Many of us saw this coming. Joe Klein in Time

Let me try to understand this: The key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care super-stores—called exchanges. The Administration has had 3 years to set up these exchanges. It has failed to do so.

This is a really bad sign. There will be those who argue that it’s not the Administration’s fault. It’s the fault of the 33 states that have refused to set up their own exchanges. Nonsense. Where was the contingency planning? There certainly are models, after all—the federal government’s own health benefits plan (FEHBP) operates markets that exist in all 50 states. So does Medicare Advantage. But now, the Obama Administration has announced that it won’t have the exchanges ready in time, that small businesses will be offered one choice for the time being—for a year, at least. No doubt, small business owners will be skeptical of the Obama Administration’s belief in the efficacy of the market system to produce lower prices through competition. That was supposed to be the point of this plan.

Certainly, the Republicans who have stood in the way of these exchanges—their own idea, by the way, born in the conservative Heritage Foundation—deserve a great deal of the “credit” for the debacle. But we are now seeing weekly examples of this Administration’s inability to govern. Just a few weeks ago, I reported on the failure of the Department of Defense and the Veterans Administration to come up with a unified electronic health care records system. There has also been the studied inattention to the myriad of ineffective job training programs scattered through the bureaucracy. There have been the oblique and belated efforts to reform Head Start, a $7 billion program that a study conducted by its own bureaucracy—the Department of Health and Human Services—has found nearly worthless. The list is endless.

Yes, the President has faced a terrible economic crisis—and he has done well to limit the damage. He has also succeeded in avoiding disasters overseas. But, as a Democrat—as someone who believes in activist government—he has a vested interest in seeing that federal programs actually work efficiently. I don’t see much evidence that this is anywhere near the top of his priorities.

One thing is clear: Obamacare will fail if he doesn’t start paying more attention to the details of implementation, if he doesn’t start demanding action. And, in a larger sense, the notion of activist government will be in peril—despite the demographics flowing the Democrats’ way—if institutions like the VA and Obamacare don’t deliver the goods. Sooner or later, the Republican party may come to understand that its best argument isn’t about tearing down the government we have, but making it run more efficiently.

Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.

Yesterday the LA Times led its front page with a poll/story saying that Hispanics favor ObamaCare. So when  the GOP speaks of repealing it, they hear them say they want to take their healthcare away.

That could be a problem.

Jim Geraghty looks at the how ObamaCare could be a lead balloon for Democrats in 2014.

I’m not sure I endorse this theory, but I’ll put it out there: What if 2012 didn’t represent a major turning point in the political preferences of the American people, didn’t signify an epoch-defining victory for liberalism over conservatism, and so on?

What if it just came down to Obama’s ability to delay the consequences of his first-term decisions until after November 2012?

One of the recurring arguments since November has been why Obamacare, never particularly popular in the polls, didn’t prove to be an Achilles’ heel for the president’s reelection bid. Whatever skepticism Americans had about Obamacare, it wasn’t enough to get them to remove the president who passed it. Perhaps they felt lingering skepticism about Mitt Romney because he passed his own health-care reform bill that included an individual mandate. Either way, not enough Americans were upset or worried enough about Obamacare to vote for the guy who pledged to repeal and replace it, over the guy who pledged to keep it.

But what if the public’s opinion on Obamacare was only half-baked in 2012? (Insert punchline about an electorate that was “half-baked” because of the marijuana-legalization initiatives here.) What if the issue was largely defused because only half of the plan had kicked in, and the second half would prove to be one kick in the pants after another to most American patients, doctors, and employers? What if the pooh-poohing of the “Death Panels” accusation proved beside the point, because long before IPAB started deeming treatments insufficiently cost-effective to be worth covering, the whole system would start to fall apart from skyrocketing costs and ludicrously complicated regulations?

Because with each new day, another promise is broken:

Unable to meet tight deadlines in the new health care law, the Obama administration is (more…)

Two stories sum it up:

Ten years after Iraq war began, Iran reaps the gains

The influence of Tehran on its neighbor is growing, while the U.S., Iraqi officials and analysts say, pursues a policy of near-total disengagement.

Ten years after the U.S.-led invasion to oust Iraqi President Saddam Hussein, the geopolitical winner of the war appears to be their common enemy: Iran.

American military forces are long gone, and Iraqi officials say Washington’s political influence in Baghdad is now virtually nonexistent. Hussein is dead. But Iran has become an indispensable broker among Baghdad’s new Shiite elite, and its influence continues to grow.

The signs are evident in the prominence of pro-Iran militias on the streets, at public celebrations and in the faces of some of those now in the halls of power, men such as Abu Mehdi Mohandis, an Iraqi with a long history of anti-American activity and deep ties to Iran.

Obama claimed credit for ending the war (Bush did), then pissed away our investment in blood and treasure to prove a point. Jerk.

Healthcare law could raise premiums 30% for some Californians

About 5 million Californians got a first glimpse at what they might pay next year under the federal healthcare law. For many, that coverage will come with a hefty price tag.

Compared with what individual policies cost now, premiums are expected to rise an average of 30% for many middle-income residents who don’t get their insurance through their employers.

Alternatively, lower-income consumers will reap the biggest savings and are projected to save as much as 84% off their coverage thanks to federal subsidies.

The figures were released Thursday by Covered California, the state agency charged with implementing the federalAffordable Care Act. They underscore the harsh reality that costs for some consumers will have to rise in order to carry out the biggest healthcare expansion in half a century…

Half a century? ObamaCare is a massive boondoggle, a wealth transfer scheme, that will set America back.

