Saturday, June 30, 2012

What I Read in the Wall Street Journal about ObamaCare
You want to call it ObamaCare – That’s OK because I do care.
President Obama, Atlanta Fund Raiser, March 26, 2012
All I know is just what I read in the papers.
Will Rogers (1879-1935)

June 30, 2012 -  The Wall Street Journal is a conservative business paper with the nation’s largest newspaper circulation.
The Friday June 28 and Saturday June 29 editions contain 17  articles on the Supreme Court decision.
I shall quote from them now.
1.Court Backs Obama on Health Care– “ The ruling means that the law’s reordering will move forward mostly  as planned, with implications affecting every hospital, doctor,  health insurer, and drug maker in the nation.”

2. Roberts Straddles Ideological Divide -  “The ruling is both a political and constitutional landmark. It is a measure of validation for President Obama’s political achievement .and cast a new light on Chief Justice Roberts, who had been frequently attacked as Republican partisan but managed to defy that view while reinforcing some long standing  conservative principles.
3. Unwanted ‘Tax’ is Savior for Law -   “He never wanted to think of it as a tax.  But the measure survived because the high court ruled the enforcement tool at its core as a tax. The court’s act may prove grist for Republicans for  the election-year argument that Mr. Obama is a classic tax-and-spend liberal.
4.  Obama’s Big Legal Victory Sets Stage for More Battles – “President Obama won a monumental legal victory,  But the fight for public opinion – and votes in November, showed signs of growing more heated.”
5.  For Health Sector: Forward March – “The Supreme Court decision largely upholding the health-care laws lifts the uncertainty over the health-care industry and puts companies back on course to prepare for the law’s implementation over the next two years.”

6. Medicaid Decisions Loom for States - The Supreme Court’s decision to let states opt oot of  the health overhaul’s Medicaid expansion without  losing current funding lifts a budget mandate from states but could mean fewer Americans gain insurance coverage under the law.”
7. For Millions, Coverage Begins in 2014 – “Most consumers can expect to keep seeing increases in premiums because the underlying cost of health care is expected to rise.”
8. The Obamacare Election – “By upholding sweeping  federal power, the Supreme Court has raised the November stakes – and given Romney an opening.”
9. The Roberts Rule – “The Chief Justice rewrites ObamaCare to Save It.”
10.  It’s Up to the Voters Now – “The last change to stop Obamacare is in November.”

11. ObamaCare the Power to Tax -  “Judicial tax-writing is particularly troubling, see. e.g, Stamp Act of 1765.”

12.  The Wrong Remedy for Health-Care- “The Affordable Care Act will exacerbate the problem of our current health-care system. Fortunately, market reforms are still possible.”
13. Triumph and Tragedy for the Law.  “The Supreme Court decision is a triumph and tragedy for our constitutional system.”  Upholding Obamacare’s mandate as a kind of ‘tax,’ the court itself engaged in a quintessential activity – redrafting the law’s unambiguous text."
14. Obama Has a Good Day –Republican backers of Mitt Romney have been feeling pretty confident, and understandably.  Their challenge now is to make the most of the moment.  They will have the help of their base, which is, at the moment, angry as hornets, loaded for bear, and fully awake.”
15. Chief Justice Roberts and his Apologists – “Some conservatives see a sliver lining  in the Obamacare Ruling.  But it’s exactly the big-govenmetn disaster it appears to be”
16.  ObamaCare:  Upheld and Doomed – “Regardless of the Supreme Court, fiscal reality will prevail. The lsat thing we needed , in a country staggering  under deficits and debt and an unaffordable entitlement structure, was a new Rube Goldberg entitlement.”
17. The Tax Duck  - “The duck test – if it looks like a duck, swims like a duck and quakes like a duck, it probably is a duck."
Stephanopolous, ABC News, September 2009 -  “Your critics say the mandate is a tax increase."
Obama-  "I absolutely reject that notion."

