Free Markets, Free People
You remember the $500 billion Obama claimed would be “saved” from Medicare to help “pay for” the ObamaCare law?
Well, what that amounted to was slashing subsidies (i.e. reimbursement rates) for a popular supplementary program known as Medicare Advantage.
Problem: doing so will effect 12 million seniors. Problem exacerbated: Seniors, who resist change especially to their health care coverage, are not likely to be happy. Problem squared: Seniors will have to select a new program beginning October 15th, a few weeks before the election.
And both political parties know that seniors vote. You can imagine the negativity of these cuts spreading like wildfire among senior communities in key states.
But, not to worry, our current most ethical and transparent administration in history has a solution:
Call it President Obama’s Committee for the Re-Election of the President — a political slush fund at the Health and Human Services Department.
Only this isn’t some little fund from shadowy private sources; this is taxpayer money, redirected to help Obama win another term. A massive amount of it, too — $8.3 billion. Yes, that’s billion, with a B.
And how will they deploy this money?
Benjamin Sasse and Charles Hurt explain:
But the administration’s devised a way to postpone the pain one more year, getting Obama past his last election; it plans to spend $8 billion to temporarily restore Medicare Advantage funds so that seniors in key markets don’t lose their trusted insurance program in the middle of Obama’s re-election bid.
The money is to come from funds that Health and Human Services is allowed to use for “demonstration projects.” But to make it legal, HHS has to pretend that it’s doing an “experiment” to study the effect of this money on the insurance market.
That is, to “study” what happens when the government doesn’t change anything but merely continues a program that’s been going on for years.
Obama can temporarily prop up Medicare Advantage long enough to get re-elected by exploiting an obscure bit of federal law. Under a 1967 statute, the HHS secretary can spend money without specific approval by Congress on “experiments” directly aimed at “increasing the efficiency and economy of health services.”
Past demonstration projects have studied new medical techniques or strategies aimed at improving care or reducing costs. The point is to find ways to lower the costs of Medicare by allowing medical technocrats to make efficient decisions without interference from vested interests.
Now Obama means to turn it on its head — diverting the money to a blatantly nonexperimental purpose to serve his political needs.
In an era of austerity, an executive department has what amounts to an 8 billion dollar taxpayer funded slush fund and has apparently chosen to use to help re-elect the president?
The good news is because of the attention brought to this ploy, just a couple of hours ago, the GAO spoke out about the planned use of the 8 billion dollars:
In a blow to the Obama administration on Medicare, government auditors Monday called for the cancellation of a costly bonus program for private health plans that congressional Republicans have criticized as a wasteful political ploy.
The nonpartisan Government Accountability Office said it’s not clear that the $8.3 billion Medicare Advantage bonus program will improve quality because most of the money is going to plans just rated average. The auditors did find, however, that the bonuses would temporarily ease the pain of unpopular cuts to insurance plans under President Barack Obama’s health care overhaul law.
The point of course, is it is a deferral of “pain” not any sort of look at an “experimental” means of improving health care. It is election year politics with an 8 billion dollar price tag.
After all, the plan for ObamaCare was to have all the unpopular aspects of it kick in during 2013, after the election, after the President was unanswerable to the American people anymore and after he was provided with more “flexibility”.
The GAO is careful in its wording but read between the lines here:
GAO, the investigative agency of Congress, did not address GOP allegations that the bonuses are politically motivated. But, its report found the program highly unusual. It “dwarfs” all other Medicare pilots undertaken in nearly 20 years, the GAO said.
Most of the bonus money is going to plans that receive three to three-and-half stars out of a possible five stars on Medicare’s quality rating scale, the report said.
Available through 2014, the bonuses will soften much of the initial impact of the Medicare Advantage cuts, acting like a temporary reprieve.
This year, for example, the bonus program offset about 70 percent of the cuts in the health care law. Indeed, Medicare Advantage enrollment is up by 10 percent and premiums have gone down on average.