Only the government could create a law called the “Affordable…” and have it raise prices. IBD

ObamaCare Turns Three: 10 Disturbing Facts Americans Have Learned

As this start date draws near, evidence is piling up that ObamaCare will:

Boost insurance costs. Officially the “Affordable Care Act,” ObamaCare promised to lower premiums for families. But regulators decided to impose a 3.5% surcharge on insurance plans sold through federally run exchanges. There’s also a $63 fee for every person covered by employers. And the law adds a “premium tax” that will require insurers to pay more than $100 billion over the next decade. The congressional Joint Committee on Taxation expects insurers to simply pass this tax onto individuals and small businesses, boosting premiums another 2.5%.

Push millions off employer coverage. In February, the Congressional Budget Office said that 7 million will likely lose their employer coverage thanks to ObamaCare — nearly twice its previous estimate. That number could be as high as 20 million, the CBO says.

Cause premiums to skyrocket. In December, state insurance commissioners warned Obama administration officials that the law’s market regulations would likely cause “rate shocks,” particularly for younger, healthier people forced by ObamaCare to subsidize premiums for those who are older and sicker.

“We are very concerned about what will happen if essentially there is so much rate shock for young people that they’re bound not to purchase (health insurance) at all,” said California Insurance Commissioner Dave Jones.

That same month, Aetna CEO Mark Bertolini said ObamaCare will likely cause premiums to double for some small businesses and individuals.

And a more recent survey of insurers in five major cities by the American Action Forum found they expect premiums to climb an average 169%.

Cost people their jobs. The Federal Reserve’s March beige book on economic activity noted that businesses “cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff.”

Around the same time, Gallup reported a surge in part-time work in advance of ObamaCare’s employer mandate. It found that part-timers accounted for almost 21% of the labor force, up from 19% three years ago.

Meanwhile, human resources consulting firm Adecco found that half of the small businesses it surveyed in January either plan to cut their workforce, not hire new workers, or shift to part-time or temporary help because of ObamaCare…

A federal judge has struck down a Missouri law exempting moral objectors from mandatory birth control coverage because it conflicts with an insurance requirement under President Barrack Obama’s health care law.

The ruling by U.S. District Judge Audrey Fleissig cites a provision in the U.S. Constitution declaring that federal laws take precedence over contradictory state laws. But Fleissig emphasized that she was taking no position on the merits of the Obama administration policy, which requires insurers to cover contraception at no additional cost to women.

Donna Brazile, longtime Democrat activist, tweeted:

What’s on your menu? Just got off the phone with my health care provider asking them to explain why my premium jumped up. No good answer!

Yes there is, it’s the ironically named “Affordable Care Act.”

I wish saying “I told you so” afforded some pleasure, but the joke is on all of us.

Colleen Medill writes to Instapundit

…I am deeply into studying the impact of Obamacare on employers, and I have been communicating with highly sophisticated ERISA lawyers who are advising employers, from Fortune 50 companies to small firms under 50 employees, on whether to keep or drop or modify their employer group health plans.

It has become very clear to everyone involved who is analytical and not ideological that the rational strategy, for both large and small firms, is to cease providing health care insurance to employees.

No company wants to admit that they are considering eliminating health insurance as an option, or be the first one to drop their health insurance plan, but once a competitor does so, the preference cascade will begin. The clear sentiment is “We will not be the first one to drop our health insurance plan, but we would be a close second.”

The coming preference cascade for employer group health plans is what the Democrats fear the most, because Obamacare was sold to the masses as “if you like your health insurance plan, you can keep it.”

The people who really know the law, and who have been following the avalanche of regulations, have already figured this out. It will take a while for this specialized knowledge to seep downward, because right now only $800+ an hour ERISA attorneys and the most sophisticated HR people understand how Obamacare really works.

Who is shocked that a shoddy law, cobbled together and rammed through Congress against the wishes of the public via parliamentary gimmicks won’t honor its promise.

Remember that Obama admitted wanting to get rid of private insurance in favor of a single payer plan.

Too late smart. First the LA Times:

States worry about rate shock during shift to new health law

WASHINGTON — Less than a year before Americans will be required to have insurance under President Obama’s healthcare law, many of its backers are growing increasingly anxious that premiums could jump, driven up by the legislation itself.

Higher premiums could undermine a core promise of the Affordable Care Act: to make basic health protections available to all Americans for the first time. Major rate increases also threaten to cause a backlash just as the law is supposed to deliver many key benefits Obama promised when he signed it in 2010.

“The single biggest issue we face now is affordability,” said Jill Zorn, senior program officer at the Universal Health Care Foundation of Connecticut, a consumer advocacy group that championed the new law.

Administration officials have consistently downplayed the specter of rate increases and other disruptions as millions of Americans move into overhauled insurance markets in 2014. They cite provisions in the law that they say will hold down premiums, including new competitive markets they believe will make insurers offer competitive rates.

Exactly how high the premiums may go won’t be known until later this year. But already, officials in states that support the law have sounded warnings that some people — mostly those who are young and do not receive coverage through their work — may see considerably higher prices than expected…

The story goes to note that young people, many of them suckers for Obama, will be the hardest hit on insurance rates.

The Washington Post picks up that angle.

Many young, healthy Americans could soon see a jump in their health insurance costs, and insurance companies are saying: It’s not our fault.

The nation’s insurers are engaged in an all-out, last-ditch effort to shield themselves from blame for what they predict will be rate increases on policies they must unveil this spring to comply with President Obama’s health-care law.

