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Crafty_Dog
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« Reply #700 on: January 07, 2011, 05:03:50 AM »

actually writes a rather coherent and honest piece shocked

Buckle Up for Round 2By DAVID BROOKS
Published: January 6, 2011
 
The health care reform law was signed 10 months ago, and what’s striking now is how vulnerable it looks. Several threats have emerged — some of them scarcely discussed before passage — that together or alone could seriously endanger the new system. These include:

The courts. So far, one judge has struck down the individual mandate, the plan’s centerpiece. Future decisions are likely to break down on partisan lines. Given the makeup of the Supreme Court, this should concern the law’s defenders.

False projections. The new system is based on a series of expert projections on how people will behave. In the first test case, these projections were absurdly off base. According to the Medicare actuary, 375,000 people should have already signed up for the new high-risk pools for the uninsured, but only 8,000 have.

More seriously, cost projections are way off. For example, New Hampshire’s plan has only about 80 members, but the state has already burned through nearly double the $650,000 that the federal government allotted to help run the program. If other projections are off by this much, the results will be disastrous.

Employee dumping. This is the most serious threat. Companies and unions across America are running the numbers and discovering they would be better off if, after 2014, they induced poorer and sicker employees to move to public insurance exchanges, where subsidies are much higher.

The number of people in those exchanges could thus skyrocket, especially as startup companies undermine their competitors with uninsured employees and lower costs. The Congressional Budget Office projects that 19 million people will move to the exchanges at a cost of $450 billion between 2014 and 2019. But according to the economists Douglas Holtz-Eakin and James C. Capretta, costs could soar to $1.4 trillion if those who would be better off in the exchanges actually moved to them. The price of the health care law could double. C. Eugene Steuerle of the Urban Institute, who has been among those raising the alarms about this, calls the law’s structure “unworkable and unfair.”

Health care oligarchy. Since the law passed, there has been a frenzy of mergers and acquisitions, as hospitals, clinics and doctor groups have joined together into bigger and bigger entities. The drafters encourage this, believing large outfits would be more efficient. The downside to this economic concentration is there could be less competition and cost control. In many places, the political power of these quasi-monopolies would be huge, with unforeseeable results. The law bans doctors from starting up hospitals to increase competition.

Public hostility. Right now about 53 percent of Americans oppose the health care law and 43 percent support it, according to an average of the recent polls. Complaints are especially high among doctors. According to a survey by the Physicians Foundation, 60 percent of private practice doctors say the law will force them to close their practices or to restrict them to certain categories of patients.

Given this level of unhappiness, people will blame the Obama law for everything they hate about the health care system. Political opposition was fierce last November, and it could easily shape the 2012 election and lead to changes or repeal.

Over all, there is a strong likelihood that the current health care law will face an existential threat over the next five years. Each party should be preparing contingency plans.

When the crisis comes, Democrats will face an interesting choice — to patch the Obama system or try to replace it with something bigger. The administration may want a patch, but by a ratio of nearly 2 to 1, according to a CNN poll, Democratic voters would prefer a more ambitious law. Liberals could logically say that the mistake was trying to create a hybrid system, rather than moving straight to a single-payer one.

Republicans are going to have to move beyond their current “Repeal!” posture and cohere behind a positive alternative. One approach, which Tyler Cowen of George Mason University has written about, is to allow more state experimentation. Another approach, championed by Capretta, Yuval Levin of National Affairs and Thomas P. Miller of the American Enterprise Institute, revolves around the words “defined contribution.”

Under this approach, Republicans would say that the federal government has a role in subsidizing health insurance — a generous role, but not unlimited. The government would provide needy citizens with a predefined amount of money to spend on insurance and allow them to shop in a transparent, regulated, but not micromanaged marketplace.

After the trauma of the last two years, many people wish the issue would go away. But it’s not going away, especially since costs will continue to rise.

Some Congresses achieve health care; members of this Congress or the next one will have health care thrust upon them.

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ccp
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« Reply #701 on: January 07, 2011, 09:56:42 AM »

It is only common sense to think that adding 45 to 50 million people to the rolls will only drive down health care costs.   huh  I have not read it but the CBO estimate or whatever it is called has to based on multiple assumptions about "preventative" and "quality" care which are really code words for restricted controlled care.  I can even in my armchair gaurantee that these assuptions are based on magical thinking and are not based in any reality.  The CBO estimate is all based on pulling the rug out from the argument that providing health care to 50 million people (at the expense of all the rest of us) will not drive up costs or the deficit.  That is like our government downplaying the Chinese military build up.  I don't know.  Did our leaders always lie like dogs to us?

There is just no end to the tales told in order to redistribute wealth from tax payers to tax benefit receivers.  As long as 50% of the country pays no Federal tax this country is screwed.  There is no end to those on the dole who are quite happy to vote themselves money from the treasury.  Answer:  all people have to pay income tax.  I admit I am not holding my breath though.

****CBO Says Healthcare Law Repeal Will Increase Deficit.
The CBO analysis of the economic effects of repealing the healthcare law garnered much press coverage on Thursday. Many sources characterized the analysis as another bone of contention between Republicans and Democrats that will only intensify the debate over health reform.

        The AP  (1/7, Alonso-Zaldivar) reports, "Repealing President Barack Obama's landmark health care overhaul would add billions to government red ink and leave millions without coverage, Congress' nonpartisan budget referees said Thursday ahead of a politically charged vote in the House." The AP adds, "In a letter to [House Speaker John] Boehner, budget office director Douglas Elmendorf estimated repeal would increase the deficit by $230 billion from 2012 to 2021," and that "about 32 million more people would be uninsured in 2019 as a consequence." But, "Boehner brushed off the Congressional Budget Office analysis as emboldened Republicans, now in the majority in the House, issued their own report arguing that Obama's coverage expansion would cost jobs and increase budget deficits."

        The Los Angeles Times  (1/7, Levey) reports, "House Republican leaders quickly dismissed the new projection from the Congressional Budget Office...as unrealistic," and "some analysts have also questioned whether all the savings in the sweeping health overhaul will be realized." Boehner said in response to the analysis, "CBO is entitled to their opinion. ... I do not believe that repealing the job-killing healthcare law will increase the deficit." Nevertheless, "the closely watched CBO, an agency which lawmakers from both parties have historically relied on, is widely considered one of the most important independent sources for information about the impact of proposed legislation."

        According to Politico  (1/7, Kliff), "Michael Steel, spokesman for Speaker John Boehner, brushed off the estimate as faulty accounting," saying, "There is no one that believes the Washington Democrats' job-killing health care law will lower costs, because it won't. That's why we pledged to repeal it and replace it with common-sense reforms that will actually work."

        The Washington Times  (1/7, Dinan) reports that House Majority Leader Eric Cantor (R-VA) also weighed in on the CBO analysis, saying, "CBO did the job it was asked to do by then the Democrat majority. And it was really comparing apples to oranges, because it talked about 10 years' worth of tax hikes and 6 years' worth of benefits. ... Everyone knows, beyond the 10-year window, this bill has the potential to bankrupt the federal government as well as the states." Yet, "CBO officials, in the letter, challenged that argument, saying the health care law will reduce deficits over the longer term as well," which "means repeal would increase the deficit in the long-term, too."

        The Washington Post  (1/7, Goldstein) reports, "The CBO's assessment, arriving as Republicans have mobilized to make the law's repeal the first major House vote of the new Congress, touches on a sensitive area for the GOP." Notably, "Republicans are vowing to take tough measures to reduce the deficit, although they already have exempted the health care measure from rules requiring that any spending increases be accompanied by offsetting reductions so that the net effect on the deficit is null." The Post says, "The CBO's analysis provided an early glimpse of the brute force politics spreading across Capitol Hill and beyond in the new era of divided government."

        The National Journal  (1/7), the Wall Street Journal  (1/7, Bendavid) "Washington Wire" blog, Reuters  (1/7, Whitesides, Cowan), and another CQ Today  (1/7, Ethridge) article also cover the story, as does The Hill  (1/7, Kasperowicz) in its "Healthwatch" blog and Medscape  (1/6, Lowes).

        Obama Vows To Veto Any Repeal Attempts. The Hill  (1/7, Youngman) reports, "President Obama officially drew a line in the sand Thursday evening, threatening to veto House Republicans' attempt to repeal Obama's landmark healthcare law." The Hill adds, "In a statement of administration policy released by the Office of Management and Budget (OMB), the administration said that repeal would 'would explode the deficit, raise costs for the American people and businesses, deny an estimated 32 million people health insurance, and take us back to the days when insurers could deny, limit or drop coverage for any American.'"

Health Policy and Legislation
House GOP Unveils Several Bills To Repeal, Defund Healthcare Law.
The Hill  (1/7, Pecquet) reports in its "Healthwatch" blog, "Republicans have already introduced almost a dozen bills aimed at repealing, defunding and otherwise weakening Democrats' healthcare reform law since the new Congress opened for business Wednesday." Indeed, "in addition to House Majority Leader Eric Cantor's (R-Va.) bill to repeal the entire law, at least two Republicans -- Reps. Steve King (R-Iowa) and Connie Mack (R-Fla.) -- have introduced straight repeal bills."

        Politico  (1/7, Brown) reports, "Republicans reopened their battle against President Barack Obama's health care law, using the first committee meeting of the new Congress Thursday to eviscerate the overhaul as a 'job killer' and a 'malignant tumor.'" Politico adds, "The committee's formal mandate Thursday was to write the terms of the debate for the repeal vote Wednesday," although "the meeting quickly turned into a rerun of the past two years in both tone and substance, with Republicans blasting Democrats for their handling of the law and Democrats accusing Republicans of flouting their own party rules to rush the repeal bill to a vote."

        Chicago Sun-Times  (1/7, Carlman) reports, "Newly installed Republicans in the US House of Representatives plan to make good this week on their vow to roll back the Patient Protection and Affordable Care Act, the package of health reforms passed by Congress and signed by President Obama less than a year ago." But, HHS Secretary Kathleen Sebelius "called the repeal effort 'a huge step backwards' and said the act already has granted Americans freedoms they did not enjoy before it was passed, including coverage for pre-existing conditions, a reduction in employers' expenses and reduced prescription costs for seniors." Sebelius added, "Those are goals we've been talking about for years, and we're finally making some progress. ... We can't afford to take benefits away from families."

Senate Dems Seek To Counter Health Reform Repeal Efforts.
CQ HealthBeat  (1/7, Norman) reports, "Senate Democrats are joining in an all-hands-on deck effort to defend their embattled health care law with a series of hearings on the measure's benefits announced Thursday for the Health, Education, Labor and Pensions committee." For instance, "Senate Democrats also launched their own hearings to counter the heat on the House side. HELP Committee Chairman Tom Harkin, D-Iowa, said he'll convene the sessions during the next several months to highlight how the law benefits Americans. They'll probably include testimony from people who live outside the Beltway," and "administration officials will be asked to discuss implementation and experts will testify."

        The Hill  (1/7, Millman) notes in its "Healthwatch" blog, "The first will examine how the law protects consumers against health insurers. The committee also will examine how the law requires insurers to be transparent about rates and spend at least 80 percent of premiums on healthcare services; benefits small business owners; reduces the deficit; increases quality of care; reduces waste, fraud and abuse; invests in prevention and wellness; provides portable insurance; and expands coverage."

Conservative Groups Urge Dems Who Voted "No" To Support Repeal.
The Hill  (1/7, Millman) reports in its "Healthwatch" blog, "Groups opposing healthcare reform are urging 13 House Democrats who voted against the reform law to support the repeal bill next week." In a letter to the lawmakers, DeFundIt.org, Americans for Prosperity, Independent Women's Voice and the Association of American Physicians and Surgeons wrote, "If you are really against ObamaCare, then you will vote yea for repeal."

Physicians Group Asks GOP To Strengthen, Not Repeal Healthcare Law.
The Hill  (1/7, Millman) reports in its "Healthwatch" blog, "A pro-reform physicians group is asking leading House Republicans to strengthen -- not repeal -- last year's healthcare overhaul." Notably, "Doctors for America on Thursday morning delivered a petition, signed by more than 2,000 physicians and medical students, to the offices of Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) that urged the new House majority to improve the healthcare reform law." The physicians wrote, "We believe repealing or weakening the Affordable Care Act will move our healthcare system backward -- and we strongly urge against it." ****
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DougMacG
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« Reply #702 on: January 07, 2011, 11:05:40 AM »

Yes, adding people to the roll can not lower costs.  CBO estimates were based on known false assumptions run various ways (including gold sales tracking for tax collections) until they kept it for a minute under a trillion.  Then they required the 'doctor fix' and other bills to continue.  Eliminating choices and competition lowers quality, not cost.  I would add in hypothetical numbers, if you tell everyone who makes between 25k to 35k that they have to make under 24k to get free health care, their share of national income is bound to decrease.

One of the socialistic theories is that if you eliminate a few percent of profit, costs drop by the same amount, hence all the non-profit hospitals.  To me that is a lack of understanding of the role of an incentive system in economics and prevents resources from flowing to their most valuable use.  The more crucial the industry, the less we utilize the strongest forces known to lower costs and increase quality and innovation. I don't know any examples of collective institutions out-performing for-profit industries.

A good friend is a cfo of a big hospital group here.  State law requires hospitals to be non-profit.  They pay themselves huge sums (IMO) to run a 'non-profit' building, then they own various 'for-profit' businesses inside the hospital such as the monopoly pharmacy on the first floor. 
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ccp
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« Reply #703 on: January 14, 2011, 12:29:30 PM »

Watch for the jornOlist talking points to include this Dem response to the REp efforts to repeal Health Care.

The Dems and their media minions will be all out claiming the Repubs are trying to take patients "rights" away:

***Greg Sargent writes in the Washington Post  (1/14) The Plum Line, "At a House Dem leadership meeting last week, Dem leaders decided that" The Patient's Rights Repeal Act "is the phrase they will officially use to brand the House GOP's push to repeal health reform, aides tell me." Sergeant adds, "With House Republicans set to press forward with repeal next week, the idea behind the Dem talking point is to emphasize what repeal would take away from you -- and to position the plight of the patient in the center of this battle." Meanwhile, "Dems are gearing up for a major campaign against repeal, in hopes that it will give them another crack at selling the American public on the law by highlighting its most popular provisions and arguing that repeal would do away with them."
***
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DougMacG
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« Reply #704 on: January 17, 2011, 10:10:53 AM »

There are a few people like Lincoln and Reagan that should post in with the founding fathers.  The late Nobel winning economist Milton Friedman would fit well with that company.  Here he speaks in 1978 at the Mayo Clinic in Rochester MN.  You wouldn't know that he missed the debate of the last couple of years.  Real Clear Politics posts a few videos each day of opinion maker highlights of the last day and sneaked this video in with them yesterday:

http://www.realclearpolitics.com/video/2011/01/16/milton_friedman_on_socialized_medicine.html
-----------------------------------------------------------------------------------------------------------------------------
Counterpoint: The NY Times writes their editorial Saturday as if we hadn't already had the debate and the groundshifting election on this issue in the past year with their warning of 'The Truth and Consequences of Repeal': http://www.nytimes.com/2011/01/16/opinion/16sun1.html
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ccp
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« Reply #705 on: January 17, 2011, 10:50:46 AM »

Doug,
The NYT piece is the beginning of the jornolist/dem politician onslaught response to Repubs efforts at HC repeal.
I heard Bamster has said he would be willing to alter the HC bill.  Again showing he is the great compromiser, the conciliator of our age. rolleyes
Now he doesn't have free reign to ram it all down our throats so he is suddenly such a marvelous compromiser. rolleyes
If I can see this coming a mile away so must our Republican leaders.