Or “Buying Seniors Off Until 2014”. And yeah, if you’re still wondering, that’s politics. The emphasized portions of both quotes are all you need to know to understand the “why” of my claim. That reprieve would keep seniors from taking their angst and anger to the polls in November and the administration is eager to avoid that.
So, in the Chicago way, the Obama administration has figured out how to use tax money to help buy the next election.
Will the administration heed the GAO? Will it cancel the program?
My guess is no – they’ll delay and prevaricate and do anything and everything they can to avoid killing the program.
At least until after the election. Then? Who cares.
Certainly not them.
Seniors, you’re being played for suckers. You need to realize that. And vote accordingly.
I’m sure you remember a few years ago the LA City Council banned fast food joints from low income neighborhoods for a year. The New York Times explains the reason they thought that was a function of government:
It has become an article of faith among some policy makers and advocates, including Michelle Obama, that poor urban neighborhoods are food deserts, bereft of fresh fruits and vegetables.
The purpose of the ban was to prevent more fast food from being made available in these poor neighborhoods that were considered “food deserts”. The belief, and that’s all it is, was that the availability of fast food and the unavailability of “fresh fruits and vegetables” was a contributor to the obesity found in poor communities.
And the myth had its own narrative too:
Speaking in October on the South Side of Chicago, she said that in too many neighborhoods “if people want to buy a head of lettuce or salad or some fruit for their kid’s lunch, they have to take two or three buses, maybe pay for a taxicab, in order to do it.”
Except for the fact that two new studies say that’s just not true.
Both, using different methodology, came to the same conclusion:
Such neighborhoods not only have more fast food restaurants and convenience stores than more affluent ones, but more grocery stores, supermarkets and full-service restaurants, too. And there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents.
Within a couple of miles of almost any urban neighborhood, “you can get basically any type of food,” said Roland Sturm of the RAND Corporation, lead author of one of the studies. “Maybe we should call it a food swamp rather than a desert,” he said.
Indeed, it is, instead, choice at work. And, as usual, government feels they should be involved in deciding which choices are made. Now, it’s easy to say, “yeah, but it’s obesity and obesity isn’t good for you”.
Given. But does that mean it is government’s job to intrude and attempt to remedy the situation with other people’s money?
Taking into consideration what the two studies have revealed, it seems, as is often the case, that government is barking up the wrong tree. The myth, or if you prefer “article of faith”, seems to be wrong. Actual facts destroy the myth. More than adequate supplies of fresh fruits and vegetables are readily available in poor neighborhoods. The problem is the poor choose not to avail themselves of them.
So obesity among the poor isn’t the fault of “food deserts” (or a lack of food it seems) in poor communities and banning fast food joints and encouraging more grocery stores to locate there isn’t going to help ameliorate the problem. Nor, apparently, is healthier food in schools.
In fact, the only way to really impact obesity is to control choice isn’t it? Dropping weight requires portion control, control of the type of food eaten and a certain level of exercise.
So what’s an intrusive and activist government to do now that their myth has been shattered?
We already have a physician shortage in this country. And with the passage of ObamaCare, it is likely to get worse.
According to a survey, young physicians (below the age of 40) are pessimistic about the future due to the increased “involvement of government” that ObamaCare promises.
An overview of young physicians in the survey revealed:
- The typical younger physician in this survey is 37 years of age and is an employee of a medical group; with the largest single segment being employees of small groups (6 or fewer physicians): 58% are employees of medical groups, and almost half of those (48%) are with the smaller groups. In contrast, 26% are with mid-sized groups (with 7 to 12 physicians), and 26%
are with larger groups (13-plus physicians).
- These physicians are markedly pessimistic regarding the future of the U.S. healthcare system, with the “new healthcare legislation” ranking as a strong #1 reason for the pessimism. Many voice considerable cynicism with (what several call) “government’ involvement.”
