'This is an issue federal government shouldn't be touching at all'
By Chelsea Schilling
© 2009 WorldNetDaily
No powers can be exercised by the Congress which are prohibited by the Constitution or which are contrary to its spirit.
– Justice John McLean, Dred Scott v. Sandford, 1857
Is a federal government takeover of the health care system constitutional?
Some argue that under the Constitution, Congress is not authorized to regulate or subsidize health care.
Michael Boldin, founder of The Tenth Amendment Center, told WND that if citizens want to understand whether health care is constitutional, they must first understand the function of the Constitution.
"The best way to look at it is that it doesn't apply to you," he said. "It doesn't apply to me. It doesn't apply to any person at all. It applies to the government, and it sets the boundaries of what government is supposed to do."
Enumerated powers
In debating whether health care is constitutional, Boldin said citizens must look to the founding document to 1) determine whether the power is specifically listed there, or 2) if there isn't a specific power listed, look to the "Necessary and Proper Clause," or Article I, Section 8, clause 18.
Article I, Section 8, specifically lists the following powers granted to Congress:
* The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;
* To borrow money on the credit of the United States;
* To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;
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* To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;
* To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;
* To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;
* To establish Post Offices and Post Roads;
* To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;
* To constitute Tribunals inferior to the supreme Court;
* To define and punish Piracies and Felonies committed on the high Seas, and Offenses against the Law of Nations;
* To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;
* To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
* To provide and maintain a Navy;
* To make Rules for the Government and Regulation of the land and naval Forces;
* To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
* To provide for organizing, arming, and disciplining the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;
* To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings; And
* To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof
'Necessary and proper'
Boldin said the last power, dubbed the "Necessary and Proper Clause," does not grant the federal government unlimited authority, but gives it some leeway for certain things – only as long as those actions apply directly to the Constitution's specifically enumerated powers.
He said a good example of a necessary and proper power in action is the authority to establish post offices listed in Clause 7.
"Article I Section 8 gives the federal government the power to build post offices," he said. "But it doesn't specifically state that it can go out and buy land to build post offices or hire labor to build post offices. Those actions would be necessary and proper and, more importantly, lesser than the main power. So, if they were only able to create a post office, but they couldn't buy the land or the tools or the labor to do it, they'd never get the post office built."
Boldin continued, "When you think of what is necessary and proper to carry out a specifically listed or enumerated power, it has to meet two criteria: It has to be directly applicable, and it also has to be lesser than the enumerated power."
'General welfare'
James Madison
Some critics point to the "general welfare" stipulation in Clause 1 as a key provision granting the federal government the authority to regulate health care. However, in The Federalist No. 41, James Madison, the "Father of the Constitution," argued that "general welfare" in Clause 1 does not give the federal government unlimited power, rendering each of the following clauses redundant.
Madison asked rhetorically, "For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power?
He continued, "Nothing is more natural nor more common than first to use a general phrase, and then to explain and qualify it by a recital of particulars."
Madison sought to address concerns of critics who warned that the "general welfare" clause opened the door to unlimited abuse.
"The Federalist Papers were public arguments to try to convince people to ratify the Constitution," Boldin said. "They weren't just writing about the general welfare clause for the hell of it. There was a real concern by people who were opposed to the Constitution that the general welfare clause would give this unlimited power to the federal government to do whatever it claimed would 'support the general welfare.'"
Referencing the "general welfare" concerns, Madison even accused critics of "labour[ing] for objections" by "stooping to such a misconstruction."
"It wasn't just the opponents of the Constitution saying there had to be limits to this," Boldin noted. "It was the proponents of the Constitution who were saying, in order for it to be general welfare, it must apply to one of the enumerated powers."
No federal authority
Because the power to regulate each citizen's medical care is not included among enumerated powers, he said, the federal government does not have the authority to impose a single-payer system.
"You have to look to the Constitution and ask, 'Is health care listed?'" Boldin said. "No. It's not."
"Is health care directly necessary and proper to carrying out any of the listed powers such as creating post offices and national defense?"
He said critics might argue that to have a good national defense, the United States must make sure that everyone is healthy.
"But that would not fall under any definition of what's considered necessary and proper," he said.
Furthermore, he cited the 10th Amendment, which states:
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
He said that while the government has overstepped its bounds in many cases and used the federal government in violation of the 10th Amendment, that provision must not be ignored.
"No one has ever repealed the 10th Amendment," he said. "They do it by judicial fiat, but it still exists."
'Equal Protection Clause' of 14th Amendment
The 14th Amendment states, "All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
Some proponents of federal health care have argued that every citizen must be treated equally, and the current health care system is an example of gross inequality that runs contrary to principles of the 14th Amendment. They say wealthy people are able to afford and obtain medical treatment while the less fortunate are left to suffer when they are unable to pay for an operation or treatment.
"That argument would lead to a crazy slope where you could say everyone should have the exact same car," Boldin said. "Then we should have the same guarantee of transportation to get to work, the same guarantee of food and shelter. Should we all have equal homes? I mean, if someone wants to make that argument, they have to make some serious changes to the Constitution to authorize it."
He said regardless of their political affiliation or position on health care, citizens must ask themselves whether they truly want a government that has no limits.
"No matter what side you are on, you don't want a government that can do whatever it wants whenever it wants because it becomes dangerous," Boldin said. "This is what the Founding Fathers and the entire founding generation had to fight against – a king who could set his own rules and make them up as he goes. Rules may not be a wonderful thing, but when you allow government to do whatever it wants, you are guaranteeing tyranny."