Insurers point to several reasons that premiums will rise. They will soon be required to offer more-comprehensive coverage than many currently provide. Also, their costs will increase because they will be barred from rejecting the sick, and they will no longer be allowed to charge older customers sharply higher premiums than younger ones.

Famed Baltimore neurosurgeon Dr. Benjamin Carson addressed the National Prayer Breakfast on Thursday morning on healthcare. Dr. Carson often criticized Obamacare and government intrusion in healthcare while President Obama sat in the audience. Dr. Carson encouraged a program where newborn babies are given health savings account as an alternative to Obamacare.

When the good doctor starts talking about healthcare, it appears Obama is looking at this smart phone. At the very least, he isn’t looking at Dr. Carson.

George Will on why ObamaCare may be doomed in the real world.

…The problems arise from the interplay of two ACA provisions — “guaranteed issue” and “community rating.”

The former forbids insurance companies from denying coverage because of a person’s preexisting health condition. The latter, says Lambert, requires insurers to price premiums “solely on the basis of age, smoker status, and geographic area, without charging higher premiums to sick people or those susceptible to sickness.”

The point of the penalty to enforce the mandate was to prevent healthy people — particularly healthy young people — from declining to purchase insurance, or dropping their insurance, which would leave an insured pool of mostly old and infirm people. This would cause the cost of insurance premiums to soar, making it more and more sensible for the healthy to pay the ACA tax, which is much less than the price of insurance.

Roberts noted that a person earning $35,000 a year would pay a $60 monthly tax and someone earning $100,000 would pay $200. But the cost of a qualifying insurance policy is projected to be $400 a month. Clearly, it would be sensible to pay $60 or $200 rather than $400, because if one becomes ill, “guaranteed issue” assures coverage and “community rating” means that one’s illness will not result in higher insurance rates.

So, Lambert says, the ACA’s penalties are too low to prod the healthy to purchase insurance, even given ACA’s subsidies for purchasers. The ACA’s authors probably understood this perverse incentive and assumed that once Congress passed the ACA with penalties low enough to be politically palatable, Congress could increase them.

But Roberts’s decision limits Congress’s latitude by holding that the small size of the penalty is part of the reason it is, for constitutional purposes, a tax. It is not a “financial punishment” because it is not so steep that it effectively prohibits the choice of payi (more…)

WSJ

President Obama said a fair bit during the fiscal-cliff negotiations—speaking for 45 minutes in one 50-minute meeting, for example—but today let’s zero in on the claim he kept repeating: “We don’t have a spending problem. We have a health-care problem.” For our money—and yours—those are two of the most remarkable sentences our Orator in Chief has ever strung together.

Not so much on the merits, insofar as the federal government is the largest, and worst, buyer of health care in America. But didn’t we recently have an epic debate on this very topic? It seems only yesterday that the President was saying that health-care reform “is no longer just a moral imperative, it’s a fiscal imperative” and “one of the best ways—in fact maybe the only way—to reduce those long-term costs.”

To be precise, that’s how Mr. Obama put it in March 2009, in a White House speech kick-starting the Affordable Care Act. In May of that year, he drew attention to “one clear, indisputable fact,” which was that “the explosion in health-care costs has put our federal budget on a disastrous path.” He added that disciplining those costs “is essential to reducing budget deficits.”

The Democratic supermajority that ran Congress proceeded to write legislation they said would achieve those goals. A year later, speaking at a pep rally for House Democrats shortly before they voted to pass what he called “one of the biggest deficit reduction measures in history,” Mr. Obama said that “Everybody who’s looked at it says that every single good idea to bend the cost curve and start actually reducing health-care costs are in this bill.”

So why is Mr. Obama invoking a special health-care spending problem now? The rational way of reading his fiscal-cliff refrain is as a concession that his cost-control promises are being repudiated by reality. Entitlement spending is headed up, as are overall U.S. health-care costs.

The health entitlements—Medicare, Medicaid, the children’s state insurance program and soon ObamaCare subsidies—accounted for 21% of the budget in 2012. But that will rise to about 24% this year, and about 33% by the end of the decade. As a share of the economy they’ll grow to 10.4% over the next 25 years from 5.4% today, according to the Congressional Budget Office, even with all those supposedly good cost-control ideas in the Affordable Care Act.

CBO wrote in November that unless these entitlements are reformed, or other spending drastically cut or taxes drastically raised, “deficits will be much larger in the future than they have tended to be in the past.” This conclusion “applies under any plausible assumptions about future trends in demographics, economic conditions, and health-care costs.” Many liberal health experts are already declaring that the Affordable Care Act was only a cost-control prelude.

So at first we thought Mr. Obama might be making a concession by acknowledging an ongoing health-care spending problem. But according to our sources, he didn’t therefore propose X, Y and Z reforms. He seems to believe his own advertising. The White House position is that the government health gnomes now have the tools they need to solve the problem. And that would help explain why Mr. Obama refused to consider more than token reforms in the budget talks in 2011 or after the election.

Nothing in practice supports this delusion. Last week Health and Human Services actuaries reported that national health expenditures rose 4.1% in 2011, the third year of relatively low growth by historical standards. HHS Secretary Kathleen Sebelius did cartwheels, claiming that “the statistics (more…)

The British National Health Service is notorious for long waiting times, dirty hospital wards and bloated costs to the taxpayer. But it is “free.”

