Ditch the insurance - "real health care reform"

South Portland doctor stops accepting insurance, posts prices online

Excerpt:

... the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.”

Ciampi expects more doctors will follow suit. Some may choose to run “concierge practices” in which patients pay to keep a doctor on retainer, he said.

Gordon Smith, a spokesman for the Maine Medical Association, wasn’t so sure, saying most patients either want to use the insurance they pay for or need to rely on Medicare and Medicaid.

Even with the loss of some patients, Ciampi expects his practice to perform just as well financially, if not better, than before he ditched insurance. The new approach will likely attract new patients who are self-employed, lack insurance or have high-deductible plans, he said, because Ciampi has slashed his prices.

“I’ve been able to cut my prices in half because my overhead will be so much less,” he said.

Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $75.

Comment: His homepage.

Stossel: "No-discrimination insurance isn't insurance. It's welfare."

In Praise of Discrimination in the Health Insurance Market

 Excerpt:

... discrimination is what makes insurance work. An insurance regime where everyone pays the same amount is called "community rating." That sounds fair. No more cruel discrimination against the obese or people with cancer. But community rating is as destructive as ordering flood insurance companies to charge me nothing extra to insure my very vulnerable beach house, or ordering car insurance companies to charge Lindsay Lohan no more than they charge you. Such one-size-fits-all rules take away insurance companies' best tool: risk-based pricing. Risk-based pricing encourages us to take better care of ourselves.

Car insurance works because companies reward good drivers and charge the Lindsay Lohans more. If the state forces insurance companies to stop discriminating, that kills the business model.

No-discrimination insurance isn't insurance. It's welfare. If the politicians' plan was to create another government welfare program, they ought to own up to that instead of hiding the cost.

Comment: On this day the the landmark SCOTUS Obamacare ruling is to be announced, this frames the discussion well! When it comes to economics, I'm basically a Libertarian

HSA plans on the rise

Choosing the Right Health-Care Plan

Excerpt:

At General Electric, rising costs are helping drive a conversion to high-deductible plans, which tend to have lower premiums and may prod employees to seek out cheaper forms of health care. One plan, for instance, has a $1,600 annual deductible for a single person, along with premium contributions and annual caps on out-of-pocket payments that vary according to the employee's income.

All of the plans offered by GE are paired with accounts that workers can use to cover the cost of the deductible, either a health reimbursement account to which the company contributes, or a health savings account (HSA) to which the employee contributes. Both can accumulate money tax-free.

Next year, such plans will be the only option for the roughly 300,000 active employees and dependents who receive coverage from GE. "We needed to do this to remain competitive" by starting to rein in health-care costs, says Ginny Proestakes, director of health benefits at GE.

Smaller employers like Watauga County, N.C., are following suit. The county will put all of its 280 employees and retirees into high-deductible plans. The county has seen a falloff in revenue from sources such as sales taxes because of the slow economy, while health costs continue to mount. "It's fundamental economics," says Deron Geouque, county manager. "We can't continue to absorb those increases."

The transition to a high-deductible plan can be abrupt for people like Debbie Jankowski, 38 years old, a school counselor in Racine, Wis. When a new contract with the school district kicked in July 1, the deductible for her family of five went from zero to $4,000. The midyear changeover didn't allow a chance to add more money to her tax-free flexible spending account or start up an HSA, she says: "It was such a shock."

Comment: My company's 2012 plans are high deductible.

The final desideratum of the New Deal welfare state

The Democrats and Health Care - An account of political self-destruction

Excerpts:

The passage of Barack Obama's health-care legislation in the spring of 2010 proved profoundly injurious to the president and his party in the November midterm elections. Studies conducted at Stanford University and the University of Minnesota agree that at least one-third of the 63-seat Democratic loss in the House of Representatives can be attributed to the electorate's negative reaction to the health-care bill—which suggests that the legislation was responsible for taking a bad election and turning it into a historic disaster.

Indeed, the determination of Democrats to push for the passage of health-care legislation may have created a new political dynamic in the United States. Since 1991, as I explained in an article published in the March 2010 issue of Commentary called "Health Care: A Two-Decade Blunder," Democrats have operated under a misperception—the misperception that health care was a winning issue for them. It has repeatedly led them to mistake voter concern for the economy for support for the Democratic health-care vision. In both 1992 and 2008, Democrats won the presidency in the midst of economic turmoil. And following both elections, Bill Clinton and Barack Obama saw their respective victories as a mandate to make a government-run health-care system—the final desideratum of the New Deal welfare state—a reality. Clinton's failure to get it and Obama's success in getting it led both men to spectacular midterm defeats.

