearby, we reprint Wisconsin Republican Paul Ryan's remarks at the health summit last week, which methodically dismantle the falsehoods—there is no other way of putting it—that Mr. Obama has used to sell "reform" and repeated again yesterday. No one in the political class has even tried to refute Mr. Ryan's arguments, though he made them directly to the President and his allies, no doubt because they are irrefutable. If Democrats are willing to ignore overwhelming public opposition to ObamaCare and pass it anyway, then what's a trifling dispute over a couple of trillion dollars?

    At his press conference yesterday, Mr. Obama claimed that "my proposal would bring down the cost of health care for millions—families, businesses and the federal government." He said it is "fully paid for" and "brings down our deficit by up to $1 trillion over the next two decades." Never before has a vast new entitlement been sold on the basis of fiscal responsibility, and one reason ObamaCare is so unpopular is that Americans understand the contradiction between untold new government subsidies and claims of spending restraint. They know a Big Con when they hear one.

    Mr. Obama's fiscal assertions are possible only because of the fraudulent accounting and budget gimmicks that Democrats spent months calibrating. Readers can find the gory details in Mr. Ryan's pre-emptive rebuttal nearby, though one of the most egregious deceptions is that the bill counts 10 years of taxes but only six years of spending.

    Some in the liberal cheering section now claim that this Medicare ruse isn't Mr. Obama's problem because it was first promised by Republicans and Bill Clinton in 1997. But then why did Democrats include the "doc fix" in all early versions of the bill to buy the support of the American Medical Association, only to dump this pricey item later when hiding it would make it easier to fake-reduce the deficit?

    The President was (miraculously) struck dumb by Mr. Ryan's critique, and in his response drifted off into an irrelevant tangent about Medicare Advantage, while California Democrat Xavier Becerra claimed "you essentially said you can't trust the Congressional Budget Office." But Mr. Ryan was careful to note that he didn't doubt the professionalism of CBO, only the truthfulness of the Democratic gimmicks that the budget gnomes are asked to score.

    Yesterday Mr. Obama again invoked the "nonpartisan, independent" authority of CBO, which misses the reality that if you feed the agency phony premises, you are going to get phony results at the other end.

    The President also claimed the reason his plan is in trouble, and the reason Democrats must abuse the Senate's rules to ram this plan into law, is that "many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies." So most of Mr. Obama's first year in office has been paralyzed over nothing more than minor regulatory hair-splitting. This is so preposterous that the President can't possibly believe it.

    Congress's spring break begins on March 29, and Democratic leaders plan on jamming this monster through Congress before then. Americans have to hope that enough rank-and-file Democrats aren't as deaf to fiscal honesty as this President.

    Dissecting the Real Cost of ObamaCare


    The following are remarks made by Congressman Paul Ryan of Wisconsin, the ranking Republican on the House Budget Committee, about the cost of the House and Senate health-care bills at President Obama's Blair House summit on health care, Feb. 25:

    Look, we agree on the problem here. And the problem is health inflation is driving us off of a fiscal cliff.

    Mr. President, you said health-care reform is budget reform. You're right. We agree with that. Medicare, right now, has a $38 trillion unfunded liability. That's $38 trillion in empty promises to my parents' generation, our generation, our kids' generation. Medicaid's growing at 21 percent each year. It's suffocating states' budgets. It's adding trillions in obligations that we have no means to pay for . . .

    Now, you're right to frame the debate on cost and health inflation. And in September, when you spoke to us in the well of the House, you basically said—and I totally agree with this—I will not sign a plan that adds one dime to our deficits either now or in the future.

    Since the Congressional Budget Office can't score your bill, because it doesn't have sufficient detail, but it tracks very similar to the Senate bill, I want to unpack the Senate score a little bit.

    And if you take a look at the CBO analysis—analysis from your chief actuary—I think it's very revealing. This bill does not control costs. This bill does not reduce deficits. Instead, this bill adds a new health-care entitlement at a time when we have no idea how to pay for the entitlements we already have.

    Now let me go through why I say that. The majority leader said the bill scores as reducing the deficit $131 billion over the next 10 years. First, a little bit about CBO. I work with them every single day—very good people, great professionals. They do their jobs well. But their job is to score what is placed in front of them. And what has been placed in front of them is a bill that is full of gimmicks and smoke-and-mirrors.

    Now, what do I mean when I say that? Well, first off, the bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.

    Now, what's the true 10-year cost of this bill in 10 years? That's $2.3 trillion.

    [The Senate bill] does [a] couple of other things. It takes $52 billion in higher Social Security tax revenues and counts them as offsets. But that's really reserved for Social Security. So either we're double-counting them or we don't intend on paying those Social Security benefits.