Amending the Constitution
Some critics say the Constitution was meant to be a "living document" that would adapt to changing times, and since health care is a modern-day issue the Founding Fathers could not have foreseen, they argue, the federal government must step in and provide a single-payer system.
With regard to the "living document" argument, Boldin said that is what the amendment process is for. However, he said, lawmakers won't propose a health care amendment because they know it will not pass.
"They just don't propose it because, if they did, that would make it a much more serious discussion," he said. "The discussion wouldn't just be about helping the poor people – which is obviously a good motive for the people who really believe that."
He continued, "Instead, the discussion would be about the proper role of the government. Should it be involved in this at all?"
States move to nullify federal health care
Activists and state legislators are now focusing their efforts on state governments as a way to resist federal health care "reform" and stop federal usurpation of state rights, according to the Tenth Amendment Center. Lawmakers in as many as 10 states are considering or seeking to propose bills and resolutions to nullify federal health care in their states.
The Tenth Amendment Center explains nullification:
When a state "nullifies" a federal law, it is proclaiming that the law in question is void and inoperative, or "non-effective," within the boundaries of that state; or, in other words, not a law as far as the state is concerned.
Florida state Sen. Carey Baker
"Nullification goes all the way back to fighting for free speech in 1798 when the federal government passed the Alien and Sedition Acts," Boldin said. "Thomas Jefferson and James Madison wrote the Kentucky and Virginia Resolutions saying, you can't do this; we're not going to abide by this in our states. Jefferson specifically said the people in our country are not united on the principle of unlimited submission to their general government. The same holds true today. We're not subjects."
Recently, the issue of nullification re-emerged when nearly two dozen states mounted a resistance to the 2005 Real ID Act. Maine and Utah led the way by passing resolutions to refuse incorporation of federal security features into state driver's licenses and identification cards. After meeting fierce state resistance to its plans, the federal government delayed implementation twice and later announced it would "repeal and replace" the controversial law.
"The federal government wasn't able to do anything," Boldin said. "It wasn't able to threaten – nothing. It had to back off, and now it's getting rid of it."
Florida state Rep. Scott Plakon
Now states have turned their attention toward nullification of federal health care "reform" should it pass Congress this year.
On July 27, Florida State Sen. Carey Baker and State Rep. Scott Plakon filed H.J.R. 37, a proposed state constitutional amendment that would prevent Florida citizens from being affected by federal health "reform."
The proposed amendment prohibits "laws or rules from compelling any person, employer, or health care provider to participate in any health care system" and permits "a health care provider to accept direct payment from a person or employer for lawful health care services."
It also exempts "persons, employers, and health care providers from penalties and fines for paying or accepting direct payment for lawful health care services" and permits the "purchase or sale of health insurance in private health care systems. …"
If approved by the state legislature, Florida residents may vote on the amendment in 2010.
Likewise, the state of Arizona has joined the growing resistance to federal health "reform."
Arizona state Rep Nancy Barto
On June 22, the Arizona state Senate voted 18-11 to concur with the House and approve H.C.R. 2014, known as the Health Care Freedom Act. Arizona residents will vote on the amendment sponsored by Arizona Rep. Nancy Barto in 2010.
This week, Louisiana state Rep. Kirk Talbot announced he will propose a constitutional amendment to shield state residents from federal health "reform."
Louisiana's health chief, Alan Levine, told The Advocate that the legal debate should get interesting.
"The 10th amendment to the Constitution ensures states have the right to conduct their affairs except for those things specifically ascribed to the federal government," he said. "Health care is not one of those things the federal government has the 'right' to impose on states."
Louisiana state Rep. Kirk Talbot
Boldin confirmed that The Tenth Amendment Center has been in contact with sources in seven other states that have indicated their legislatures will see similar health care nullifications as early as 2010.
In a July interview with the Mark Davis Show, Texas Gov. Rick Perry indicated that his state may join the showdown with the White House over federal health care.
"I think you'll hear states and governors standing up and saying 'no' to this type of encroachment on the states with their health care," Perry said. "My hope is that we never have to have that stand-up. But I'm certainly willing and ready for the fight if this administration continues to try to force their very expansive government philosophy down our collective throats."
Boldin said he expects the movement to grow as people realize they can take their concerns to their own state governments
"Once the ball gets rolling, I think people will recognize that you can bang your head on the federal doorstep year in and year out and fail because they don't listen to us in D.C.," he said.
"This is what Jefferson, Madison and most of the founders recommended – this idea that there's a balance of government. When the federal government gets out of control, you have to look to your state governments to protect you against it."
He referenced the recent surge in protests at health care town hall meetings across the nation.
"If these were all focused on state governments, we would probably see 10 or 20 nullification bills in states already," he said. "And the health care program would be dead in the water."
Ultimately, Boldin said, it's not up to the federal government to provide health care for the nation.
"This is an issue that the federal government shouldn't be touching at all."
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Will the elites control life itself?
Saturday, August 15, 2009
Friday, August 14, 2009
Obama's Forfeited Credibility Sabotaging Obamacare
by David Limbaugh
President Barack Obama apparently came to believe the myth of his messiahship and has accordingly abused and squandered his good will and political capital and possibly self-sabotaged his socialized medicine scheme.
Of all the newsworthy aspects of this desperate "reform" effort, none is more so than the robust democratic processes it has reinvigorated in this nation. While Democrats insist the nationwide grass-roots movement against his Draconian measure is contrived and illusory, it is just the opposite.
Nothing could be so real as the American people, emboldened by their passion for liberty, standing up against a callous, dishonest government trolling for its freedoms in exchange for false promises.