Unfortunately, we are also seeing signs they plan on dealing with it by also compromising.  They may be afraid to risk being labeled the party of no and shutting down government which does not go well with the swingers based on history from the 90's.

Thus I think efforts to repeal/block HC will fold as the Republicans will try to meet or one up the Bamster with looking like they are working with the other side IMO.

A new MSM buzz word is "governing".  The republicans can either fall into this trap or risk being tarnished as "shutting down" government.
The two parties *MUST* compromise to do the business of "governing" (Not my opnion but  MSM).  Obviously the MSM idea of governing is ramming endless thousand page bills down the throats of taxpayers.
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ccp
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« Reply #706 on: January 18, 2011, 09:44:11 AM »

The Dem strategy among the entire political party and the complicit journolist MSM is now clear. 
They will *fix* the non popular portions of Healthcare (thus appearing to be compromisers while at the same time they will mitigate any unpopularity of their party).

Also, the Dems are already playing the sympathy card (scrapping this bill will hurt so many people, 127 million poeple benefit from this yada yada yada) and the cans are essentially silent.  Cans also have to meet head on the already multiple airway claims about why this bill will not help as many people as it will *hurt*.

The Republicans are already being outdone.  They should be hitting airwaves incessantly as to why the whole bill has to be scrapped and started over and the Dems cannot pick and choose and make every single line of the 2000 page morrass into some sort of separate topic for "vigorous debate".

I think we've lost.  I am not confident about our "leadership".  Boehner looks like an idiot crying all the time.  The first time was touching.  The last several times are bizarre - like said, the "weeper of the House".
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Crafty_Dog
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« Reply #707 on: January 19, 2011, 08:59:59 AM »

I fear you may be right.
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ccp
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« Reply #708 on: January 20, 2011, 03:07:40 PM »

Personally the HC bill is secondary.  Actually as a primary care provider some actually think I should be grateful for the Democrat bill as it attempts to boost primary care.
But I am totally against it.  I am totally against the entire liberal agenda which this is just a part.  I agree with Morris.  Now the Republicans and teaparties have to fight even harder.  The bamster charm offensive is in full gear.  Unfortunately Clinton showed him the way and it works.  Already Bamster is doing better in the polls. Not a good sign.  I just wish conservatives would just stop telling how smart Obama is.  He is just reading scripts.  He is nothing more then the front guy for what is really going on.

***DickMorris.com OBAMA’S CHOICETHE PERILS OF PALIN »RIGHT MUST FIGHT ROUND 2
By Dick Morris01.19.2011Share this article
 
Published on TheHill.com on January 18, 2011

Now for the counteroffensive. The House Republicans are pushing to repeal ObamaCare. While they will doubtless succeed in the House and either fail in the Senate or face an Obama veto, their decision to raise and debate the issue is a crucial one. As happened when it passed last year, ObamaCare will ignite a national controversy.

But are conservatives prepared to win the debate? When ObamaCare was being pushed through Congress by the likes of Pelosi, Reid, Obama and Emanuel, the right was galvanized. Rallies, demonstrations, town-hall forums, television ads, letters to the editor, television commentary — all bombarded the nation, emphasizing the faults of the bill. But now these voices are stilled, complacent, perhaps exhausted. Or are they intimidated by the liberal spin on the Gabrielle Giffords shooting that we all must lower our voices?


Already, liberal groups and unions are running ads calling on House Republicans not to repeal ObamaCare. One such spot, paid for by Americans United for Change, says:

“Members of Congress know that their health insurance plan can’t deny coverage for their kids. Congressmen can rest assured that their insurance plan won’t drop their families if they get sick. The Affordable Care Act gave your family the same protections that members of Congress get. But Republicans want to take that protection away from your family. They want to put insurance companies back in charge. Call Congress. Tell them you deserve the same health insurance protection they get. Tell them: Don’t repeal the Affordable Care Act. You deserve the same health insurance protections as Congress.”

Where is the conservative reply? Where are the conservative voices? Could the opportunity to repeal ObamaCare give the left a chance to make its case without an answer?

Voters still oppose ObamaCare. The Rasmussen Poll has them backing repeal by 55-40. But if opponents of the program remain complacent, those numbers could change quickly.

Republicans need to remind America that the huge increases they are now paying in their health insurance are concrete evidence of the impact of the mandates in ObamaCare. They need to point out that the $500 billion of Medicare cuts are coming and that, already, reductions in physician fees are driving thousands of doctors to close their doors to Medicare patients. The Republicans need to explain how ObamaCare creates an entirely new entitlement and will swell the deficit.

Voters don’t buy the argument that ObamaCare will cut the deficit. According to Rasmussen, 45 percent say that repealing the program is more likely to cut the deficit, while 33 percent say leaving it on the books will be a better way to reduce it. Republicans need to underscore this linkage.

The larger point is that the new Republican House gives conservatives a chance to re-litigate the battles they lost in Congress in 2009 and 2010. At each turn, they need to re-fight the battle for public opinion and carry it each time. A president usually sets the agenda. But conservatives can keep the focus on the unpopular spending and legislation Obama jammed through a Democratic Congress by pushing for de-funding and repeal.

Republicans won’t get repeal. But they will be able to de-fund the program. They can block the IRS from enforcing the individual and employer mandates and can stop the Department of Health and Human Services from slicing $500 billion from Medicare and implementing healthcare rationing. But it will be a long fight. Republicans will have to demand these concessions as a prerequisite for approving the budget and perhaps even a debt-limit increase. They will need to stand their ground in the face of the hue and cry that they are being irresponsible and holding the nation hostage.

And they’ll need public opinion on their side!

They will need the Tea Party to get loud and conservative groups to start advertising. It’s the second round. A round the opponents of ObamaCare can win. But they mustn’t go to sleep. They need to wake up!***
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ccp
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« Reply #709 on: January 24, 2011, 01:21:40 PM »

Britain Plans to Decentralize Health Care
By SARAH LYALL
Published: July 24, 2010
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CloseLinkedinDiggMixxMySpaceYahoo! BuzzPermalink LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

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Andrew Testa for The New York Times
The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget.
Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.

The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.

Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.

It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.

David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget.

“It’s like getting your waiter to manage a restaurant,” Mr. Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”

But advocacy groups for general practitioners welcomed the proposals.

“One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.

The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

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« Reply #710 on: January 24, 2011, 01:22:36 PM »

Britain Plans to Decentralize Health Care
Published: July 24, 2010
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The government has promised that the new plan will not affect patient care and that the health care budget will not be cut. But some experts say those assertions are misleading. The previous government, controlled by the Labour Party, poured money into the health service — the budget is now about three times what it was when Labour took over, in 1997 — but the increases have stopped. The government has said the budget will continue to rise in real terms for the next five years, but it is unlikely that the increases will keep up with the rising costs of care and the demands of an aging population.

“The real mistake that is being made by the health secretary is to drive through an ideologically determined program of reorganization which is motivated by the principle of efficiency savings,” said Robin Durie, a senior lecturer in politics at the University of Exeter. “History shows clearly that quality will suffer as a consequence.”

Dr. Durie added, “The gulf between the rhetoric of the white paper and the technicalities of what is involved in the various elements of the overall reorganization being proposed is just extraordinary.”

For example, he asked, how will the government make good on its promise to give patients more choice — a promise that seems to require a degree of administrative oversight — while cutting so many managers from the system?

“How will the delivery of all this choice be funded?” Dr. Durie asked. “And how will the management of the delivery of choice be funded?”

Dr. Vautrey said the country needed to have a “mature debate about what the N.H.S. can and cannot afford.”

He said: “It is a sign of the mixed messages that government sends out. They talk about choice and competition and increased patient expectations at the same time as they tell the service they need to cut costs and refer less and prescribe less. People need to understand that while the needs of everyone may be met, their wants will be limited.”

As they prepare for the change, many doctors are wondering whether it will be permanent this time around.

“Many of our colleagues have seen this cycle of change repeatedly,” Dr. Vautrey said. “Many would look at previous reorganizations and compare it to this one and wonder how long the current change will last before the next one comes along.”

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ccp
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« Reply #711 on: January 24, 2011, 01:30:30 PM »

Interesting to note the gov is giving some control to primary care in Britain.  Being the czar here Berwick seems to think British model is the model we should follow I don't know what to make of it.  Other than it is obvious guaranteeing care to everyone and expecting to control costs with primary care is likely to fail.

If, as I am not clear from this article, that the government is giving up and saying to primary care doctors - here we give you X amount of money and you spend it however you think best and take the rest for your salaries - than - if that the case - expect a big problem.  This formula has been used by mangaed care and is a recipee for cut throat health care.  Imagine going to a doctor who you know will make more money denying care to you.  His/her judgement on every single decision is now clouded by their knowing that.  Is that what we want.  I have seen that first hand.  I wouldn't dream of going to any doctor with that in mind.  The doctor will constantly balance what he can deny you with the risk of if it's wrong - getting his ass sued.  To protect that he/she will document up the wazoo as much as possible.

That is how they sometimes get away with it. 

The whole idea we will bend the cost curve down while providing care to 50 million more is aburd.  And they are guaranteeing everyone get the same?
We will all pay more and get less.  Not more. 

Oh sure Gifford would get managed care.  Yeah right.
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ccp
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« Reply #712 on: January 24, 2011, 02:26:55 PM »

Everything starts with repeal
By Charles Krauthammer
Friday, January 21, 2011

Suppose someone - say, the president of United States - proposed the following: We are drowning in debt. More than $14 trillion right now. I've got a great idea for deficit reduction. It will yield a savings of $230 billion over the next 10 years: We increase spending by $540 billion while we increase taxes by $770 billion.
He'd be laughed out of town. And yet, this is precisely what the Democrats are claiming as a virtue of Obamacare. During the debate over Republican attempts to repeal it, one of the Democrats' major talking points has been that Obamacare reduces the deficit - and therefore repeal raises it - by $230 billion. Why, the Congressional Budget Office says exactly that.

Very true. And very convincing. Until you realize where that number comes from. Explains CBO Director Douglas Elmendorf in his "preliminary analysis of H.R. 2" (the Republican health-care repeal): "CBO anticipates that enacting H.R. 2 would probably yield, for the 2012-2021 period, a reduction in revenues in the neighborhood of $770 billion and a reduction in outlays in the vicinity of $540 billion."

As National Affairs editor Yuval Levin pointed out when mining this remarkable nugget, this is a hell of a way to do deficit reduction: a radical increase in spending, topped by an even more radical increase in taxes.

Of course, the very numbers that yield this $230 billion "deficit reduction" are phony to begin with. The CBO is required to accept every assumption, promise (of future spending cuts, for example) and chronological gimmick that Congress gives it. All the CBO then does is perform the calculation and spit out the result.


In fact, the whole Obamacare bill was gamed to produce a favorable CBO number. Most glaringly, the entitlement it creates - government-subsidized health insurance for 32 million Americans - doesn't kick in until 2014. That was deliberately designed so any projection for this decade would cover only six years of expenditures - while that same 10-year projection would capture 10 years of revenue. With 10 years of money inflow vs. six years of outflow, the result is a positive - i.e., deficit-reducing - number. Surprise.

If you think that's audacious, consider this: Obamacare does not create just one new entitlement (health insurance for everyone); it actually creates a second - long-term care insurance. With an aging population, and with long-term care becoming extraordinarily expensive, this promises to be the biggest budget buster in the history of the welfare state.

And yet, in the CBO calculation, this new entitlement to long-term care reduces the deficit over the next 10 years. By $70 billion, no less. How is this possible? By collecting premiums now, and paying out no benefits for the first 10 years. Presto: a (temporary) surplus. As former CBO director Douglas Holtz-Eakin and scholars Joseph Antos and James Capretta note, "Only in Washington could the creation of a reckless entitlement program be used as 'offset' to grease the way for another entitlement." I would note additionally that only in Washington could such a neat little swindle be titled the "CLASS Act" (for the Community Living Assistance Services and Supports Act).

That a health-care reform law of such enormous size and consequence, revolutionizing one-sixth of the U.S. economy, could be sold on such flimflammery is astonishing, even by Washington standards. What should Republicans do?

Make the case. Explain the phony numbers, boring as the exercise may be. Better still, hold hearings and let the CBO director, whose integrity is beyond reproach, explain the numbers himself.

To be sure, the effect on the deficit is not the only criterion by which to judge Obamacare. But the tossing around of such clearly misleading bumper-sticker numbers calls into question the trustworthiness of other happy claims about Obamacare. Such as the repeated promise that everyone who likes his current health insurance will be able to keep it. Sure, but only if your employer continues to offer it. In fact, millions of workers will find themselves adrift because their employers will have every incentive to dump them onto the public rolls.

This does not absolve the Republicans from producing a health-care replacement. They will and should be judged by how well their alternative addresses the needs of the uninsured and the anxieties of the currently insured. But amending an insanely complicated, contradictory, incoherent and arbitrary 2,000-page bill that will generate tens of thousands of pages of regulations is a complete non-starter. Everything begins with repeal.

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Crafty_Dog
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« Reply #713 on: February 03, 2011, 08:31:01 AM »

By KARL ROVE
ObamaCare has recently been dealt three body blows. Speaker John Boehner pushed a bill to repeal it through the House. GOP leader Mitch McConnell will get to put Senate Democrats on record with a vote on repeal as well. And this week, U.S. District Judge Roger Vinson declared the law unconstitutional.

The White House's reaction is dismissive. The nation doesn't want to "re-litigate" ObamaCare, we're told. So long as Mr. Obama sits in the Oval Office, repeal is going nowhere. The Supreme Court will uphold the law. And by 2012, health care will be a winning issue for Democrats.

I'm not so sure. Take the question of Granny. In a speech last Friday defending his health-care law's effect on seniors against GOP attacks, Mr. Obama said, "I can report that Granny is safe." She may not feel that way if she's one of the 700,000 seniors whose private Medicare Advantage insurance policy was not renewed last year because her insurance provider quit the business.

There will be more nonrenewals in 2011. This year's funding cuts to Medicare Advantage will be $2 billion; next year's will be $6 billion. The Centers for Medicare and Medicaid Services (CMS) estimate that half of those with Medicare Advantage policies—seven million seniors—will lose their coverage eventually. And 60% the doctors surveyed by the nonprofit Physicians Foundation said health-care reform would "compel them to close or significantly restrict" the number of patients in their practices, especially those on Medicare or Medicaid.
Granny's daughter, son and grandchildren are not all that safe, either. Providers such as Guardian Life and the Principal Financial Group are dropping their health-insurance businesses. And companies will be tempted to drop coverage for their employees and dump them onto the government's tab.


No taxpayer is safe, either. Last week Richard Foster, CMS's chief actuary, confirmed to Congress that ObamaCare's Medicare cuts couldn't be used to reduce both Medicare's unfunded liability and to pay for ObamaCare's expense. Since the Obama administration is relying on this double counting to rig the numbers, Mr. Foster's testimony was particularly damaging.

What the country most needs—and what the GOP must now advocate—is a fundamentally new approach to containing health-care costs.

The most promising model for Medicare comes from Clinton Budget Director Alice Rivlin and House Budget Committee Chairman Paul Ryan (R., Wis.). Under their plan, starting in 2021 those turning 65 and going on Medicare would get a fixed contribution to use to purchase insurance, allowing them in many instances to keep their existing coverage. Consumers will be in charge.

Annual support would grow at the same yearly rate as the economy plus 1%. Medicare payments would be adjusted by income, geography and health risk. Poor seniors would get extra help for out-of-pocket expenses.

This bipartisan model builds on the success of the Medicare prescription drug benefit passed in 2003. This market- and competition-oriented experiment gave seniors a fixed sum they could use to purchase drug insurance coverage. In response, drug companies and insurance providers flooded the market with options that drove prices for consumers down.