Meanwhile over at the New York Times, they are uncorking  the champaign  bottles.  Don’t’ leave them open too long.  They may turn to vinegar.
Tweet: WSJ says Supreme Court’s ObamaCare decision  is BFD (Big F------  Deal”) and SNAFU (Situation Normal All F---ed Up) but fixable in November

June 30, 2012

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    Friday, June 29, 2012

    Supreme Court Ruling: A Pyrrhic Victory for Obama
    Another victory and we are ruined.
    Pyrross, King of Epirus, in Plutarch’s Phyrhus, meaning a victory that harms  the victor more than the vanquished
    No human wisdom can calculate the end. It has but one thing certain, and that is to increase the taxes.
    Thomas Paine (1737-1809), Prospects on the Rubicon
    June 29, 2012 - It has been 24 hours since the Supreme Court ruled.  In those 24 hours I have received a near record number of hits on my blog and phone calls asking for my read on the situation.  
    After a day of mental digestion, I conclude Obama won a Pyrrhic victory which may cost him the election in November.    He won the judicial constitutional battle, but lost the policy war.   In this time of record deficits and record spending, public attention shifted from constitutional issues to taxation issues stemming from a deeply unpopular health law that will require unprecedented levels of taxation, which will fall on everybody, particularly the middle class.  
    As far as doctors are concerned,   the decision, as the Doctor Patient Medical Association, said  is “A slow motion disaster,” which if implemented, will strip doctors of their autonomy, income, status, and flexibility. 
    As I said in a previous post in November 2010, “Impact of Obamacare on Doctors,”
    “59% of doctors think the quality of medicine will decline in the next five years and 79% are less optimistic about the future of medicine. 69% are thinking about dropping out of government health programs, 53% would consider opting out of treating insurance-covered patients, and 45% have considered leaving the profession altogether.”
    The Court decision does not change those figures.
    The spinmeisters have made their statements, the consensus is that the Court and Chief Justice Roberts handed Obama critics a golden opportunity on a silver platter, if I may use a precious metal metaphor.  
    The Supreme Court moved the debate from the judicial box to the ballot box.  The Court  focused on the constitutionality of government’s power to tax.  And it drew rapt and undivided attention to the monumental tax burden the health law will bring if Obama is re-elected - $400 billion already in the pipeline,   trillions more as Bush tax cuts are phased out, the estimated $1.76 trillion to $2.5 trillion the law will cost from 2014 to 2024,   much of which will fall on the middle class and future generations.
    Here is how Douglas Holtz-Eakin , a distinguished economist and present of the American Action Forum, reacted,
    The field of play now shifts from a legal battle to a policy debate. In addition to the Court's endorsement of the policy foundations of the challenge to the ACA, the fundamental policy flaws remain."

    "The ACA remains a damaging, anti-growth vehicle for taxation. The so-called Medicare surtax increases marginal tax rates on the return to saving, investment, and innovation. The medical device tax will hurt innovation and cost jobs. A bill to repeal it is gathering dust in the Senate. Also, the insurers fee - the "premium tax" - will roil insurance markets, disrupt patient-provider relationships, and the vast majority of the burden will fall on the middle class. "

    "The ACA remains an unwise expansion of entitlement programs at a dangerous fiscal moment in U.S. history. The U.S. has suffered a downgrade, has a debt-to-GDP ratio over 100 percent - a level historically associated with 1 percentage point slower growth and a heightened probability of financial crisis - and faces a spending-driven explosion of debt over the next decade. Also, the ACA does not reform Medicare, which has a cash-flow deficit of nearly $300 billion annually and is responsible for one-fourth of all federal debt since 2001.”

    I close with a quote from Winston Churchill.  After his defeat as Prime Minister after World War II, his wife Clementine told him, “This may be a blessing in disguise."  Churchill replied, “If this is a blessing, it seems quite well disguised.”
    Tweet:   Supreme Court ruling that the individual mandate is constitutional is a Pyrrhic victory for the Obama administration.

