ObamaCare: Dead or Alive?

Oh, the days dwindle down
To a precious few…

Maxwell Anderson (1888-1959)

Will ObamaCare survive results of the midterm elections,which was disastrous for President Obama and the Democrats?

That is a question I keep asking myself.

And it a question I address in my forthcoming triology of books on the history of ObamaCare – the first leading up to the October 2013, the second on results of the first launch, and the third on events from the end of the launch to the midterms. The title of my third book will be ObamaCare: Dead or Alive?


Midterms exit polls after the Republican sweep of state legislatures, governorships, House, and Senate races indicate the three major issues were the economy, ObamaCare, and immigration. The three are interrelated. ObamaCare is perceived as a drag on the economy, people are having a hard time paying for rising health costs, and recent immigrants, legal and illegal comprise a big chunk of the uninsured.

What are the prospects for ObamaCare over the next two years of the Obama presidency?

First, the health law and the President will face incremental challenges on taxes on medical innovation companies, on employer mandates and penalties for covering employees, on the expense of one-size-fits-all benefits for everyone, on subsidies and Medicare expansion to all states, on the roles, rules, and legalities of state and federal exchanges, and a host of other issues, large and small.


Second, some of the more popular ObamaCare provisions – covering young adults under their parents’ policies, those with pre-existing illnesses, many of the disenfranchised receiving subsidies, seniors falling into the donut hole – are likely to be retained.

Third, ObamaCare has set in motion a number of irreversible forces - young physicians seeking security in hospital employment, hospital consolidation with higher prices from dominant systems, electronic health records and big data as a basis for physician performance and payment, and a two-tier system – with one tier covered by government and health plans, and a another tier dominated by physicians, physician organizations, and private organizations offering health care services in retail and online settings.

Two things are self-evident.

One, health care, its structure and its services, will never be the same again.

Two, ObamaCare, as it is currently structured, will dwindle. Its excesses will be excised. It will become more market-based. It will be more consumer-directed with more price transparency, more online information about quality and outcomes, and more reliance of self-care and self-choice.

Three. ObamaCare will live. It will not die completely. It will not be totally repealed but it will be commonsensically transformed to make it more consumer friendly and less costly, for that is what American voters will demand.

TOVIP: What the Election Is All About

What’s it all about Alfie

Is is just the moment we live

What is it all about

When you sort it all out.

Song from 1966 Movie “Alfie”

President Obama is famous for proclaiming a “pivot” – to the economy, to jobs, to Asia. By my count he has announced more than 20 pivots during his presidency to matters that bring political benefit and away from those that don’t.

Fred Barnes, “A Most Pivotal Election,” WSJ, November 3, 2014

You won’t find TOVIP in the dictionary. I just coined it. TOVIP is “pivot” spelled backward. TOVIP is a reverse pivot, and it is what this election is all about.

Here are sixteen TOVIPs taking place this election day.

1. A TOVIP away from ObamaCare, and a TOVIP toward market-based care, with shopping across state lines, more price transparency, and more choices of doctors and health plans and more flexible methods of payment.

2. A TOVIP away from “social organizing”, with its emphasis on minorities and wealth redistribution and government regulations, to a stress on the middle class with more free enterprise with more economic growth with positive benefits for all.

3. A TOVIP away from big government with high taxes for the rich and American corporations to tax reform fro all with closing of loopholes.

4. A TOPIV away from equal outcomes for all, no matter what their contribution to society, to equal opportunity for all, based on their skills and contributions.

5. A TOPIV away from sheer rhetoric laced with promises to clear documented results.

6. A TOPIV away from unilateral executive actions to constitutional checks and balances.

7. A TOPIV aware from late administrative “surprises” over media reported scandals to oversight and management beforehand.