    It takes $72 billion and claims money from the CLASS Act. That's the long-term care insurance program. It takes the money from premiums that are designed for that benefit and instead counts them as offsets.

    The Senate Budget Committee chairman [Kent Conrad] said that this is a Ponzi scheme that would make Bernie Madoff proud.

    Now, when you take a look at the Medicare cuts, what this bill essentially does [is treat] Medicare like a piggy bank. It raids a half a trillion dollars out of Medicare, not to shore up Medicare solvency, but to spend on this new government program.

    . . . [A]ccording to the chief actuary of Medicare . . . as much as 20 percent of Medicare's providers will either go out of business or will have to stop seeing Medicare beneficiaries. Millions of seniors . . . who have chosen Medicare Advantage will lose the coverage that they now enjoy.

    You can't say that you're using this money to either extend Medicare solvency and also offset the cost of this new program. That's double counting.

    And so when you take a look at all of this; when you strip out the double-counting and what I would call these gimmicks, the full 10-year cost of the bill has a $460 billion deficit. The second 10-year cost of this bill has a $1.4 trillion deficit.

    . . . [P]robably the most cynical gimmick in this bill is something that we all probably agree on. We don't think we should cut doctors [annual federal reimbursements] 21 percent next year. We've stopped those cuts from occurring every year for the last seven years.

    We all call this, here in Washington, the doc fix. Well, the doc fix, according to your numbers, costs $371 billion. It was in the first iteration of all of these bills, but because it was a big price tag and it made the score look bad, made it look like a deficit . . . that provision was taken out, and it's been going on in stand-alone legislation. But ignoring these costs does not remove them from the backs of taxpayers. Hiding spending does not reduce spending. And so when you take a look at all of this, it just doesn't add up.

    . . . I'll finish with the cost curve. Are we bending the cost curve down or are we bending the cost curve up?

    Well, if you look at your own chief actuary at Medicare, we're bending it up. He's claiming that we're going up $222 billion, adding more to the unsustainable fiscal situation we have.

    And so, when you take a look at this, it's really deeper than the deficits or the budget gimmicks or the actuarial analysis. There really is a difference between us.

    . . . [W]e've been talking about how much we agree on different issues, but there really is a difference between us. And it's basically this. We don't think the government should be in control of all of this. We want people to be in control. And that, at the end of the day, is the big difference.

    Now, we've offered lots of ideas all last year, all this year. Because we agree the status quo is unsustainable. It's got to get fixed. It's bankrupting families. It's bankrupting our government. It's hurting families with pre-existing conditions. We all want to fix this.

    But we don't think that this is the . . . the solution. And all of the analysis we get proves that point.

    Now, I'll just simply say this. . . . [W]e are all representatives of the American people. We all do town hall meetings. We all talk to our constituents. And I've got to tell you, the American people are engaged. And if you think they want a government takeover of health care, I would respectfully submit you're not listening to them.

    So what we simply want to do is start over, work on a clean-sheeted paper, move through these issues, step by step, and fix them, and bring down health-care costs and not raise them. And that's basically the point.

    Slaughter House Rules-How Democrats may 'deem' ObamaCare into law, without voting.
    Mar 16, 2010

    Back to Top

    We're not sure American schools teach civics any more, but once upon a time they taught that under the U.S. Constitution a bill had to pass both the House and Senate to become law. Until this week, that is, when Speaker Nancy Pelosi is moving to merely "deem" that the House has passed the Senate health-care bill and then send it to President Obama to sign anyway.

    Under the "reconciliation" process that began yesterday afternoon, the House is supposed to approve the Senate's Christmas Eve bill and then use "sidecar" amendments to fix the things it doesn't like. Those amendments would then go to the Senate under rules that would let Democrats pass them while avoiding the ordinary 60-vote threshold for passing major legislation. This alone is an abuse of traditional Senate process.

    But Mrs. Pelosi & Co. fear they lack the votes in the House to pass an identical Senate bill, even with the promise of these reconciliation fixes. House Members hate the thought of going on record voting for the Cornhusker kickback and other special-interest bribes that were added to get this mess through the Senate, as well as the new tax on high-cost insurance plans that Big Labor hates.

    So at the Speaker's command, New York Democrat Louise Slaughter, who chairs the House Rules Committee, may insert what's known as a "self-executing rule," also known as a "hereby rule." Under this amazing procedural ruse, the House would then vote only once on the reconciliation corrections, but not on the underlying Senate bill. If those reconciliation corrections pass, the self-executing rule would say that the Senate bill is presumptively approved by the House—even without a formal up-or-down vote on the actual words of the Senate bill.