...

In June 2009, according to the New Republic's Jonathan Cohn, chief Obama adviser David Axelrod briefed the president on polling numbers showing the unpopularity of his health-care plans, telling him that "these numbers are pretty discouraging—there's a political cost to this." Obama responded with a story of a cancer patient who lacked health insurance and told Axelrod, "Let's keep fighting."

In August 2009, Vice President Joe Biden and White House Chief of Staff Rahm Emanuel suggested that they turn away from health care to spare the party a political disaster. Obama refused, telling some of his aides, "I feel lucky." A month later, according to David Paul Kuhn of Real Clear Politics, Virginia Senator James Webb visited President Obama in the White House and "told him this was going to be a disaster." As Webb described it, Obama somewhat blithely "believed it was all going to work out." In retrospect, the preternaturally calm-in-a-crisis Obama celebrated in best-selling books like Game Change seemed less calm than bizarrely oblivious.

Comment: Word of the day (new word for me!): desideratum. The Dem health care plan (passed into law), commonly called Obamacare, is not better or less costly! Hopefully key provisions will die in the courts!

Pawlenty on Obamacare and Free Markets

Pawlenty: Obamacare repeal major part of presidential bid

Excerpt:

Gov. Tim Pawlenty, appearing on CNN's State of the Union with Candy Crowley Sunday morning, said repealing President Obama's health care overhaul would be a major part of his platform if he runs for president in 2012.

“I think Obamacare is one of the worst pieces of legislation passed in the modern history of the country,” said the outgoing GOP governor. “I'm doing everything I can in Minnesota to stop, delay or avoid implementation in my state, including signing an executive order saying we're not going to participate unless required by law or approved by me.”

Asked if repealing the health care overhaul would be a major part of his platform in a run for president, Pawlenty answered, “Yes.”

He then launched verbatim into phraseology he has been repeating recently on the subject: “I think having health solutions dragged into Washington, D.C., top down, command-and-control, bureaucratically run entitlement programs they can't afford are a bad idea. I like markets. I like people being in charge of decisions, not the Federal bureaucracy."

Comment: I see Pawlenty as more of a 2nd tier Republican candidate. Could be Mitt Romney's VP running mate. Should have been McCain's!

More Savings (NOT!) from Obamacare

Health Care Reform Blamed for Huge Hike in Premiums

Excerpt:

[Connecticut] has given Anthem Blue Cross and Blue Shield the go ahead to raise premiums by as much as 47 percent for some members, and says health care reform is the reason why.

Attorney General Richard Blumenthal sent a letter to Insurance Commissioner Thomas Sullivan on Oct. 6, asking what he called "excessive" increases were approved without full consideration of all the facts. His letter mentioned rate increases for both Anthem and Aetna.

The new rates took effect Oct. 1, and include increases from 19 percent all the way to 47 percent depending on the individual, the Hartford Courant reported.

Sullivan responded to Blumenthal saying the new rates included "very rich benefits" mandated by federal law.

"There is not one person in the state of Connecticut who will see an increase in their current premiums based on what the department approved for Anthem and Aetna," Sullivan said in a release. "The rates that were filed and approved reflect the current cost to deliver care and the impact of more comprehensive benefit designs required under the federal healthcare reform law. If the attorney general wants to complain to someone, he should complain to Congress."

People who were enrolled in the Anthem program prior to the increase will not see a change, according to the agency. The increased rates will be applied to new customers.

In a letter to Blumenthal, Sullivan said the rates granted were reduced from the company's original request of 39 percent to 58 percent increases.

"I find myself in an unprecedented place and time, as do my counterparts throughout the country, in overseeing one of the most far-reaching policy initiatives enacted by the federal government in recent history," Sullivan said in the letter. "It is unfortunate that this reform, while addressing insurer behavior, has provided little to no reform of the escalating costs of the health care delivery system."

Comment: Obama voters .... you believed a LIE!

