Health Care Reform » Gress... Has Issues

ObamaCare Repeal Possibilities

Government, Health Care, Health Care Reform, History, Legislation, Taxation

Mar 312010

FDR,ObamaCare & States' Rights

The Judge (yes, he’s a real judge) gives us a heads-up, straight from the Constitution – a short video that’s a good start for a quick exploration of this ObamaCare repeal issue. FYI, the Interstate Commerce Clause and General Welfare provisions are not valid bases for imposing this legislation on the states and individuals. To find out why, we do some historical, political and legal analysis. So, either strap yourself in or risk emotional and intellectual whiplash.

First up is our link to a powerful look at how we’ve been here before, how it turned out, and the guidance offered for ourselves and the current administration. J.R. Dunn at The American Thinker had a well-commented-upon post up yesterday called The Supreme Court and FDR’s Power Grab. Now, I know a lot of you are going “Here we go again, the old Conservative animus against FDR.” Not so…at least not predominantly. This is thoughtful, relevant history that can be easily checked out. I urge you to take a look – it’s a fun and informative read.

Next, a short, healthy dose of Public Policy research by The Foundry, a policy blog from the conservative Heritage Foundation. They dig a little deeper than Judge Napolitano, especially regarding constitutional limitations on federal power.

None of these clauses—or any others found in the Constitution—gives Congress the power to create a government healthcare system.

The “General Welfare” clause gives Congress the power “To lay and collect taxes, duties, imposts, and excises, to pay the debts and provide for the common defense and general welfare of the United States.” This clause is not a grant of power to Congress (as constitutional law professor Gary Lawson has shown). It is a limit to a power given to Congress. It limits the purpose for which Congress can lay and collect taxes.

Finally, a contemporary take by political analyst Dick Morris on the steps necessary to repeal and how he weighs its chances of success. In a blog post for Andrew Breitbart’s Big Government, he has a post titled Take Back Congress to Stop ObamaCare. As you would expect, his is not the conventional, angry take on how to fight the constitutionality of this bill.

The Obama health care bill was an authorization measure which established a program and set down its parameters. But authorization bills are not appropriations. Each year the Congress must act on appropriations for each department and agency in the government. If no funds are appropriated, nothing can be spent.

Just in case you are out of time, patience or interest and decide to not go read this very short piece by Morris, I have to confess I really got a kick out of his Uncle Sam poster. So, through the magic of blog technology, here it is:

Morris is Serious About This

That’s pretty much of a wrap. We’ll be talking about this for the next four to six years, by which time the Democrats expect we will be totally (as in totalitarian) embracing ObamaCare in all its particulars, and the notion of repeal will be a small footnote in the history books. Or not

Health Mandates, or Incentives – Which is Smarter?

Government, Health Care Reform

Mar 242010

Government Ideologues Ignore Constitution, Avoid Real Problem-Solving

Think Harder

So it’s come to this – again. Mankind’s Overwhelming Question: Do we allow the government, or does the government – acting for our benefit, of course – allow us? If government has provided the physical infrastructure and the organizational enablers for our training and success, has it not earned the right to dictate our behavior on any matter that may have social consequence? If we are assured of being protected from enemies foreign and domestic, from extreme deprivation or disability, surely it would be selfish and ungrateful to not be obedient, when asked, to our benefactors.

And when it comes to setting our personal priorities, doesn’t service to the society that nurtures us and with whom we are totally interdependent have first call? Family and friends, neighbors and colleagues, after all, are also interconnected in the vast network we call society and upon which we all depend. And doesn’t it follow that the leaders we elect are merely acting out the mandate of history to make the best decisions possible on our behalf. Doesn’t the progress of civilization itself rely on their wisdom and valor?

And isn’t it essential to peace, harmony and cooperation that so-called individuals don’t arrogantly and selfishly assert themselves in a manner that is disruptive to the social milieu? What place is there in a truly harmonious society for narcissistic, competitive and combative egoists? And if that person cannot restrain himself from saying hurtful things and taking disruptive actions, shouldn’t a socially-just administration undertake his retraining into a more harmonious component of the whole?

NOT!!!