8. A TOPIV away from “one-size-fits-all” health benefits to the “right-size-for-each-individual."

9. A TOPIV away from losing wars to preventing and winning them.

10. A TOPIV away from soft “resets” with negative consequences to resolute actions without regrets.

11. A TOPIV away from a center-left, to a center-right nation.

12. A TOPIV away from an heavily regulated economy to a freedom-oriented innovative economy.

13. A TOPIV away from a war on women to peace-based gender-neutrality and equality.

14. A TOPIV away from energy dependent nation based on wind and sun fantasies and an electric care in every garage to a more realistic energy dependent nation relying on a balance of nuclear, natural gas-driven vehicles, oil pipelines, fracking, and oil exporting.

15. A TOPIV away from a foreign policy based and shame and weakness to a foreign policy based on pride and respect.

16. As for President Obama, he has no TOPIV planned (Carri Budoff Brown, "No Obama Pivot After Midterms," Politico, November 5, 2014.

In summary, TOPIVs are about the size and scope and actions of government. TOPIV is about constitutional law. TOPIV is about the security of the nation . TPIV is about managerial competence, military and economic strength, integrity, and honor.

Quote to Note: The Final Word

The Washington Post's Election Lab model casts the Republican takeover as a near certainty, giving it a 96 percent probability of happening. Nate Silver's FiveThirtyEight model says Republicans have a 73 percent chance at the majority, while LEO, the New York Times model, pegs it at 68 percent.

Chris Cillizza, “The Senate Will Go Republican, the Election Models Say”, Washington Post, November 3, 2014

A reader has asked where he can obtain copies of my recent books. You can buy these four books on Amazon.

• Direct Pay Independent Practice – Medicine and Surgery, $9.77, Kindle Edition

• Understanding ObamaCare: Travails of Implementation: Notes of a Health Reform Watcher, $3.99, Kindle Edition

• Obama, Doctors, and Health Reform: A Doctor Assesses Odds for Success, $19.75 paperback

• The Health Reform Maze: A Blueprint for Physicians’ Practices, $41.27

The U.S.S Obama

Sail on, O Union, strong and great!

Humanity with all its fears,

With all its hopes of future years,

Is hanging breathless in thy fate.

Longfellow (1807-1882), Evangeline

Pollsters predict Ship Obama will break upon the rocks of reality tomorrow.

This crash will occur because Americans are dissatisfied with the State of the Union and the Direction of the Country by 36 points (63% to 27%).

This wreckage upon the shore may be temporary because the Captain has the option of taking down the Ship’s sails and throwing its powerful engines in reverse.

What are the passengers aboard ship thinking? Are they afraid the Good Ship U.S.S. Obama is about to crash upon the rocks? Or do they think it can right itself?

Opinions vary.

Mutinous Crew

The ship’s crew is mutinous. Half of them have vowed to throw the captain overboard, and they say so loudly, vociferously, and continually. The Captain responds by insulting them, accusing them of trying to change the ship’s course. But the mutinous crew says they are interested only in results, not insults.

Out of Control Foreign Affairs

Everybody on ship has a cell phone, smart phone, or other mobile device. They connect with what’s going on in the outside world. They are deeply concerned that events in Kiev, Kobani, Damascus, Baghdad, Gaza and Benghazi. They fear events outside the ship are out of control and may sink the ship. The fear the Captain has made bad decisions – not crossing the Syrian red line he drew himself, withdrawing prematurely from Iraq, not stopping ISIS when the stopping was possible.

People on the Decks and in the Holds

Those with cabins on the upper deck support the Captain. But the majority of people in the middle deck have sinking economic prospects and feel they are merely ballast, and those in the lower decks – minorities, the poor, the young, single women, and others who feel disenfranchised, though supportive of the Captain, are suffering from present and future disenchantment. People in the hold are still on hold, hoping and waiting for promises to be fulfilled.

Asleep at the Helm and Tiller

Many passengers worry about the Captain always being asleep-at-the-helm-and-tiller, always the last-to-know –about-budding- scandals, always surprised and angered at what-he-should- have-known-before-the-media-told-him-so about VA waiting lists, IRS scandals, and the like. These Johnny-come-lately moments bring up the problem of managerial competence.