20 Promises for $2,500: All Americans Now Await Lower Premiums Promised by Obama

Comment: Not gonna happen!

Virginia leads the legal challenges

Health Care: Cue Up the Legal Fights

Excerpt:

Folks in Virginia, according to the story, appear eager to challenge the bill on two other grounds as well — that Congress’s power to regulate interstate commerce does not extend to a bill this far-reaching, and that the bill conflicts with a state law saying that no Virginian shall be compelled to buy insurance.

“This is such an incredible federal overreach,” said Virginia’s attorney general, Ken Cuccinelli. Cuccinelli added, however, that there was “no rush” to enjoin the bill from taking effect, as the so-called “individual mandate” does not take effect until 2013.

Comment: Sic semper tyrannis

Fantasy in, fantasy out.

The Real Arithmetic of Health Care Reform

Excerpt:

ON Thursday, the Congressional Budget Office reported that, if enacted, the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but because it would raise some revenues and lower some costs, it would also lower federal deficits by $138 billion. In other words, a bill that would set up two new entitlement spending programs — health insurance subsidies and long-term health care benefits — would actually improve the nation’s bottom line.

Could this really be true? How can the budget office give a green light to a bill that commits the federal government to spending nearly $1 trillion more over the next 10 years?

The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out.

In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.

Gimmick No. 1 is the way the bill front-loads revenues and backloads spending. That is, the taxes and fees it calls for are set to begin immediately, but its new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending.

Even worse, some costs are left out entirely. To operate the new programs over the first 10 years, future Congresses would need to vote for $114 billion in additional annual spending. But this so-called discretionary spending is excluded from the Congressional Budget Office’s tabulation.

Consider, too, the fate of the $70 billion in premiums expected to be raised in the first 10 years for the legislation’s new long-term health care insurance program. This money is counted as deficit reduction, but the benefits it is intended to finance are assumed not to materialize in the first 10 years, so they appear nowhere in the cost of the legislation.

Another vivid example of how the legislation manipulates revenues is the provision to have corporations deposit $8 billion in higher estimated tax payments in 2014, thereby meeting fiscal targets for the first five years. But since the corporations’ actual taxes would be unchanged, the money would need to be refunded the next year. The net effect is simply to shift dollars from 2015 to 2014.

In addition to this accounting sleight of hand, the legislation would blithely rob Peter to pay Paul. For example, it would use $53 billion in anticipated higher Social Security taxes to offset health care spending. Social Security revenues are expected to rise as employers shift from paying for health insurance to paying higher wages. But if workers have higher wages, they will also qualify for increased Social Security benefits when they retire. So the extra money raised from payroll taxes is already spoken for. (Indeed, it is unlikely to be enough to keep Social Security solvent.) It cannot be used for lowering the deficit.

A government takeover of all federally financed student loans — which obviously has nothing to do with health care — is rolled into the bill because it is expected to generate $19 billion in deficit reduction.

Finally, in perhaps the most amazing bit of unrealistic accounting, the legislation proposes to trim $463 billion from Medicare spending and use it to finance insurance subsidies. But Medicare is already bleeding red ink, and the health care bill has no reforms that would enable the program to operate more cheaply in the future. Instead, Congress is likely to continue to regularly override scheduled cuts in payments to Medicare doctors and other providers.

Removing the unrealistic annual Medicare savings ($463 billion) and the stolen annual revenues from Social Security and long-term care insurance ($123 billion), and adding in the annual spending that so far is not accounted for ($114 billion) quickly generates additional deficits of $562 billion in the first 10 years. And the nation would be on the hook for two more entitlement programs rapidly expanding as far as the eye can see.

Comment: As they vote today .... consider how this mess will impact the next generation of Americans: more debt, more entitlements! Title - "Fantasy in, fantasy out" - is a play on Garbage In, Garbage Out

Milton Friedman: The origin of our medical care morass

A Way Out of Soviet-Style Health Care: Solzhenitsyn's prophetic warning about the depersonalization of medicine

Excerpt:

For the first 30 years of my life, until World War II, that kind of practice [private medical practice] was the norm. Individuals were responsible for their own medical care. They could pay for it out-of-pocket or they could buy insurance. "Sliding scale" fees plus professional ethics assured that the poor got care. On entry to a hospital, the first question was "What's wrong?" not "What is your insurance?" It may be that some firms provided health care as a benefit to their workers, but if so it was the exception not the rule.