Though more seniors signed up for the benefit, signed up quicker and used it more than expected, the program costs much less than estimated (the original Congressional Budget Office estimate was $552 billion for the first 10 years, but the estimated cost is now $385 billion). Competition and consumer choice are far more effective in containing costs than is bureaucratic price-setting.

We're at an unprecedented moment. The huge historic advantage Democrats have enjoyed on the health-care issue has evaporated. ObamaCare is increasingly less popular. Its unpopularity is up nine points in the last month, to 50%, in a Kaiser/Harvard survey. The public is now taking a close look at what the Republican Party might have to offer.
The Rivlin-Ryan alternative plan is bold and not without risk. Past efforts at entitlement reform haven't been successful. Having worked in the Bush White House during the 2005 Social Security battle, I know of what I speak. Still, the Rivlin-Ryan plan is right on substance. And unlike 2005, it may also be the right moment.

Thanks in good measure to Mr. Obama's profligacy, the entitlement crisis is no longer a vague, abstract concern. More and more Americans understand the current course leads to a disaster for the nation's finances. And so the public may be willing to go places and do things that in the past it may not have.

This is an unusual and fluid moment. My hunch is voters are more inclined than ever to reward the political party that addresses entitlement reform—and more inclined than ever to punish the one that fiddles while America's fiscal house burns.

Mr. Rove is the former senior adviser and deputy chief of staff to President George W. Bush.
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bigdog
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« Reply #714 on: February 08, 2011, 05:34:24 AM »

This is an interesting discussion of the legality of the health care law, two Supreme Court justices, and the role of Congress to regulate interstate commerce.   

http://www.nytimes.com/2011/02/08/opinion/08tribe.html?_r=2&hp=&adxnnl=1&adxnnlx=1297162948-Ry0HQx71YHQsncxJVfxlvw
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DougMacG
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« Reply #715 on: February 08, 2011, 08:43:20 AM »

BD, Okay interesting. Surprisingly, I disagree with his reasoning and conclusion. 

Usually I stop reading commentary when I reach the first falsehood:

"Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."

Bullsh*t.

There is also the possibility of fee for service, pay on the spot or mail me a bill, which has worked in almost every other industry since founding of the Republic, and then some.  Fee for service worked fine in health care until government meddling (and other factors) drove costs beyond normal reach.  Insurance does not bring down cost, it smooths out variable costs - at a higher level than they would otherwise be to pay for administration of the insurance and to pay for how the coverage increases usage. Under a nationwide program, more people, not fewer will be taking a free or subsidized ride on the health care system. Is there not any way to arrive at constitutionality without starting with a false premise??

"...confused assertion that what is at stake here is a matter of personal liberty — the right not to purchase what one wishes not to purchase... "

Is that not clearly spelled out in the 9th amendment, almost word for word?  smiley  ...competing with the unenumerated power of government to PARTICIPATE in interstate commerce.

Just as the Professor dismisses the view of two judges so far, he will disagree with the Court when this is decided. Delusional IMO to think this is a 9-0 uphold certainty because: "Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce."

There are plenty of people on and off the Court that think that power has already been read too broadly.  Trivialize it as political or "a misunderstanding of the court and the Constitution" if that is expedient, better yet call it a fundamental disagreement in principles.

BD or LT, do you support the constitutionality of mandatory national food insurance, food crossed state lines, and then what is next after that?
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bigdog
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« Reply #716 on: February 08, 2011, 09:46:12 AM »

DougMacG: I think you misunderstood Tribe's intention in regard to Scalia and Kennedy.  As you are no doubt aware, there is much made about the "political decisions" of the Court, and the view of a few justices in particular.  I think what Tribe is trying to do, at least in part, is to take a pure legal view of the merits, and note that the justices in question have voted in a particular way in prior cases.  This would suggest, Tribe asserts, that the justices will follow precedent rather than follow the politics that they are often accused of.  (I would think that, on its face, this is something you would agree with.)

What may be less apparent from the article is the ongoing battle between legal scholars and political scientist who study Supreme Court decion making.  Legal scholars opine, not surprisingly, that the law matters, and that the value of stare decisis helps to understand why cases are decided in a particular fashion.  Some political scientists, with Jeffrey Segal and Harold Spaeth being the most cited examples, believe that we can predict how a Supreme Court justice will vote based on personal preferences.  I suspect that much of Tribe's article was aimed at political scientists. 
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DougMacG
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« Reply #717 on: February 08, 2011, 01:14:25 PM »

Bigdog,  Thank you and I respect that. I understand from a citizen and layman's point of view the importance of stare decisis, a higher standard required to overturn what was wrongly decided, and I believe this case  gives ample wiggle room to each Justice to either say as Prof. Tribe did, that this is no different than what they have always done, as well as to very reasonably say this goes considerably further than we have ever read that ever-expanding power to go. (Same newspaper predicting precedents will fall unpredictably in this Court: http://www.nytimes.com/2007/06/21/washington/21memo.html)

Having read Prof. Tribe on many occasions, I find him to be more effective as an advocate for one side of interpretation than as a predictor of how others will reason and decide a case.  You disagree?  In this piece I read him to be taunting or leading the so-called other side to see this as a continuation of past decisions rather than a serious prediction that Scalia and Kennedy are "open and shut" with him because of the established power to regulate and that no rights of any value are violated in the process.

The Florida judge said (something like) if this power isn't limited, what power would be?  I posted the food insurance question and Obama when opposing the mandate suggested facetiously that we could mandate home purchases to end homelessness. I can't say whether he thought that was unconstitutional or just a stupid idea, but unlimited power certainly was not the intent or language used to define central government power.

I agree Scalia (or any of those 5) would vote against his presumed political position to be consistent in his constitutional interpretation. I don't find Tribe persuasive though.  As I pointed out, he started with a false premise (that is a big deal to me in logic) and then trivialized a right of private affairs to not have terms and choices of private contracts coerced and tracked by central authorities. Even auto insurance is a state mandate and avoidable by choosing other OR NO transportation. Kennedy I find unpredictable but people say he is strong on states' rights.  Regulating commerce across state lines has not meant in most other industries that there can only be one set of rules.  There were state based solutions available to address this issue that disappear with a federal mandate. Separate from merit, 26 states suing is a pretty strong indicator that states' interests are being tromped on, at least in their view.
-----
Prof. Tribe: "Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce." - True.

Synonyms of 'regulate' http://thesaurus.com/browse/regulate :
manage, organize
adapt, adjust, administer, allocate, arrange, balance, classify, conduct, control, coordinate, correct, determine, direct, dispose, fit, fix, govern, guide, handle, improve, legislate, measure, methodize, moderate, modulate, monitor, order, oversee, pull things together, put in order, readjust, reconcile, rectify, rule, run, set, settle, shape up, square, standardize, straighten up, superintend, supervise, systematize, temper, time, true, tune, tune up
* Thesaurus ran through the whole alphabet without hitting 'mandate', 'coerce', or 'participate'.
-----
Synonyms  of verb 'mandate':
delegate, designate, depute, assign
order, prescribe, dictate
* Accepted interpretations of the English language include the root word of 'dictatorship' but not 'regulation'.
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G M
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« Reply #718 on: February 08, 2011, 01:14:52 PM »

http://althouse.blogspot.com/2011/02/professor-tribe-would-like-you-to-know.html

February 8, 2011
Professor Tribe would like you to know how nonpartisan the Supreme Court Justices are ... I mean, will be, when they decide the individual mandate question the way he would like.
The NYT has an op-ed by lawprof Larry Tribe that purports to demonstrate how obvious it supposedly is that the Supreme Court will find the health care law constitutional.

    The justices aren’t likely to be misled by the reasoning that prompted two of the four federal courts that have ruled on this legislation to invalidate it on the theory that Congress is entitled to regulate only economic “activity,” not “inactivity,” like the decision not to purchase insurance. This distinction is illusory. Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system. They know that if they need emergency-room care that they can’t pay for, the public will pick up the tab. This conscious choice carries serious economic consequences for the national health care market, which makes it a proper subject for federal regulation.

Of course, the argument Tribe likes was presented, considered, and rejected in the 2 federal court cases. It's a perfectly comprehensible argument, but that doesn't make its success in the Supreme Court a sure thing. Acting as if it does, Tribe says "it’s distressing that many assume its fate will be decided by a partisan, closely divided Supreme Court." Oh, you terrible people who fail to bow to the obviousness of one side of a constitutional argument! You compound your sins by falling prey to the upsetting belief that the Supreme Court Justices are politically partisan!

    To imagine Justice Scalia would abandon that fundamental understanding of the Constitution’s necessary and proper clause because he was appointed by a Republican president is to insult both his intellect and his integrity.

That's not sarcasm. Read the whole thing. You'll see, it's not intentional sarcasm. It might be an attempt to sweet-talk Scalia into using the health-care litigation to score some political neutrality points, but it's not sarcasm. It's more: Ah! What a fine Justice, full of integrity and intellect, I will say Justice Scalia is if he decides this case my way!

    Justice Anthony Kennedy, whom many unfairly caricature as the “swing vote,” deserves better as well.

Oh! People are sooooo unfair to Justice Kennedy. I, Larry Tribe, will protect him from the scurrilous "swing vote" remarks people make.... when he decides this case my way!

    Yes, his opinion in the 5-4 decision invalidating the federal ban on possession of guns near schools is frequently cited by opponents of the health care law.

I hope they do a better job of pointing at the Lopez case than that NYT link does. Here's the right link, in case anyone cares.

    But that decision in 1995 drew a bright line between commercial choices, all of which Congress has presumptive power to regulate, and conduct like gun possession that is not in itself “commercial” or “economic,” however likely it might be to set off a cascade of economic effects.

Drew a bright line, eh? But the line, if you can call it a line, isn't about "commercial choices." That's Tribe's phrase — as he assures us the line is bright! — and what the Court said was "commercial activity" — which is why the argument about the distinction between activity and inactivity has been so important in the health care litigation. Tribe declares lines to be bright precisely at the point when he is shedding darkness. (If you think you can't shed darkness, I agree. I'm just riffing on the linguistic oddity of the lawyer's expression "bright line." Aren't easy-to-see lines usually dark — like black ink on white paper?)

    The decision about how to pay for health care is a quintessentially commercial choice in itself, not merely a decision that might have economic consequences.

"Quintessentially" is such a strong word that perhaps you will not notice that it's next to the phrase that is not "economic activity."

    Only a crude prediction that justices will vote based on politics rather than principle would lead anybody to imagine that Chief Justice John Roberts or Justice Samuel Alito would agree with the judges in Florida and Virginia who have ruled against the health care law.

Oh, come on. Tribe's rhetorical move has become comical at this point. It reminds me of an old-fashioned mother exerting moral pressure on a child by telling him how sure she is that he is such a good little boy that he could never do whatever it is she doesn't want him to do. Put more directly, it's an assertion of authority: I'm telling you what's right and if you don't do it, you'll be wrong. Could the Justices possibly yield to pressure like that? It's crude to think that they would, isn't it? It's an insult both their intellect and their integrity.

And yet, Larry Tribe does think it, right? That's what's behind his rhetoric. I believe. Crudely.

UPDATE: I have 2 more posts about this op-ed, one dealing with Tribe's disapproval of people who fail to take responsibility and one dealing with the meaning of "choice."
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G M
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« Reply #719 on: February 08, 2011, 01:24:46 PM »

http://althouse.blogspot.com/2011/02/i-have-to-take-3rd-shot-at-larry-tribes.html#more

February 8, 2011
I have to take a 3rd shot at Larry Tribe's op-ed: That big word "choice."

Here's my first shot and here's my second shot at Larry Tribe's op-ed purporting to say why the Supreme Court will come down in favor of the constitutionality of the individual mandate to buy health insurance. I didn't set out to write one post after another about the op-ed, but I must go on to talk about his use of the word "choice" — which is monumentally important in the discussion of abortion rights. Tribe's op-ed has nothing to say about abortion. I wonder if he would have written it differently if abortion had crossed is mind, but I can't believe that a constitutional law professor would overlook the abortion-related significance of the word "choice."

Tribe's op-ed, as I wrote in the first post, rests very heavily on misrepresenting the Supreme Court's commerce power doctrine as referring to "commercial choices." In fact, the cases refer to "commercial activities," and a switch from "activity" to "choice" is immensely important in the health care litigation, in which opponents stress that the failure to buy insurance is inactivity, not activity, and therefore beyond even the broadest interpretations the Supreme Court has ever given to the Commerce Clause.

Tribe attempted to skew opinion by substituting "choice" for "activity," and I have called him on that. But I need to go further, because someone who uses words to get things done needs to be kept honest not only about shifting from one word to another, but also about changing the meaning of the same from case to case. Let's look at how Tribe talked about "choice" and health insurance and then see how that squares with what "choice" is supposed to mean in the abortion context.

In today's op-ed, Tribe wrote:

    Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system. They know that if they need emergency-room care that they can’t pay for, the public will pick up the tab. This conscious choice carries serious economic consequences for the national health care market, which makes it a proper subject for federal regulation.

You can see that Tribe has given a very broad definition to the notion of choice. People bumble along, doing what they want, aware of the chance of an undesirable outcome, vaguely expecting to take advantage of an out that isn't very nice. That's a choice. It is something real and specific that the individual has done. Society can, as a group, based on our idea of the good, say to that person: We are now going to require you to take responsibility at that early decision point of yours. So Tribe says.

Now, apply that to abortion. If we take a similarly broad view of choice, we could say — as anti-abortion advocates do — that women who know they may be fertile have a choice when they go ahead and have sexual intercourse with a man. They can refrain from having sex, but if they go forward, they know that if they need emergency-room care get that they can’t pay for get pregnant, the public will pick up the tab they can get an abortion.

Of course, the Supreme Court case law does not present the woman's right to choose in terms of taking responsibility at that early point. It says:

    These matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State.

The choice that matters is an elaborate process of high-level reflection that occurs after the woman becomes pregnant — that is, when it's too late to take the precautions that the majority might have liked her to take so that she would not show up with the demand for something it wants to prevent.

I realize there are many distinctions that can be made between health insurance and abortion, but there is so much sophistry around the word "choice" that I think it's important to concentrate on what choice means and how it matters in the law. It seems to me that society, acting through a legislature, may have a preference about when an individual should be required to make a choice, and that the individual, valuing autonomy, may want a broader range of choice than the majority would like to permit. When we think about government power and individual autonomy, how consistent must we be about what "choice" means?
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Crafty_Dog
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« Reply #720 on: February 10, 2011, 12:38:28 PM »



No one should expect much real health-care progress for the next two years, but at least President Obama is now making concessions to the political mood, however minor. The White House is suddenly trying to pacify the critics it used to claim were partisans, or industry shills, or arguing in bad faith.

The latest penitent is Kathleen Sebelius, who has finally admitted that there are severe fiscal problems with a new entitlement for long-term care that was included in ObamaCare. Speaking Tuesday at the Kaiser Family Foundation, the Health and Human Services Secretary defended the new government insurance program, known by the acronym Class. But she also said that "The law, while the structure in the statute wasn't perfect, provided ample flexibility to make sure that Class is successful. . . . We at HHS are committed to using that authority to making sure that both the program meets people's needs while remaining fiscally sound."

In other words, Ms. Sebelius plans to use her administrative powers to rewrite the Class program so it doesn't follow Congressional orders and bankrupt itself by design. She even made a promise that her rewrite will be so complete that "no taxpayer dollars will be used to pay for Class benefits," period.

 
That would certainly be a first in entitlement history, which is why President Obama's own deficit commission recommended the "reform or repeal" of Class. It said the program will "require large general revenue transfers or else collapse under its own weight," while Senate Budget Chairman Kent Conrad has called Class "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of."

The main reason Democratic liberals insisted on passing Class is because it will crowd out private insurance for long-term care like home health aides or nursing homes. But they also used it to rig the bill's budget math to make it appear to reduce the deficit.