    Democrats would thus send the Senate bill to President Obama for his signature even as they claimed to oppose the same Senate bill. They would be declaring themselves to be for and against the Senate bill in the same vote. Even John Kerry never went that far with his Iraq war machinations. As we went to press, the precise mechanics that Democrats will use remained unclear, though yesterday Mrs. Pelosi endorsed this "deem and pass" strategy in a meeting with left-wing bloggers.

    This two-votes-in-one gambit is a brazen affront to the plain language of the Constitution, which is intended to require democratic accountability. Article 1, Section 7 of the Constitution says that in order for a "Bill" to "become a Law," it "shall have passed the House of Representatives and the Senate." This is why the House and Senate typically have a conference committee to work out differences in what each body passes. While sometimes one house cedes entirely to another, the expectation is that its Members must re-vote on the exact language of the other body's bill.

    As Stanford law professor Michael McConnell pointed out in these pages yesterday, "The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form." If Congress can now decide that the House can vote for one bill and the Senate can vote for another, and the final result can be some arbitrary hybrid, then we have abandoned one of Madison's core checks and balances.

    Yes, self-executing rules have been used in the past, but as the Congressional Research Service put it in a 2006 paper, "Originally, this type of rule was used to expedite House action in disposing of Senate amendments to House-passed bills." They've also been used for amendments such as to a 1998 bill that "would have permitted the CIA to offer employees an early-out retirement program"—but never before to elide a vote on the entire fundamental legislation.

    We have entered a political wonderland, where the rules are whatever Democrats say they are. Mrs. Pelosi and the White House are resorting to these abuses because their bill is so unpopular that a majority even of their own party doesn't want to vote for it. Fence-sitting Members are being threatened with primary challengers, a withdrawal of union support and of course ostracism. Michigan's Bart Stupak is being pounded nightly by MSNBC for the high crime of refusing to vote for a bill that he believes will subsidize insurance for abortions.

    Democrats are, literally, consuming their own majority for the sake of imposing new taxes, regulations and entitlements that the public has roundly rejected but that they believe will be the crowning achievement of the welfare state. They are also leaving behind a procedural bloody trail that will fuel public fury and make such a vast change of law seem illegitimate to millions of Americans.

    The concoction has become so toxic that even Mrs. Pelosi isn't bothering to defend the merits anymore, saying instead last week that "we have to pass the bill so that you can find out what is in it." Or rather, "deeming" to have passed it.

    ObamaCare Passes House by 219-212, Smaller Margin than in November-A landmark of liberal governance whose price will be very steep.
    Mar 21, 2010

    Back to Top

    House Democrats last night passed President Obama's federal takeover of the U.S. health-care system, and the ticker tape media parade is already underway. So this hour of liberal political victory is a good time to adapt the "Pottery Barn" rule that Colin Powell once invoked on Iraq: You break it, you own it.

    This week's votes don't end our health-care debates. By making medical care a subsidiary of Washington, they guarantee such debates will never end. And by ramming the vote through Congress on a narrow partisan majority, and against so much popular opposition, Democrats have taken responsibility for what comes next—to insurance premiums, government spending, doctor shortages and the quality of care. They are now the rulers of American medicine.

    Mr. Obama and the Democrats have sold this takeover by promising that multiple benefits will follow: huge new subsidies for the middle class; lower insurance premiums for consumers, especially those in the individual market; vast reductions in the federal budget deficit and in overall health-care spending; a more competitive U.S. economy as business health-care costs decline; no reductions in Medicare benefits; and above all, in Mr. Obama's words, that "if you like your health-care plan, you keep your health-care plan."

    We think all of this except the subsidies will turn out to be illusory, as most of the American public seems intuitively to understand. As recently as Friday, Caterpillar Inc. announced that ObamaCare will increase its health-care costs by $100 million in the first year alone, due to a stray provision about the tax treatment of retiree benefits. This will not be the only such unhappy surprise.

    While the subsidies don't start until 2014, many of the new taxes and insurance mandates will take effect within six months. The first result will be turmoil in the insurance industry, as small insurers in particular find it impossible to make money under the new rules. A wave of consolidation is likely, and so are higher premiums as insurers absorb the cost of new benefits and the mandate to take all comers.

    Liberals will try to blame insurers once again, but the public shouldn't be fooled. WellPoint, Aetna and the rest are from now on going to be public utilities, essentially creatures of Congress and the Health and Human Services Department. When prices rise and quality and choice suffer, the fault will lie with ObamaCare.

    While liberal Democrats are fulfilling their dream of a cradle-to-grave entitlement, their swing-district colleagues will pay the electoral price. Those on the fence fell in line out of party loyalty or in response to some bribe, and to show the party could govern. But even then Speaker Nancy Pelosi could only get 85% of her caucus and had to make promises that are sure to prove ephemeral.