I was watching the early-morning Anchors on CNBC’s ”Squawkbox” (Carl Quintanilla, Joe Kernan and Becky Quick) discussing the aftermath of the Congressional passing of the two health care bills – and the discussion hit an odd cul-de-sac. They couldn’t determine the legitimate extent of government compulsion necessary when a common, necessarily shared, good was involved. This was probably touched off by the bills’ individual mandate, requiring citizens to buy insurance. Was it the same as states requiring auto insurance? Motorcycle helmets? Is it fair for someone to be allowed to abuse their own health if the rest of society is going to pay for the consequences? If not, where does government legislative remedy stop? Food? Tattoos? Smoking? Seat Belts?

And if the government recognizes that you are harming the planet with your careless use of energy (and exhaling CO2, and emitting methane), is it justified, for the good of all, to use various forms of coercion to control your social (and planetary) destructiveness?

And if the government can define what constitutes a threat to the society (and planet) it is charged with protecting, where will it end? Because in each of these scenarios, the threat is you! If you protest that a threat is not real and you, therefore, are doing no harm, to whom would you protest?

And that’s why we got rid of King George. Kings are able to make arbitrary rules about what constitutes a just society, and enforce it as they please. George Washington, it is said, was popular enough to become a King, or at least ruler for life. He didn’t want it. He recognized that, not only would the new US government need to continue the best aspects of the British system of the rule of law, but with a new twist: It was now the government’s job to protect the individual – from government! It’s the genius of the founders that has produced the “American Exception,” as well as the free market principles that have freed more people from poverty than any system ever devised.

That said, the first couple of paragraphs, above (just before “NOT!!!”) are nonsense. All of that infrastructure was bought and paid for, many times over, by the hard work and sacrifice of individuals in a society that works from the ground up. Some inventiveness may come from government labs and contractors, but we must remember who paid for the labs and contracts, and who selected the government representatives who made the decisions. Most businesses start very small, often with just one person with an idea. America’s job is to protect that person and to not hinder him in his (or her) individual efforts. The reward is a taxation bonanza and a prosperous, free country.

Health care is complicated and politically difficult. You can either tackle the difficult components of the problem or go for sweeping change. The lazy and unsatisfactory way is the latter. You don’t have to change 16% of the economy in order to mitigate a handful of problems that can be dealt with individually. You don’t have to mandate that every individual not getting employee health insurance buy insurance or be fined. Think a little harder, plan a bit, and you can come up with a plan that will incentivize each individual to want to buy insurance.

That’s the American way, Becky, Carl and Joe. The other is authoritarian and shouldn’t even be a consideration.

Medicare Docs Disappearing

Health Care, Health Care Reform

Mar 212010

RX Harold and Margret Thomas, with Dr. Steven Knope, a concierge doctor in Tucson who charges a yearly retainer

IF I were warning about something that might happen if we strip half a billion dollars out of Medicare and put it into a national health care experiment, some would be justified in labeling me an alarmist; If I were, on the other hand, to point out that doctors have been abandoning the failing Medicare system for years – but that nearly 30% of the remainder threaten to quit or retire if ObamaCare passes – I would be a very accurate alarmist! Alarmists sound alarms. Alarms are to let you know there is something terribly wrong, and you need to act to prevent bad things.

In an article written in April of last year by NYT’s Julie Connelly, it’s made pretty clear that we are way, way short of Primary Care docs willing to take Medicare patients, and bound to lose even more with any addition of 30 million (47 million, if you count our illegal immigrants) new patients to our already overstressed health care system.

Here’s what she says:

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them - often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Connelly (the ‘Alarmist’) not only warns about the missing Docs, but delves into some strategies that might be used to deal with the problem. Among these are a) A private contract with your doctor, b) Bargaining for continuing care from an “Urgent Care Center,” and c) Joining with a group that contracts with certain docs for “Concierge Care.”

Type “urgent care centers” into a search engine and thousands come up. In June, the Academy of Urgent Care Medicine plans to add a list of centers it has accredited to its Web site, www.aaucm.org.

Another, more expensive option is concierge or “boutique” care, which comes in two forms. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals. Before signing up and paying the retainer, patients should get a written agreement spelling out which services the doctor will bill Medicare for and which the retainer covers. And always check carefully for double-billing.