The program will start collecting premiums up front in 2012 but won't pay out any cash benefits until five years later. The $70 billion or so accumulated during that lead time will finance other parts of ObamaCare, and then the Class program is scheduled to go broke sometime between 2020 and 2025 in part because the money can't be spent twice.

Ms. Sebelius promised to resolve problems that "threaten the financial stability long term of the plan," like eliminating "loopholes that could allow people to skip premium payments and then re-enroll in the program without paying any penalty." (Speaking of small favors.) She also noted that "as currently written," premiums are required to be flat but benefits are indexed to inflation.

One question is why Ms. Sebelius didn't speak about these defects before the bill passed. The answer, we'd guess, is that she and Mr. Obama like the Class program as written but now fear that House Republicans and even Senate Democrats could vote to repeal it wholesale unless the Administration pledges to reform it.

The reality is that as long as entitlements are on the books, they always expand. Ms. Sebelius may change the program now, but a future Congress will quietly restore the same ills. Republicans should fight to repeal Class in its entirety, and then let Mr. Obama defend a program that even his chief health deputy now admits is a disaster waiting to happen.

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Crafty_Dog
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« Reply #721 on: February 10, 2011, 12:40:16 PM »

By KARL ROVE
Senate Majority Whip Dick Durbin likes to taunt his Republican colleagues, arguing that ObamaCare can't be repealed because 60 votes are required to end debate in the Senate on any measure.

Though Republicans will likely win control of the Senate in 2012, Mr. Durbin is right that they probably won't get to 60 senators. That would require the GOP to win back more than half the Democratic seats up next year. Rep. Jim Moran (D., Va.) recently called GOP promises of repeal "a political scam on their base. . . . It can't happen."

Not so fast. Keith Hennessey, a former White House colleague of mine, says Democrats are wrong. He argues that Republicans can repeal health-care reform with a simple Senate majority.

Director of the National Economic Council under President George W. Bush, Mr. Hennessey now teaches at Stanford Business School and is a research fellow at the Hoover Institution. Last week on his website, KeithHennessey.com, he made the case that congressional Republicans could use the reconciliation process to kill ObamaCare with 51 votes in the Senate and a majority in the House of Representatives.

The Budget Act of 1974 established the reconciliation process. The House and Senate Budget Committees can direct other committees to make changes in mandatory spending (like ObamaCare's Medicaid expansion and insurance subsidies) and the tax code (such as ObamaCare's levies on insurance policies, hospitals and drug companies) to make spending and revenue conform with the goals set by the annual budget resolution.

View Full Image

Associated Press
 
President Obama signing the health care bill last March.
.For example, under reconciliation the Senate Budget Committee could instruct the Senate Finance Committee to reduce mandatory spending on insurance subsidies and Medicaid expansion. These two items make up more than 90% of spending in ObamaCare. All the changes from all the committees are then bundled into one measure and voted upon. Because reconciliation is protected by the rules of the budget process, it doesn't take 60 votes to bring it up and it requires only a simple majority to pass.

Will this 51-vote strategy work? One long-time GOP budget whiz, embarrassed he hadn't thought of this, told me it would. Another Republican veteran of the budget wars agreed, though she had some concerns that certain elements of ObamaCare, such as some insurance provisions, might be beyond the reach of reconciliation. For example, would reconciliation allow Republicans to kill the requirement that younger, healthier workers pay higher premiums than they rightly should to keep premiums for older workers lower?

Mr. Hennessey believes that these are "strategically unimportant" items. He says the goal should be to repeal ObamaCare's big-cost drivers, and reconciliation provides the tool to do it.

Using reconciliation would require that Republicans pick up at least four seats in 2012, when 23 senators who caucus with the Democrats are up for re-election, many in red states. Already, vulnerable Democratic senators like Jon Tester of Montana, Claire McCaskill of Missouri and Joe Manchin of West Virginia are talking about how to get rid of some of ObamaCare's most objectionable parts, like the individual mandate. They'll only get more skittish as the election approaches. Democrats cannot complain if the GOP uses reconciliation after Democrats used it to pass ObamaCare through the Senate.

Congressional Republicans are getting crucial help in this battle from allies outside Washington. Republican governors know that ObamaCare's mandatory expansion of Medicaid rolls will collapse state budgets. Texas Gov. Rick Perry has called ObamaCare "unaffordable, unsustainable and unworkable," and many have criticized the law for shifting billions of dollars onto the states. GOP governors are in charge of at least 10 key battleground states and can continue to drill home this message in states such as Ohio and Florida that are vital to Mr. Obama's re-election.

Even Democratic governors in swing states are critical of ObamaCare's Medicaid expansion. "There is no hidden pool of money" to pay for expanding Medicaid, lamented Colorado Gov. John Hickenlooper. North Carolina Gov. Bev Perdue said she opposes health-care reform "that shifts costs to the states." States are "not going to be in a position to pick up the tab" of expanding Medicaid, warned Washington Gov. Christine Gregoire.

Democrats harp on the 60-vote threshold and ignore the reconciliation option because they want Americans to accept the inevitability of ObamaCare. But its roots are clearly in shallow soil.

Of course, a 51-vote Senate strategy would also require a Republican president who would sign a reconciliation bill. All of which means that ObamaCare will be a central issue in the 2012 election. The president may not want to "re-litigate" ObamaCare, but Republicans—and a majority of Americans—do.

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

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« Reply #722 on: February 23, 2011, 01:07:51 PM »

By LLOYD M. KRIEGER
The Republicans who now control the House of Representatives hope to repeal or defund ObamaCare, but the law has already yielded profound, destructive changes that will not be undone by repeal or defunding alone. Active steps and new laws will be needed to repair the damage.

The most significant change is a wave of frantic consolidation in the health industry. Because the law mandates that insurers accept all patients regardless of pre-existing conditions, insurers will not make money with their current premium and provider-payment structures. As a result, they have already started to raise premiums and cut payments to doctors and hospitals. Smaller and weaker insurers are being forced to sell themselves to larger entities.

Doctors and hospitals, meanwhile, have decided that they cannot survive unless they achieve massive size—and fast. Six years ago, doctors owned more than two-thirds of U.S. medical practices, according to the Medical Group Management Association. By next year, nearly two-thirds will be salaried employees of larger institutions.

Consolidation is not necessarily bad, as larger medical practices and hospital systems can create some efficiencies. But in the context of ObamaCare's spiderweb of rules and regulations, consolidation is more akin to collectivization. It means that government bureaucrats will be able to impose controls with much greater ease.

With far fewer and much larger entities to browbeat, all changes in Medicare and Medicaid policies will go through the entire system like a shock wave. There will be far fewer individual insurers, doctors, hospitals, device makers, drug manufacturers, nursing homes and other health-care players to resist.

There is little mystery how the government will exercise its power. Choices will be limited. Pathways to expensive specialist care such as advanced radiology and surgery will decline. Cutting-edge devices and medicines will come into the system much more slowly and be used much less frequently.

This is why simply defunding enforcement of the individual mandate and other upcoming directives will not be enough: Given all this consolidation, limits on treatment choices are already becoming hardwired into the system. Lawmakers must take concrete steps to stop and reverse this.

On the provider end, this means enacting tax and other economic shields for insurers and providers that choose not to succumb to the financial pressure encouraging consolidation. It means unwinding all of the rules—about data compilation, reporting and compliance requirements, and information technology—designed to increase overhead to the point that only massive and easily regulated provider organizations can survive.

Legislators will have to scrub the 2,700-page ObamaCare law line by line to remove all of the disincentives for medical practices, hospitals and others to remain smaller and independent.

On the consumer end, reform means re-establishing choice at all levels of the system. Lawmakers at a minimum should change the individual mandate so that people can choose what type of coverage they buy. To do this, legislation has to ensure that all consumers have access to a menu of options for varying types of coverage, and that they are free to purchase policies across state lines. There should also be tax breaks for people who purchase medical care not covered by their insurance, so there is reasonable chance of escaping government-imposed limits on treatment choices.

System-wide, collectivization will be dismantled only by limiting the power of government agencies to determine what care gets funded. That means new legislation to supersede Section 1311 of the Patient Protection and Affordable Care Act, which requires herding everyone into "qualified plans" and forcing doctors (via fines, penalties and nonpayment) to follow care guidelines determined by the secretary of Health and Human Services.

ObamaCare is already doing great damage, even years before its individual mandate and other controls kick in. Its systematic undoing is an urgent necessity.

Dr. Krieger, a plastic surgeon, invests in health-care companies.

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« Reply #723 on: February 28, 2011, 11:14:49 AM »

A NY TImes (Pravda on the Hudson) editorial today:

The number of kidneys available for transplants falls far short of the need, so there is no choice but to ration them. An emotionally difficult proposal to change the first-come-first-served transplant system makes good sense.

There are nearly 90,000 people on waiting lists to receive kidney transplants, and in 2009 there were only some 10,400 kidneys from dead donors to give them. And about 6,300 kidneys were transplanted from living people who donated one of their two kidneys and usually specified the recipient.

Currently the kidneys from dead donors are provided, through an organ procurement and transplantation network, to people who have been waiting the longest. That may seem fair since many transplant candidates wait for years, and some die while waiting.

But the system has serious shortcomings. Some elderly recipients get kidneys that could function far longer than they will live and that could have done more good for a younger recipient. Some younger recipients get kidneys that will fail and will need to be replaced, using up another scarce kidney.

These problems could be eased through a proposal under consideration at the transplant network to better match the likely longevity of the patient with the likely functional life of the kidney.

The patients and kidneys would each be graded separately. About 20 percent of the kidneys predicted to have the longest functional lives would be provided to the youngest and healthiest patients. The other 80 percent of kidneys would go to patients who are no more than 15 years older or younger than the donor.

The approach seems likely to make it harder for elderly people to get a kidney. But when kidneys are already scarce — and apt to get scarcer as much of the population ages and sickens — it is a rational choice.

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« Reply #724 on: March 03, 2011, 09:39:29 PM »

This is the most obvious mathematical question ever to NOT be asked aloud by so many people for so long.  This question has gone through my mind every time I have heard the fact that Pelosi-Obama Care has to use 10 years of revenues to pay for 6 years of benefits in order to keep the 'cost' to the Treasury (almost) under a trillion dollars.  Is there not one person trained in mathematical progressions bold enough and smart enough to ask the most obvious question on earth: 

WHAT ABOUT THE ELEVENTH YEAR?!!!!

I don't believe I ever wrote it or asked or heard or read anyone else ask it until I heard this.  I am not familiar with Sam Zell, but i nearly fell off my chair to hear him ask this.

http://finance.yahoo.com/video/cnbc-22844419/24401227#video=24399404

"What about the eleventh year?  You guys have constructed this with ten year of revenues and six years of costs, what about the eleventh year?"
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« Reply #725 on: March 08, 2011, 12:47:19 PM »

Bachmann Calls on Congress to Block $105B in Health Law Money
Published March 08, 2011
FoxNews.com
Reuters

U.S. Rep. Michele Bachmann at the 38th annual CPAC meeting at the Marriott Wardman Park Hotel in Washington, Feb. 10, 2011.

Rep. Michele Bachmann is threatening to leverage a must-pass budget bill to ensure Congress strips billions of dollars from the federal health care overhaul -- money she says was unfairly baked into the law.

Though Democrats dispute her charges and it's unclear whether she could rally enough support in her party to force the rescission, Bachmann, R-Minn., told Fox News she wants to use the fiscal 2011 budget process to eliminate $105 billion in "buried" health law funding. That money was included as mandatory spending over the next eight years, meaning it's automatic and not subject to annual spending votes by Congress.

"This is a crime against democracy," Bachmann told Fox News on Tuesday. "No one knew that Harry Reid, Pelosi and Obama put $105 billion in spending in the bill. ... This is a bombshell."

The hefty down payment for the health law makes it more difficult for Republicans who want to de-fund the policy through the annual appropriations process. To remedy this, Bachmann said she wants to include language demanding the money back in the next short-term budget bill, which will probably be required to fund the government when the latest short-term bill expires March 18.

"You didn't tell the American people, you didn't tell the Senate, you didn't tell the House. Give the money back. And then we'll start talking about the budget. This is the first thing," Bachmann told Fox News Monday night.

But Democrats pushed back on Bachmann's claim, particularly an earlier remark she made about the funding being a "deceitful" trick hidden from public view. One Democratic aide said the $105 billion was calculated as part of the original "score" for the bill presented to Congress.

"The Congressional Budget Office had this included in their score. They scored the bill and found it (saved) $1.2 trillion over 20 years," the aide said. "What is deceitful is Bachmann voting to end patients' rights while keeping her taxpayer-funded health care."

Though Bachmann claims the authors of the health care law "buried" the money, the House had three months to find it before approving the final version last March.  Bachmann's also not the first person to point this out. Rep. Steve King, R-Iowa, tried earlier this year, without success, to block the $105 billion. The mandatory money was the subject of a study by Heritage Foundation fellow and former congressman Ernest Istook in late January.

Istook got his figures in large part from a Congressional Research Service report dated Oct. 14 of last year.

Though the information has been floating around in various Washington studies, Istook wrote in January that the inclusion of the money was a major foul on Democrats' part. He accused the bill's authors of bypassing the normal appropriations process to block any future Congress from meddling with the money.

"Making years' worth of spending decisions in advance is an attempt to handcuff the current Congress and prevent it from determining current levels of spending," he wrote.

Among other provisions, about $40 billion would go to the Children's Health Insurance Program, $15 billion would go to a prevention and public health fund, $10 billion would go to Medicare and Medicaid innovation programs, and $9.5 billion would go to the Community Health Centers Fund.

Bachmann claims part of that spending would essentially give Health and Human Services Secretary Kathleen Sebelius a $16-billion "slush fund" that would allow her to do "whatever she wants with this money."

Bachmann called on the bill's supporters to give the money back, though Democrats who backed the health law, most notably President Obama, have argued that the law goes a long way toward insuring the uninsured and protecting health care consumers.


Read more: http://www.foxnews.com/politics/2011/03/08/bachmann-calls-congress-block-105-billion-health-law-money/#ixzz1G1aSPUbj
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« Reply #726 on: March 09, 2011, 10:14:11 PM »

By SCOTT GOTTLIEB
Across the country, cash-strapped states are leveling blanket cuts on Medicaid providers that are turning the health program into an increasingly hollow benefit. Governors that made politically expedient promises to expand coverage during flush times are being forced to renege given their imperiled budgets. In some states, they've cut the reimbursement to providers so low that beneficiaries can't find doctors willing to accept Medicaid.

Washington contributes to this mess by leaving states no option other than across-the-board cuts. Patients would be better off if states were able to tailor the benefits that Medicaid covers—targeting resources to sicker people and giving healthy adults cheaper, basic coverage. But federal rules say that everyone has to get the same package of benefits, regardless of health status, needs or personal desires.

These rules reflect the ambition of liberal lawmakers who cling to the dogma that Medicaid should be a "comprehensive" benefit. In their view, any tailoring is an affront to egalitarianism. Because states are forced to offer everyone everything, the actual payment rates are driven so low that beneficiaries often end up with nothing in practice.

Dozens of recent medical studies show that Medicaid patients suffer for it. In some cases, they'd do just as well without health insurance. Here's a sampling of that research:

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TWISTED PATIENT
.• Head and neck cancer: A 2010 study of 1,231 patients with cancer of the throat, published in the medical journal Cancer, found that Medicaid patients and people lacking any health insurance were both 50% more likely to die when compared with privately insured patients—even after adjusting for factors that influence cancer outcomes. Medicaid patients were 80% more likely than those with private insurance to have tumors that spread to at least one lymph node. Recent studies show similar outcomes for breast and colon cancer.