    Thursday, June 28, 2012

    Confusion: My Reaction to Supreme Court Ruling
    Confusion hath made his masterpiece!
    Shakespeare (1564-1616), MacBeth

    June 28, 11AM -    My first reaction to the Supreme Court decision is confusion.  The ruling upholds the individual mandate as a tax,  but strikes  down the law as a vehicle for expanding Medicaid access in the states. 
    The ruling is a victory for the Obama administration and a relief for Democrats.   It enhances Obama’s chances in November.   It is a challenge for Republicans, but it may energize their base into turning out in November to elect a President and Congress to repeal Obamacare.
    It’s still too early to foretell  what it all means.
    Here is what headlines in national newspapers say.
    ·         “Health Law Stands: Roberts Joins Majority Affirming Mandate, Victory for Obama, But Ruling Limits Medicaid Expansion” New York Times 

    ·         “Court Upholds Health Mandate as a Tax” JusticedsFind Fault with Medicaid Expansion” Wall Street Journal

    ·         “Court Upholds Obama Health Care Law,” USA Today.

    ·         “Supreme Court Upholds Health-Care Law: Says Mandate is Permissible Under Congress  Taxing Authority,” Washington Post

    The ruling disappoints and confuses me for two reasons.  One, President Obama has said repeatedly the law was not a tax.  Two,  I thought the intent of the law was to expand access to care in the states via Medicaid expansion. 
    The stage is now set for a vigorous debate between now and November, with sides takes their shots and offering their spin on Obamacare consequences. 
    Let the people decide. Maybe they will help clear up the confusion.
    Tweet: Supreme Court upholds the Individual Mandate but limits expansion of Medicaid in the States – a confusing and contradictory ruling.

    Wednesday, June 27, 2012

    "Health Policy Groups Prepare for a Day of Spin", from Capsules the KHN Blog
    We owe to our ancestors to preserve entire those rights, which they have delivered to our care; we owe it to your posterity, not to suffer thier dearest ineritance to be destroyed.
    The Letters  of Junius 176-1771)
    June 27, 2012 - Here are some ways health policy groups are preparing for Thursday’s decision:
    ·         The National Federation of Independent Businesses’ Legal Center has scheduled a media conference call for Thursday at noon. The group, which is one of the plaintiffs in the challenge to the federal health law, will also host a live-chat on Thursday at 1:00 p.m.
    ·         Virginia Attorney General Ken Cuccinelli, also a plaintiff, will host a live news conference in Richmond, Va., and teleconference call on Thursday at noon, after he has had an opportunity to study the ruling. The attorney general will also send out an immediate reaction to the ruling at 10:15 A.M. A link to the video press conference will be posted on Cuccinelli’s website.
    ·         The National Health Council, a patient advocacy group comprised of more than 100 member organizations, created their own website dedicated to the Supreme Court’s decision. The group will be posting statements, documents and other responses from their member organizations on the website on decision-day.
    ·         The National Council of La Raza, a civil rights and advocacy group for the Latino community, will be hosting a Twitter-chat Friday to broadcast their reactions and to explain what kind of impact they expect the Supreme Court’s actions will have on Latino, LGBT and female Americans.
    ·         Jessica Arons, the director of the Women’s Health and Rights Program at the Center For American Progress will also host a Twitter-chat Friday
    ·         Young Invicibles, the advocacy group that focuses on young adult health care issues, is holding a press call at 12:30 p.m. Thursday. On the same day, the group is going to host a Twitter-Chat (@YI_Care) at 1 p.m., using the hashtag #Young AmerChat.
    ·         The Employee Benefits Research Institute published a blog post last Friday written by director of health research Paul Fronstin that looks at what employers may do once the Supreme Court makes a decision.
    ·         Brookings and the American Enterprise Institute have lined up experts to speak about the various outcomes
    ·         The National Coalition On Health Care said they will release a statement on Thursday. Their president and CEO John Rother is already scheduled to talk to media on the day of the decision.
    ·         Avram Goldstein, a spokesman for Health Care For America Now! said that on Thursday, their partnerships around the country will conduct various events from rallies to press conferences. “Each group does its own thing in a different way. Maybe going to a hospital, maybe visiting an Attorney General’s office, maybe visiting a member of Congress.” He said that his organization is going to have a spreadsheet of all the different events happening around the country and will share it with the public on the day of the Supreme Court decision.
    ·         The CATO Institute initially planned to host a policy forum on June 28th, but pushed their event to July 2nd now that the Supreme Court is going to make a decision on the 28th. The forum, which will address the impact of the Supreme Court’s decision on the health care law, will include Randy Barnett from Georgetown University Law Center, Avik Roy from the Manhattan Institute and Grace-Marie Turner from the Galen Institute.
    ·         Health Affairs, the peer-reviewed health care journal, is hosting an event on Friday, June 29th at Georgetown University’s Law Center to talk about how the Supreme Court’s decision will affect Americans. Their panel includes: David B. Rivkin, a lawyer who representing the 26 states that challenged the constitutionality of the health care law, M. Gregg Bloche from Georgetown University and author of The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise Their Promise to Heal, and Sara Rosenbaum, a professor at George Washington University School of Public Health and Health Services who helped draft part of President Clinton’s health care proposal.
    This entry was posted on Wednesday, June 27th, 2012 at 8:43 am.
    Two Responses to “Health Policy Groups Prepare For Day Of Spin”
    # One Response, If the high court rules to fully uphold Obamacare, the biggest winners will be the private insurance companies. They will see 30 plus million new subscribers enter the health care insurance market. Next in line in the winners circle will be the hospitals. They will see a dramatically reduced volume of charity care as less uninsured freeloaders will be walking into their emergency rooms expecting free “mandated” charity health care. If the high court does as Republicans want them to do and they strike down Obamacare, we will all go back to business as usual in a broken fee-for-service health care system that is twice the cost of any other nation on earth and ranks 37th worldwide in delivery and efficiency. We will return to insurance companies canceling your policy if you get sick. Students and other young adults will get tossed off their parent’s policy. Seniors will see Donut Hole relief end and they will also see the end of free preventive testing. No wonder Republicans are called Neanderthals and Tea Party cave dwellers
    #2 Response - My response to first response
    This is fairly typical elitist spin,
    Namely, should the GOP win,
    It will be a triumph of the Neanderthal
    A victory for the cave dwellers folderal
    Only liberals, you see, have minds,
    Others represent mankind’s behinds.
    Only Obama et al have real compassion,
    Conservative shutdown is out of fashion.
    Only libs know how to spend others’ money,
    Even if it’s not there, which is not so funny.
    My question:  what speaks of more intelligence,
    Spend it now, or save future generation's inheritance.
    Tweet:   Various health industry groups are preparing their win-lose  spins on  tomorrow’s Supreme Court decision on Obamacare, and how it will effect the election and health reform future.