The NHS has done some outsourcing to become more efficient. WSJ

Richard Branson built a fortune stamping his irreverent Virgin brand on everything from airplanes to rock ‘n’ roll records. But the billionaire entrepreneur is taking heat for putting the Virgin label on one thing many Britons don’t want branded: their taxpayer-funded health-care system.

The Virgin Care unit of Mr. Branson’s Virgin Group has spent the past 2½ years supplying health-care services like podiatry and dermatology to the National Health Service, which is increasingly turning to private-sector contractors in a bid to save money and improve service.

So: outsourcing saves money and delivers better service. Win-win, right?

Oh, no………

Many doctors, patients and members of the public object to the outsourcing trend, saying they don’t like the idea of private-sector companies squeezing a profit out of the already cash-strapped NHS.

Virgin, as one of the biggest and most recognized names in the business, has become a lightning rod for such criticism.

The company says its contracts require it to save the NHS certain sums of money before taking a profit for itself.

Progressives would rather punch themselves in the face than allow someone to earn a profit, those filthy capitalists.

Sigh.

A voice for Michigan’s labor unions voiced this gripe:

“It would have been easy for the current political party to walk away and say it is done, but instead, during this lame duck session when they feel they have the votes, they’re pushing through a right-to-work law, allowing no debates.”

Oh, you mean like ObamaCare?

Except in Michigan, this was a straight-up vote. ObamaCare passed with parliamentary gimmickry.

They knew that when Scott Brown took office, the bill was doomed. And Scott Brown was elected on a promise to vote against ObamaCare. So it was a giant F-you to America.

And ObamaCare affected 1/8th of the American economy.

By the time the crony capitalists have their way, there is no chance ObamaCare will ever reduce costs. Gaming the system has already begun.

Jeffrey H. Anderson in the Weekly Standard

…States are not required to set up Obamacare exchanges, but it seems to have surprised observers that many are choosing not to. Politico reports that, with only 17 states so far having said they will set up the exchanges, the “Department of Health and Human Services’s role in bringing the law to life is going to be a lot bigger than originally thought.” More than a third of all states have already said they won’t set up the Obamacare exchanges. Among others, Republican governors Scott Walker, John Kasich, Sam Brownback, Rick Perry, Bobby Jindal, Nikki Haley, Nathan Deal, Paul LePage, Robert Bentley, Mary Fallin, and Sean Parnell have said they’ll refuse to set up the exchanges in their states.

In Missouri, voters took matters into their own hands, approving a ballot measure to vest authority over the decision in the Republican-led state legislature, rather than leaving it up to the Democratic governor. Missouri will not be establishing an exchange. Utah governor Gary Herbert, meanwhile, has opted for a sort of mild civil disobedience, saying that his state will continue to pursue “our version of an exchange based on defined contribution, consumer choice, and free markets” — a type of exchange that is rather plainly banned by Obamacare.

States’ refusal to be complicit in this crucial aspect of Obamacare should shine a spotlight on the development of the federal exchanges — and what it illuminates won’t be pretty.

The Obama administration’s congressional allies botched the drafting of this aspect of the health care overhaul, as the plain language of Obamacare doesn’t empower federal exchanges to distribute taxpayer-funded subsidies to individuals; it empowers only state-based exchanges to distribute the subsidies. (The administration pretends otherwise.) Moreover, the Department of Health and Human Services (HHS) is lagging behind in developing the federal exchanges.

It gets worse. HHS has contracted with a subsidiary of a private health care company to help build and police the very exchanges in which that company will be competing for business. The person who ran the government entity that awarded that contract has since accepted a position with a different subsidiary of that same company. An insurance industry insider (speaking on the condition of anonymity) says that HHS, in an attempt to hide this unseemly contract from public view until after the election, encouraged the company to hide the transaction from the Securities and Exchange Commission.

According to my source (the basis for most of this account), in January, HHS awarded Quality Software Services, Inc. (QSSI) what the Hill describes as “a large contract to build a federal data services hub to help run the complex federal health insurance exchange.” At that time, the director of Obamacare’s newly established Center for Consumer Information and Insurance Oversight (CCIIO) — which the Hill describes as “the office tasked with crafting rules for the national exchange” — was Steve Larsen. Larsen had been the insurance commissioner for Maryland when Obama’s HHS secretary, Kathleen Sebelius, was the insurance commissioner for Kansas, and the two are reportedly close. The CCIIO awarded the Obamacare exchange contract to QSSI while Larsen was the CCIIO’s director, and he played a central role in planning the construction of the exchanges — although it’s not known whether he made the decision to award the contract to QSSI or not.

Under the contract that it signed with HHS, QSSI’s power would be substantial — as QSSI would shape, run, and affect companies’ ability to compete to sell insurance through Obamacare’s federal exchanges. The Hill writes, “A draft statement of work for the contract awarded to QSSI states the contractor should provide services necessary to acquire, certify and decertify health plans offered on a federal exchange.” Moreover, “It stipulates the contractor should monitor agreements with health plans, ensure compliance with federal standards and” — somewhat strikingly — “take corrective action when necessary.”

Walter Russell Mead

One of the reasons blue programs jump the shark is that over time more and more special interests lobby politicians to get special features added. The small add-ons and tweaks make programs more expensive and complicated to administer—and much, much harder to reform. This process begins when the laws are written; the lobbyists are there to tuck special little surprises between the pages of the bill. It continues as the regulations necessary to implement the new laws are written; once again, lobbyists are on hand to mold the regs to their liking. And it persists year after year after year, as lobbyists look for ways to amend the existing laws or add new requirements by inserting language into other bills.