- Financial-related considerations play a key role in the choice of practice/ arrangement. Most cite “income/cash flow” and “employment security” as factors influencing their current arrangement. And among the 27% who changed (or considered changing) their practice/arrangement in the past year, the leading reason given related to “financial issues.”
- The vast majority express satisfaction with their current practice /arrangement (with 35% saying they are “highly satisfied,” and another 45% saying they are “somewhat satisfied”); and most expect to stay with the current practice/ arrangement for 8 years or more. Many (39%) aspire to some form of ownership position in the future (as either sole owner or partner).
There’s a reason for the marked pessimism. They’ve already had to deal with government involvement at the level it now exists and their experience with doing so gives them no confidence that further involvement will lead to any sort of improvement. Quite the contrary they apparently feel it will lead to a degradation in the quality of medicine practiced and an increase in the bureaucratic meddling they’ll have to endure.
Note the satisfaction index with the current system (80% highly or somewhat satisfied). And note also the fact that many aspire to some form of ownership position in the future. I’d put forth a guess that the 39% so aspiring see such a dream as threatened by further government involvement.
As to their pessimism about ObamaCare, the survey says:
These young physicians exhibit considerable pessimism regarding the future of the U.S. healthcare system:
- When it comes to the Affordable Care Act, 49% believe the impact on their practice will be negative, vs. only 23% who believe it will be positive. Among the three practice-types, the Primary Care physicians exhibited somewhat less pessimism vs. the other two segments: They were a bit more likely to be “positive” or “neutral,” a bit less likely to be negative.
- And well over half (57%) are pessimistic about the future of the U.S. healthcare system (with over 30% saying they’re “highly pessimistic”). In contrast, only 4% are “highly optimistic,” and 18% who are “somewhat optimistic”. When asked (open-ended) reasons for their pessimism, responses covered a wide spectrum of negatives – with the “new healthcare legislation” leading the way. Indeed, as one peruses the responses to the question, the cynicism voiced by so many – with most of it directed at “government” – stands out.
Of course it does. And some of their specific comments tell you why:
“Government controlled healthcare will be the downfall. Anyone who has worked in government environment such as VA would know this – ask any vet who receives their care through VA how good the system is!”
“The current administration is only concerned with money and maintaining their power and socialism.”
“Government regulation has too many strings attached. (It) has not been well thought out. (It) will bankrupt the country. (We are) pushing toward socialist medicine.”
“I do not feel optimistic because of all the increased regulatory burdens on physicians. There will be an increased shortage of physicians to provide primary care and decreased access to care.”
“The very reasons why people come to the U.S. to obtain care (research, quality, availability, cutting edge, good physicians, etc) is being taken away one at a time. The changes that are being made are not made with the patient in mind, but with the ‘bottom line’ economically in mind. Not once is the patient mentioned in all these changes.”
“I think the government is destroying healthcare.”
If you read the survey, you’ll find that even the more “optimistic” comments certainly are only relatively optimistic in comparison to the above.
The comment about the reasons people come to the US is the most telling of the group. It pretty well describes what critics of the law have been saying since its passage. You can’t have the best medical care available if the focus is cutting cost. It’s a lie. And pretending that you can do both is the biggest lie of all. That’s precisely the snake oil sales job that has been used to justify the law. But poll after poll has said the American people have rejected the sales job.
It should also be clear that most young physicians have as well. They are not optimistic about the future of US health care.
And if they’re not optimistic, why in the world should patients who will suffer through it hold any optimism either?
Welcome to the stupid zone. Of course this is the result of unthinking acceptance of what is now considered by many to be junk science:
An elderly woman was ordered to find a new GP because the “carbon footprint” of her two-mile round trips to the surgery where she had been treated for 30 years was too large.
Avril Mulcahy, 83, was told to address the “green travelling issues” over her journeys from her home in Westcliff-on-Sea, Essex, to the West Road Surgery.
The letter said: “Our greatest concern is for your health and convenience but also taking into consideration green travelling issues. Re: Carbon footprints and winter weather conditions, we feel it would be advisable for patients to register at surgeries nearer to where they live. We would be very grateful if you could make the necessary arrangements to re-register at another practice.”