    Supreme Court Ruling on Thursday
    Thursday come, and the week is gone.
    George Herbert (1503-1611)
    Alas, regardless of their doom
    The little victims play!

    No sense have they of ills to come
    Nor care beyond today.

    Thomas Gray (1716-1771)
    June 27, 2012  -   Tomorrow, Thursday,  is Decision Day  Whatever the Supreme Court decides, there will be plenty of apocylyptic doom and gloom, and promise of economic boom to go around.
    Should it go down, Democrats will be full of doom and gloom.  Their signature domestic achievement will be in shreds.  However one tatters  it,  this would  be bad news for the November election. It would  leave them little to run on, and much to run away from. 
    Yes, Obamanites could  blame Congress for obstructionism and the Supreme Court for partisanship.   But they can’t blame the American public, who will welcome news of judicial repeal. And they can’t  escape the colossal political  blunder of focusing on health reform rather than the economy.
    As for the Republicans,  there will be cheers and spiking of the ball in the end zone. Perhaps the end zone should be called the start  zone.  For the GOP must now come up with a plan to move the ball up the reform field again.   For the GOP, the good news may well be another kind of spike – a spike in hiring  as the economic uncertainties of Obamacare disappear. But, alas, an economic recovery spike  in the 130 days before the election could favor Obama.
    Should it be upheld.  Well, that’s another kettle of fish. Democrats will no doubt rejoice.  Republicans will pray for a political sweep in November and a second chance at repeal.
    Should the decision be mixed, with turndown of the mandate and retention of other elements, that’s beyond the scope of this post.
    Tweet:  Tomorrow the Supreme Court announces its decision on Obamacare which will be met with a mix of doom, gloom, and promise of an economic boom.