All the proof we need that Obama and Democrats recognize the authenticity of this grass-roots protest is their hysterical reaction to it. They wouldn't be hyperventilating about it if they believed it to be fake, but would use their super-majorities to ram through this bill.
Indeed, that congressmen have not been able or courageous enough (against the threat of being removed from office in 2010) to pass this bill is the story of the year. Integral to that story is the unraveling of the Obama mystique, occasioned by Obama's ongoing arrogance and duplicity, most recently on the Obamacare issue.
Let's just look at some of the myriad ways Obama has betrayed the enormous trust bestowed upon him -- on the health care issue alone.
Obama has said he just wants a dialogue with the American people on health care. Sorry, but there are just so many times a person can say the exact opposite of what he means and retain a shred of credibility. While saying he wants this dialogue, he's also telling his opponents to shut up -- literally. Even more revealing, he was adamant that this bill be passed before the August recess -- a bill whose provisions he admitted or pretended he was not familiar with. How could there have been a dialogue if he had already made up his mind and if the deadline he had artificially imposed could not possibly have allowed a dialogue?
Obama has said his opponents were trying to "scare and mislead the American people," when in fact his opponents are the American people whom he is trying to scare and mislead.
Obama misleads us concerning the public option, saying people can keep their private plans if they prefer. Yet the House bill, which he was urging be passed before the August recess, effectively would coerce employers, through punitive and positive incentives, to dump their private plans in favor of the public option. Most Americans have employer-provided health insurance, so a wholesale exodus to the public option would be inevitable -- and intended. In fact, the bill would prevent those who lose private coverage from reacquiring it, except plans conforming to a slew of new mandated regulations, which eventually would drive such plans out of existence. Obama's propagandette, Linda Douglass, falsely denied that Obama said he supports the public option, but he's on tape.
Obama misleads us in his inartful attempt to analogize the postal industry with his health plan, saying privately run FedEx and UPS have fared well against the government-run Postal Service. He fails to tell us how different the public/private competitive environment would be under his health care plan with the deck stacked -- by law -- against the survival of private insurers and private care.
Obama misleads us by denying that bureaucrats would "meddle" in our health care decisions or with the doctor-patient relationship. Yet in almost the same breath, he boasts that he would bundle payments to doctors based on the quality, not the quantity, of the services they provide -- such quality to be determined by his bureaucratic boards. The House bill is replete with provisions conferring such decisions on government bureaucrats.
Obama misleads us when he and his minions cavalierly dismiss the public's genuine concern about the government, under his plan, insinuating itself into end-of-life decisions. Instead of responding to provisions of the bill legitimately generating such concerns, he puts words into our mouths, saying we claim that the bill would require "euthanasia." Even some of Obama's state-run media fact checkers suggested that Reps. Thaddeus McCotter and John Boehner made that claim. In fact, they said provisions of the bill "could create ... a more permissive environment for euthanasia ... and physician-assisted suicide." Someone needs to check the fact checkers.
Of course there are legitimate concerns here, and it insults our intelligence to suggest otherwise. The bill would immediately impose a monumental conflict of interest on government bureaucrats by tasking them to cut costs drastically while simultaneously empowering them to "counsel" people about their end-of-life (and other) medical care. Such a conflict of interest -- over life and death itself -- is unconscionable and unthinkable in the United States of America.
The "messiah" has lost his mojo -- by betraying his unearned trust with the people.
President Barack Obama apparently came to believe the myth of his messiahship and has accordingly abused and squandered his good will and political capital and possibly self-sabotaged his socialized medicine scheme.
Of all the newsworthy aspects of this desperate "reform" effort, none is more so than the robust democratic processes it has reinvigorated in this nation. While Democrats insist the nationwide grass-roots movement against his Draconian measure is contrived and illusory, it is just the opposite.
Nothing could be so real as the American people, emboldened by their passion for liberty, standing up against a callous, dishonest government trolling for its freedoms in exchange for false promises.
All the proof we need that Obama and Democrats recognize the authenticity of this grass-roots protest is their hysterical reaction to it. They wouldn't be hyperventilating about it if they believed it to be fake, but would use their super-majorities to ram through this bill.
Indeed, that congressmen have not been able or courageous enough (against the threat of being removed from office in 2010) to pass this bill is the story of the year. Integral to that story is the unraveling of the Obama mystique, occasioned by Obama's ongoing arrogance and duplicity, most recently on the Obamacare issue.
Let's just look at some of the myriad ways Obama has betrayed the enormous trust bestowed upon him -- on the health care issue alone.
Obama has said he just wants a dialogue with the American people on health care. Sorry, but there are just so many times a person can say the exact opposite of what he means and retain a shred of credibility. While saying he wants this dialogue, he's also telling his opponents to shut up -- literally. Even more revealing, he was adamant that this bill be passed before the August recess -- a bill whose provisions he admitted or pretended he was not familiar with. How could there have been a dialogue if he had already made up his mind and if the deadline he had artificially imposed could not possibly have allowed a dialogue?
Obama has said his opponents were trying to "scare and mislead the American people," when in fact his opponents are the American people whom he is trying to scare and mislead.
Obama misleads us concerning the public option, saying people can keep their private plans if they prefer. Yet the House bill, which he was urging be passed before the August recess, effectively would coerce employers, through punitive and positive incentives, to dump their private plans in favor of the public option. Most Americans have employer-provided health insurance, so a wholesale exodus to the public option would be inevitable -- and intended. In fact, the bill would prevent those who lose private coverage from reacquiring it, except plans conforming to a slew of new mandated regulations, which eventually would drive such plans out of existence. Obama's propagandette, Linda Douglass, falsely denied that Obama said he supports the public option, but he's on tape.