    Most prominently, she won over Michigan's Bart Stupak and other anti-abortion Democrats with an executive order from Mr. Obama that will supposedly prevent public funds from subsidizing abortions. The wording of the order seems to do nothing more than the language of the Senate bill that Mr. Stupak had previously said he couldn't support, and of course such an order can be revoked whenever it is politically convenient to do so.

    We have never understood why pro-lifers consider abortion funding more morally significant than the rationing of care for cancer patients or at the end of life that will inevitably result from this bill. But in any case Democratic pro-lifers sold themselves for a song, as they usually do.

    Then there are the self-styled "deficit hawks" like Jim Cooper of Tennessee. These alleged scourges of government debt faced the most important fiscal vote of their careers and chose to endorse a new multitrillion-dollar entitlement. They did so knowing that the White House has already promised to restore some $250 billion in reimbursement cuts for doctors that were included in yesterday's bill to make the deficit numbers look good. Watch for these Democrats to pivot immediately and again demand "tough choices" on spending—and especially tax increases—but this vote has squandered whatever credibility they had left.

    Mrs. Pelosi did at least abandon, albeit under pressure, the "deem and pass" strategy that would have passed the legislation without a vote on the actual Senate language. We and many others criticized that ruse early last week, and the House decision to drop it exposes the likes of Norman Ornstein of the American Enterprise Institute and other analysts who are always willing to defend the indefensible when Democrats are doing it.

    All of this means the Senate's Christmas Eve bill is ready for Mr. Obama's signature, though only because rank-and-file House Members also passed a bill of amendments that will now go back to the Senate under "reconciliation" rules that require only 50 votes. Those amendments almost certainly contravene the plain rules of reconciliation, and the goal for Senate Republicans should be to defeat this second "fix-it" bill. It's notable that Democrats didn't show yesterday for a meeting with the Senate parliamentarian to consider GOP challenges, no doubt because they fear some of them might be upheld.

    Though it's hard to believe, the original Senate bill is marginally less harmful than the "fixed" version, not least because the middle-class insurance subsidies are less costly and it would avert the giant new payroll tax. That's the White House increase in the Medicare portion of the payroll tax to 3.8% that Democrats cooked up at the last minute and would apply to the investment income of taxpayers making more than $200,000.

    If the reconciliation bill goes down, Big Labor and its Democratic clients would be forced to swallow a larger excise tax on high-cost insurance plans, and it would also forestall the private student-loan takeover that Democrats included as a sweetener. In other words, they'd be forced to eat the sausage they themselves made as they have abused Congressional procedure to push ObamaCare into law.

    We also can't mark this day without noting that it couldn't have happened without the complicity of America's biggest health-care lobbies, including Big Pharma, the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the Business Roundtable and such individual companies as Wal-Mart. They hope to get more customers, or to reduce their own costs, but in the end they have merely made themselves more vulnerable to the gilded clutches of the political class.

    While the passage of ObamaCare marks a liberal triumph, its impact will play out over many years. We fought this bill so vigorously because we have studied government health care in other countries, and the results include much higher taxes, slower economic growth and worse medical care. As for the politics, the first verdict arrives in November.

    ObamaCare and the Constitution - If Congress can force you to buy insurance, Article I limits on federal power are a dead letter.
    Apr 2, 2010

    Back to Top

    The constitutional challenges to ObamaCare have come quickly, and the media are portraying them mostly as hopeless gestures-the political equivalent of Civil War re-enactors. Discussion over: You lost, deal with it.

    The press corps never dismissed the legal challenges to the war on terror so easily, but then liberals have long treated property rights and any limits on federal power to regulate commerce as 18th-century anachronisms. In fact, the legal challenges to ObamaCare are serious and carry enormous implications for the future of American liberty.

    The most important legal challenge turns on the "individual mandate"-the new requirement that almost every U.S. citizen must buy government-approved health insurance. Failure to comply will be punished by an annual tax penalty that by 2016 will rise to $750 or 2% of income, whichever is higher. President Obama opposed this kind of coercion as a candidate but has become a convert. He even argued in a September interview that "I absolutely reject that notion" that this tax is a tax, because it is supposedly for your own good.

    Florida Attorney General Bill McCollum and 13 other state AGs-including Louisiana Democrat Buddy Caldwell-claim this is an unprecedented exercise of state power. Never before has Congress required people to buy a private product to qualify as a law-abiding citizen.

    As the Congressional Budget Office noted in 1994, "Federal mandates typically apply to people as parties to economic transactions, rather than as members of society." The only law in the same league is conscription, though in that case the Constitution gives Congress the explicit power to raise a standing army.