She’s been going to the same practice for 30 years. And note the lie about “greatest concern”. It is obviously not their greatest concern, is it. The supposed “carbon footprint” appears to fill that role.
“Green traveling issues” with two mile round trips.
I assume the doctors and nurses live at the surgery, no?
Well, how about government mandates?
If government wants to lower the cost of health care, there’s an immediate means of doing so. Health insurance should be like a Chinese restaurant menu – pick one from column A and two from column B. But if you don’t want acupuncture coverage or massage therapy or, in fact, have a uterus, why in the world should you forced to buy coverage for all of that?
I think it is felt, whether true or not at this point since we really don’t know, that ObamaCare is in real trouble. You can see it everywhere with the NY Time opining that overturning it would be judicial activism and the various and sundry liberal blogs bleating out the same refrain. They’re shocked. They’re stunned. They’ve decided they have to somehow characterize this as they tried to do Bush v. Gore, as a form of judicial malfeasance.
But as Don Surber points out, the arguments against the law aren’t new even if the left tried to wave them off and pretend they were weak.
And so, as John Podhoretz argues:
I diagnose the shock at the powerful Constitutional arguments advanced against Obama’s health-care plan as another example of the self-defeating parochialism of American liberals, who are continually surprised that conservative ideas and conservative arguments are formidable and can only be bested if they are taken seriously: “the strength of the conservative arguments only came as a surprise to [Jeffrey] Toobin, [Linda] Greenhouse and others because they evidently spent two years putting their fingers in their ears and singing, ‘La la la, I’m not listening’ whenever the conservative argument was being advanced.”
Its really not “conservative” ideas we’re talking about here (honestly, they’ve gone along with plenty of laws which shred the Constitution), but instead fundamental ideals on which the country was founded. They were certainly advanced by conservatives in this case. They are powerful ideas and I agree with Podhoretz, that liberals just waved them off. They could not conceive of a law filled to the brim with good intentions (no matter how abysmal its execution or horrendous its cost) could be found as anything but Constitutional.
I can only suggest that their earlier takeover of the public education system left them in a civics class knowledge deficit about what the Constitutions says. Must have happened about the time they decided schools had the job of indoctrinating youth about sex education and the like.
So as the law’s date with SCOTUS approached the left was supremely confident:
Twenty-six states and the National Federation of Independent Business challenged the constitutionality of President Obama’s signature piece of domestic legislation, the Patient Protection and Affordable Care Act. The sophistries on which the Obamaphiles relied to defend their health care power grab were perhaps best summarized by Slate legal columnist Dahlia Lithwick: “That the law is constitutional is best illustrated by the fact that — until recently — the Obama administration expended almost no energy defending it.”
That lack of energy came back to haunt them Tuesday when Solicitor General Donald Verrilli turned in a stammering, barely coherent performance worthy of the public defender in My Cousin Vinny as he struggled to articulate a constitutional defense of Obamacare. The arguments went only slight better for Verrilli yesterday. The administration seemed ill prepared to answer even basic, predictable questions about the law’s constitutional basis.
Absolutely correct. Verrilli was awful and that is acknowledged by both sides (it was like he was arguing for something he just really didn’t believe in at times).
It’s not surprising that liberals, most of whom have not read or shown interest in the arguments of the challengers, were stunned to learn that there really is a constitutional difference between taxing and regulating and between inducing one into commerce and regulating commerce that already exists. It is this failure to understand, let alone imagine that constitutional text has meaning and there are actual limitations on federal power, that explains the stunned reaction of the liberal elite. Like puppies smacked on the nose by a rolled-up copy of the Constitution, they are flabbergasted.
Greg Sargent seems to understand the point:
But there’s another explanation for the botched prediction: Simply put, legal observers of all stripes, and Obamacare’s proponents, including those in the administration, badly misjudged, and were too overconfident about, the tone, attitude and approach that the court’s conservative bloc, particularly Justice Scalia, would take towards the administration’s arguments.