This is happening as states develop the requirements for insurance under Obamacare. Chiropractors and acupuncturists are lobbying to make sure that their services are included among the “essential” services that the new insurance must provide. The New York Times details some of this reportedly “marginal” tweaking that’s already going on:

According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in New Hampshire, but not in Arizona.

Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.

Whatever the merits of the claims, any new required service will inevitably drive up the cost of insurance.

This same process will happen again and again and again. The nurse lobby will make sure that only licensed nurses can provide certain procedures. Other groups will protect their vested interests by influencing the regulations following amending laws. Ultimately even the positive features of the law will be significantly compromised by the steady accretion of small changes, almost unnoticeable in themselves in many cases—and even well intended sometimes—that over time will turn the law into an unholy mess.

The law is a blunt instrument; fixing the health care system by government fiat is like neurosurgery with a hammer. It’s going to hurt more than you think, and will harm more than it helps. Let’s hope politicians figure that out before too much damage is done.

Washington Times

It’s well established that Obamacare is sending the cost of health care skyrocketing. What’s less known is it will make trips to the grocery store more expensive and drive up the cost of pizza. All this is happening because nanny state zealots slipped a zinger into the measure just before it came up for a vote.

A provision requiring restaurant menus to display calorie counts might seem like a minor addition to legislation representing the takeover of one-sixth of the economy, but the seemingly simple addition will cost billions. President Obama’s own Office of Management and Budget listed the menu display imposition as the third most burdensome statutory requirement enacted that year, forcing retail outlets to expend 14,536,183 work hours every year just to keep Uncle Sam happy.

Instead of applying the menu rule just to restaurants, the Food and Drug Administration (FDA) decided on its own initiative to sweep certain convenience stores and pizza delivery storefronts under the calorie-count requirements. FDA bureaucrats are even micromanaging compliance, down to determining the sizes of fonts that can be used on menu signs. Small-business franchisees will bear the majority of the burden. “If they want to put in new products or change pricing or add new toppings, they have to buy new menu boards,” said Jenny Fouracre-Petko, director of legislative affairs for Domino’s Pizza. “That’s where it gets expensive.”

It will also become confusing, as the boards must convey the calorie counts for the 34 million possible topping combination that the chain offers. Never mind that most customers order pizza over the telephone or through the Internet. Never mind that Domino’s already has an online calculator for weight-conscious customers to figure out calorie counts. Mr. Obama’s minions demand things be done their way.

The signage overload is also headed for grocery stores that feature items like fresh bakery goods and food bars. Store owners must either slap up the signs everywhere or label each individual product. The problem is that suppliers, ingredients and recipes constantly change. If a store wants to offer something different, it will have to cough up around $500 to ship the product to a lab for testing and certification. This ultimately affects the products stores will be able to offer consumers. “It forces you into a central kitchen,” said Jennifer Hatcher, a senior vice president for the Food Marketing Institute, which represents 26,000 retail food stores. “It eliminates creativity and regional variation.”

Administration zealots insist having calorie counts plastered onto (more…)

Indiana governor Mitch Daniels

Over the next few years and maybe just months, the debts we have accumulated and that this presidency has doubled will begin to assert themselves. We must hope and work to see that an easily imaginable panic and economic ruin does not result. At best, economic circumstances will remain difficult.

Even if reserve currency status and the absence of alternatives continues to protect us a while longer, the ObamaCare legislation will take effect. Its implementation will likely be a nightmare of missed deadlines, public confusion, inconsistent exceptions, and dashed expectations. Every claim made for the bill will be shown to have been false: health care costs will go up, not down; government spending and debt will go up, not down; the economy will be injured, not benefited; people by the millions will in fact lose the health insurance they have and like. Indeed, these calamities are already evident.

These failures, abetted by the natural tendency of Americans to swing the pendulum every so often, set the stage for a powerful restoration of an architecture of liberty. Freedom’s friends must be ready, not just with cerebral prescriptions for better policy, but with a moral argument that affirms the God-given dignity of each of us, that says “Yes, you can” to everyone. . . .

In 1980, a Wyoming single mother mystified a New York Times reporter by stating that yes, absolutely she supported candidate Reagan’s proposed income tax cuts. “But, why?” the reporter spluttered. “You don’t make enough money to pay income taxes!” The woman’s reply was “One day I will.” Freedom’s friends must shape their words and actions, when the opportunity for action arrives, in ways that say emphatically “Yes, you can” and “One day you will.”

Michael Tanner at NY Post

Shortly after Nov. 6, Zane Tankel, who runs 40 Applebee’s restaurants in the New York City area, announced that his company was freezing employment and would not build any new restaurants. President Obama’s re-election, Tankel explained, meant that ObamaCare was likely to be fully implemented, costing his company millions of dollars and significantly raising the cost of hiring a worker.

Tankel’s statement prompted outrage and threats of a boycott, but he was far from alone. Already John Schnatter, CEO of Papa John’s Pizza, has announced that he would likely lay off some workers. Earlier, Schnatter said that ObamaCare would cost his business $5 billion to $8 billion annually, forcing him to increase the price of pizzas.

Meanwhile, two other restaurant chains, Olive Garden and Red Lobster, are moving many of their employees from full- to part-time work in order to avoid the law’s mandate that anyone working more than 30 hours must have insurance. An owner of 40 Denny’s in Florida, meanwhile, says he’ll add a 5% surcharge to customer bills in 2014 to cover his increased costs.