• Major surgical procedures: A 2010 study of 893,658 major surgical operations performed between 2003 to 2007, published in the Annals of Surgery, found that being on Medicaid was associated with the longest length of stay, the most total hospital costs, and the highest risk of death. Medicaid patients were almost twice as likely to die in the hospital than those with private insurance. By comparison, uninsured patients were about 25% less likely than those with Medicaid to have an "in-hospital death." Another recent study found similar outcomes for Medicaid patients undergoing trauma surgery.

• Poor outcomes after heart procedures: A 2011 study of 13,573 patients, published in the American Journal of Cardiology, found that people with Medicaid who underwent coronary angioplasty (a procedure to open clogged heart arteries) were 59% more likely to have "major adverse cardiac events," such as strokes and heart attacks, compared with privately insured patients. Medicaid patients were also more than twice as likely to have a major, subsequent heart attack after angioplasty as were patients who didn't have any health insurance at all.

• Lung transplants: A 2011 study of 11,385 patients undergoing lung transplants for pulmonary diseases, published in the Journal of Heart and Lung Transplantation, found that Medicaid patients were 8.1% less likely to survive 10 years after the surgery than their privately insured and uninsured counterparts. Medicaid insurance status was a significant, independent predictor of death after three years—even after controlling for other clinical factors that could increase someone's risk of poor outcomes.

In all of these studies, the researchers controlled for the socioeconomic and cultural factors that can negatively influence the health of poorer patients on Medicaid.

So why do Medicaid patients fare so badly? Payment to providers has been reduced to literally pennies on each dollar of customary charges because of sequential rounds of indiscriminate rate cuts, like those now being pursued in states like New York and Illinois. As a result, doctors often cap how many Medicaid patients they'll see in their practices. Meanwhile, patients can't get timely access to routine and specialized medical care.

The liberal solution to these woes has been to expand Medicaid. Advocacy groups like Families USA imagine that once Medicaid becomes a middle-class entitlement, political pressure from middle-class workers will force politicians to address these problems by funneling more taxpayer dollars into this flawed program.

President Barack Obama's health plan follows this logic. Half of those gaining health insurance under ObamaCare will get it through Medicaid; by 2006, one in four Americans will be covered by the program. A joint analysis from the Republican members of the Senate Finance and House Energy and Commerce Committees estimates that this will force an additional $118 billion in Medicaid costs onto the states.

We need an alternative model. One option is to run Medicaid like a health program—rather than an exercise in political morals—and let states tailor benefits to the individual needs of patients, even if that means abandoning the unworkable myth of "comprehensive" coverage.

Democratic and Republican governors are pleading with the president for flexibility to do just this. At least so far, this has been a nonstarter with an Obama health team so romanced by Medicaid's cozy fictions that it neglects the health coverage that Medicaid really offers, and the indecencies it visits on the poor.

Dr. Gottlieb is a clinical assistant professor at the New York University School of Medicine and a resident fellow at the American Enterprise Institute.

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« Reply #727 on: March 17, 2011, 08:41:17 PM »

WSJ:

The future tragedies of government health care will include today's many warnings about how it operates in practice. The subsidize-mandate-overregulate insurance model is imploding in Massachusetts. Then there's Washington state, where a government board may decide that modern medicine is too expensive for kids with diabetes.

Seriously. In 2006, Washington created a board to scrutinize the cost-effectiveness of various surgeries and treatments, known as the Health Technology Assessment program. At a hearing today, the panel will debate glucose monitoring for diabetic children under 18. In other words, the board is targeting the fundamental standard of diabetes care that has been the established medical consensus for at least three decades.

This state issue deserves far more scrutiny, if only because ObamaCare and the stimulus devoted billions of dollars to comparative effectiveness research. As President Obama has so often put it, the idea is to pit Treatment X against Treatment Y and find out "what works and what doesn't." In theory, it sounds great. But the Health Technology Assessment is an example of how comparative effectiveness will work in the real world, as the political system tries to find ways to restrict or limit treatment to control entitlement spending.

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 .Diabetes affects the body's secretion of insulin, the hormone that metabolizes sugar, and most kids with type 1 diabetes take multiple daily insulin injections or use insulin pumps. The best way to manage this chronic disease is with frequent self-monitoring and then calibrating the insulin dose to current blood-sugar levels. Patients do so either with finger sticks that are read by an electronic meter or continuous glucose monitors that track blood sugar levels virtually in real time.

The Health Technology Assessment has homed in on both technologies, claiming that the "effectiveness and optimal frequency of self-monitoring of blood glucose in patients is controversial." Not among physicians. But in a recent report, the panel suggests that there isn't enough "evidence" to support monitoring among childhood and adolescent diabetics, and that the randomized controlled trials that have been conducted aren't high quality.

Such a trial would violate medical ethics: A group of children would essentially be required to not monitor glucose—putting them at risk for long-run complications from too high or low blood sugar, including seizures and even death. Following a landmark 1993 trial on tight glycemic control, and the vastly improved outcomes since, the clinical benefits of intensive management are irrefutable.

Except, apparently, to a government board looking to scrimp. Washington's Health Technology Assessment makes decisions for state-subsidized health care, including Medicaid beneficiaries, public employees and prisoners—about 750,000 people. If it bans continuous monitors or limits finger sticks to a certain daily number at today's hearing, pediatric patients and their parents will lose the tools—and the more and better information—they need to manage their disease.

The most compelling reason to be worried about comparative effectiveness research is simple. Randomized trials are designed to find average results over large groups of people, but doctors do not treat averages. They care for individuals, and what works for the typical patient may not work for you or your diabetic child.

More to the point, as shown by the arbitrary Washington state method, political comparative effectiveness isn't about informing choices. It's really about taking away options. Note that all of the largest U.S. health insurers that Democrats like to claim hate treating sick people—Aetna, Cigna, WellPoint, UnitedHealth—cover diabetes self-monitoring. So do the local plans Premera Blue Cross and Regence Blue Cross Blue Shield.

Which brings us from Washington state to Washington, D.C. The Health Technology Assessment program's director, Leah Hole-Curry, was appointed last year as a governor of the comparative effectiveness board established by ObamaCare. The national board is known as the Patient-Centered Outcomes Research Institute, yet at an early meeting in November, Ms. Hole-Curry and the other 14 governors debated whether or not patients were the institute's "primary constituents."

Now this agenda is on autopilot. The institute is built on self-executing funding—that is, not subject to annual appropriations like other federal programs—and dedicated taxes on insurers. At the very least Americans deserve some honesty about who these people are and what they favor.

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« Reply #728 on: March 23, 2011, 01:18:31 PM »

Patient, heal thyself
A bottom-up approach to the biggest problem in government
Mar 17th 2011 | from the print edition
 IN ANY discussion about the role of the state, one subject soon dwarfs all others: health care. McKinsey points out that American spending on this has grown at an annual lick of 4.9% over the past 40 years, whereas GDP per person has grown by just 2.1%. Pessimists are convinced nothing can be done to restrain it. A refreshingly different perspective is provided by Sir John Oldham, a British doctor who is clinical lead for productivity in the National Health Service.

His view of what he calls the coming tsunami is as pessimistic as anybody’s. Health costs, he points out, are determined by long-term conditions—things like diabetes, heart disease, obesity and lung disease, which are usually linked to lifestyle and diet. Some 15m Britons suffer from such conditions, which take up 70% of “bed days” in hospitals.

The numbers of cases in other countries are equally worrying. They explain why America, which currently spends 16% of its GDP on health care (see chart 5), is theoretically on track to spend 100% of its GDP on health care by 2065, followed soon by Japan. China too has seen a huge rise in such conditions. They are no longer diseases of the old: in America, says Sir John, the Facebook generation is picking them up so rapidly that it might be the first not to live longer than its parents. But they are still mainly diseases of the poor, who live less healthy lives, smoking more, drinking more and consuming more salt and trans fats in processed food.

A hard-hearted economist might spot potential savings (especially on pensions) from people dying younger. But even he would be disappointed: any such savings would be wiped out by the adverse effect of such diseases on the productivity of the working-age population. One obvious way to alleviate this problem is to tax the things that are causing it: when governments are having to strengthen their ambulances to cope with heavier patients, it is time for a levy on cheeseburgers. But Sir John reckons that getting patients to help manage their illnesses might be even more promising.

Technology is starting to make this vastly easier. Futurists dream of small gadgets roaming people’s bodies and reporting their findings to computers, but lower-tech versions of this already exist. In one pilot scheme in Britain’s Stoke-on-Trent patients use fairly basic methods to record their own weight, cholesterol, blood pressure and so on every week and text the result to a computer, which tells them what to do about them.

This can be economically attractive, because the most expensive things in health care tend to be unscheduled visits to hospital. But it also improves people’s health. A patient is always around to monitor himself, and he will be highly motivated. A big study by the Cochrane Institute showed that among people who managed their own anticoagulant treatment, repeat blood clots declined by half; deaths from clots also fell.

Sir John suggests that the NHS should set up an incentive scheme for its workers to lead healthier lives that would create rewards (or, as he likes to call them, “care miles”). That would set a good example. But for the biggest employer in the country it could also save a lot of money.
The Economist welcomes your views.

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« Reply #729 on: March 25, 2011, 01:22:40 PM »

Health care mandates for everyone - except Bamster's friends:

****Michelle Malkin  •  March 25, 2011 10:39 AM

The Weiner Waiver Wormhole
by Michelle Malkin
Creators Syndicate
Copyright 2011

New York Democratic Rep. Anthony Weiner toasted the one-year anniversary of Obamacare this week — and accidentally spilled his champagne glass all over the disastrous, one-size-fits-all mandate. Ostensibly one of the federal health care law’s staunchest defenders, Weiner exposed its ultimate folly by pushing for a special cost-saving regulatory exemption for New York City.

If it’s good for the city Weiner wants to be mayor of, why not for each and every individual American and American business that wants to be free of Obamacare’s shackles?

Weiner joins a bevy of the “Patient Protection and Affordable Care Act’s” loudest cheerleaders — unions, foundations and left-leaning corporations — in clamoring for more waivers for favors. (The list of federal waiver recipients now tops 1,000, covering more than 2.6 million workers.) And he follows a gaggle of health care takeover-promoting Democrats maneuvering on Capitol Hill for get-out-of-Obamacare loopholes.

At a speech before the George Soros-supported Center for American Progress, as reported by Politico.com, Weiner revealed that he’s “in the process now of trying to see if we can take (President Barack Obama) up on” a favor waiver and is “taking a look at all of the money we spend in Medicaid and Medicare and maybe New York City can come up with a better plan.” Echoing all the Republican critics of Obamacare who objected to top-down rules that override local variations in health care expenditures, Weiner explained: “I’m just looking internally to whether the city can save money and have more control over its own destiny.”

More local control over taxpayers’ destiny, eh? Give that man a “Hands Off My Health Care” sign, a Gadsden flag and a tea party membership card ASAP!

I kid, of course. The ultimate agenda of many waiver-seekers is to create a wormhole path to even more radical restructuring of the health system. Weiner has brazenly called for a single-payer “public option” to replace Obamacare should it be repealed. Democratic Sen. Ron Wyden of Oregon has also crusaded for more Kabuki “flexibility” in the law through a bipartisan state waiver proposal.

But as The Heritage Foundation noted, the plan “simply changes a date on an existing ‘state innovation’ provision of Obamacare from 2017 to 2014 — still well after the federal Obamacare infrastructure has been cemented in place.” And it is essentially “a back-door vehicle for progressive states to enact the ‘public option’ and speed up the establishment of a single-payer system for health care.” White House health care advisers Nancy-Ann DeParle and Stephanie Cutter further reinforced in a conference call to liberal advocates that the bill would help states implement single-payer health care plans, such as those tested in Connecticut and Vermont.

Weiner argues that the waiver process dispels “this notion that the government is shoving the bill down people’s throats.” But only the politically connected, deep-pocketed, lawyered-up and Beltway-savvy can apply. And the White House refuses to shed more light on its decision-making process. Obama’s selective favor waivers simply underscore the notion that unaccountable regulatory bureaucrats are presiding over government by the cronies, for the cronies and of the cronies.

Real control over our destinies means flexibility and choice for all. Repeal is the ultimate democratic waiver.****

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« Reply #730 on: March 29, 2011, 09:51:06 AM »

Replace ObamaCare With Health Savings Accounts

Mar. 26 2011 - 1:12 pm | 5,209 views | 0 recommendations | 13 comments
As we pass the one year anniversary of the passage of the Patient Protection and Affordable Care Act, lovingly known to most as ObamaCare, and with a repeal movement trying to get into full swing, it’s worth revisiting what could have been, and what could still be.  Simply repealing ObamaCare might save the country from the certain financial and health care disasters it would bring, but repeal alone doesn’t address the noble goal of ensuring as many people as possible, and the necessary goal of curbing runaway health care inflation.  There is another way.

It’s vital to understand that the twin problems of uninsured Americans and exploding costs were not caused by the lack of a federal solution to health care.   Quite to the contrary, it is precisely the government’s involvement in this sector of the economy that has caused these problems.    Numbers released by the U.S. Centers for Medicare & Medicaid Services back in January place the government’s share at a little over 43% of 2009’s total health care spending, although Cato Institute’s Michael Cannon wonders if the numbers should be closer to 50%.   Consider this contrast:  Senator Jim De Mint has proposed a balanced budget amendment that would limit government spending to 20% of GDP, and that has many on the left (and the right, but for different reasons) completely apoplectic.   Apparently 20% of the entire economy is too little for the left but nearly half of a huge sector of our economy is just fine.   But more on government’s meddling later.

The root causes by example

For almost anyone having health insurance, the exact cost of services delivered is rarely questioned.  When your doctor says, “We’re going to order some tests…”, or, “I’d like you to get an MRI…”,  you probably reply “OK, sure.”.   Let’s assume that these tests and scans are unquestionably required.  There may be several labs in the area that could do those tests, or a few different facilities with MRI equipment, but more than likely, you’ll take your doctor’s recommendation (“we have a lab right down the hall”) and go through the motions.

With almost any other purchasing decision, it would not be uncommon to shop around for your personally desired mix of quality versus price versus service versus location versus whatever.

However, for some reason, we’ve allowed our medical care transactions to be treated differently.  With a lot of insurance plans, the aforementioned tests and MRI’s probably won’t even be billed to you.   You’ll never know what they really cost.

But what of the situation that precipitated those tests?   Perhaps it was a physical, which being a responsible person you’ve had annually for as long as you remember.   Similarly, you probably change the oil in your car on a regular basis.

Do you file a claim with your auto insurance company to change your oil?

And there you have two of the major reasons health care is so expensive, and why health insurance, which isn’t the same as health care, is equally so.

Now few people would suggest that you should question your doctor’s every recommendation.  You’d find your customer or boss questioning your every action equally irritating and disrespectful.   And few people would argue for skipping annual physicals on a regular basis as a cost-saving measure.

But in health care have we somehow reached a place where we use insurance to pay for things that have very high probabilities of occurring.    Insurance was invented to protect against calamities that hopefully never happen.   Companies that sell insurance employ armies of people who try to predict the likelihood of these calamities.   Given a probability, pricing the insurance is then pretty straightforward, and given an accurate probability, the product can be offered at a consistent level of profit, one that allows the insurance company to be there when you need it.

Here’s where things go awry.

If an insurance company is certain that they’re going to pay, say, $2,500 in claims on a policy each year, then they need to collect at least $2,500 just to have a prayer of staying in business.    In fact, with their own costs of salaries, taxes, rents, records-keeping, their own employee benefits and so on, they might need to collect $5,000 just to have anything left over after paying out that $2,500.

“Well that sounds kind of stupid, having to send the insurance company $5,000 just so they can send $2,500 of it back.”