    Tuesday, June 26, 2012

    Why Doctors Dislike Obamacare
    Please do not
    Annoy, Torment
    Pester, Plague,
    Molest, Worry,
    Badger, Harry,
    Harass, Heckle,
    Persecute, Irk,
    Bully, Vex,
    Disquiet, Grate,
    Beset, Bother,
    Tease, Nettle,
    Tantalize or
    Ruffle the animals.
    Sign near entrance of San Diego Zoo

    June 26, 2012 -   Practicing physicians are not zoo animals.  But sometimes they feel  caged mammals   as they spend up to 1/3 of their time abiding by, complying with, being threatened by federal regulations , begging for permission to perform tests,  and taking the blame for raising costs of health by ordering “unnecessary” tests and procedure to fend off possible future malpractice suits. 
    Meanwhile physician incomes, dictated in large part by a coding system devised and guided by the federal government and the AMA, has kept their income flat for over a decade while expenses have been rising 4%to 5% each year.
    In survey after survey, doctors complain of “harassment” and “hassle” by third parties, parmamout among these Medicare, as they struggle to maintain their practices,  lifestyles, and sanity. 
    Small wonder, then, that 2/3rds of physicians believe Obamacare will lower quality of care, decrease their autonomy, reduce their incomes, and make the practice of medicine less attractive. 
    Small wonder that 25, 000 new physician are entering practice each year while 35,000 are leaving the profession. 

    Small wonder that a political access crisis to physicians looms in three to 5 years, as 30 millon more Medicaid patients enter the government rolls in 2014, and 10,000 baby boomers became Medicare eligible  each day for the next 18 years.
    Doctors’ reaction and resistance to Obamacare, of course, is only one factor in the politics of health reform, and it is seldom mentioned as the Supreme Court announces its decision on the constitutionality of Obamacare in two days on June 28, but I submit it is an important consideration, for it is physicians who must deliver the care under the provisions of Obamacare.
    Health reform is a complicated and difficult proposition to implement in the US for many reasons beyond the scope of this blog.
    But in a previous post, in September 2009.  I touched on some the reasons why. 
    You might enjoy rereading this post, which I reprint now.
    December 23, 2009
    Government Care-Why Reform is Difficult: It's the U.S. Form of Government
    In today’s The Health Care Blog, Humphrey Taylor, Chairman of the Harris Poll and Harris Interactive, speculates why U.S. health reform is more difficult than in other countries.

    He gives these reasons. The comments are mine.

    ONE, their systems are much simpler, i.e., they don’t have a thousand points of payment. Comment: In America, we call this freedom and choice.

    TWO, they already have universal coverage and can focus on improving care, efficiency, and cost containment. Comment: In other words, government rules and trumps private sector.

    THREE, they have parliamentary systems, where a simple majority rules. Comment: “Simple majorities” can lead to social tyranny.

    FOUR, lobbies, i.e. special interests, are more influential in the U.S. Comment: The biggest “special interest” of them all is a dominant unchecked politic party.

    FIVE, the power of money: in other countries elected officials do not have to raise vast amounts of money to be elected. Comment: I agree. A prime example is Barack Obama, who raised unprecedented amounts of money from Wall Street and Internet followers.

    SIX, they only need a bare majority of votes in their legislature and have no such thing as a filibuster. Comment: Good point. Our founding fathers set up a system to frustrate sweeping changes by a “bare” majority.

    SEVEN, the U.S. has partisan news networks, especially Fox News, and talk radio that spread emotional, often misleading arguments that fuel populist feelings, and dumb down the debate. Comment: This is typical elitist rhetoric, that somehow those in D.C. and liberal media have a stranglehold on intellect, wisdom, and objectivity.
    Tweet:   Health reform is difficult in the U.S because of our constitution, our distrust of government, and our desire for clinical freedom.