While restaurants, with traditionally low profit margins and large numbers of low-skilled, low-wage workers, are exceptionally vulnerable to ObamaCare’s costs, other business are being hit too. For example, Boston Scientific has announced that it will now lay off up to 1,400 workers and shift some jobs to China.

And Dana Holdings, an auto-parts manufacturer with more than 25,000 employees, says it to is exploring ObamaCare-related layoffs.

Look at the upside: the Dems took a wrecking ball to our economy, but they did manage to insure 10 million more Americans (most of whom had health coverage from the government anyway.)

Robert Samuelson

Just recently, the Internal Revenue Service issued an 18-page, single-spaced notice explaining how to distinguish between full-time and part-time workers under the Affordable Care Act (“Obamacare”). The difference matters, because the act requires employers with 50 or more full-time workers to provide health insurance for those workers. At the same time, no company has to buy insurance for part-time employees, defined as those working less than 30 hours a week.

Here’s a sample:

This notice expands the safe harbor method described in a previous notice to provide employers the option to use a look-back measurement period of up to 12 months to determine whether new variable hour employees or seasonal employees are full-time employees, without being subject to a payment under section 4980H for this period with respect to those employees.

Obamacare has faded as a campaign issue, perhaps because it doesn’t suit either the president or Mitt Romney. It’s not popular, a minus for Barack Obama. Its resemblance to Romney’s Massachusetts program is a minus for him. But Obamacare’s relentless march to full-fledged introduction in 2014 demonstrates that, for all its good intentions, it will make the health-care system more confusing (see above), costly and contentious. It won’t control health spending — the system’s main problem — and will weaken job creation.

Consider the treatment of full-time and part-time workers as an object lesson.

Exempting part-time workers is a concession to practicality. If companies had to provide insurance for all part-time and seasonal workers — often unskilled and poorly paid — the high costs (a worker-only insurance policy can run more than $5,000) would eliminate many jobs or inspire mass evasion. On the other hand, exempting too many “part-time” and “seasonal” workers would make achieving near-universal insurance coverage much harder.

So there’s a balancing act: preserving jobs vs. providing insurance. The problem (more…)

The ADA comes to medical equipment:

The health care reform measure recently passed by Congress and signed into law by President Obama includes provisions to address access for people with disabilities to medical diagnostic equipment. The “Patient Protection and Affordable Care Act” authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment. Access to such equipment has been problematic under the Americans with Disabilities Act (ADA).

“The Board welcomes this opportunity to improve access to medical care for millions of Americans with disabilities,” states David Capozzi, the Board’s Executive Director. “The standards to be developed will fill a critical gap by making sure that the equipment used to provide such care is accessible to all.” The Board develops and maintains accessibility guidelines and standards for facilities, outdoor environments, transportation, and information and communication technologies under the ADA and other laws.

The law calls upon the Board to issue the standards within two years in consultation with the Food and Drug Administration. The standards are to address independent access to, and use of, equipment by people with disabilities to the maximum extent possible. The Board is also responsible for periodically reviewing and updating the standards. The law implements these provisions through amendments to the Rehabilitation Act.

The speaker is Clarence Otis, CEO of Darden Restaruants

Sandra Pedicini at the Orlando Sentinel

In an experiment apparently aimed at keeping down the cost of health-care reform, Orlando-based Darden Restaurants has stopped offering full-time schedules to many hourly workers in at least a few Olive Gardens, Red Lobsters and Long Horn Steakhouses.

Darden said the test is taking place in “a select number” of restaurants in four markets, including Central Florida, but would not give details. The company said there has been no decision made about expanding it.

In an emailed statement, Darden said staffing changes are “just one of the many things we are evaluating to help us address the cost implications health care reform will have on our business. There are still many unanswered questions regarding the health care regulations and we simply do not have enough information to make any decisions at this time.”

Analysts say many other companies, including the White Castle hamburger chain, are considering employing fewer full-timers because of key features of the Affordable Care Act scheduled to go into effect in 2014. Under that law, large companies must provide affordable health insurance to employees working an average of at least 30 hours per week.

If they do not, the companies can face fines of up to $3,000 for each employee who then turns to an exchange — an online marketplace — for insurance.

“I think a lot of those employers, especially restaurants, are just going to ensure nobody gets scheduled more than 30 hours a week,” said Matthew Snook, partner with human-resources consulting company Mercer.Darden said its goal at the test restaurants is to keep employees at 28 hours a week.

Analysts said limiting hours could pose new challenges, including higher turnover and less-qualified workers.

“It’s a real problem for restaurants,” said Howard Penney, a restaurant analyst and managing director for Hedgeye Risk Management.
Darden, the world’s largest casual-dining company and one of the nation’s 30 largest employers, said it offers health insurance to all its approximately 185,000 employees. Many are offered a limited-benefit plan. That type of coverage is being phased out under health-care changes, which will ban annual limits for most plans.

George Will

…Late in the debate, when Romney for a third time referred to Obamacare’s creation of “an unelected board, appointed board, who are going to decide what kind of [medical] treatment you ought to have,” Obama said, “No, it isn’t.” Oh?

The Independent Payment Advisory Board perfectly illustrates liberalism’s itch to remove choices from individuals, and from their elected representatives, and to repose the power to choose in supposed experts liberated from democratic accountability. Beginning in 2014, IPAB would consist of 15 unelected technocrats whose recommendations for reducing Medicare costs must be enacted by Congress by Aug. 15 of each year. If Congress does not enact them, or other measures achieving the same level of cost containment, IPAB’s proposals automatically are transformed from recommendations into law. Without being approved by Congress. Without being signed by the president.