Hold that thought.  Enter,  Health Savings Accounts.

Separating Health Care from Health Insurance

Only Health Savings Accounts distinguish the “care” from the “insurance”.     They are different issues, and they require different solutions.

To demonstrate the difference, say you currently have a traditional “family plan” through your employer that costs the employer $12,000 a year.     Your employer is very generous, and pays for all of it.   You see whatever doctors you want, and make “co-payments” of $25 per doctor visit.   Beyond that, it’s basically all you can eat — the buffet line starts to your left.

With a Health Savings Account, your employer still spends $12,000 a year (in actuality, probably less).   But they take $5,000 of the $12,000 and put it into an account with your name on it.   The money is now legally yours.  It’s a form of compensation.  With the remaining $7,000, they buy a “High Deductible Health Plan“, whose deductible just happens to be $5,000.   The HDHP covers you in full for any unlikely tragedy that should it occur, would be financially devastating.

When you go for your physical, since it’s a non-risk, near-certain probability event, you pay for the physical with a plastic card linked to your HSA.   Here’s the kicker:  since that $5,000 is your money, whatever balance you have at the end of the year is yours to keep.   Note that this is distinctly different from “Flexible Spending Accounts” that many people have, which have a “use it or lose it” aspect to them (thus making them the local eyeglass store’s best friend in December).

Next year, your employer deposits another $5,000 into the account and the process repeats.    Over time, the balance in the HSA account can grow, and it’s yours to keep if you change employers.   And hopefully, the health tragedy that your high-deductible plan would cover in full, never happens.

Now you’re in a whole new world.

Suddenly you’ll pocket the difference in price between one provider of lab work, and a cheaper but totally acceptable alternative.    Under a system of widespread HSA’s, labs would start advertising their services and prices to the retail customer.   MRI service providers would do the same, as would doctors’ offices.

Can’t evaluate one lab versus another?   A lot of people might be in that category, so a new company would pop up that would do that for you — the “Consumer Reports” of lab comparisons, if you will.  You might even pay more for a lab that had a certain level of certification that you trusted.   Think the certifying company might be corruptible?    Any more so than your local government agency that might otherwise be mandated to do the same thing, paid for by additional tax dollars from you?

Of course, many different types of High Deductible Plans would be offered to cover the catastrophic events, some of which might have their own additional limitations or costs, in return for an even lower annual rate.   Just as the labs and MRI providers would undoubtedly compete for business, the insurance companies, returning largely to the business of pricing risk, not certainty, would have every incentive to compete as well.   We want to allow the insurance companies to beat each other up in the marketplace, rather than beat us up.

“But wait a minute.” you say.  “In your example, I might have to spend $300 on the physical, where right now I only make a $25 co-payment”.   True, but where did the $300, or the $25, come from in the first place?   In both cases, your employer is the originator of the money, as they are funding the full $12,000.   But with the HSA, you have an incentive to retain as much of the $5,000 each year as you can.  With the traditional plan and the $25 co-payments, you don’t.   The concept is the same even if you have to pay a portion of your health insurance costs from each paycheck, as is the more typical case.

Some history, and the future

Remember, our current system of indirect payments for medical care came about as a result of World War II wage controls, under which employers realized they could raise an employee’s “compensation” by paying for their medical insurance.   Since then, endless additions of regulations and stipulations on what must be covered, and how insurance can be sold, have straitjacketed the free market’s ability to work its wonders in the health care sector of our economy.  Nowadays, the often “gold-plated” medical benefits given to some unions in lieu of higher wages are killing state budgets.  ObamaCare, at its core, just enlarges the very system we already have, the system that is both fundamentally broken and bankrupting us.   It can not work.

By contrast, in places where HSA’s are being offered, people are voluntarily flocking to them.  For example, in the state of Indiana, 70% of state employees have switched into HSA’s. The state is projected to save over $20 million in 2010 because of this, and the employees have accumulated over $30 million in their HSA’s since the plan’s inception.   Ironically, using HSA’s can achieve what was originally intended after the WW II wage controls: they can increase an employee’s total compensation, but in an actuarially sound way.

That’s not to say that we should force all Americans into HSA’s.  For certain people, they may not make sense.  All that says is that any employer should simply offer HSA’s as an option to their existing health care choices, and allow the employees to decide for themselves.

“Well it all sounds intriguing Zarras, but what’s the catch behind all this?”   The catch is that suddenly you and your doctor are in much greater control of your health care.    Since most of your spending is going to be on non-catastrophic events, your insurance company rarely enters into the picture.   Also absent are many of the rules and restrictions the government would want to put on your insurance plans and the way you go about purchasing and using them.

And there you have the reason why big-government politicians loathe these plans: their role in your health care is dramatically reduced.

http://blogs.forbes.com/deanzarras/2011/03/26/replace-obamacare-with-health-savings-accounts/
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« Reply #731 on: March 29, 2011, 11:42:43 AM »

Second post.

Bwahaha:

White House Hit with FOIA Lawsuit Over Obamacare Waivers
11:30 AM, MAR 23, 2011    • BY MARK HEMINGWAY

Crossroads GPS, the policy arm of Karl Rove's American Crossroads PAC, just dropped a lawsuit on the Obama administration:

Today, a law firm representing Crossroads Grassroots Policy Strategies (GPS), a nonprofit conservative issue advocacy organization, filed a lawsuit against the U.S. Department of Health and Human Services (HHS) in the United States District Court for the District of Columbia, over the department’s repeated failure to comply with the Freedom of Information Act by providing information about the department’s granting of waivers from the Patient Protection and Affordable Health Act, also known as Obamacare.

The lawsuit seeks judicial enforcement of a FOIA request for “any and all memoranda, guidance, directives, instructions and other documents … relating to the criteria to be applied by HHS in deciding whether to grant or deny applications for waiver of the annual limit requirements” ordered by the Obamacare law.

“The Obamacare waiver program has all the same flaws as the underlying law: unfettered government power, federal bureaucrats picking winners and losers, and the appearance, if not the reality, of favoritism to political cronies,” said Steven Law, president of Crossroads GPS. “Until President Obama is willing to grant the entire country a waiver from Obamacare, his Administration needs to come clean on how they decide who wins and losers in the waiver lottery.”

 Crossroads GPS submitted its FOIA request to HHS on January 7, 2011, and HHS acknowledged its receipt of the request on January 11, 2011. After repeated attempts by letter, phone, email and fax to generate action on the request, no action has been taken, despite the 20 day statutory limit on fulfilling FOIA requests.

So far the administration has issued over a thousand waivers, with no clear guidance as to who's elligible to duck the law. This lawsuit could result in a treasure trove of politically embarassing information.

http://www.weeklystandard.com/blogs/white-house-hit-foia-lawsuit-over-obamacare-waivers_555381.html

Suit PDF here:

http://crossroadsgps.org/sites/default/files/HHS%20FOIA%20Complaint.pdf
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« Reply #732 on: March 29, 2011, 11:44:46 AM »

Third post.

Obamacare's small business impact:


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« Reply #733 on: March 30, 2011, 08:49:30 AM »

http://reason.com/blog/2011/03/29/fixing-the-doc-fox
Reason Magazine


Fixing the Doc Fix

Peter Suderman | March 29, 2011

At the end of this year, Medicare’s physician reimbursement formula calls for doctors to face a 29.5 percent fee cut. Needless to say, it’s a near certainty that this won’t happen. Since 2003, Congress has consistently passed overrides to the cuts dictated by the formula, known as the Sustainable Growth Rate. Last year alone, Congress passed five short-term extensions, including a 13-month extension that keeps rates from dropping until 2012.

This problem has become known as the “doc fix,” and in his most recent budget proposal, President Obama called for a permanent fix. But his ten-year proposal only pays to keep physician’s rates from dropping for two years (and it does so with cuts that are spread out over a complete decade, meaning we'll have spent the money before the cuts pay off).

Neither Democrats nor Republicans are terribly interested in letting doctors’ Medicare payment rates fall, hence the regular overrides. Doing so would anger two powerful interest groups: physicians and seniors. Given that the president and both parties want to ensure that the fees don’t drop, one has to operate under the assumption that they won’t. Somehow, reimbursement rates will be kept at (or at least near) current levels.

But that means coming up with money to pay for those higher fees. How much money? According to the Congressional Budget Office, the cost, which continues to grow the longer Congress delays a fix, is now about $380 billion. The problem is that these days, pay-fors—revenue raisers or spending offsets that could be used to fund the fix—are hard to come by. That’s why the president proposed a decade-long series of snips in order to pay for extending current rates by just two years. And why are pay-fors so hard to come by? Because the biggest, most obvious Medicare cuts—about $500 billion worth—were used to fund last year’s health care overhaul. (And it should be noted that even those cuts are far from certain to go through and actually pay off as projected.)

If you presume that the doc fix will be funded somehow—even if it means more short-term extensions and deficit spending—then you have to think of this as irresponsible on the part of President Obama and the Democratic members of Congress who voted for the health care overhaul. They had a $380 billion problem to fix within Medicare, their existing system. But after coming up with changes that they believed would reduce the cost of that system by about $500 billion, they ignored the problem they already had and spent the money on a new entitlement instead. 
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« Reply #734 on: March 30, 2011, 09:24:22 AM »

2nd post:

Hamburger on Waivers — Part III
Jonathan H. Adler • March 20, 2011 3:42 pm

Columbia Law’s Philip Hamburger has a third essay on the constitutional problems with the issuance of waivers under the health care reform law.  (Here are my posts on I and II.) The Department of Health and Human Services has given out over 1,000 waivers of various requirements thus far, and more are surely on the way.  Setting aside the general constitutional objections to waivers of regulatory requirements, Hamburger argues that if, as I would argue, waiver authority must be delegated by Congress, some of the waivers issued thus far remain legally problematic.

The constitutional defense of the health-care waivers has thus far been a defense of waivers in general, without attention to the realities of the health-care statute. As a result, the defense of the waivers not only is wrong on the Constitution but also is irrelevant to the statutory realities. . . .

the health-care statute says nothing about granting HHS a power to waive the restricted annual limits. As reported by David J. Shestokas, congressman Cliff Stearns of Florida — chairman of the House Energy and Commerce subcommittee on oversight and investigations — complained, “The word ‘waiver’ is not in there. We can’t find it anywhere.”

Of course, Congress could have granted the power to waive the restrictions in a more subtle manner — for example, as part of the substantive authority granted to the secretary of HHS to determine the restricted annual limits. But statutory provisions must be understood in their statutory context, and this context shows that when Congress sought to give the secretary a waiver power, it had no difficulty doing so expressly. For example, in its provision on state innovation, the statute specifies that “The Secretary may grant a request for a waiver . . . ” In contrast, in its provision on restricted annual limits, the statute does not say anything of the sort. Evidently, Congress did not delegate a waiver power for the restricted annual limits.

I find Prof. Hamburger’s statutory arguments more compelling than the blanket constitutional argument against waiver authority.  Agency authority to waive statutory or regulatory requirements should come from Congress. If, as Hamburger claims, HHS has granted waivers where it lacked clear statutory authority to do so, this would be problematic, but it is not clear who, if anyone, would have standing to challenge the waiver.

UPDATE: The NYT has more on the waiver debate:

Obama administration officials say they were expecting praise from critics of the new health care law when they offered to exempt selected employers and labor unions from a requirement to provide at least $750,000 in coverage to each person in their health insurance plans this year.Instead, Republicans have seized on the waivers as just more evidence that the law is fundamentally flawed because, they say, it requires so many exceptions. To date, for example, the administration has relaxed the $750,000 standard for more than 1,000 health plans covering 2.6 million people. . . .

Waivers are usually seen as a way to deal with exceptional circumstances in which the enforcement of a law or policy might cause hardship. But with the new health care law, exceptions like these have become increasingly common. They provide wiggle room in a law originally thought to be strict and demanding.

http://volokh.com/2011/03/20/hamburger-on-waivers-part-iii/
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« Reply #735 on: March 31, 2011, 12:43:21 PM »

http://reason.com/blog/2011/03/03/whoops-medicare-makes-48-billi
Reason Magazine

Whoops! Medicare Makes $48 Billion in "Improper" Payments

Peter Suderman | March 3, 2011

Your waste, fraud, and abuse factoid of the day: The federal government spent just a hair over $500 billion on Medicare payments in 2010—and nearly 10 percent of that spending was improper for some reason, including fraud, according to a new report by the Government Accountability Office.

Medicare, which the GAO notes is already on an “unsustainable” long-run path, shelled out an estimated $48 billion in "improper payments" last year—and, the report says, those in charge of the program aren’t doing nearly enough to avoid making similar payment mistakes in the future. In fact, the $48 billion figure is probably low, because it doesn’t include any improper payments from the Medicare Part D prescription drug benefit.

Even still, it’s enough for the government watchdog to warn that Medicare suffers from “pervasive internal control deficiencies.” Consequently, the GAO has dubbed Medicare a “high risk” program “because its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges.”

It’s not clear how much of the problem is related to fraud and how much is related to internal factors, and some Republicans seem upset about the lack of clarity on that front. The inability to tell which is which is a sign of how little oversight there is in the program’s payment system, but I’m not sure there’s much comfort to be had here either way: A system that loses tens of billions of dollars each year to sloppy, incompetent management is arguably even worse than one that’s been willfully defrauded by clever schemers. It’s one thing to lose a truckload of taxpayer money when someone is making a concerted effort to bilk you out of it. It’s another thing entirely to lose it because you were so inept that you couldn’t keep track of it.

This is the sort of thing to remember when single-payer supporters talk up Medicare-For-All. Yes, Medicare remains popular, but it’s incredibly wasteful and has severe, ongoing management problems. As GAO notes, this isn’t the first time tens of billions in waste has been found in the system; when the program was examined in 2007, GAO found similarly problematic spending patterns, and recommended changes accordingly. But Medicare’s administrators have failed to effectively follow up on the bulk of the oversight office’s suggestions since then. Expand Medicare, especially to the point where it has a monopoly or near-monopoly, and you’re only going to expand this sort of waste and mismanagement.

That’s obviously not to say that private insurers have no waste, no mismanagement. But they differ from Medicare in two important ways: First, they can go out of business. If they consistently lose money due to incompetence, it won’t take long before they shut down. Second, those dealing with private insurers can leave for competitors if poor management forces prices up too high. Now, competition in the health insurance is far from perfect, and occurs mostly at the employer level. But as anyone who’s ever had to switch plans after their employer went to a new insurance provider knows, it does exist, and employers do make changes when they think they can get a better deal from another provider. But Medicare doesn’t have that sort of competition, and and it continues to run on the taxpayer’s dime regardless of how poorly managed it is—all of which helps explain why it wastes so much money on mismanagement and how it ended up on the unsustainable, fiscally ruinous course it’s on now.
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« Reply #736 on: March 31, 2011, 12:48:33 PM »

Remember those rotten, profit driven insurance companies driving up health care costs? Their profit is one quarter of what the GAO says Medicare misallocates.

Medicare Loses Nearly Four Times as Much Money as Health Insurers Make
3:48 PM, MAR 3, 2011    • BY JEFFREY H. ANDERSONSingle PagePrintLarger TextSmaller Text
In a newly released report, the Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4.


This is sobering news for the minority of Americans who (for some reason) continue to think that government-run health care is a model of efficiency and cost-effectiveness. Last year, total outlays for Medicare were $509 billion; therefore, Medicare spent nearly 10 percent of its outlays on fraudulent or improper claims. Actually, it may have been even worse than that: The GAO writes that this $48 billion in taxpayer money that went down the drain doesn’t even represent Medicare’s full tally of lost revenue, since it “did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount.”   