    Democrats claim the mandate is justified under the Commerce Clause, because health care and health insurance are a form of interstate commerce. They also claim the mandate is constitutional because it is structured as a tax, which is legal under the 16th Amendment. And it is true that the Supreme Court has ruled as recently as 2005, in the homegrown marijuana case Gonzales v. Raich, that Congress can regulate essentially economic activities that "taken in the aggregate, substantially affect interstate commerce."

    But even in Raich the High Court did not say that the Commerce Clause can justify any federal regulation, and in other modern cases the Court has rebuked Congress for overreaching. In U.S. v. Lopez(1995), the High Court ruled that carrying a gun near a school zone was not economically significant enough to qualify as interstate commerce, while in Morrison (2000) it overturned a law about violence against women on the same grounds.

    All human activity arguably has some economic footprint. So if Congress can force Americans to buy a product, the question is what remains of the government of limited and enumerated powers, as provided in Article I. The only remaining restraint on federal power would be the Bill of Rights, though the Founders considered those 10 amendments to be an affirmation of the rights inherent in the rest of the Constitution, not the only restraint on government. If the insurance mandate stands, then why can't Congress insist that Americans buy GM cars, or that obese Americans eat their vegetables or pay a fat tax penalty?

    The mandate did not pose the same constitutional problems when Mitt Romney succeeded in passing one in Massachusetts, because state governments have police powers and often wider plenary authority under their constitutions than does the federal government. Florida's constitution also has a privacy clause that underscores the strong state interest in opposing Congress's health-care intrusion.

    As for the assertion that the mandate is really a tax, this is an attempt at legal finesse. The mandate is the legal requirement to buy a certain product, while the tax is the means of enforcement. This is not a true income or even excise tax. Congress cannot, merely by invoking a tax, blow up the Framers' attempt to restrain government under Article I.

    The states also have a strong case with their claim that ObamaCare upsets the Constitution's federalist framework by converting the states into arms of the federal government. The bill requires states to spend billions of dollars to rearrange their health-care markets and vastly expands who can enroll in Medicaid, whether or not states can afford it.

    Florida already spends a little over a quarter of its budget on Medicaid, and under ObamaCare that will expand by at least 50% as some 1.3 million new people enroll. Those benefits, and the burden of setting up the new exchanges, will cost Florida $149 million in 2014 and $1.05 billion annually by 2018. The state will either have to cut other priorities or raise taxes. In legal essence, ObamaCare infringes on state sovereignty and unconstitutionally conscripts state officials.

    Less potent, at least to our reading, is the challenge on behalf of state laws that bar or exempt their citizens from the mandate. Virginia passed such a law earlier this year, and Attorney General Ken Cuccinelli is suing on those grounds. But while such efforts serve as healthy political protest, federal laws that are constitutional are supreme under the 10th Amendment, and states can't "nullify" a Congressional action.

    Judicial and media liberals are trying to dismiss these challenges as a revanchist attempt to repeal the New Deal, or, worse, as a way to restore the states's rights of Jim Crow. Modern liberals genuinely believe the federal government can order the states and individuals to do anything as long as it is in pursuit of their larger social agenda. They also want to deter more state Attorneys General from joining these lawsuits.

    The AGs should not be deterred, because the truth is that ObamaCare breaks new constitutional ground. Neither the House nor Senate Judiciary Committees held hearings on the law's constitutionality, and we are not aware of any Justice Department opinion on the matter. Judges have an obligation not to be so cavalier in dismissing claims on behalf of political liberty. Under the Constitution, American courts don't give advisory opinions. They rule on specific cases, and the states have a good one to make.

    Democrats may have been able to trample the rules of the Senate to pass their unpopular bill on a narrow partisan vote, but they shouldn't be able to trample the Constitution as well

    Obamacare: Why the AMA Wants to Muzzle Your Doctor
    It is always ethical to tell patients the truth, which is what doctors are doing by educating them about ObamaCare.

    MAY 7, 2010

    Back to Top


    The American Medical Association (AMA) is putting the doctors of America on notice. A major cheerleader for ObamaCare, the organization is now trying to silence doctors who oppose it. It is time the American people understood what the AMA is really all about.

    Last month, not long after a Florida urologist placed a sign in his door making it clear that patients who voted for President Obama were not welcome in his practice, the AMA issued the following statement: "[P]hysicians might reflect on how to properly balance their obligations as members of the medical profession with their rights as individual citizens who will be affected by reform. In particular, physicians may wonder whether it is appropriate to express political views to patients or their families." The statement goes on to say that while the AMA "supports the right of physicians to free political speech and encourages them to exercise the full scope of their political rights . . . physicians should conduct political communications with sensitivity to patients' vulnerability and desire for privacy."