But as usual, tries to make it personal and political instead of acknowledging the power of the arguments against the law:
All of which is to say that the law’s proponents were badly caught off guard by the depth of the conservative bloc’s apparent hostility towards the law and its willingness to embrace the hard right’s arguments against its constitutionality. They didn’t anticipate that this could shape up as an ideological death struggle over the heart and soul of the Obama presidency, which, as E.J. Dionne notes today, is exactly what it has become.
Or in other words, sticking up for the foundational principles underlying the US Constitution is now a “hard right” thing. Any possibility they’ll continue to be “shocked” in the future?
They will if they repeat the “arrogant, dismissive and ill-prepared” tactic in the future.
Again, we don’t know how this will actually end and have to be careful about reading too much into the oral arguments, but that said it is hard not to note how poorly those arguments went for the administration and at least realize that after arrogantly ramming the bill through the Democratic controlled Congress and waving it around triumphantly in the face of those who opposed it, its at least an enjoyable bit of schadenfreude going on right now, isn’t it?
A lot has been said and written about the oral arguments before the Supreme Court concerning ObamaCare. Many have claimed you can’t base much on such arguments.
Perhaps. But it seems to me that you can get an indication of the mood of the court if you consider them carefully and keep them in context.
What I’ve surmised over the past few days is the law is in deep trouble. I think, if nothing else, the oral arguments pointed out how dismally weak and poor the arguments “for” this law are.
Of course, depending on how they would like to see the court rule, each side has found ways to spin these arguments to support their hoped for result. No huge surprise there.
But I think the one thing that is clear is the court is pretty well split down the middle and along ideological lines. And, as we’ve said for some time, in reality the result will hinge on the vote of Justice Kennedy.
However, I think you have to keep in mind that it won’t be a single ruling but one which entails several votes. One on the individual mandate, one on severability and possibly, depending on how the severability vote goes, if portions or the whole bill ought to be struck down. If the whole law is struck down, of course the expanded Medicare portion discussed yesterday will go with it.
That leaves you wondering where Kennedy is in his deliberation of the case. Again, if looking at indications to be gleaned from the oral arguments, one could assume he finds it true that the individual mandate would “fundamentally change” the citizen’s relationship with government – and not to the citizen’s favor. I think it is also true that he is not satisfied that the government has successfully articulated a “limiting principle” – a critical and key point in the discussion.
Finally, I get the impression, from yesterday’s arguments, that Kennedy is leaning toward “paving over” the whole law. In other words, giving Congress a “do over” since taking the mandate out would create a law and a consequence that it is hard to argue was Congress’s original intent. What is also interesting is the developing opinion that striking down the entire law would actually be an exercise in judicial restraint, not judicial activism.
Justice Ruth Bader Ginsburg said Mr. Clement is asking the Court to conduct "a wrecking operation," before stating that "the more conservative approach would be salvage rather than throwing out everything." The Obama Administration didn’t say exactly that, but it did argue that the mandate is indispensable to its supposedly well-oiled regulatory scheme and if it is thrown out the insurance rules should be too.
But Justice Anthony Kennedy doubted Justice Ginsburg’s logic, since by taking out only the individual mandate the Court would in effect be creating a new law that Congress "did not provide for, did not consider." To wit, costs would soar without any mechanism to offset them.
"When you say judicial restraint," Justice Kennedy said, "you are echoing the earlier premise that it increases the judicial power if the judiciary strikes down other provisions of the act. I suggest to you it might be quite the opposite." Overturning the mandate alone, he continued, "can be argued at least to be a more extreme exercise of judicial power than to strike the whole."
This is a critical point.