The combined profits of the nation’s ten largest health insurers are down 2 percent from 2008. In fact, the nation's ten largest health insurers’ combined profits last year were less than the profits that Walmart — a supporter of Obamacare — made all by itself.  Walmart made $14.3 billion last year, up 12 percent from 2008. (On the Fortune 500 list, Walmart’s profits also dwarf the profits of all but one oil company.)

True, private insurers may never manage to make nearly as much money as government-run heath care programs manage to lose. Still, there is good news on the horizon for insurers: If Obamacare isn’t repealed, then, as of 2014, every American will be required to buy their product (or a federally mandated version of it) under penalty of law. Moreover, the Congressional Budget Office estimates that $1 trillion would be funneled from taxpayers, through Washington, to those same insurers, from 2014 to 2025. Ever wonder why insurers didn’t oppose Obamacare?

http://www.weeklystandard.com/blogs/medicare-loses-nearly-four-times-much-money-health-insurers-make_552860.html
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« Reply #737 on: April 06, 2011, 10:50:53 PM »

How ObamaCare Strokes the Fat Cats by Michael D. Tanner
from Cato Recent Op-eds

When government says it's set to do something for the little guy, hang on to your wallet.

The latest evidence for this came in a congressional report released last week, showing that the seniors lobby (and insurance giant) AARP stands to make more than $1 billion as a result of ObamaCare.

The game works this way: The new health-care law contains more than $136 billion in cuts to the Medicare Advantage program, which now covers one in five seniors. As a result, according to Medicare's chief actuary, at least 7 million seniors will be forced out of their Medicare Advantage plan and back into traditional Medicare.

But since traditional Medicare lacks several Medicare Advantage benefits, many will have to buy so-called "Medigap" policies to make up the difference. And who's the nation's largest marketer of Medigap plans? The AARP.

An 18-month congressional probe found that the AARP stands to make $55 million to $166 million in one year alone from seniors switching from Medicare Advantage to AARP Medigap plans. Over the next 10 years, it would earn more than $1 billion from new customers. Business is good if you can get the government to put your competitors out of business.

The AARP isn't the only big ObamaCare winner to come to light in the last few days. A hearing by the House Energy and Commerce's Subcommittee on Oversight and Investigations disclosed that labor unions and big businesses — including General Electric, Verizon, AT&T and IBM — have received nearly $1.9 billion in payments under the new health-care law to help offset health-insurance costs for early retirees.

The biggest single recipient: the United Auto Workers, which got nearly $207 million in taxpayer money. By the time the feds finish handing out funds to well-connected companies and unions, it's expected to have cost taxpayers $5 billion.

The program doesn't even require companies or unions to demonstrate any "financial need" for the subsidy. As a result, it enables companies to incentivize early retirement for older employees, saving the companies money and improving their balance sheets — with taxpayers footing the bill.

This is nothing new, of course. ObamaCare has benefited special interests and big businesses from the start. The major pharmaceutical firms got a requirement that all insurers must cover their products. That's one reason why Big Pharma spent more than $150 million on ads in favor of the bill.

Other provider groups and beneficiary constituencies are pursuing a similar strategy. They've been lobbying a government panel that will determine the benefits that must be included in every insurance plan. At recent hearings, interests ranging from the in-vitro-fertilization industry to autism groups showed up to demand their share of the spoils.

Even large insurers played the game: They got a mandate requiring everyone to buy their product. Sure, they'll have to adjust to some costly new regulations, and those added benefits will be expensive, but they can simply pass the costs on to consumers via higher premiums. After all, what can consumers do? If they decide not to buy insurance, the government will punish them.

Nor should we forget that politically connected firms and unions have regularly received waivers from ObamaCare's worst provisions.

So one year in, ObamaCare's big winners are becoming clear: Big Business, Big Labor and special-interest lobbies. The only losers are the American people.

Michael Tanner, a Cato Institute senior fellow, is co-author of Healthy Competition: What's Holding Back Health Care and How To Free It.

http://www.cato.org/pub_display.php?pub_id=12951
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« Reply #738 on: April 07, 2011, 03:22:55 PM »

Wash. Post, CBS, NBC Should Disclose Receipt of ObamaCare Subsidies
from Cato @ Liberty by Michael F. Cannon
1 person liked this
By Michael F. Cannon

It's not an easy period for major media organizations, what with all this creative destruction revamping that sector of the economy.  So the Washington Post Co. couldn't help but be pleased when it received a $570,000 bailout from ObamaCare's Early Retiree Reinsurance Program.  That program allows the Obama administration to run up the national debt another $5 billion by doling out cash to corporations that provide retiree health benefits.   The CBS Corporation received more than $720,000.  General Electric, a part owner of NBC Universal, Inc., cleared nearly $37 million.

Since The Washington Post, CBS News, NBC News, and MSNBC have now received subsidies (the latter two indirectly) from this very controversial law, their reporters should disclose that fact to their audiences when reporting on ObamaCare.  A disclaimer like this should suffice: "The Washington Post Corporation has received subsidies under the health care law."  That would be consistent with how NBC discloses its relationship with General Electric:

http://www.thedailyshow.com/watch/thu-march-24-2011/family-matters

Oh, and kudos to the marketing whiz who decided to call all these ObamaCare spending programs "slush funds."

http://www.cato-at-liberty.org/wash-post-cbs-nbc-should-disclose-receipt-of-obamacare-subsidies/
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« Reply #739 on: April 22, 2011, 07:20:47 AM »

WHAT does Medicaid have in common with “I Dream of Jeannie,” “Lost in Space” and “Get Smart”? They all made their debut in 1965. Although we enjoy watching reruns of these classics, the television networks have updated their programming. The federal government should do the same.

In recent years Washington has taken an obsolete program, which covers health care for low-income Americans, and made it worse through restrictive rule-making that defies common sense. It is biased toward caring for people in nursing homes rather than in their own homes and neighborhoods. It lacks the flexibility to help patients who require some nursing services, but not round-the-clock care.

If we were designing a health insurance program for low-income families today, we would use a much different model to drive efficiency and innovation — one that recognizes that the delivery of health care is fundamentally personal and local.

Time and again states like Wisconsin have blazed the path in Medicaid — from giving individuals greater control over their care to expanding the use of electronic medical records — while the federal bureaucracy has lagged behind. Just now Washington is discovering accountable care organizations (networks of doctors and hospitals that share responsibility for caring for patients and receive incentives to keep costs down) and “medical homes” (a model in which one primary-care doctor takes the main responsibility for a patient).

Wisconsin has created a database of claims and payments that gathers information from all insurers, including private companies and the state Medicaid program. It allows people to compare cost and quality across providers. We have asked Washington to add its data to our database, but it has not done so.

We need to modernize not only Medicaid’s benefits and service delivery, but also its financing. In good times, the open-ended federal Medicaid match encourages states to overspend. Amazingly, the program is now viewed by some states as a form of economic development because each state can at least double its money for each dollar spent. That matching feature penalizes efficiency and thrift, since a reduction of $1 in state spending also means forfeiting at least one federal dollar, often more.

Medicaid in its present, outdated form is unsustainable. Without serious reform, it is unthinkable to add 16 million more people, as President Obama’s health care legislation would do. The White House budget would temporarily pay 100 percent of the costs of new Medicaid enrollees. As a result, many states would expand enrollment, deferring the hard decisions until the federal money goes away.

An alternative approach is to offer block grants for Medicaid, as my fellow Wisconsinite, Representative Paul D. Ryan, the chairman of the House Budget Committee, has urged. Why now support a block grant for Medicaid when similar proposals have failed?

First, we know from more than a decade of experience with welfare reform that switching from open-ended entitlements to block grants pushes both individuals and states to behave more responsibly.

Second, more than a decade of experience with the State Children’s Health Insurance Program, which has vastly expanded coverage for children while being more flexible than Medicaid, shows the success of the block-grant model.

Third, there are already caps within Medicaid through so-called Section 1115 demonstration projects. It is through such projects, known as waivers, that innovative programs like BadgerCare in Wisconsin and MassHealth in Massachusetts (which President Obama says was his model for reform) were built. States from Arizona to Washington have also had waivers that capped federal liability for Medicaid. Their success shows that we can move beyond demonstration projects and let the federal government relinquish control over Medicaid.

Finally, some state officials oppose block grants because capped financing would bring the fiscal discipline they try desperately to avoid. But this discipline is precisely what is necessary to slow the rate of growth in health care costs. It is unlikely that doctors and hospitals will support authentic cost-saving measures as long as they believe there is more money coming from somewhere.

States are not merely “laboratories of democracy,” but also sovereign governments under our system of federalism. Unfortunately, the encroachment of the federal government in Medicaid threatens to reduce states to mere agents.

Block grants would bring a truce to the tug-of-wars between Washington and the states. This is the best option for Medicaid, facing a midlife crisis, to survive.

Scott Walker, a Republican, is the governor of Wisconsin.

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« Reply #740 on: April 25, 2011, 12:45:59 PM »

I posted on Media Issues that WSJ editorial writer Joseph Rago won the 2011 Pulitzer Prize for Editorial Writing today. Here are the stories for which he won the award: Hot links for all at the link: http://online.wsj.com/article/SB10001424052748703916004576271222668393848.html

1) Back to the ObamaCare Future, March 1, 2010

2) The ObamaCare Crossroads, March 20, 2010

3) ObamaCare and the Constitution, April 2, 2010

4) Farewell, Medicare Advantage, June 11, 2010

5) The Avastin Mugging, August 18, 2010

6) ObamaCare 'Amnesia,' Sept. 10, 2010

7) Big Insurance, Big Medicine, Oct. 26, 2010

8.) Breast Cancer and the FDA, Dec. 17, 2010

9) Sebelius's Price Controls, Dec. 22, 2010

10) PolitiFiction, Dec. 23, 2010


« Last Edit: April 25, 2011, 01:36:40 PM by DougMacG » Logged
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« Reply #741 on: April 25, 2011, 08:23:07 PM »

http://reason.com/blog/2011/04/25/obamacares-cutthroat-corporati

ObamaCare's Cutthroat Corporatism

Peter Suderman | April 25, 2011

Prior to the passage of the Patient Protection and Affordable Care Act, many of the big players in the health care industry met with the White House in order to cut deals that would result in industry support. The logic, at the time, was that a health care overhaul was inevitable, and therefore it was more advantageous for industry groups to be seen as friendly towards the legislation than as oppositional. The White House, for its part, was at least somewhat anxious about the prospect of fighting a big-dollar industry campaign to kill the law (like the one that helped defeat HillaryCare), and so had an incentive to bring industry groups to the bargaining table.

We're still waiting for information on many of the negotiations that took place between the White House and various outside corporate and union groups. But it's fairly well established that the drug industry, through PhRMA, cut a deal to support the overhaul. In exchange, the White House promised to limit industry concessions to about $80 billion, and agreed that Medicare would not use its bargaining power as a pharmaceutical megapurchaser to negotiate cheaper prices on prescription drugs.

PhRMA saw the health care overhaul as a chance to advance its long-term interests and played along. But funny enough, it now seems that the White House is not all that interested in holding up its end of the bargain. President Obama's recent speech on the debt included proposals that would violate the agreement.

Drug industry sources tell FOX Business the Administration is backtracking on what is called the “PhRMA deal” in health reform, a deal that was struck behind closed doors in late 2009 and early 2010 in order to get the industry to support and endorse health-care reform.

In the “PhRMA” deal, drug companies would fork over $80 billion in fees as well as give drug discounts to seniors in Medicare over 10 years, among other things.

In exchange, the White House agreed, among other items, to not force the drug industry to accept rebates on drugs sold through Medicare Part D, a program launched under President George W. Bush to subsidize prescription drugs for seniors.

But President Barack Obama's new deficit push calls for those Medicare rebates, via the Simpson-Bowles plan.

The deficit plan "has blown the deal to smithereens," says William S. Smith, managing director of Healthcare National Strategies, a D.C.-based government affairs consulting firm. “The Obama Administration has repudiated the PhRMA deal,” says Smith, a former vice president for US public affairs and policy at Pfizer.

The Obama debt plan may not become law. But the fact that the president is willing to propose these deal-breaking measures at all suggests that the White House feels no obligation to honor the agreement. And why should the White House stick to its word? The incentive to play along disappeared the day the law passed. At this point, you have to wonder why PhRMA and other groups agreed to these non-enforceable deals in the first place. Either way it tells you a lot about the mangled state of America's quasi-government-run health care system: Industry makes a backroom deal to buy into new federal regulations out of self-interest, then, after the regulations pass, finds out that the government has no plans to stick by the agreement. It's cutthroat corporatism at its finest.
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Body-by-Guinness
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« Reply #742 on: May 02, 2011, 10:30:31 AM »

Doc Holiday

by Michael D. Tanner


This article appeared in The New York Post on May 1, 2011.


The United States already faces a growing physician shortage. As our population ages, we require more and more intensive health care. At the same time, enrollment in medical schools has been essentially flat, meaning we are not producing new physicians at anywhere near the rate we need to. In fact, according to the American Association of Medical Colleges, we face a shortfall of more than 150,000 doctors over the next 15 years.

And it could get a whole lot worse.

The health reform bill signed into law last year is expected to significantly increase the number of Americans with health insurance or participating in the Medicaid program. Meanwhile, an aging population will increase participation in Medicare. This means a greater demand for physician services.

romising universal health coverage is easy. But what does universal coverage mean if you can't actually see a doctor?
But at the same, the bill may drive physicians out of practice.

Existing government programs already reimburse physicians at rates that are often less than the actual cost of treating a patient. Estimates suggest that on average physicians are reimbursed at roughly 78% of costs under Medicare, and just 70% of costs under Medicaid. Physicians must either make up for this shortfall by shifting costs to those patients with insurance — meaning those of us with insurance pay more — or treat patients at a loss.

As a result, more and more physicians are choosing to opt-out of the system altogether. Roughly 13% of physicians will not accept Medicare patients today. Another 17% limit the number of Medicare patients they will see, a figure that rises to 31% among primary care physicians. The story is even worse in Medicaid, where as many as a third of doctors will not participate in the program.

Traditionally, most doctors have been willing to take some Medicare patients either out of altruism or as a "loss leader," to reach other family members outside the Medicare program. Others try to get around Medicare's low reimbursement rates by unbundling services or providing care not covered through the program. (Nearly 85% of seniors carry supplemental policies to cover these additional services). With many office and equipment costs fixed, even a low reimbursement patient may be better than no patient at all for some doctors. This is even more true for hospitals where Medicare patients may account for the majority of people they serve. And doctors can take some comfort in the fact that Medicare is pretty much guaranteed to pay and pay promptly. The same is not always true of private insurance.

But if reimbursements fall much more, the balance could be tipped.

The government's own chief actuary says that reimbursement cuts could mean "reductions in access to care and/or the quality of care." Once the cuts hit hospitals, they too will be in trouble. Medicare's actuaries estimate that 15% of hospitals could close. Inner-city and rural hospitals would be hardest hit.

Nor is the pressure on reimbursement rates likely to be felt solely in government programs. The health care law contains a number of new regulations that are already driving up insurance premiums. The government is responding by cajoling and threatening insurers. If insurers find their ability to pass on cost increases limited, they too may begin to cut costs by cutting reimbursements.

For a lot of older physicians, retirement in Florida may begin to look like a very good option. Roughly 40% of doctors are age 55 or over. Are they really going to want to stick it out for a few more years if all they have to look forward to is more red tape (both government and insurance company) for less money? Those that remain are increasingly likely to join "concierge practices," limiting the number of patients they see and refusing both government and private insurance.

And, at the same time, fewer young people are likely to decide that medicine is a good career. Remember, the average medical school graduate begins their career with more than $295,000 in debt.