    Obamacare Echo Chamber
    Blow bugle, blow, set the wild echoes flying,
    Blow bugle, answer, echoes,  dying, dying, dying
    Alfred North Tennyson (1809-1892), The Princess III
    June 26, 2012 – On Thursday, June 28,   we shall learn if the liberal echo chamber-  Democrats, the media, and academics talking to each other and closing their ears to voices outside the Beltway – have heard what the Supreme Court thinks of  health reform correctly.
    Here is how Hugh Hewitt, in the Hewitt Bolog describes what happens when you listen only to your own bugles. Hugh Hewitt (born February 22, 1956) is an American radio talk show host with the Salem Radio Network, lawyer, academic, and author.
    Hewitt Blog
    June 24, 2012

    "This New York Times' story ("Wearing Brave Face, Obama Braces for Supreme Court Ruling")tells how the left came to be surprised by the legal vulnerabilities of Obamacare. The surprise among Democrats, media and academics as the Supreme Court approaches its decision is palpable, and the irony is that over the past few years the left has enjoyed accusing conservatives of "epistemic closure," which is high brow jargon for getting your information from too few sources and discussing that limited amount of information in an echo chamber, say MSNBC. It has always been blender of nonsense with projection, but there it is: The left's big sneer at the right's alleged anti-intellectualism."

    "Now we have the great pipe organ of the left wheezing out a dirge about how the left and its party never saw it coming. And why were Democrats taken by surprise? Because, the paper tells us, they relied on the brilliant Pelosi and the Chicago gang who said there was nothing to worry about in this crazy talk about enumerated powers and the limits of the Commerce Clause. You have to read it to capture the full force of their shock. They genuinely didn't know that there would be a serious challenge, which means they shuttered their ears to the chorus of warnings that steadily rose over the two years it took to jam the disaster down the throat of America."
    "The costs of Obamacare have already been vast and the dislocations it has already brought about terrible --especially its drag on job creation-- but the one good thing it may have produced is this article and its enduring value as "an admission against interest" by the left about the left's lack of basic constitutional literacy and its indifference to argument and facts."

    This is another way of saying one man's intellectual is another man's ineffectual.

    Tweet;  One man’s echo chamber is one man’s bugle and another man’s trumpet and chamber pot.

    Monday, June 25, 2012

    Public Opposes What Obamacare Proposes By Significant Margins
    What the President proposes, the Public opposes.
    June 25, 2012 -  As we all anxiously await the Supreme Court ruling on Obamacare,  it is important to keep in mind three sets of facts or circumstances.

    One,  the latest average of national pollls indicates  the public favors repeal of Obamacare (data from Real Clear Politics).
    Polling Data

    RCP Average
    4/5 - 6/18
    Against/Oppose +10.8
    6/14 - 6/18
    1007 A
    Against/Oppose +14
    6/9 - 6/10
    1000 LV
    Against/Oppose +14
    6/7 - 6/11
    1099 A
    For/Favor +1
    5/31 - 6/3
    976 A
    Against/Oppose +14
    5/29 - 5/31
    1009 A
    Against/Oppose +8
    4/13 - 4/17
    1000 A
    Against/Oppose +9
    4/11 - 4/17
    2577 RV
    Against/Oppose +13
    4/9 - 4/11
    910 RV
    Against/Oppose +13
    4/5 - 4/8
    1003 A
    Against/Oppose +14

    Two, although the health law will cover an estimated 56 million uninsured and underinsured in 2014,   at present (2012) it  covers a much smaller number of Americans.

    ·         3.1 million young adults now covered up to age 26 under their parents’ plans. 
    ·         651. 000 Americans with pre-existing illness  who have been denied coverage by the four major insurers over the last 3 years (and possibly  a million or so more if one includes all insurers ( insurers now accept 9 of 10 with pre-existing illness albeit at high rates). 
    ·         1.2 million seniors falling into the donut hole  who now receive 50% discounts on drugs)
    Three,  There are four possible scenarios of Supreme Court ruling, now expected on Thursday, June 28.  These scenarios will effect different Americans in different states in different ways.
    1. The entire law is upheld.
    2. The insurance mandate is struck down, but the entire rest of the law stays.
    3. The manadate and two related provisions are struck down, but the rest of the law stayes.
    4. The entire law is struck down.
    Tweet:   The public  opposes Obamacare by  a large margin (10.8%), but the law so far directly effects only about 6 million Americans.