    Many doctors interpreted this as an attempt—albeit with verbal parachutes attached—to keep them from sharing their opinions about health-care reform with their patients. This position is troubling on many levels.

    The AMA was not only a major supporter of ObamaCare but also an accomplice in its passage. Without the support of the AMA it is quite possible that the health-care reform initiative would have failed. So why the effort to silence other doctors? The AMA is not only worried about protecting this misguided legislation, it is worried about protecting itself.

    In the weeks since passage of this 2,700 page bill, more and more of its policy land-mines have exploded, including rising insurance premiums and admissions of inevitable rationing. Not surprisingly, an increasing number of physicians have expressed alarm over the impact that the legislation will have on their patients. This growing opposition makes the actions of the AMA, which represents only 17% of the doctors in the U.S., look very bad.

    It is essential to understand the primary reason the AMA stands alongside President Obama on health-care reform. The organization wants to protect a monopoly that the federal government has created for it—a medical coding system administered by the AMA that every health-care professional and hospital must use if they wish to get paid for the services they provide. This monopoly generates income of $70 million to $100 million annually for the AMA. That makes the AMA less an association looking out for doctors and more a special-interest group beholden to Congress and the White House.

    This isn't the first time the AMA has acted in its own selfish interests and not the interests of the medical profession. The last time it had a chance to take a public stand against government intrusion into health care was the HillaryCare fight. The AMA disappeared during this debate, leaving others to fight for doctors and patients.

    Yet doctors who oppose ObamaCare have not relented. Passage of this bill has stirred in them long dormant political emotions. Doctors across the country are educating their patients about how ObamaCare will limit their freedom to make their own health-care decisions. There are 925,000 doctors in America and the average doctor has at least 2,000 patients, with many of us already asking our patients if we can take two minutes to discuss this bill with them. This terrifies Congress and the White House.

    Did someone in Washington give the AMA the order to muzzle outspoken doctors? Could it be Democratic Congressman Henry Waxman, the Malibu coastline representative who calls businesses to appear before his Energy and Commerce Subcommittee if in abiding by securities laws they reveal the hidden costs of ObamaCare? Perhaps it was House Speaker Nancy Pelosi, who has staked her speakership on this bill?

    The irony is that in supporting ObamaCare and trying to silence doctors the AMA has forgotten its own mission statement and ethical code: "[T]o help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues." It is always medically ethical to tell patients the truth, which is what doctors are now doing by educating them about ObamaCare.

    My own group, Docs4PatientCare, which to date represents more than 3,000 doctors, intends to continue providing materials and information to doctors who wish to educate and inform their patients about ObamaCare. We will also continue to challenge ObamaCare advocates whenever they show America the ugly face of intolerance and attempt to silence dissent.

    Inasmuch as the AMA is allowed to operate a monopoly under the watchful eye of the federal government, I would expect the GOP Doctors Caucus in the House of Representatives to demand an investigation and request that the AMA fully disclose whether it was pressured by Congressional leadership, the White House or the Department of Health and Human Services to engage in intimidation tactics.

    Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.

    You're losing your plan -- ObamaCare's true face emerges
    June 14, 2010

    Back to Top


    Late last week saw the first leaks of the administration's draft regulations for imple menting the ObamaCare law -- and everything is playing out just as the critics warned.

    The 3,000-odd pages of legislation left most of the really important (and controversial) policy decisions to the regulations that government agencies were told to issue once the bill passed. Now that those regs are starting to take shape, it's clear that the Obama team is using its new power to exert tight control over the payment and delivery of all formerly "private" health insurance.

    The ObamaCare law references the Secretary of Health and Human Services almost 2,200 times and uses the phrase "the secretary shall" more than 725. Each reference requires HHS to set new rules on medical care, giving control to an existing federal office or one of 160 new agencies that the bill created.

    HHS Secretary Kathleen Sebelius (who was once the Kansas state-insurance commissioner) has taken to these tasks with zeal. In some circles, she's now known as the nation's "insurance regulator in chief."

    She's starting off by applying new regs to health plans offered by large employers -- even though these costly rules were supposedly only going to apply to plans sold in the state insurance "exchanges" that don't get created until 2014. This twist is spelled out in an 83-page draft of a new regulation that leaked late last week.

    Bottom line: Sebelius means to dictate what your insurance plan must look like almost from day one, no matter how you get your coverage.

    Indeed, the draft regs envision more than half of all policies having to change within three years -- an unmistakable break with President's Obama's oft-repeated promise, "If people like their insurance, they will be able to keep it."

    Yet that may be the least of the broken promises.