A 2010 IBD/TPP Poll found that 45% of doctors would at least consider leaving their practices or taking early retirement as a result of the new health care law. And, an online survey by Sermo.com, a sort of Facebook for physicians, found that 26% of physicians in solo practices were considering closing. Of course, not every doctor who told these polls that he or she would consider leaving the field will actually do so. But if even a small portion depart, our access to medical care will suffer.

In fact, we have already seen the start of this process in Massachusetts, where Mitt Romney's health care reforms were nearly identical to President Obama's. Romney's reforms increased the demand for health care but did nothing to expand the supply of physicians. In fact, by cracking down on insurance premiums, Massachusetts pushed insurers to reduce their payments to providers, making it less worthwhile for doctors to expand their practices. As a result, the average wait to get an appointment with a doctor grew from 33 days to over 55 days.

Promising universal health coverage is easy. But what does universal coverage mean if you can't actually see a doctor?
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prentice crawford
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« Reply #743 on: May 10, 2011, 07:57:52 PM »

Woof,
 This brought to you by the same government that will be running your healthcare:

           http://news.yahoo.com/s/ap/20110510/ap_on_re_us/us_postal_problems

              P.C.
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ccp
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« Reply #744 on: May 16, 2011, 09:58:51 AM »

By LAURA MECKLER
White House hopeful Newt Gingrich called the House Republican plan for Medicare "right-wing social engineering," injecting a discordant GOP voice into the party's efforts to reshape both entitlements and the broader budget debate.

More on Politics from WSJ
The New Speed of Politics in 2012 Fiscal Health Hinges on Containing Costs of Care Huckabee Declines to Endorse Anyone Rep. Ryan Weighs Run for the Senate Kyl May Be Open to Revenue Increases Medicare Stirs Fray Over Debt Full coverage at Washington Wire blog In the same interview Sunday, on NBC's "Meet the Press," Mr. Gingrich backed a requirement that all Americans buy health insurance, complicating a Republican line of attack on President Barack Obama's health law.

The former House speaker's decision to stick with his previous support for an individual mandate comes days after former Massachusetts Gov. Mitt Romney defended the health revamp he championed as governor, which includes a mandate.

The moves suggest the Republican primary contest, which will include both men, could feature a robust debate on health care, with GOP candidates challenging the Democratic law while defending their own variations.

On the List for 2012?
Read about the potential Republican presidential contenders.

View Interactive

More photos and interactive graphics Later Sunday, in an interview with the Wall Street Journal, he also acknowledged that many Republicans are uncomfortable with requiring insurance coverage but challenged them to offer an alternative solution. "Most Republican voters agree with the principle that people have some responsibility to pay for their costs," he said.

View Full Image

NBC / Associated Press
 
As Mike Huckabee exits, Newt Gingrich takes a shot at Paul Ryan's plan, and like Mitt Romney, supports the concept of a mandate to buy insurance.
Mr. Gingrich also said he would like to see the mandate implemented at the state level, with states experimenting with alternative approaches. But he said he should apply to all Americans.

The Republican presidential field is beginning to take shape after an unusually long delay, with former Arkansas Gov. Mike Huckabee saying he would skip the 2012 race and the other candidates beginning to engage in substantive policy debates.

Mr. Huckabee declined to endorse any of the remaining candidates. His decision opens the door for other Republicans to court the Christian conservatives who fueled the former Baptist minister's 2008 campaign.

Mr. Gingrich, who has fashioned himself as a policy wonk in recent years, instantly roiled an already controversial debate over the U.S.'s long-term budget picture. He said on NBC's "Meet the Press" that seniors should not be required to use a new Medicare program, as envisioned by the House GOP, but should be persuaded to voluntarily migrate to a better system.

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Associated Press
 
Paul Ryan
"I don't think right-wing social engineering is any more desirable than left-wing social engineering," he said when asked about a Medicare plan championed by House Budget Chairman Paul Ryan (R., Wis.) as an element of the party's 2012 budget proposal. He said he was against "radical change" on the right and the left.

The House GOP budget would privatize Medicare for Americans under age 55. When they reach retirement age, they would receive a government subsidy to buy a private insurance policy instead of participating in the existing government-run system. The subsidies' value likely would not rise as quickly as health care costs are expected to rise.

Ryan spokesman Conor Sweeney said in response to Mr. Gingrich that Mr. Ryan's plan is the only serious proposal for Medicare, which faces long-term financial crisis as health costs rise and Baby Boomers join the program's ranks. "The most 'radical' course of action on Medicare is to continue to cling to the unsustainable status quo," he said.

View Full Image

Associated Press
 
Mike Huckabee
The GOP budget cleared the House as part of a budget outline without a single Democratic vote, and Democrats have sought to use the policy as a line of political attack with voters.

Republican leaders have said they do not plan to write legislation that would flesh out details of the concept. But they also say the Ryan plan remains their position in budget talks with the White House and the Senate.

Other Republican candidates for president, including Mr. Romney and former Minnesota Gov. Tim Pawlenty, have applauded Mr. Ryan for showing leadership in putting together a budget plan, but have declined to endorse its elements.

In the interview with the Journal, Mr. Gingrich also said that in advocating for big changes to Medicare, House Republicans have failed to both come up with the right policy, and to properly sell it to the country. He said bad salesmanship was part of President Obama's problem in pushing his own health care plan. "Republicans should learn. There's a big lesson there," he told the Journal.

Mr. Gingrich also stuck with his past support for the central plank of the Obama health plan—the mandate to buy insurance.

In 1993, Mr. Gingrich said Americans should be required to have health insurance just as they are required to have automobile insurance. Back then, he endorsed the use of vouchers to help everyone buy insurance. He also endorsed the use of income-based vouchers to help everyone buy insurance.

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Body-by-Guinness
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« Reply #745 on: May 17, 2011, 10:07:41 PM »

Nearly 20 percent of new Obamacare waivers are gourmet restaurants, nightclubs, fancy hotels in Nancy Pelosi’s district
By Matthew Boyle - The Daily Caller   12:07 AM 05/17/2011
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Of the 204 new Obamacare waivers President Barack Obama’s administration approved in April, 38 are for fancy eateries, hip nightclubs and decadent hotels in House Minority Leader Nancy Pelosi’s Northern California district.

That’s in addition to the 27 new waivers for health care or drug companies and the 31 new union waivers Obama’s Department of Health and Human Services approved.

Pelosi’s district secured almost 20 percent of the latest issuance of waivers nationwide, and the companies that won them didn’t have much in common with companies throughout the rest of the country that have received Obamacare waivers.

Other common waiver recipients were labor union chapters, large corporations, financial firms and local governments. But Pelosi’s district’s waivers are the first major examples of luxurious, gourmet restaurants and hotels getting a year-long pass from Obamacare.

For instance, Boboquivari’s restaurant in Pelosi’s district in San Francisco got a waiver from Obamacare. Boboquivari’s advertises $59 porterhouse steaks, $39 filet mignons and $35 crab dinners.

Then, there’s Café des Amis, which describes its eating experience as “a timeless Parisian style brasserie” which is “located on one of San Francisco’s premier shopping and strolling boulevards, Union Street,” according to the restaurant’s Web site.

“Bacchus Management Group, in partnership with Perry Butler, is bringing you that same warm, inviting feeling, with a distinctive San Francisco spin,” the Web site reads. Somehow, though, the San Francisco upper class eatery earned itself a waiver from Obamacare because it apparently cost them too much to meet the law’s first year requirements.

The reason the Obama administration says it has given out waivers is to exempt certain companies or policyholders from “annual limit requirements.” The applications for the waivers are “reviewed on a case by case basis by department officials who look at a series of factors including whether or not a premium increase is large or if a significant number of enrollees would lose access to their current plan because the coverage would not be offered in the absence of a waiver.” The waivers don’t allow a company to permanently refrain from implementing Obamacare’s stipulations, but companies can reapply for waivers annually through 2014.

Café Mason, a diner near San Francisco’s Union Square, got a waiver too. When The Daily Caller asked the manager about the waiver and how the president’s new sweeping federal health care law was affecting his restaurant, he hung up the phone. The Franciscan Crab restaurant on Fisherman’s Wharf in San Francisco got a waiver. Its menu features entrees ranging from about $15 to $60. The Franciscan’s general manager didn’t return TheDC’s requests for comment.

Four-star hotel Campton Place got one too, as did Hotel Nikko San Francisco, which describes itself as “four-diamond luxury in the heart of the city.” Tru Spa, which Allure Magazine rated the “best day spa in San Francisco,” received an Obamacare waiver as well.

Before hanging up on TheDC, Tru Spa’s owner said new government health care regulations, both the federal-level Obamacare and new local laws in Northern California, have “devastated” the business. “It’s been bad for us,” he said, without divulging his name, referring to the new health care restrictions.

But, the spa owner wouldn’t talk about it or the reason his company sought a waiver. He hung up after saying, “I’ve got clients on the other line, good-bye.”

San Francisco Honda, which has two of its three locations in Pelosi’s district, and San Francisco’s Royal Motors Group both got waivers too. Neither called TheDC back.

Blue & Gold Fleet, which describes itself as “the Bay Area’s premier provider of Bay Cruise, Ferry Service and Motorcoach Tours,” got an Obamacare waiver approved in April. The tour service company didn’t return TheDC’s requests for comment.

Nightclub Infusion Lounge got an Obamacare waiver approved in April too. Infusion Lounge calls itself a “sophisticated nightlife destination” with “Asian inspired sub-rosa lounge, fashioned by Hong Kong’s hottest designer, Kinney Chan,” which makes for a “true ultra lounge catering to both dancing hipsters and young professionals looking to relax in style.” Infusion Lounge’s owners didn’t return TheDC’s requests for comment either.

Simco Restaurants and several other affiliated chains based in the area got waivers for their businesses as well. For example, Gordon Yoshida, the manager of memorabilia store Only in San Francisco, told TheDC that Sandra Fletcher of Simco walked him through the process of getting an Obamacare waiver. Fletcher did not return TheDC’s requests for comment.

Pelosi’s office did not respond to TheDC’s requests for comment either.

http://dailycaller.com/2011/05/17/nearly-20-percent-of-new-obamacare-waivers-are-gourmet-restaurants-nightclubs-fancy-hotels-in-nancy-pelosi’s-district/
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DougMacG
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« Reply #746 on: May 18, 2011, 07:01:51 AM »

I can pose this under constitutional questions as well, but in terms of health care policy, given the equal protection clause of the 14th amendment, why isn't a waiver for one - automatically a waiver for all?
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The Equal Protection Clause, part of the Fourteenth Amendment to the United States Constitution, provides that "no state shall ... deny to any person within its jurisdiction  the equal protection of the laws".[1]  The Equal Protection Clause can be seen as an attempt to secure the promise of the United States' professed commitment to the proposition that "all men are created equal"[2]  by empowering the judiciary to enforce that principle against the states.[3]  As written it applied only to state governments, but it has since been interpreted to apply to the Federal Government of the United States as well.
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Crafty_Dog
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« Reply #747 on: May 18, 2011, 10:11:42 AM »

This seems to me to be a very pertinent and troubling question.
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Body-by-Guinness
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« Reply #748 on: May 18, 2011, 12:34:27 PM »

Volokh is aslo nibbling at this, asking if the waivers count as political favors:

Are Health Care Waivers Political Favors?
Jonathan H. Adler • May 18, 2011 10:38 am

The Daily Caller reports that a substantial percentage of recent health care waivers issued by the Department for Health and Human Services have gone to businesses in Rep. Nancy Pelosi’s San Francisco district — and not just any businesses, but swanky spas, restaurants and nightclubs.

Does this story mean that health care waivers are being used for political purposes? We don’t know. The issuance of 1,000-plus waivers is a relatively short period has raised lots of questions. The problem is that HHS has not been sufficiently clear about the criteria it is using in its waiver decisions. As a consequence, it is difficult to know whether waivers are being used improperly. As I’ve written before (see, e.g., here, here, and here), I think waivers can be a valuable policy tool, so long as their use is guided by a clear, ascertainable standard for their use. Thus far, I don’t think that has been the case with waivers issued under the PPACA.

UPDATE: As a commenter notes below, one explanation for the large number of waiver applications for San Francisco businesses is “Healthy San Francisco”. As this story from the San Francisco Business Times explains:

Under Healthy San Francisco, all San Francisco businesses with over 20 employees must provide health care coverage or access to health care for its employees. Many employers opt to open a Health Reimbursement Account or HRA for its employees; those accounts are then used to reimburse employers for some health care costs.

The waivers that are granted for one-year periods are intended to protect employees from suffering any reduction in coverage because of suddenly increased premiums, and to limit how much employers need to pay in a given year for coverage. The federal Department of Health and Human Services has approved 1,372 waivers so far — almost 90 percent of the waiver requests it has received.

“We have mandatory health care expenditures. We are the only place I know of in the country that has that,” said Rob Black, executive director of the Golden Gate Restaurant Association. “Because we have a 100 percent expenditure rate, we are going to have a much higher take-up rate (of waivers) than the country as a whole. That is what is driving that.”

As for the standards upon which waivers are granted, I do not believe the two guidance documents linked in the comments (here and here) concerning the waiver program HHS created with interim final regulations last year provide much in the way of clear criteria. Further, as Columbia’s Professor Joseph Hamburger has argued, it is not clear the PPACA authorizes a wavier authority as wide-ranging as that which HHS has exercised.

Meanwhile, on Friday Nevada became the third state to receive a waiver for the PPACA’s requirements that insurers spend a minimum of 80 percent of premiums on care, following New Hampshire and Maine. Five more state waiver requests are pending.

http://volokh.com/2011/05/18/are-health-care-waivers-political-favors/
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DougMacG
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« Reply #749 on: May 20, 2011, 12:13:10 PM »

From the Newt discussion, thanks CCP, this is worth pursuing here:

Newt:"Citizens should not be able to cheat their neighbors by not buying insurance, particularly when they can afford it, and expect others to pay for their care when they need it"

CCP: Good point.  There is no easy answer to this.
...
CCP: People don't get insurance because they can't pay for it, can't get it (preexisting condition), or take a chance.

But all these groups know they can show up in an ER and they will get treated.
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Above on this thread page, Lawrence Tribe put it this way (in a BD post):  "Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system."
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I feel bad about posting my honest and accurate reaction to Tribe/BD: ("Bullsh*t") because that seemed to end the discussion, but as one healthy self-employed person with enough assets to be disqualified from state plans who now has lapse in coverage, I can say that none of the above is the reason.  In fact, the Republican counter-proposal to Obamacare of last year would have solved my problem, but Dems are not going to allow any partial fixes to pass while Utopia is pending in court.

I paid almost 20 years of major medical coverage when I went self-employed without receiving an insurance dime paid out toward my health care.  Now I desperately want to be covered again but can't find any plan to fit my need.  My illiquid assets are my coverage.  Yes I will be treated in any emergency room or any other medical facility and it will be FEE FOR SERVICE just like it was when I was covered and just like it is for ever other product or service I procure in the economy almost anywhere in the world.  That does not make me a leach on society.  I will be paying the bill.  Not Prof. Tribe or anyone else. 

I am victim of the 12 cent rule.  My experience is that every dollar 100% of every healthcare product and service I have procured was paid by me out of my pocket and watched like a hawk, in addition to the tens of thousands I paid in premiums.  But I pay 100% in a world where everyone else is paying only 0.12 of every dollar of service and don't give a rip what it costs.

Third party pay is the problem, not the solution.  I would LOVE to pay fair market value for medical services I can afford and medical coverage beyond what I can afford, but that would be beyond the value of any bond that Newt would require.
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When mandatory car insurance started, we also had the option of posting 'bond' up to minimum coverage in lieu of sharing risk with worse drivers.  That alternative should have been 'post assets of your choosing' - in a free society - and furthermore that partial freedom provision quietly went away once people became acclimated with mandatory insurance.


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