Obama misleads us in his inartful attempt to analogize the postal industry with his health plan, saying privately run FedEx and UPS have fared well against the government-run Postal Service. He fails to tell us how different the public/private competitive environment would be under his health care plan with the deck stacked -- by law -- against the survival of private insurers and private care.
Obama misleads us by denying that bureaucrats would "meddle" in our health care decisions or with the doctor-patient relationship. Yet in almost the same breath, he boasts that he would bundle payments to doctors based on the quality, not the quantity, of the services they provide -- such quality to be determined by his bureaucratic boards. The House bill is replete with provisions conferring such decisions on government bureaucrats.
Obama misleads us when he and his minions cavalierly dismiss the public's genuine concern about the government, under his plan, insinuating itself into end-of-life decisions. Instead of responding to provisions of the bill legitimately generating such concerns, he puts words into our mouths, saying we claim that the bill would require "euthanasia." Even some of Obama's state-run media fact checkers suggested that Reps. Thaddeus McCotter and John Boehner made that claim. In fact, they said provisions of the bill "could create ... a more permissive environment for euthanasia ... and physician-assisted suicide." Someone needs to check the fact checkers.
Of course there are legitimate concerns here, and it insults our intelligence to suggest otherwise. The bill would immediately impose a monumental conflict of interest on government bureaucrats by tasking them to cut costs drastically while simultaneously empowering them to "counsel" people about their end-of-life (and other) medical care. Such a conflict of interest -- over life and death itself -- is unconscionable and unthinkable in the United States of America.
The "messiah" has lost his mojo -- by betraying his unearned trust with the people.
The Etiquette Czar's Rules for Patriotic Protest
by Michelle Malkin
The White House press office is now Miss Manners' office. President Obama's press secretary, Robert Gibbs, took to the television airwaves this week to criticize congressional town hall protesters for "yelling." Gibbs' underling, Bill Burton, chastised voters not to "disrupt" and "scream." Instead, he advised America to engage in a "spirited debate about health care, a real vigorous conversation about it."
What constitutes "spirited"? How do they define "vigorous"? When does forceful dissent become intolerable disruption? Herewith, the Obama Etiquette Czar's Official Rules for Patriotic Protest. Keep this guide with you at all times to avoid being flagged by the Democratic politeness monitors.
-- No shouting. Congressional representatives cannot sell Obamacare with mobs of unruly senior citizens and small-business owners interrupting to press them on specific sections of the bill. Limit your objections to a library whisper and only challenge your lawmakers with hushed, dulcet tones. Otherwise, you will scare them, and they will be forced to hide behind teleconference calls, sick children at hospitals or union bosses.
If, on the other hand, you are attending a presidential town hall to show your affection and approbation, "spirited" chanting is acceptable.
Don't: "HANDS OFF HEALTH CARE!" and "READ THE BILL!"
Do: "I LOVE YOU, BARACK!" "AMEN!" and "YES, WE CAN!"
Also permitted: Shouting at historic inaugurations to protest war (as legions of Code Pink activists did in 2005 during the president's address) and shouting, "We didn't cross the borders, the borders crossed us!" to protest immigration enforcement (as thousands of illegal alien supporters did during raucous rallies in 2006).
Do refrain from boisterous shrieking against those who accuse you of lacking patriotism -- unless you are Hillary Clinton, who bellowed at the top of her lungs in 2003:
"I am sick and tired of people who say that if you debate and you disagree with this administration, somehow you're not patriotic. We should stand up and say we are Americans and we have a right to debate and disagree with any administration."
-- No laughing. Snickering at proponents of nationalized health care is rude, bordering on political terrorism. Stifle all derisive chuckling at bogus statistics and denials that Obamacare will lead to long lines and rationed care. That would be "evil-mongering," as Senate Majority Leader Harry Reid put it on Thursday.
If, however, you are a member of Congress confronted with silly questions about whether you have read the bill, feel free to giggle. For tips on executing acceptable levels of cackling, take a cue from House Majority Leader Steny Hoyer. "If every member pledged to not vote for it if they hadn't read it in its entirety, I think we would have very few votes," Hoyer told CNSNews.com while choking back laughter after a recent news conference. "I'm laughing because a) I don't know how long this bill is going to be, but it's going to be a very long bill." Tee-hee-hee.
-- No Nazi comparisons. References to fascism are ugly and un-American. Swastikas have no place in debates about nationalizing 20 percent of the economy. Swastikas may, however, still be used as substitutes for the "S" in "BusHitler" and tattoos on the forehead of Darth Cheney.
-- No boorish questions. "Real vigorous conversation" requires town hall attendees to formulate queries that will encourage true debate. This is not the time to ask why Congress won't subject itself to the health mandates it wants to foist on every other American. This is not the time to ask how the White House will pay for the massive Obamacare bureaucracy without raising taxes on the middle class. The White House endorsed model citizen questioning at its East Room health care town halls in March and July, including this:
"Hi, Mr. President. I'm a member of SEIU, and I'm down here in Fairfax County working on Change That Works. What can I do, as a member of the union, to help you with your reform bill?"
-- No mean signs. That 11-year-old daughter of a Massachusetts Obama donor and campaigner who was randomly chosen to criticize the scary posters held up by town hall protesters in New Hampshire was right. "Mean" signs are, well, mean. Never mind the placards that blared "Bush is the only dope worth shooting" in Nancy Pelosi's San Francisco and the assassination art depicting former President Bush with a gun to his head in Chicago. "Obama is a socialist" is a sign too far and cannot be tolerated in a civil society. Period.