The first major change in those arrangements was a byproduct of wage and price controls during World War II. Employers, pressed to find more workers under wartime boom conditions but forbidden to offer higher money wages, started adding benefits in kind to the money wage. Employer-provided medical care proved particularly popular. As something new, it was not covered by existing tax regulations, so employers treated it as exempt from withholding tax.

It took a few years before the Internal Revenue Service got around to issuing regulations requiring the cost of employer-provided medical care to be included in taxable wages. That aroused a howl of protest from employees who had come to take tax exemption for granted, and Congress responded by exempting employer- provided medical care from both the personal and the corporate income tax.

Because private expenditures on health care are not exempt from income tax, almost all employees now receive health care coverage from their employers, leading to problems of portability, third party payment and rising costs that have become increasingly serious. Of course, the cost of medical care comes out of wages, but out of before-tax rather than after-tax wages, so that the employee receives what he or she regards as a higher real wage for the same cost to the employer.

...

The best way to restore freedom of choice to both patient and physician and to control costs would be to eliminate the tax exemption of employer-provided medical care. However, that is clearly not feasible politically. The best alternative available is to extend the tax exemption to all expenditures on medical care, whether made by the patient directly or by employers, to establish a level playing field, in terms of the currently popular cliche.

Many individuals would then find it attractive to negotiate with their employer for a higher cash wage in place of employer-financed medical care. With part or all of the higher cash wage, they could purchase an insurance policy with a very high deductible, i.e., a policy for medical catastrophes, which would be decidedly cheaper than the low-deductible policy their employer had been providing to them, and deposit all or part of the difference in a special "medical savings account" that could be drawn on only for medical purposes. Any amounts unused in a particular year could be allowed to accumulate without being subject to tax, or could be withdrawn with a tax penalty or for special purposes, as with current Individual Retirement Accounts—in effect, a medical IRA. Many employers would find it attractive to offer such an arrangement to their employees as an option.

Comment: Written in 1996 by the brilliant economist Milton Friedman

The vote is really about who commands the country's medical resources.

The ObamaCare Crossroads

Excerpts:

The consequences of this bill will not only be destructive for the health-care system and the country's fiscal condition, though those will be bad enough. Inextricably bound up in a plan as far-reaching and ambitious as ObamaCare are also larger questions about the role of government, the dynamism of American enterprise and the nature of a free society. Above anything else, this explains why Democrats have had such trouble convincing the public, let alone their own Members.

...

In our world of infinite wants but finite resources, there are only two ways to allocate any good or service: either through prices and the choices of millions of individuals, or through central government planning and political discretion. This choice is inexorable. Stripped of its romantic illusions, ObamaCare is really about who commands the country's medical resources. It vastly accelerates the march toward a totally state-driven system, in contrast to reforms that would fix today's distorted status quo by putting consumers in control.

Friedman lays out how the country arrived at our current pass, starting with the World War II-era decision to offer tax subsidies for employer-sponsored coverage only. Like the company store, this inefficient and inequitable preference encourages workers to be paid in kind rather than cash, and over the years the third-party payer system it entrenched has inhibited competition and desensitized patients to the costs of their own care. With the 1965 creation of Medicare for seniors and Medicaid for the poor, government has come to play the leading role in shaping the way care is paid for and provided.

Naturally, the result has been high and rising costs. Since 1962, the share of the economy devoted to health care has risen to about 17% from 6%. Today, health entitlements account for about 5% of GDP but on current trend will rise to 7% in 2025 and about 15% in 2062.

...

Once the health-care markets are put through Mr. Obama's de facto nationalization, costs will further explode. The Congressional Budget Office estimates ObamaCare will cost taxpayers $200 billion per year when fully implemented and grow annually at 8%, even under low-ball assumptions. Soon the public will reach its taxing limit, and then something will have to give on the care side. In short, medicine will be rationed by politics, no doubt with the same subtlety and wisdom as Congress's final madcap dash toward 216 votes.

As in the Western European and Canadian welfare states, doctors, hospitals and insurance companies will over time become public utilities. Government will set the cost-minded priorities and determine what kinds of treatment options patients are allowed to receive. Medicare's price controls will be exported to the remnants of the private sector.