Since most of the cost of the health system we are so eager to fix globally is actually located in our elderly population, coupled with the expensive procedures that often occur in that age group, we need to consider what to do if Docs and hospitals are scarce, drugs hard to get, and waiting times intolerable. The younger folks not directly affected by those concerns (except to pay) can blithely vote for policies that will be disastrous for their elders – and with us for generations.

Photo by Chris Richards

Paul Ryan(R-Wis) Tells Obama True Health Care Costs

Government, Health Care Economics, Health Care Reform, Legislation, Taxation

Mar 212010

President Obama Sits Stunned

Is ObamaCare Worth This Much??

Long after the Great Health Care Reform Debate of 2009 & ’10 has become part of the history that goes untaught in our pathetic public school system, this six minutes of video will inform. Not only the ‘emperor’s clothes’ blast of reality concerning the health care numbers that had been fronted by the Democrats, but a priceless lack of reaction from a normally voluble and argumentative President. If you haven’t watched this on You Tube, already – and you really care about accuracy in this issue – spend a few minutes, and prepare to dazzle your friends!

If this clip is way too Republican and one-sided for you, take a look at our recent Post linking to a lecture by the President’s health care economist, titled “ObamaCare’s Planner Here,” starring MIT prof Jonathan Gruber. Enjoy!

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ObamaCare’s Planner Here

Government, Health Care Economics, Health Care Reform

Mar 202010

It Must be Popular!

Regardless of your political persuasion, here is a health care economist who claims to have been advising the Obama Administration on their HC Reform plans. Few of us have time for this stuff, but his presentation takes only the first half hour – the rest is actually pretty substantive Q & A from a Holy Cross audience sprinkled with physicians.

The plan may pass into law in the next few days and there will be a lot in it, so before it’s too late, get yourself the foundational viewpoint of the Progressive professional class.

Jonathan Gruber is an MIT health care economist. He claims to not know whether the proposed law will actually improve coverage or control costs, but asserts we must halt the trend toward health care as 40% of GDP. (It’s 17% now, but it seems odd to me that, as an economist, he acted like the journalists and politicians in treating the healthcare economy as if it were strictly cost/demand. He mentioned wealthy medical specialists, but skipped the tens of thousands who take home more modest paychecks and stimulate the economy with their spending.

Likewise, he explains that Pharma charges less abroad than here, so we rich American can subsidize TV commercial and (necessary) R & D. His solution is to get rid of the ads, but he doesn’t even consider having Pharma finally raise their drug prices abroad. Again, odd for an economist (but not for an ideologue).

He decries the emphasis over the last year on lowering cost, rather than emphasizing coverage; he then makes the argument that costs will be reduced dramatically over 20 years, primarily through waste & fraud elimination and tax hikes on companies and wealthy individuals. A cutback in hospital admissions and less testing should also help. He doesn’t say who will be available to actually provide the care mandated by his plan. (Something his audience was concerned about.)

Finally, regarding his uncertainty over future effectiveness, he leans heavily on the many “pilot projects” that are at the heart of ObamaCare, each one being an experiment in what might work to head off the destructive trend he claims we’re on. That being so, one has to wonder why the Administration – if it’s truly interested in discovering the most effective way forward – wouldn’t sponsor these experiments in the various states to demonstrate what might be practical to adopt nationally.

To view the interview, click here: Jonathan Gruber on Health Care @ Holy Cross 3/11/10 AP Photo/Susan Walsh

Single-Payer Proxy, or State Compacts?

Government, Health Care, Health Care Economics, Health Care Reform

Feb 272010

Aren't Larger Risk-Pools the Solution?

A Puzzlement for Us, Too

Well, As our old friend the King of Siam (aka Yul Brynner) was wont to say: ”It’s a puzzlement.” Our current President (peace be upon him) has often stated “there will be no government takeover of health care.” And, in his usual coded way, he’s right. Literally, that is. But both he and certain salient members of Congress have stated their strong preference for a single-payer system, government run, everyone covered. This has also been the oft-stated goal of various American Leftists and, in more recent years (post infiltration), of the Democrat(ic) Party. Nothing new there.