Instead, print out the "STAND UP FOR HEALTH REFORM" signs helpfully produced by Obama's Organizing for America, and burn your "Don't Tread on Me" flags. Such rebellious sentiments are dangerous incitements to violence.
To those of you who can't abide by The Rules: Shhhhhhhhh.
The White House press office is now Miss Manners' office. President Obama's press secretary, Robert Gibbs, took to the television airwaves this week to criticize congressional town hall protesters for "yelling." Gibbs' underling, Bill Burton, chastised voters not to "disrupt" and "scream." Instead, he advised America to engage in a "spirited debate about health care, a real vigorous conversation about it."
What constitutes "spirited"? How do they define "vigorous"? When does forceful dissent become intolerable disruption? Herewith, the Obama Etiquette Czar's Official Rules for Patriotic Protest. Keep this guide with you at all times to avoid being flagged by the Democratic politeness monitors.
-- No shouting. Congressional representatives cannot sell Obamacare with mobs of unruly senior citizens and small-business owners interrupting to press them on specific sections of the bill. Limit your objections to a library whisper and only challenge your lawmakers with hushed, dulcet tones. Otherwise, you will scare them, and they will be forced to hide behind teleconference calls, sick children at hospitals or union bosses.
If, on the other hand, you are attending a presidential town hall to show your affection and approbation, "spirited" chanting is acceptable.
Don't: "HANDS OFF HEALTH CARE!" and "READ THE BILL!"
Do: "I LOVE YOU, BARACK!" "AMEN!" and "YES, WE CAN!"
Also permitted: Shouting at historic inaugurations to protest war (as legions of Code Pink activists did in 2005 during the president's address) and shouting, "We didn't cross the borders, the borders crossed us!" to protest immigration enforcement (as thousands of illegal alien supporters did during raucous rallies in 2006).
Do refrain from boisterous shrieking against those who accuse you of lacking patriotism -- unless you are Hillary Clinton, who bellowed at the top of her lungs in 2003:
"I am sick and tired of people who say that if you debate and you disagree with this administration, somehow you're not patriotic. We should stand up and say we are Americans and we have a right to debate and disagree with any administration."
-- No laughing. Snickering at proponents of nationalized health care is rude, bordering on political terrorism. Stifle all derisive chuckling at bogus statistics and denials that Obamacare will lead to long lines and rationed care. That would be "evil-mongering," as Senate Majority Leader Harry Reid put it on Thursday.
If, however, you are a member of Congress confronted with silly questions about whether you have read the bill, feel free to giggle. For tips on executing acceptable levels of cackling, take a cue from House Majority Leader Steny Hoyer. "If every member pledged to not vote for it if they hadn't read it in its entirety, I think we would have very few votes," Hoyer told CNSNews.com while choking back laughter after a recent news conference. "I'm laughing because a) I don't know how long this bill is going to be, but it's going to be a very long bill." Tee-hee-hee.
-- No Nazi comparisons. References to fascism are ugly and un-American. Swastikas have no place in debates about nationalizing 20 percent of the economy. Swastikas may, however, still be used as substitutes for the "S" in "BusHitler" and tattoos on the forehead of Darth Cheney.
-- No boorish questions. "Real vigorous conversation" requires town hall attendees to formulate queries that will encourage true debate. This is not the time to ask why Congress won't subject itself to the health mandates it wants to foist on every other American. This is not the time to ask how the White House will pay for the massive Obamacare bureaucracy without raising taxes on the middle class. The White House endorsed model citizen questioning at its East Room health care town halls in March and July, including this:
"Hi, Mr. President. I'm a member of SEIU, and I'm down here in Fairfax County working on Change That Works. What can I do, as a member of the union, to help you with your reform bill?"
-- No mean signs. That 11-year-old daughter of a Massachusetts Obama donor and campaigner who was randomly chosen to criticize the scary posters held up by town hall protesters in New Hampshire was right. "Mean" signs are, well, mean. Never mind the placards that blared "Bush is the only dope worth shooting" in Nancy Pelosi's San Francisco and the assassination art depicting former President Bush with a gun to his head in Chicago. "Obama is a socialist" is a sign too far and cannot be tolerated in a civil society. Period.
Instead, print out the "STAND UP FOR HEALTH REFORM" signs helpfully produced by Obama's Organizing for America, and burn your "Don't Tread on Me" flags. Such rebellious sentiments are dangerous incitements to violence.
To those of you who can't abide by The Rules: Shhhhhhhhh.
Wednesday, August 12, 2009
What the HR 3200 (AAHCA 2009) Health Care Bills Says
John David Lewis
What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.
This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws. I have only touched pieces of the bill here. For instance, I have not considered the establishment of (1) “Health Choices Commissio0ner” (Section 141); (2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity; (3) a Public Health Insurance Option (Section 221); and similar provisions.
This is the evaluation of someone who is neither a physician nor a legal professional. I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore.
We may answer one question up front: How will the government will pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services—there are no other options. We will all pay for this, enrolled in the government “option” or not.
(All bold type within the text of the bill is added for emphasis.)
1. WILL THE PLAN RATION MEDICAL CARE?
This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:
‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
and, under “Definitions”:
‘‘(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .
and:
‘‘(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.
and:
‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .
‘‘(C) the measures of readmissions . . .