ObamaCare, Stumbling Websites, Winners, and Losers

Speaking of competence, there’s widespread concern over the abysmal launch of healthcare.gov, other shortfalls of ObamaCare in general, and the Ebola epidemic in particular. Yes, the health law has had its winners - the uninsured, the poor, and those below four times the poverty line – but it has a host of losers too – the middle class, those paying higher premiums and unaffordable, those fearful of losing their doctors and their health plans, health plans, fearful of losing their shirts, small businesses, fearful they cannot afford to cover their employees. Redistributing health benefits and the wealth associated with those benefits and achieving social justice has adverse consequences, some of them harm economic growth and hurt those it was intended to help –Blacks, Hispanics, other minorities, millenials, and single women all of whom are having difficulties finding economic safety boats.

The Grand Perhaps

Still aboard ship, there is still hope reality can be avoided. Perhaps the crew will not mutiny. Perhaps common sense compromises can be reached among political winners and losers. Perhaps the Captain and crew will be able to sit at the same table. Perhaps together they can swell the sails and ignite the engines of economic growth. Perhaps new men at the helm and a transformed Captain, shocked into reality, will signal full-speed ahead again. Perhaps the Ship of State, which recent storms have threatened to destroy, will sail safely on more open and less perilous seas.

This Sunday Is Different: It’s Two Days Until Midterms

Sunday should be different from another day.

Samuel Johnson (1709-1784), from Boswell, Journal of the Hebrides


This Sunday is different. It’s two days until midterms. This Sunday I sought to get the lay of the electoral landscape by reviewing my favorite Sunday news sources, Real Clear Politics Sunday and Sunday Review The New York Times.

Real Clear Politics

• Real Clear Politics features a mixed bag of sources – some liberal, some conservative - usually in equal doses – made up of opinion pieces, videos, poll averages, and news, commentary, and analyses from Washington, the White House, and elsewhere.

This Sunday there are 61 pieces in the mix.

The pieces, in my judgment, break down this way.

1. Positive (Good News), for Democrats and the Obama administration, 11( Eleven)

2. Negative (Bad News), for Democrats and the Obama administration, 42 (Forty Two)

3. Neither Positive or Negative (Neutral) for Democrats and the Obama administration, 8( Eight).

The average of national polls break this way.

Battle for the Senate, no toss ups, 47 Democrats, 52 Republicans

Battle for the House, no toss ups, 194 Democrats, 241 Republicans

Battle for Governor , no tossups, 21 Democrats, 28 Republicans

Summary: 42 of 61 entries (42 of 61) are bad news for Democrats, President Obama and his administrative team.

Sunday New York Times

• My second source is the Sunday New York Times.

Here I list those articles relating to the Tuesday November 4, midterm elections. In most instances, the implications of the headlines, and subtitles are self-evident, and I shall not comment on their contents.

1. “ Both Parties See Campaign Tilting to Republicans: Democrats on Defense: Election Day Closing In Battles for 9 Senate Seats”

2. “Braced for Shift in Congress, Obama Is Setting a New Agenda”

3. “Defects Found Before Debut of Health Care Sites for Small Businesses”

4. “Complacency is Common Enemy in Battles for Senate”

5. Colorado, “Republicans Setting Pace in Early Ballots”

6. Iowa, “Endurance Test of a Race for Candidates and Voters.”

7. North Carolina, “Campaigns Play to Dislikes In Effort to Stoke Interest”

8. “Wistful But Having Fun, Obama Gives Last Push”

9. “The Health Care Law As Equalizer. Who Was Helped Most”

10. " American Partisanship, Fro Sports to Disease, Midterm Stakes”

11. “The Painful Whimpers of 2014”

12. “Why a Win This Year Won’t Help the GOP”

13. “How Obama Lost America

14. “If Pigs Could Vote: The Bumpkinification of the Midterms.”

Summary: Serge Schmemann, a member of the New York Times Board of Editors, sums up the situation “There are plenty of prognoses, analyses and prophecies out there, but the basic picture is that Republicans stand to take control of the Senate away from Democrats…President Obama could spend the last two years defending his signature health care reform against inevitable onslaughts and rule by fiat.”

In other words, one man’s signature can be another man’s ligature, so,when you may be out of it, go fiat.