Comment: Interesting how wage price controls after WWII created system whereby employers offer health insurance. See next post for Milton Friedman 1996 article

Is the "Slaughter" rule constitutional?

The Health Vote and the Constitution

Excerpt:

n just a few days the House of Representatives is expected to act on two different pieces of legislation: the Senate version of the health-care bill (the one that contains the special deals, "Cadillac" insurance plan taxes, and abortion coverage) and an amendatory bill making changes in the Senate bill. The House will likely adopt a "self-executing" rule that "deems" passage of the amendatory bill as enactment of the Senate bill, without an actual vote on the latter.

This enables the House to enact the Senate bill while appearing only to approve changes to it. The underlying Senate bill would then go to the president for signature, and the amendatory bill would go to the Senate for consideration under reconciliation procedures (meaning no filibuster).

This approach appears unconstitutional. Article I, Section 7 clearly states that bills cannot be presented to the president for signature unless they have been approved by both houses of Congress in the same form. If the House approves the Senate bill in the same legislation by which it approves changes to the Senate bill, it will fail that requirement.

Rep. Louise Slaughter (D., N.Y.), chair of the House Rules Committee and prime mover behind this approach, has released a letter from Yale Law School's Jack Balkin asserting that a "rule which consolidates a vote on a bill and accompanying amendments, or, as in this case, a reconciliation measure and an amended bill, is within the House's powers under Article I, Section 5, Clause 2."

But that does not actually address the point at issue. No one doubts that the House can consolidate two bills in a single measure; the question is whether, having done so, it may then hive the resulting bill into two parts, treating one part as an enrolled bill ready for presidential signature and the other part as a House bill ready for senatorial consideration. That seems inconsistent with the principle that the president may sign only bills in the exact form that they have passed both houses. A combination of two bills is not in "the same form" as either bill separately.

Defenders of the Democratic strategy say that a self-executing rule has been used many times before by both parties. But never in this way. Most of the time a self-executing rule is used to incorporate amendments into a pending bill without actual votes on the amendments, where the bill is then subject to a final vote by the House and Senate. That usage may be a dodge around House rules, but it does not violate the Constitution. I am not aware of any instance where a self-executing rule has been used to send one bill to the president for signature and another to the Senate for consideration by means of a single vote.

Self-executing rules have also been used to increase the debt ceiling by virtue of adopting a budget resolution. That procedure is questionable, but because budget resolutions are not laws, this usage does not have the feature of using one vote to send a bill to the president and at the same time to send a different bill to the Senate. There may have been other questionable uses of self-executing rules, but not often enough or in prominent enough cases to establish a precedent that would overcome serious constitutional challenge.

Whether the courts would entertain such a challenge is a harder question. The "enrolled bill doctrine," announced by the Supreme Court in Marshall Field v. Clark (1892), holds that the courts will not question whether a bill certified as having passed both houses of Congress was properly enacted. More recently, in United States v. Munoz-Flores (1990), in a footnote, the Supreme Court stated that Field concerned only the "evidence" the courts would consider in such a challenge and that when "a constitutional provision is implicated," the enrolled bill doctrine would not apply. These holdings are not easy to reconcile. The D.C. Circuit, in a 1995 case, essentially said that it did not understand the Munoz-Flores footnote and thus would not follow it.

Comment: Sure stinks but this is what we have come to expect from Pelosi!

Democratic Shell Game

Excerpt:

Democrats are planning to introduce legislation later this spring that would permanently repeal annual Medicare cuts to doctors, but are warning lawmakers not to talk about it for fear that it will complicate their push to pass comprehensive health reform. The plans undercut the party's message that reform lowers the deficit, according to a memo obtained by POLITICO.

Democrats removed the so-called doc fix from the reform legislation last year because its $371-billion price tag would have made it impossible for Democrats to claim that their bill reduces the deficit. Republicans have argued for months that by stripping the doc fix from the bill, Democrats were playing a shell game.

“Most health staff are already aware that our health proposal does not contain a 'doc fix.' … The inclusion of a full SGR repeal would undermine reform’s budget neutrality. So again, do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. Instead, focus only on the deficit reduction and number of Americans covered,” the memo, sent Thursday to Democratic staff, said.