Coup de e’tat!

These facts refute Obama’s Denver assurance that IPAB “can’t make decisions about what treatments are given.” It can and will by controlling payments to doctors and hospitals. Hence the emptiness of Obamacare’s language that IPAB’s proposals “shall not include any recommendation to ration health care.”

By Obamacare’s terms, Congress can repeal IPAB only during a seven-month window in 2017, and then only by three-fifths majorities in both chambers. After that, the law precludes Congress from ever altering IPAB proposals.

Because IPAB effectively makes law, thereby traducing the separation of powers, and entrenches IPAB in a manner that derogates the powers of future Congresses, it has been well described by a Cato Institute study as “the most anti-constitutional measure ever to pass Congress.” But unless and until the Supreme Court — an unreliable guardian — overturns it, IPAB is a harbinger of the “shock and awe statism” (Indiana Gov. Mitch Daniels’s phrase) that is liberalism’s prescription for curing the problems supposedly caused by insufficient statism.

They don’t want Obama’s big mouth blowing their dirty little secret.

Joel Gehrke at the Washington Examiner.

President Obama invoked AARP to defend his health care law last night, prompting the influential group to release a statement telling him not to do that again.

“While we respect the rights of each campaign to make its case to voters, AARP has never consented to the use of its name by any candidate or political campaign,” the group posted in a statement. “AARP is a nonpartisan organization and we do not endorse political candidates nor coordinate with any candidate or political party.”

Obama can perhaps be forgiven for thinking he could mention AARP given how they coordinated with him to pass Obamacare, which is a golden goose for the organization.

“Thanks to its cuts to Medicare Advantage, Obamacare is expected to expand the number of seniors buying “medigap” supplemental insurance plans,” The Washington Examiner explained in an editorial. “AARP controls 34 percent of the market for such plans. According to a 2011 House Ways and Means Committee report, AARP stands to make between $55 million and $166 million from Obamacare in 2014 alone.”

The speaker is Barbara Bellar, and she’s running for the Illinois state senate

She’s not your typical person. Starting out as a nun, she went on to become a Major in the Army, a Doctor, a Lawyer, and a small business entrepreneur. Her life is encompassed by one phrase, serving others.

WSJ editorial (read it all at the link.)

What the debate over Mr. Ryan’s reform is revealing is that the real health-care choice, and the real choice this November, is about the role of government. The Orszags of the world ultimately have what President Obama would call an “ideological” preference for coercion over individual choice. They want to impose the unilateral decisions of the state over those of millions of Americans.

…another ObamaCare godfather, the surgeon and influential New Yorker magazine writer Atul Gawande, has further instructions for the medical masses, this time from—believe it or not—the Cheesecake Factory, the chain restaurant.

Dr. Gawande’s point is that medicine would function better if care were delivered by huge health systems that can achieve economies of scale, like commercial kitchens. Care ought to be standardized like preparing a side of beef, with a “single default way” to perform each treatment supposedly based on evidence, with little room for personalization.

No doubt health care could learn a lot about efficiency from a lot of industries, but to understand the core problem with assembly-line medicine, recall that ObamaCare actively promotes medical corporatism. The reason isn’t to encourage business efficiency but for political control. Liberals believe in health-care consolidation because fewer giant corporations are easier for Mr. Orszag’s central committee to control, and more amenable to its orders.

Thanks to ObamaCare, Cheesecake Factory medicine is already becoming a reality. Irving Levin Associates, a research firm that tracks health-care mergers and acquisitions, reports that M&A hit $61.2 billion in the second quarter and the highest annual levels since the 1990s. Three of five hospitals now belong to a parent company’s network, while more than half of physicians are employed by hospitals or systems, not independent practitioners.

On the insurer side, too, incumbents are demolishing their smaller rivals. Aetna is buying Coventry Health Care, a company that administers Medicare and Medicaid benefits, for $5.6 billion. WellPoint made the same play in acquiring Amerigroup for $5 billion in July, while last October Cigna laid out $3.8 billion for HealthSpring.

This bureaucratization will amplify everything patients and businesses despise about the current system: the unintelligible $103,234.61 bill for a turned ankle, the doctor who can’t take a phone call because of how the hospital schedules shift.

Why aren’t mom’s eight specialists aware of each other’s existence? Why is health care mostly conducted via a pad and pen, and beepers and fax machines, in the iPhone era? Why are there so few geriatricians when the first wave of Baby Boomers is already turning 65? Why is it still so hard to find usable information about quality and prices?

The reason isn’t a lack of hospital administrators or technocratic experts. More often than not it’s that patients aren’t the true consumers. The government is, and medical providers inevitably serve the paymaster.

Mr. Ryan’s insight is that health care would work better if patients were controlling their own dollars. His reform accepts the fact that health, disease and treatment are usually complex, individual and unpredictable, not commodities that can and should be reduced to protocols, metrics, algorithms.

***

The immediate danger of the Orszag-Gawande-Obama vision is that layer on layer of new regulation will lock in less-than-best practices. This makes the status quo worse, because too-big-to-fail oligopolists have less incentive to innovate to reduce costs and improve quality.

The longer-run danger is that Mr. Orszag’s cost board starts to decide what types of care “work” for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan’s market proposal is rejected, then government a la Orszag will do it by brute political force.