EVALUATION OF THE PASSAGES:
1. This section amends the Social Security Act
2. The government has the power to determine what constitutes an “applicable [medical] condition.”
3. The government has the power to determine who is allowed readmission into a hospital.
4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.
5. This is government rationing, pure, simple, and straight up.
6. There can be no judicial review of decisions made here. The Secretary is above the courts.
7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.
2. Will the plan punish Americans who try to opt out?
What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:
‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
(1) the taxpayer’s modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .”
EVALUATION OF THE PASSAGE:
1. This section amends the Internal Revenue Code.
2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.
3. The IRS will be a major enforcement mechanism for the plan.
3. what constitutes “acceptable” coverage?
Here is what the bill says, pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:
(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .
(b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services . . .
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services . . .
(9) Maternity care.
(10) Well baby and well child care . . .
(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .
(3) MINIMUM ACTUARIAL VALUE.—
(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
EVALUATION OF THE PASSAGES:
1. The bill defines “acceptable coverage” and leaves no room for choice in this regard.
2. By setting a minimum 70% actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.
4. Will the PLAN destroy private health insurance?
Here is what it requires, for businesses with payrolls greater than $400,000 per year. (The bill uses “contribution” to refer to mandatory payments to the government plan.) Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE
(a) IN GENERAL.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—
(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and
(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.
(The bill then includes a sliding scale of payments for business with less than $400,000 in annual payroll.)
The Bill also reserves, for the government, the power to determine an acceptable benefits plan: page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.
5 (a) IN GENERAL.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.
EVALUATION OF THE PASSAGES:
1. The bill does not prohibit a person from buying private insurance.
2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”
3. The pressure for business owners to terminate the private plans will be enormous.
4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.
5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.
6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.
5. Does the plan TAX successful Americans more THAN OTHERS?
Here is what the bill says, pages 197-198, SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS
‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
‘‘(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—
‘‘(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,
‘‘(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
‘‘(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.
EVALUATION OF THE PASSAGE:
1. This bill amends the Internal Revenue Code.
2. Tax surcharges are levied on those with the highest incomes.
3. The plan manipulates the tax code to redistribute their wealth.
4. Successful business owners will bear the highest cost of this plan.
6. Does THE PLAN ALLOW THE GOVERNMENT TO set FEES FOR SERVICES?
What it says, page 124, Sec. 223, PAYMENT RATES FOR ITEMS AND SERVICES:
(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.
(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.
EVALUATION OF THE PASSAGES:
1. The government’s authority to set payments is basically unlimited.
2. The official will decide what constitutes “excessive,” “deficient,” and “efficient” payments and services.
7. Will THE PLAN increase the power of government officials to SCRUTINIZE our private affairs?
What it says, pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES.
‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—
‘‘(i) taxpayer identity information with respect to such taxpayer,
‘‘(ii) the filing status of such taxpayer,
‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),
‘‘(iv) the number of dependents of the taxpayer,
‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
‘‘(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.
And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:
(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.
EVALUATION OF THE PASSAGE:
1. This section amends the Internal Revenue Code
2. The bill opens up income tax return information to federal officials.
3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.
4. Employers are required to report whatever information the government says it needs to enforce the plan.
8. Does the plan automatically enroll Americans in the GOVERNMENT plan?
What it says, page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:
(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.
And, page 145, section 312:
(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).
EVALUATION OF THE PASSAGES:
1. Do nothing and you are in.
2. Employers are responsible for automatically enrolling people who still work.
9. Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?
What it says, page 124, Section 223, PAYMENT RATES FOR ITEMS AND SERVICES:
(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.
And, page 256, SEC. 1123. PAYMENTS FOR EFFICIENT AREAS.
‘‘(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—
‘‘(i) the identification of a county or other area under subparagraph (A); or
‘‘(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).
EVALUATION OF THE PASSAGES:
1. Sec. 1123 amends the Social Security Act, to allow the Secretary to identify areas of the country that underutilize the government’s plan “based on per capita spending.”
2. Parts of the plan are set above the review of the courts.
What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.
This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws. I have only touched pieces of the bill here. For instance, I have not considered the establishment of (1) “Health Choices Commissio0ner” (Section 141); (2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity; (3) a Public Health Insurance Option (Section 221); and similar provisions.
This is the evaluation of someone who is neither a physician nor a legal professional. I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore.
We may answer one question up front: How will the government will pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services—there are no other options. We will all pay for this, enrolled in the government “option” or not.
(All bold type within the text of the bill is added for emphasis.)
1. WILL THE PLAN RATION MEDICAL CARE?
This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:
‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
and, under “Definitions”:
‘‘(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .
and:
‘‘(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.
and:
‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .
‘‘(C) the measures of readmissions . . .
EVALUATION OF THE PASSAGES:
1. This section amends the Social Security Act
2. The government has the power to determine what constitutes an “applicable [medical] condition.”
3. The government has the power to determine who is allowed readmission into a hospital.
4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.
5. This is government rationing, pure, simple, and straight up.
6. There can be no judicial review of decisions made here. The Secretary is above the courts.
7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.
2. Will the plan punish Americans who try to opt out?
What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:
‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
(1) the taxpayer’s modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .”
EVALUATION OF THE PASSAGE:
1. This section amends the Internal Revenue Code.
2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.
3. The IRS will be a major enforcement mechanism for the plan.
3. what constitutes “acceptable” coverage?
Here is what the bill says, pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:
(a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .
(b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services . . .
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services . . .
(9) Maternity care.
(10) Well baby and well child care . . .
(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .
(3) MINIMUM ACTUARIAL VALUE.—
(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
EVALUATION OF THE PASSAGES:
1. The bill defines “acceptable coverage” and leaves no room for choice in this regard.
2. By setting a minimum 70% actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.
4. Will the PLAN destroy private health insurance?
Here is what it requires, for businesses with payrolls greater than $400,000 per year. (The bill uses “contribution” to refer to mandatory payments to the government plan.) Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE
(a) IN GENERAL.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—
(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and
(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.
(The bill then includes a sliding scale of payments for business with less than $400,000 in annual payroll.)
The Bill also reserves, for the government, the power to determine an acceptable benefits plan: page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.
5 (a) IN GENERAL.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.
EVALUATION OF THE PASSAGES:
1. The bill does not prohibit a person from buying private insurance.
2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”
3. The pressure for business owners to terminate the private plans will be enormous.
4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.
5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.
6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.
5. Does the plan TAX successful Americans more THAN OTHERS?
Here is what the bill says, pages 197-198, SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS
‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
‘‘(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—
‘‘(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,
‘‘(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
‘‘(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.
EVALUATION OF THE PASSAGE:
1. This bill amends the Internal Revenue Code.
2. Tax surcharges are levied on those with the highest incomes.
3. The plan manipulates the tax code to redistribute their wealth.
4. Successful business owners will bear the highest cost of this plan.
6. Does THE PLAN ALLOW THE GOVERNMENT TO set FEES FOR SERVICES?
What it says, page 124, Sec. 223, PAYMENT RATES FOR ITEMS AND SERVICES:
(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.
(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.
EVALUATION OF THE PASSAGES:
1. The government’s authority to set payments is basically unlimited.
2. The official will decide what constitutes “excessive,” “deficient,” and “efficient” payments and services.
7. Will THE PLAN increase the power of government officials to SCRUTINIZE our private affairs?
What it says, pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES.
‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—
‘‘(i) taxpayer identity information with respect to such taxpayer,
‘‘(ii) the filing status of such taxpayer,
‘‘(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),
‘‘(iv) the number of dependents of the taxpayer,
‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
‘‘(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.
And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:
(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.
EVALUATION OF THE PASSAGE:
1. This section amends the Internal Revenue Code
2. The bill opens up income tax return information to federal officials.
3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.
4. Employers are required to report whatever information the government says it needs to enforce the plan.
8. Does the plan automatically enroll Americans in the GOVERNMENT plan?
What it says, page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:
(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.
And, page 145, section 312:
(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).
EVALUATION OF THE PASSAGES:
1. Do nothing and you are in.
2. Employers are responsible for automatically enrolling people who still work.
9. Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?
What it says, page 124, Section 223, PAYMENT RATES FOR ITEMS AND SERVICES:
(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.
And, page 256, SEC. 1123. PAYMENTS FOR EFFICIENT AREAS.
‘‘(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—
‘‘(i) the identification of a county or other area under subparagraph (A); or
‘‘(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).
EVALUATION OF THE PASSAGES:
1. Sec. 1123 amends the Social Security Act, to allow the Secretary to identify areas of the country that underutilize the government’s plan “based on per capita spending.”
2. Parts of the plan are set above the review of the courts.
The Truth About Health Insurance.
REVIEW & OUTLOOK - Wall Street Journal
Only nine states have the costly rules that Obama wants to impose nationwide.
The White House is priming the defibrillator paddles to revive ObamaCare, and its new strategy is to talk about "health-insurance reform," rather than "health-care reform." The point is to make its proposals seem less radical than they are, while portraying private insurers as villains for supposedly denying coverage to the sick.
Sounds like a good time to explain a few facts about the modern insurance market. Start with the reality that nine out of 10 people under 65 are covered by their employers, most of which cover all employees and charge everyone the same rate. President Obama's horror stories are about the individual insurance market, where some 15 million people buy coverage outside of the workplace.
Mr. Obama does have a point about insurance security. If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.
Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.
Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.
That's one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.
Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.
New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.
There are better ways to go. Tax credits to individuals to buy insurance would make it more affordable and thus strengthen the individual market. Other tax rule changes could also make it easier for people to join and form their own risk pools beyond their employers, such as through business federations, labor unions or, say, the Kiwanis Club. They would no longer be hostage to one job for insurance.
University of Chicago economist John Cochrane also argues that in a more rational individual insurance market, people could insure not merely against medical expenses but also against changes in health status. This kind of insurance would cover the risk of premiums rising as you get older and your health condition changes.
In turn, that would free insurers to compete for the business of all patients, including those with pre-existing conditions, because then they could charge enough to cover the costs—instead of passing them to others. As for those with rare conditions ("orphan diseases") that require a lifetime of special care and are thus uninsurable, this is where government subsidies could be both appropriate and affordable.
ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."
Only nine states have the costly rules that Obama wants to impose nationwide.
The White House is priming the defibrillator paddles to revive ObamaCare, and its new strategy is to talk about "health-insurance reform," rather than "health-care reform." The point is to make its proposals seem less radical than they are, while portraying private insurers as villains for supposedly denying coverage to the sick.
Sounds like a good time to explain a few facts about the modern insurance market. Start with the reality that nine out of 10 people under 65 are covered by their employers, most of which cover all employees and charge everyone the same rate. President Obama's horror stories are about the individual insurance market, where some 15 million people buy coverage outside of the workplace.
Mr. Obama does have a point about insurance security. If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.
Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.
Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.
That's one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.
Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.
New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.
There are better ways to go. Tax credits to individuals to buy insurance would make it more affordable and thus strengthen the individual market. Other tax rule changes could also make it easier for people to join and form their own risk pools beyond their employers, such as through business federations, labor unions or, say, the Kiwanis Club. They would no longer be hostage to one job for insurance.