“As most health staff knows, leadership and the White House are working with the AMA to rally physicians for a full SGR repeal later this spring. However, both health and communications staff should understand we do not want that policy discussion discussed at this time, lest (it) complicate the last critical push to pass health reform,” according to the memo.

The memo helps explains why the American Medical Association has supported reform even though their top legislative priority, the doc fix, was left out. The group is working behind the scenes with Democratic leadership and the White House to fix the cuts later this year.

Indeed, in a statement this afternoon, the AMA announced its support for the reconciliation bill -- and hinted that the debate is not over with reform's passage.

“This is not the last step, but the next step toward real health system reform. We will remain actively engaged with Congress and the administration to ensure that before Congress adjourns there are additional important changes to our health system," AMA president James Rohack said. "Congress must act to preserve access to care for seniors and military families by permanently repealing the Medicare physician payment formula that will cut Medicare payments by 21 percent next month.”

The memo also repeatedly advises Democrats not to discuss the details of the CBO score.

“We cannot emphasize this enough: do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. Instead, focus only on the deficit reduction and number of Americans covered," the memo says

Comment: Wiki: Shell game

Decades of health care wars

The Health-Care Wars Are Only Beginning

Excerpt:

On Dec. 7, 1941, an announcement was made during the football game between the hometown Washington Redskins and the Philadelphia Eagles. All the generals and admirals at Griffith Stadium were instructed to report to their duty stations. Little did they know their lives would be changed forever and America would be at war, or on war footing, for the next half-century. Pearl Harbor had been attacked.

America will be in a constant health-care war if ObamaCare is enacted. Passage wouldn't end the health-care debate. Rather, it would perpetuate ObamaCare as the dominant issue for decades to come, reshape politics, create an annual funding crisis in Congress, and generate a spate of angry lawsuits. Yet few in Washington seem aware of what lies ahead.

We only have to look at Great Britain to get a glimpse of the future. The National Health Service—socialized medicine—was created in 1946 and touted as the envy of the world. It's been a contentious issue ever since. Its cost and coverage are perennial subjects of debate. The press, especially England's most popular newspaper, The Daily Mail, feasts on reports of long waiting periods, dirty hospitals, botched care and denied access to treatments.

A Conservative member of the European Parliament, Daniel Hannan, last year in an interview on Fox News denounced the NHS as a "60-year mistake," declaring he "wouldn't wish it on anybody." As prime minister, Margaret Thatcher bravely cut NHS spending in the 1980s, but current Tory leaders regard criticism of the NHS as too risky. "The Conservative Party stands four square behind the NHS," its leader, David Cameron, said in response to Mr. Hannan.

House Speaker Nancy Pelosi believes ObamaCare would have a more congenial fate—that it will become as popular as Social Security and Medicare with voters. She's kidding herself. Social Security and Medicare were popular from the start and passed with bipartisan support. ObamaCare is unpopular and partisan. It's extremely controversial. Its passage is far more likely to spark a political explosion than a wave of acceptance.

Democratic leaders believe the public doesn't focus on the process of how legislation is enacted. But in this case they're wrong. I've been amazed at how many people understand "reconciliation"—a process that allows budget and spending bills to pass in the Senate with only 51 votes, instead of 60. Many voters are also now studying the details of the "Slaughter solution," which would allow the House to "deem" the Senate health-care bill to have passed without actually voting on it and then to vote through changes to the Senate bill. These legislative shortcuts are already infuriating ObamaCare's opponents.

If ObamaCare passes, sooner or later the backlash against it would morph into a movement to repeal it. Republicans would likely make repeal a top issue in congressional elections this November. The GOP is expected to win a substantial number of seats in Congress this fall. If Republicans take control of the House or Senate or both, clashes over health care would be unavoidable.

Comment: It will bankrupt the US .... if SS doesn't first

The IRS as health care enforcer

Republicans assail IRS provision in health care bill

Excerpt:

Subcommittee on Oversight ranking member Charles Boustany (R-La.) said the IRS provision in the bill "dangerously expands, in an ominous way the tentacles of the IRS and it's reach into every American family," he said today during a press conference.

"This is a vast expanse of power," he said.

Boustany said the bill would allow the IRS to confiscate refunds if there are penalties for not buying health care.

Lawmakers have questioned whether the IRS can handle the increased workload to oversee, administer and collect penalties for people who don't buy health insurance.