    Ultimately, these rules force consumers to buy one of just four health policies -- which vary mostly only by trading off higher co-payments for lower premiums, while offering essentially the same actual benefits. In arguing for passage of the law, ObamaCare's defenders claimed the rules were aimed at health plans sold in the "exchanges." Oops: Now Sebelius is applying them to employer plans. Eventually, this would force all but the very wealthiest Americans into a single government-designed insurance scheme.

    This is far from the only area where Secretary Sebelius is exploiting the law's fuzzy language to tighten her control over the private insurance market. In recent weeks, she has said that the new law gives her authority to review and even set the rates on health policies sold in private markets, a role previously left to state insurance regulators.

    The ObamaCare bills were written to paper over an intellectual divide between White House economists and HHS policy wonks. Some economists wanted genuine competition to take root in the new federally managed insurance "exchanges." The HHS crew favored a one-sized government plan with tight federal regulation over benefits.

    The law itself didn't explicitly side with either school -- but it did leave the writing of the implementing regs to those same HHS wonks. Unfortunately, those more moderate White House economists are now leaving the administration, including the rumored departure of widely admired businessman and health-care expert Robert Kocher.

    Washington insiders refer to this HHS team as "true believers" -- a group of earnest, left-leaning activists who've long favored a single nationalized health plan. They are massaging the law's vagueness to give themselves the tight federal control over health care that will bring their vision into practice.

    Critics warned that the Obama bill meant a federal takeover of health care, with Washington bureaucrats making core decisions about medical care. With ObamaCare taking shape, that's exactly what consumers are getting. Saying "we told you so" is no consolation to those who took the president at his word.

    Scott Gottlieb, a physician and American Enterprise Institute fellow, was a senior official at the Centers for Medicare and Medicaid Services. He is partner in a firm that invests in health-care companies.

    Who Pays for ObamaCare?-What Donald Berwick and Joe the Plumber both understand.
    JULY 12, 2010

    Back to Top

    Among Donald Berwick's greatest rhetorical hits is this one: "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 less fortunate." Count that as one more reason that President Obama made Dr. Berwick a recess appointee to run Medicare and Medicaid rather than have this philosophy debated in the Senate.

    We are also learning that "spreading the wealth," as Mr. Obama famously told Joe the Plumber in 2008, is the silent intellectual and political foundation of ObamaCare. We say silent because Democrats never admitted this while the bill was moving through Congress.

    But only days after the bill passed, Senate Finance Chairman Max Baucus exulted that it would result in "a leveling" of the "maldistribution of income in America," adding that "The wealthy are getting way, way too wealthy, and the middle-income class is left behind." David Leonhardt of the New York Times, who channels White House budget director Peter Orszag, also cheered after the bill passed that ObamaCare is "the federal government's biggest attack on economic inequality" in generations.

    An April analysis by Patrick Fleenor and Gerald Prante of the Tax Foundation reveals how right they are. ObamaCare's new "health-care funding plan" will shift some $104 billion in 2016 to Americans in the bottom half of the income distribution from those in the top half. The wealth transfer will be even larger in future years. While every income group sees a direct or indirect tax increase, everyone below the 50th income percentile comes out a net beneficiary.

    At least at the start, Americans in the 50th through 80th income percentiles—or those earning between $99,000 to $158,000—are nearly beneficiaries too, if not for the taxes on insurers, drug makers and other businesses that will be passed on to everyone as higher health costs. This group will eventually get soaked even more—probably through a value-added tax—once ObamaCare's costs explode. But at the beginning the biggest losers are the upper middle class, especially the top 10% of income earners, mainly because a 3.8% Medicare "payroll" tax surcharge will now apply to investment income. ObamaCare, in short, is almost certainly the largest wealth transfer in American history.

    Distributional analyses like the Tax Foundation's are usually staples in any Beltway policy debate, especially when Republicans want to cut taxes. Yet aside from this or that provision, none of the outfits that usually report for this duty—the Tax Policy Center of the Brookings Institution and Urban Institute, the Center for Budget and Policy Priorities—have attempted to estimate the full incidence of ObamaCare's taxes and subsidies.

    In part this may be because ObamaCare is such a complex rewrite of health, tax, welfare and labor laws. But it's also embarrassing to liberals that much of ObamaCare's redistribution will merely move income to the lower middle class from the upper middle class, and the President habitually promises that people earning under $200,000 will be exempt from his tax increases. We now know they won't be.

    With his vast new powers over what government spends, Dr. Berwick will be well situated to equalize outcomes even more, and he certainly seems inclined to do so. The most charitable reading of his redistribution remarks, delivered in a 2008 London speech, is that any health insurance system will involve some degree of redistribution to the "less fortunate," that is, to the sick from the healthy.