University of Chicago economist John Cochrane also argues that in a more rational individual insurance market, people could insure not merely against medical expenses but also against changes in health status. This kind of insurance would cover the risk of premiums rising as you get older and your health condition changes.
In turn, that would free insurers to compete for the business of all patients, including those with pre-existing conditions, because then they could charge enough to cover the costs—instead of passing them to others. As for those with rare conditions ("orphan diseases") that require a lifetime of special care and are thus uninsurable, this is where government subsidies could be both appropriate and affordable.
ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."
Obama’s Tone-Deaf Health Campaign
The president shouldn’t worry about the protestors disrupting town hall meetings. He should worry about the Americans who have been sitting at home listening to him.
By DOROTHY RABINOWITZ
It didn’t take chaotic town-hall meetings, raging demonstrators and consequent brooding in various sectors of the media to bring home the truth that the campaign for a health-care bill is, to put it mildly, not going awfully well. It’s not hard now to envision the state of this crusade with just a month or two more of diligent management by the Obama team—think train wreck. It may one day be otherwise in the more perfect world of universal coverage, but for now disabilities like the tone deafness that afflicts this administration from the top down are uninsurable.
Consider former ABC reporter Linda Douglass—now the president’s communications director for health reform—who set about unmasking all the forces out there “always trying to scare people when you try to bring them health insurance reform.” People, she charged, are taking sentences out of context and otherwise working to present a misleading picture of the president’s proposals. One of her key solutions to this problem—her justly famed message encouraging citizens to contact the office at flag@whitehouse.gov if they got an email or other information about health reform “that seems fishy”—set off a riotous flow of online responses. (The word “fishy,” with its police detective tone, would have done the trick all by itself.)
These commentaries, packed with allusions to the secret police, the East German Stasi and Orwell, were mostly furious. Others quite simply hilarious. Ms. Douglass, who now has, in her public appearances, the air of a person consigned to service in a holy order, was not amused.
Neither has she seemed to entertain any second thoughts about the tenor of a message enlisting the public in a program reeking of a White House effort to set Americans against one another—the good Americans protecting the president’s health-care program from the bad Americans fighting it and undermining truth and goodness.
She intended no such outcome, doubtless. That this former journalist, now a communications director, failed to notice anything amiss in the details of that communiqué is a bit odd but not altogether surprising.
Crusades are busy endeavors, the enlistees in this one, like those in every undertaking of this White House, concerned with just one message. Which is that the Obama administration is in possession of vital answers to ills and inequities that have long afflicted American society (whether Americans know it or not), and that those opposed to those answers and that vision are cynics, or operatives of the powerful vested interests responsible for the plight Americans find themselves in (whether they know it or not), or political enemies bent on destroying the Obama administration.
It shouldn’t have been surprising, either, that the tone of much of the commentary on the town-hall protests was what it was. There was Mark Halperin for one, senior political editor for Time, bouncing off his chair, Sunday, in agitation over all the media coverage of this rowdiness—“a horrible breakdown of our political culture, our media culture” and so “bad for America,” as he told CNN’s Howard Kurtz. “I’m embarrassed about what’s going on, as an American.” The disruptions and coverage thereof distorted serious discussion, he explained. Mark Shields said much the same on Friday’s PBS NewsHour, if with less excitation, pointing out that these events were “not good for the democratic process,” and were a breakdown of civil debate.
There was no such hand-wringing over the decline of civil debate, during, say, election 2004, when cadres of organized demonstrators carrying swastika-adorned pictures of George W. Bush routinely swarmed about, and packed rallies. There was also that other “breakdown of our media culture,” that will dwarf all else as a cause for embarrassment, the town-hall coverage included, for the foreseeable future. That would be, of course, the undisguised worshipful reporting of the candidacy of Barack Obama.
That treatment, or rather its memory—like the adulation of his great mass of voters—has had its effect on this president, and not all to the good. The election over, the warming glow of those armies of supporters gone, his capacity to tolerate criticism and dissent from his policies grows thinner apace. His lectures, explaining his health-care proposals, and why they’ll be good for everybody, are clearly not going down well with his national audience.
This would have to do with the fact that the real Barack Obama—product of the academic left, social reformer with a program, is now before that audience, and what they hear in this lecture about one of the central concerns in their lives—his message freighted with generalities—they are not prepared to buy. They are not prepared to believe that our first most important concern now is health-care reform or all will go under.
The president has a problem. For, despite a great election victory, Mr. Obama, it becomes ever clearer, knows little about Americans. He knows the crowds—he is at home with those. He is a stranger to the country’s heart and character.
He seems unable to grasp what runs counter to its nature. That Americans don’t take well, for instance, to bullying, especially of the moralizing kind, implicit in those speeches on health care for everybody. Neither do they wish to be taken where they don’t know they want to go and being told it’s good for them.
Who would have believed that this politician celebrated, above all, for his eloquence and capacity to connect with voters would end up as president proving so profoundly tone deaf? A great many people is the answer—the same who listened to those speeches of his during the campaign, searching for their meaning.
It took this battle over health care to reveal the bloom coming off this rose, but that was coming. It began with the spectacle of the president, impelled to go abroad to apologize for his nation—repeatedly. It is not, in the end, the demonstrators in those town-hall meetings or the agitations of his political enemies that Mr. Obama should fear. It is the judgment of those Americans who have been sitting quietly in their homes, listening to him.
Ms. Rabinowitz is a member of the Journal’s editorial board.
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