"This is increasing tax liability and tax scrutiny," said Rep. Peter Roskam (R-Ill.).

Comment: Earlier post

2 predictions (I hope I'm wrong!)

• Minnesota will lose to Xavier tomorrow
  
• Pelosi's health care debacle will pass
  

Is "Deemed into law" constitutional?

Slaughter House Rules

Excerpt:

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

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

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

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

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

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

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

Comment: The US Supremes would have a field day with this!

Duck and Cover

House may try to pass Senate health-care bill without voting on it

Excerpt:

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

Instead, Pelosi (D-Calif.) would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers "deem" the health-care bill to be passed.

The tactic -- known as a "self-executing rule" or a "deem and pass" -- has been commonly used, although never to pass legislation as momentous as the $875 billion health-care bill. It is one of three options that Pelosi said she is considering for a late-week House vote, but she added that she prefers it because it would politically protect lawmakers who are reluctant to publicly support the measure.

"It's more insider and process-oriented than most people want to know," the speaker said in a roundtable discussion with bloggers Monday. "But I like it," she said, "because people don't have to vote on the Senate bill."

Comment: As for Duck and Cover reference, click the link.

The Democrats "March to Folly"

If Democrats ignore health-care polls, midterms will be costly

Excerpts:

As pollsters to the past two Democratic presidents, Jimmy Carter and Bill Clinton, respectively, we feel compelled to challenge the myths that seem to be prevailing in the political discourse and to once again urge a change in course before it is too late. At stake is the kind of mainstream, common-sense Democratic Party that we believe is crucial to the success of the American enterprise.

Bluntly put, this is the political reality:

First, the battle for public opinion has been lost. Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate's reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.

...

Voters are hardly enthralled with the GOP, but the Democrats are pursuing policies that are out of step with the way ordinary Americans think and feel about politics and government. Barring some change of approach, they will be punished severely at the polls.

Now, we vigorously opposed Republican efforts in the Bush administration to employ the "nuclear option" in judicial confirmations. We are similarly concerned by Democrats' efforts to manipulate passage of a health-care bill. Doing so in the face of constant majority opposition invites a backlash against the party at every level -- and at a time when we already face the prospect of losing 30 or more House seats and eight or more Senate seats.

For Democrats to begin turning around their political fortunes there has to be a frank acknowledgement that the comprehensive health-care initiative is a failure, regardless of whether it passes. There are enough Republican and Democratic proposals -- such as purchasing insurance across state lines, malpractice reform, incrementally increasing coverage, initiatives to hold down costs, covering preexisting conditions and ensuring portability -- that can win bipartisan support. It is not a question of starting over but of taking the best of both parties and presenting that as representative of what we need to do to achieve meaningful reform. Such a proposal could even become a template for the central agenda items for the American people: jobs and economic development.

Unless the Democrats fundamentally change their approach, they will produce not just a march of folly but also run the risk of unmitigated disaster in November.

Comment: Article written by Democratic pollsters!

What's missing in health care reform

NPR: Why Public Support For Health Care Faltered

Excerpt:

As a candidate, Barack Obama promised to pass a health plan with important benefits for the average American. For the typical family, costs would go down by as much as $2,500 a year. Adults wouldn't be required to buy insurance. No one but the wealthy would face higher taxes.

George Will: Democrats on the precipice of failure

Excerpt:

... Democrats have had to resort to serial bribery to advance it. Massachusetts voted immediately after the corruption of exempting, until 2018, union members from the tax on high-value health insurance plans. This tax was supposedly the crucial component of what supposedly was reform's primary goal: reducing costs.

Comments: Why people are angry about it:

• The Cornhusker Kickback
  
• The Louisiana Purchase
  
• Union exemption from the “Cadillac tax” on high-cost health-care plans
  
• People probably don't care about taxing high income workers (AKA more than $ 250,000 per year!). But most doubt the Dems can keep that promise
  
• The public option smells like socialism. There is mistrust (rightly so!) that the government can do it better. Medicare is going broke! The government couldn't handle the relatively simple "cash for clunkers" program!
  
• It is another unfunded Trillion $ program
  
• Many object to mandatory buy-in requirements!
  
• It is not bi-partisan!
  
• There is no tort reform
  
• It will not cost less