The puzzlement is, if they pass the sidecar bill and reconciliation and we wind up with “the National Exchange,” do the single-payer supporters get something they really want, i.e., low premiums and wholistic care? Near as I can tell, the exchange gets them a very good proxy for national health care. That is, instead of the public option that was intended to drive the insurance companies out of business – again, the President (pbuh) has stated he wants them gone – or the co-ops that would have done the same job a little more slowly, we offer for your delectation (Tah-dah!) – the Exchange.

This ‘corpus of deciders’ will approve which insurers can compete, decide which coverage is acceptable, and veto any premium level they find unacceptable. If you’re a single-payer person, this is way cool. OTOH, an insurance company that cannot determine what services it’s offering or what they charge for those services is effectively a government plan-administrator. Voila! Single-payer cleverly disguised as a bunch of lapdog insurance companies (Pay no attention to the person behind the curtain). Not as neat as direct government administration, but the good news (?) is that the feds get to pick the winners and losers.

Now, whether you’re a wise Progressive or a ‘Fascist Pig’ (you know who you are), you want to make sure that you’re not one of the losers. This requires some careful scrutiny, but not careful enough to make you roll your eyes back and think suicidal thoughts. I hope. Low premiums and wholistic care. Well, we all know that adding 30M people to the rolls and extending benefits represents a huge increase in costs.

The wholistic part means that more health care visits will be made, but presumably with less chronic complaints. That’s good… unless. Unless the crowded clinics operated by nurses or lesser-trained people proliferate, and you don’t get to see a real doc until things are very serious. And this transition may cause us to lose a lot of docs who don’t want to be told how to care for their patients under the guise of “best practice.” Just sayin.’ (And this combination could cause very long waits for either appointment).

But of course, none of that can happen at an affordable premium if the insurance companies’ risk pools aren’t large enough to accommodate the extra people and the extra care at a level that is an improvement over the present system. A common misconception about insurance companies and competition is that competition under any circumstance produces better service and lower prices as the companies vie for your business. An insurance company is a product that mitigates your risk by pooling your payments together with others who are at risk in order to have a large enough pool of money to handle the occasional loss experienced by only some of the people in the pool.

Our catch here is that we want to increase the number of insureds, and their level of care, without letting the insurers expand the risk pools enough to handle the increase. This is potentially bad news for anyone who will be buying coverage under the exchange.

There are two economic ways to lower these premiums: mandatory participation, and the reduction of the number of health insurers and expansion over state lines until a handful of very large insurance entities are created. Here it gets interesting (at last!). Insurance companies, as you probably know by now, are only licensed in states and the residents of those states are only permitted to buy insurance from them. These would be state monopolies subject to anti-trust prosecution, except for the federal exemption in place since the ’40′s. Congress just rescinded the exemption.

This seems to mean (I’d appreciate your comments on this – no registration necessary) that if the insurance companies tried to increase their client base by selling nationally, across state lines, as soon as they got large enough to have the size risk pool necessary to lower premiums and increase benefits, the federal government could target them for prosecution as monopolies (because this is not the federal government’s desired solution to health care). And, as an aside, they would also be approaching the realm of “too big to fail.” But if forced to remain small and not combine with one another in order to achieve the desired result (a Progressive plus), they simply could not break out of the current dilemma wherein competition in a small geographic area forces premiums high and care low.

There seem to be serious legal experts who think that federalizing any part of health care is an infringement on states’ rights and not justifiable using the usual interstate commerce clause of the constitution as an excuse. In other words, unconstitutional. Anything enacted without being initiated by the states could be subject to years of litigation and eventual overturning by the Supremes.

I’m clearly no expert, but, as I say – a puzzlement.

Which brings us to your favorite feature and mine:

FREQUENTLY UNASKED QUESTIONS

What legal obstacles need to be overcome in order to achieve an effective result?

Would it be better to leave reform to the states, passing federal legislation that allows them to form compacts that result in large insurance pools?

The insurance companies have offered to drop pre-existing exclusions if participation is mandatory. This increases the pool, but effects those who can’t afford the insurance. Is there a constitutional way for either the federal government or the states to require the purchase of insurance by every citizen?

Is there a way of incentivizing the voluntarily uninsured, especially the young, to insure without a mandate?

Perhaps low premiums that accumulate as refundable savings at specific intervals, if unused?