    Yet Dr. Berwick made those comments in the context of a larger, and bitter, indictment of the U.S. health system, even though the huge public programs he will run already account for about half of all national health spending. From his point of view this isn't enough. And his main stance was that individual clinical choices must be subordinated to government central planning to serve his view of social justice and health care guaranteed by the state.

    The great irony is that this sort of enforced egalitarianism imposes higher taxes and other policies that reduce the total stock of wealth and leave less for Dr. Berwick to redistribute. Economic growth has been by far the most important factor in improving health and longevity, especially for those whom Dr. Berwick calls "the poorer and less fortunate."

    Americans have learned the hard way over the past two years that this Administration believes in wealth redistribution first, economic growth second. Or as Dr. Berwick also put it in his wealth-redistribution speech, it is crucial not to have to rely on "the darkness of private enterprise."

    How ObamaCare Guts Medicare -- The president's pledge that 'If you like your health plan, you will be able to keep it' clearly does not apply to America's seniors.
    SEPTEMBER 9, 2010

    Back to Top


    The Democratic Senatorial Campaign Committee has attacked Senate Republican candidates for wanting "to end Medicare as we know it." And in Nevada's hotly contested Senate race, Majority Leader Harry Reid is attacking Republican Sharron Angle, saying she wants to "gut" Medicare. But Mr. Reid has already gutted it. He and his colleagues did so by passing ObamaCare.

    Senior Editorial Writer Joseph Rago explains the increase in insurance premiums. Columnist Mary Anastasia O'Grady critiques the President's plan.

    In his analysis accompanying the recently released Annual Report of the Medicare Board of Trustees, Richard Foster, Medicare's chief actuary, noted that Medicare payment rates for doctors and hospitals serving seniors will be cut by 30% over the next three years. Under the policies of the Patient Protection and Affordable Care Act, by 2019 Medicare payment rates will be lower than under Medicaid. Mr. Foster notes that by the end of the 75-year projection period in the Annual Medicare Trustees Report, Medicare payment rates will be one-third of what will be paid by private insurance, and only half of what is paid by Medicaid.

    Altogether, ObamaCare cuts $818 billion from Medicare Part A (hospital insurance) from 2014-2023, the first 10 years of its full implementation, and $3.2 trillion over the first 20 years, 2014-2033. Adding in ObamaCare cuts for Medicare Part B (physicians fees and other services) brings the total cut to $1.05 trillion over the first 10 years and $4.95 trillion over the first 20 years.

    These draconian cuts in Medicare payments to doctors, hospitals and other health-care providers that serve America's seniors were the basis for the Congressional Budget Office's official "score"—repeatedly cited by the president—that the health-reform legislation would actually reduce the federal deficit. But Mr. Obama never disclosed how that deficit reduction would actually be achieved.

    There will be additional cuts under ObamaCare to Medicare Advantage, the private option to Medicare that close to one-fourth of all seniors have chosen for their coverage under the program because it gives them a better deal. Mr. Foster estimates that 50% of all seniors with Medicare Advantage will lose their plan because of these cuts. Mr. Obama's pledge that "If you like your health plan, you will be able to keep it" clearly does not apply to America's seniors.

    Moreover, there will be additional cuts to Medicare adopted by bureaucrats at the Medicare Independent Payment Advisory Board. ObamaCare empowers this board to close Medicare financing gaps by adopting further Medicare cuts that would become effective without any congressional action. Mr. Foster reports that "The Secretary of HHS is required to implement the Board's recommendations unless the statutory process is overridden by new legislation."

    The drastic reductions in Medicare reimbursements under ObamaCare will create havoc and chaos in health care for seniors. Many doctors, surgeons and specialists providing critical care to the elderly—such as surgery for hip and knee replacements, sophisticated diagnostics through MRIs and CT scans, and even treatment for cancer and heart disease—will cease serving Medicare patients. If the government is not going to pay, then seniors are not going to get the health services, treatment and care they expect.

    Mr. Foster reports that two-thirds of hospitals already lose money on Medicare patients. Under ObamaCare it will get much worse. Hospitals also will shut down or stop serving Medicare patients.

    The president's concept of spreading the wealth includes sacking the Medicare system, on which America's seniors have come to rely for medical care, in favor of others the president's progressive vision deems more worthy.

    Everyone should know by now that Medicare suffers dramatic long-term deficits and unfunded liabilities, and is in need of fundamental, structural reforms. But effectively refusing to pay the doctors and hospitals that provide the medical care the program promises to seniors is no way to solve that problem.

    Mr. Ferrara is director of entitlement and budget policy at the Institute for Policy Innovation and author of "The ObamaCare Disaster," forthcoming from the Heartland Institute. Mr. Hunter is president of the Social Security Institute.
    Reading List