A murderer’s row of liberal health-care gurus—Zeke Emanuel, Neera Tanden, Don Berwick, David Cutler, Uwe Reinhardt, Steve Shortell, Mr. Orszag, many others—recently acknowledged as much in the New England Journal of Medicine. They conceded that “health costs remain a major challenge” despite ObamaCare. That would have been nice to know in, oh, 2009 or 2010.

Anyhow, their big idea is the very old idea of price controls that are “binding on all payers and providers,” much as post-RomneyCare Massachusetts is already doing. When that strategy fails as it always has, and the public denies further tax increases, the Orszag payment board will then start to ration or prohibit access to medical resources that it decides aren’t worth the expense.

These political choices will be unpopular and even deadly, which is why Mr. Orszag worked so hard to insulate his payment board from oversight or accountability. Congress can only reject the board’s decisions if it substitutes something else that reduces costs by as much. More amazing still, only a minority of the board can be “directly involved” in the provision of health care.

This latter provision is supposed to prevent the alleged conflicts of interest that come from knowing something about how health care is provided in the real world. What it reveals instead is that this board isn’t about medical quality at all. It is purely a balance-sheet exercise to make sure that the Orszag-Obama agenda of top-down health care can’t be undone by something as crude as democratic consent.

And they claim that Paul Ryan’s proposal is “radical”?

Keep reading.

Michael Graham at Boston Herald

…Akin’s opinion about abortion and rape, Obama said, “is why we shouldn’t have a bunch of politicians, a majority of which are men, making health care decisions on behalf of women.”

Excuse me, but did the guy who gave us Obama- care just say we don’t want “politicians making health care decisions?” Am I missing something?

Admittedly, Obama’s plan for an oversight board (the Independent Payment Advisory Board) to limit what treatments will be funded by government programs doesn’t just make health care decisions for women. Obamacare will (theoretically, at least) cut costs by limiting treatments for everyone.

But some of the people who’ll be denied, say, the radical and expensive breast cancer treatment their doctor recommended will be women. How are Obama- care supporters different from pro-lifers?

The biggest lie of the left’s “Republican War on Women” smear is that pro-life Americans like me want to be involved in the choices women make. The only lie that comes even close is that allegedly “pro-choice” liberals don’t want to tell women — and everyone else — what to do with their bodies.

Ask yourself: Who’s slapping the 17-ounce soda out of your hands at the movie theater? It’s not “right-wing” Michael Graham. It’s uber-liberal Michael Bloomberg.

Who’s forcing Catholics — women and men — to pay for day-after abortifacients that violate their religious beliefs? Not me. It’s “pro-choice” President Obama.

The key provision of Obamacare (which they stole from Romneycare — thanks, Mitt) is that women can’t choose the health coverage they want. Young, working women can’t have a high-deductible, low-benefits policy, for example, that doesn’t pass Obama’s approval.

So tell me who’s “making health care decisions for women” again?

From the salt in your food to the seatbelt in your car to the plastic water bottles in your fridge to the cigarette you can’t even smoke in the parking lot anymore, it’s the hypocritical “pro-choice” left that is constantly, happily and unceasingly telling you what to do with your body and how to do it.

Meanwhile, small-government conservatives like me want to leave you alone to smoke pot and watch porn — and we’re smeared as waging a war on “choice?”

Ah, so the question arises: Why am I anti-abortion? And this is the part that makes this issue so painful and the liberal smears so shameful.

Regardless of your politics, the biological truth is that every abortion ends a human life. We can debate “personhood” and “brain wave activity” — all legitimate debates. But this fact — a human life ends — is indisputable…

It’s a bit unfair to call this RomneyCare, given how much his original program was perverted by the Democrats after he left.

WSJ

ObamaCare’s illusions are starting to fall like autumn leaves, even among some liberals, and what they’re discovering are things that have happened over and over again in Massachusetts. Beacon Hill “reformed” health care four years before Capitol Hill, and ever since it has reliably predicted the national trend—on surging costs, price controls, physician shortages and so much else.

So Boston’s latest adventure deserves particular scrutiny, since odds are its methods are coming soon to a hospital near you. After more than a year and a half of debate, last week the legislature passed a far-reaching “cost containment” bill that Democratic Governor Deval Patrick is about to sign. It is the inevitable postscript to the model that Mitt Romney introduced in 2006.

Editorial board member Joe Rago on Massachusetts’s legislature passing price controls to hold down health costs. Photos: Getty Images

The claim then, as with the Affordable Care Act, was that health care would be less expensive if everyone had insurance. Soon Massachusetts Democrats leaked that their political strategy all along was to expand coverage only, because had RomneyCare seriously squeezed providers it never would have overcome industry opposition. “Bending the curve” on costs could be saved for another day, once a vast new government liability was locked in.

Sure enough, 79% of the newly insured are on public programs. Health costs—Medicaid, RomneyCare’s subsidies, public-employee (more…)

Desperate Canadians come to America to get health care.

A Canadian study released Wednesday found that many provinces in our neighbor to the north have seen patients fleeing the country and opting for medical treatment in the United States.

The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993.

Specialist physicians surveyed across 12 specialties and 10 provinces reported an average total wait time of 19 weeks between the time a general practitioner refers a patient and the time a specialist provides elective treatment — the longest they have ever recorded.

The good news is your pain is curable, just suffer for another four months and we’ll have you as good as new.

In 2011, Canadians enrolled in the nation’s government-dominated health service waited long periods of time for an estimated 941,321 procedures. As many as 2.8 percent of Canadians were waiting for treatment at any given time, according to the Institute.

“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to the Institute. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.”