I think it is clear the 4 justices traditionally identified with the liberal side of the court are fore-square for the law and will find some way to justify it’s egregious and unconstitutional over-reach. And yes, no secret, I’ve always considered the law to be that and nothing I’ve heard in oral arguments has changed that. I think Justices Thomas, Alito and Scalia are for finding the mandate unconstitutional and for killing the entire law. I think Chief Justice Roberts is against the mandate although I’m not sure it’s a foregone conclusion that he wants to kill the entire law at this point. However I think he’ll be persuaded eventually.
That would make Kennedy the guy … again. No surprise for most who’ve watched the court for the past few sessions. He often ends up as the swing guy. You may disagree with my assessment of where he is in his decision making process, but his questions and comments, at least to me, seemed to indicate he was forming a particular opinion and that opinion favored both striking down the mandate and then striking down the whole law.
Should that be the case, and given the Democrats are unlikely to have an unassailable majority in Congress anytime soon as they did when they passed this monstrosity, this is indeed “the most important case in 50 years”. That’s a “good thing” because the likelihood that a “replacement” will be passed in Congress becomes much less likely. Kennedy’s vote could save America as we know it and protect us from a law that would “fundamentally” change our relationship with government and place us in a position of involuntary servitude to a government given license to run our lives in pretty much any way it see’s fit to pursue.
One of the jokes that has gone around for some time concerning ObamaCare’s eventual hearing in the Supreme Court is it will likely revolve around what Justice Kennedy had for breakfast. The obvious point being most SCOTUS observers can pretty much predict how the other 8 Justices might rule, but Kennedy is sort of the wild card and swing vote.
So, as you might imagine, many eyes are on him.
Today was the 2nd day of oral arguments in the case. This question from Justice Kennedy may give an indication of how he’s leaning in the case:
JUSTICE KENNEDY: “Could you help — help me with this. Assume for the moment — you may disagree. Assume for the moment that this is unprecedented, this is a step beyond what our cases have allowed, the affirmative duty to act to go into commerce. If that is so, do you not have a heavy burden of justification? I understand that we must presume laws are constitutional, but, even so, when you are changing the relation of the individual to the government in this, what we can stipulate is, I think, a unique way, do you not have a heavy burden of justification to show authorization under the Constitution?”
My answer to his question is “you bet”. How did the Solicitor General answer?
GENERAL VERRILLI: So two things about that, Justice Kennedy. First, we think this is regulation of people’s participation in the health care market, and all — all this minimum coverage provision does is say that, instead of requiring insurance at the point of sale, that Congress has the authority under the commerce power and the necessary proper power to ensure that people have insurance in advance of the point of sale because of the unique nature of this market, because this is a market in which — in which you — although most of the population is in the market most of the time — 83 percent visit a physician every year; 96 percent over a five-year period — so virtually everybody in society is in this market, and you’ve got to pay for the health care you get, the predominant way in which it’s — in which it’s paid for is insurance, and — and the Respondents agree that Congress could
require that you have insurance in order to get health care or forbid health care from being provided.
Uh, I don’t know about you, but it seems to me that the Solicitor General sidestepped the question and erected a giant strawman.
If you want to read the transcript of today’s oral arguments they’re here and they’re very interesting. If I had to guess, I’d say the law is in trouble. I found the arguments for to be fairly weak and I got the indication that most of the Justices (well, at least a majority of the Justices) may have as well.
Bottom line, Kennedy’s question is still laying out there unanswered.
UPDATE: More Justice Kennedy:
JUSTICE KENNEDY: But the reason, the reason this is concerning, is because it requires the individual to do an affirmative act. In the law of torts our tradition, our law, has been that you don’t have the duty to rescue someone if that person is in danger. The blind man is walking in front of a car and you do not have a duty to stop him absent some relation between you. And there is some severe moral criticisms of that rule, but that’s generally the rule.
And here the government is saying that the Federal Government has a duty to tell the individual citizen that it must act, and that is different from what we have in previous cases and that changes the relationship of the Federal Government to the individual in the very fundamental way.
Indeed, it does.
And as with most things politicians promise, Few of the promises necessary to sell this awful program are true or being kept: