Freedom Line Blog

Dr. Barbara Bellar is running for State Senate in Illinois. That is a real shame for the Romney camp, which certainly could have used her services in the speechwriting department:

Rep. Chris Van Hollen (D-MD) told Roll Call what the biggest challenge is while preparing Vice President Joe Biden to debate Paul Ryan:

“I sit next to Paul Ryan in the Budget Committee day in and day out,” he said on his preparation for the role.”So, I know how he presents the Republican case.

“He presents a plan that’s bad for the country with a smile, so I think the challenge is dealing with presentation of the plan, explaining why the plan is bad for the country,” he added.

With all due respect to Rep. Van Hollen, his biggest challenge is helping Joe Biden explain how ripping out more than $700 million from Medicare to pay for ObamaCare is a better policy than Ryan’s idea to convert future Medicare benefits into a fiscally sustainable premium support voucher.

It would take all of Bill Clinton’s rhetorical sleight-of-hand to pull off that feat.  Instead, Van Hollen is working with the gaffe-prone Biden.

Good luck overcoming that handicap, Congressman.  You’ll need it.

Below is one of the latest cartoons from two-time Pulitzer Prize-winner Michael Ramirez.

 View more of Michael Ramirez’s cartoons on CFIF’s website here.

I’ll add my voice of support to the chorus here, and say I think Paul Ryan is an inspired choice to be Mitt Romney’s running mate.  One of the benefits of selecting Ryan, is that Romney gives conservatives a chance to articulate the dramatically different trend lines between the parties when it comes to reforming Medicare.

Under ObamaCare, $700 million is ripped out of an already teetering Medicare system to pay for new entitlements.  By contrast, Ryan’s reform grandfathers current seniors while converting Medicare into a voucher program for younger Americans.  Whereas ObamaCare creates new spending commitments with the same pile of money – thus spiking deficits – Ryan’s reform (and by extension, Romney’s) caps Medicare’s subsidy at a level that makes federal spending more sustainable over the long haul.

The campaign just got serious.  I’m looking forward to the next 12 weeks.

In an interview with CFIF, Congresswoman Nan Hayworth, M.D. (NY-19), the only female physician serving in Congress, discusses why repealing and replacing ObamaCare will provide immediate relief for millions of Americans who are desperate to find jobs and the need for a flatter, fairer and simpler tax code to relieve burdens on small business owners and employers, strengthen the economy and grow jobs.

Listen to the interview here.

God bless residents of the Pacific Northwest for casting rightful suspicion on ObamaCare’s state-based, federally-directed, health insurance exchanges:

Focus groups in Oregon expressed emotions about buying coverage that included “skepticism” and “frustration,” and some individuals and small businesses used “black hole” and other less-kind terms to refer to insurance, brand design firm Sandstrom Partners told the Oregon Health Insurance Exchange in a presentation made available by the exchange.

The word exchange “raises some suspicions of loopholes and fine print” and “implies current coverage may needed to be traded for something else,” wrote communications company GMMB in a presentation to the Washington State Health Benefit Exchange. Part of the problem, GMMB said, was that the word was “perceived as a verb and unfamiliar as a noun” and reminded people of the New York Stock Exchange or military exchange stores.

…

Washington state is leaning toward calling its program Washington HealthLink, as long as it doesn’t conflict with existing trademarks, and plans to use green and blue in its logo design because the colors are considered to be reassuring, said Michael Marchand, the state’s exchange director. The exchange’s board of directors will make the final decision on the name, he said.

Focus group participants had also been asked to consider HealthChoice but it “makes some wonder if Washington State is making the choice for them,” consultants and the exchange board concluded.

The Wall Street Journal article from which these excerpts are culled goes on to detail other stories of states trying to brand government-created “marketplaces” as something other than a first big step to government-run health care, but you get the point.

No matter what you call an ObamaCare exchange, it’s still an entry point for socialized medicine.

Politico reports that in a campaign speech in Colorado today President Barack Obama framed his Patient Protection and Affordable Care Act (aka ObamaCare) this way:

“Let me tell you something, Denver, I don’t think your boss should get to control the health care that you get,” Obama told the crowd at a campaign stop in Colorado. “I don’t think insurance companies should control the care that you get. I don’t think politicians should control the care that you get. I think there’s one person to make these decisions on health care and that is you.”

What the President neglected to mention is that instead of employers, insurance companies, and politicians – and despite his comments about individuals – the constituency he really favors making health care decisions is the federal bureaucracy.

ObamaCare’s Medicaid expansion is intended to capture millions of Americans newly eligible for government coverage that will be – at least initially – cheaper than their current private provider.  The state-based, but federally-directed, health care exchanges are really just Trojan horse structures allowing HHS to seize control of the states’ traditional role in regulating health insurance whenever a state defies a federal prerogative.

And let’s not forget that the Independent Payment Advisory Board is empowered to act as a backdoor ration board, setting price caps on medical reimbursements that will distort the market and cause shortages.  In socialized systems like Britain and Canada long waiting times are the norm, as are denials of procedures in favor of pain management.

All of these elements – Medicaid expansion, federally managed health exchanges, and IPAB – empower one group: unelected, unaccountable bureaucrats.  To claim as the President does that private individuals will be the ones calling the shots on health care decisions is either foolish or deceptive, and I don’t think the man is lacking in smarts.

Last week, I posted here about the fact that the growing crisis in the supply of American doctors is driven partially by structural deficiencies in Medicare. A new piece out today in the Wall Street Journal (subscription required) illuminates another key part of the puzzle: the growing tendency of doctors to refuse new patients under Medicaid — the vehicle that the Obama Administration intends to use to insure millions more Americans under Obamacare:

Some 31% of physicians in a sample of 4,326 said they wouldn’t accept Medicaid beneficiaries, economist Sandra Decker of the National Center for Health Statistics reported in an article in the journal Health Affairs published Monday. Most of the doctors cited the low reimbursement from Medicaid.

…

The health law passed by Democrats in March 2010 was supposed to expand coverage to around 16 million low-income people by signing them up for Medicaid. The Supreme Court decision in June effectively gave states the chance to opt out of the expansion. It isn’t yet clear how many will do so, although it’s likely to be a hot political issue. Either way, the coverage gained by low-income Americans could be less useful if they are unable to find a doctor to see them.

There are problems at the macro level too. Consider what Democratic(!) governors have been saying about the Medicaid expansion. Kentucky’s Steve Beshear has said “I have no idea how we’re going to pay for it.” California’s Jerry Brown has called it “devastating.” And Montana’s Brian Schweitzer — a man often touted by Democrats as a potential presidential candidate — has warned, ” I’m going to have to double my patient load and run the risk of bankrupting Montana.”

As Thomas Sowell is fond of saying, one of the hallmarks of liberalism is judging intent rather than outcomes when it comes to public policy. Thus do we get decades-long wars on poverty that do next to nothing for the impoverished, and stimulus programs of which it is always claimed that they would have worked if they only been a little bit bigger.

I’m not sure the abject failures of Obamacare will get a free pass based on good intent though. Theses sorts of consequences — patients unable to find doctors, states teetering on the verge of bankruptcy — are nearly impossible to ignore … no matter how desperately the White House will try.

Over the weekend a New York Times profile of my (and Ashton’s) hometown of Riverside, California sounded the alarm over the crisis-level shortfalls of doctors practicing in America. For a publication as married to do-gooder liberalism as the Times, it’s tone was surprisingly fatalistic:

The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

Well, there is at least one thing the feds could do: get out of the way. A helpful explainer from the Heartland Institute shows how badly government distorts the market for doctors:

[The Heritage Foundation’s Kathryn] Nix points out that when Congress passed the 1997 Balanced Budget Act, it included a cap on the number of residency positions Medicare is allowed to fund. The step wasn’t controversial at the time, and in fact it had the support of multiple organizations, since concerns abounded at the time that the United States had an oversupply of physicians.

Since then, the number of residency positions funded by Medicare has remained unchanged, capped at 1996 levels despite exploding population growth and increased demand. Groups such as the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) have since changed positions and now support increasing the 1996 cap or eliminating it entirely.

“The biggest concern is that the demand is going up as the population ages,” Nix continued. We’re going to have more people on Medicare, elderly who need more medical attention. The new health care law will exacerbate the problem, first of all by increasing and subsidizing demand, but several of the provisions of the new law will discourage physicians from staying in the profession and will discourage young people from joining it.”

An utterly avoidable human tragedy, bred by ignorance. Who could’ve anticipated that capping supply would lead to shortages? Anyone who’s ever cracked a basic economics textbook, that’s who. We can argue over the proper methods for restructuring Medicare, but it should be obvious that “restrict the number of doctors and leave everything else the same” isn’t going to cut it.

And this is just the tip of the iceberg. As has been widely noted, Obamacare’s virtually indestructible Independent Payment Advisory Board has the potential to morph into precisely the kind of “death panel” Sarah Palin warned about.

Bureaucratic incompetence has long been a bugbear of conservatives. But the day is soon arriving when the bean counters will go from costing money to costing lives.

Kenneth Blackwell and Ken Klukowski have a superb column out today on how states can help block ObamaCare as a whole by refusing to set up state insurance “exchanges.”

Key passage:

Third, if employers with 50+ employees do not provide federally-approved healthcare, ObamaCare imposes a $2,000 penalty per employee, per year. (Minimum penalty $100,000.) However, that penalty is triggered when those employees receive tax subsidies from a state-based exchange.

Since HHS-run exchanges have no subsidies, for states refuseing to create exchanges, no employer in that state will be subject to that penalty.

I’m up at FoxNews.com today.

As President Obama’s mandated insurance coverage of sterilization, contraception, and abortion-inducing drugs takes effect on August 1 for ordinary businesses, the Health and Human Services mandate’s ultimate survival suddenly appears blessedly jeopardized.

Federal district Judge John J. Kane of Colorado on Friday issued a temporary injunction blocking the mandate from being applied to Hercules Industries, a family-owned manufacturer of air-conditioning products….

Citing precedent, Kane wrote that the weakness of the mandate’s legal position looks “serious, substantial, difficult and doubtful” based on statutory grounds alone, without even considering the significant constitutional challenges raised by Hercules. As Kane summed it up, the government’s stance amounted to an assertion that “a for-profit, secular employer… cannot engage in an exercise of religion.” This is poppycock – and dangerous poppycock at that. It amounts to a claim that an individual employer, or a closely-held family corporation, does not enjoy the right to religious exercise unless those rights are channeled through a church in a formal worship setting….

The ramifications of this decision could be enormous. If even a secular entity enjoys a “likelihood of success” on the merits of the challenge to Obama’s sweeping edict, then the dozens of suits filed by explicitly faith-related institutions probably enjoy a particularly strong likelihood of victory in court….

This could be very, very important for small businesses nationwide.

In my column last week, I outlined how ObamaCare’s Medicaid expansion is a way to sneak in socialized medicine by making it cheaper to accept government health insurance instead of paying for it (directly) oneself.

But the Medicaid expansion is only half of ObamaCare’s formula for moving most of America onto a federally-run health system.

The other half is made up of the so-called state-based health insurance exchanges that are subsidized (and regulated) by the federal government.  With the individual mandate in place, people that fail to qualify for Medicaid will most likely be forced into the exchanges.  (ObamaCare purposefully makes it cheaper for employers to pay a fine rather than cover employees.)

Writing in the New York Times on Saturday, Tyler Cowen, an economics professor at George Mason University, explains how to make the best of the very bad possibility that President Barack Obama is reelected and ObamaCare continues to be implemented, albeit with the inevitable cost overruns.

There is one way this might work: by limiting the subsidies for insurance. Note that the law itself mandates cuts if those subsidies exceed a certain percentage of gross domestic product by 2018. Most likely, the reform could not stop there, because the insurance cost burden for many Americans would feel intolerably high without the subsidies.

The next step, therefore, would lower costs by limiting the mandate to covering catastrophic conditions. Yet a further step would remove the mandate for noncatastrophic coverage, thus giving people more control over how much they want to spend on health care versus other priorities.

We would then have government-subsidized and mandated catastrophic insurance, and a freer market for other health care expenditures. We might even return to a health savings account approach on the noncatastrophic side.

That’s far from a perfect outcome, but it’s probably the most positive path that can be achieved.

Let’s hope it doesn’t come to that.

When one tries too hard to be popular, the result is usually less popularity.  That appears no less true when it comes to the Supreme Court.

Last week, we highlighted how public approval of the Supreme Court instantly plummeted following last month’s ObamaCare decision.  One week prior to the Court’s decision, twice as many people – 36% to 17% – believed that the Court was doing a “good” or “excellent” job as opposed to a “poor” job.  In the immediate aftermath of that decision, almost as many said that the Court was doing a “poor” job as a “good” or “excellent” job.  Additionally, over twice as many Americans – 56% to 27% – now believe that the justices pursue political agendas as opposed to maintaining impartiality.

As reported by The Hill, a poll this week confirms that backlash:

Negative opinions of the Supreme Court jumped in the wake of its ruling on the constitutionality of the 2010 health care law, according to a new Pew Research Center poll released on Thursday that shows the percentage who have an unfavorable opinion of the Court is higher than at any point since Pew began tracking it in 1985.”

And that’s not just among Republicans.  According to the poll, disapproval among independents increased while approval remained unchanged.  That’s not good news for Barack Obama, and it certainly doesn’t reflect well on Chief Justice John Roberts’s apparent attempt to sacrifice judicial prudence at the altar of popularity.

In an interview with CFIF, Peter Ferrara, Carleson Center for Public Policy Senior Fellow, discusses the Supreme Court’s ruling on the Affordable Care Act and how to repeal and replace ObamaCare.

Listen to the interview here.

Discussed here. Here’s just a small taste:

Multitudinous other lawsuits against the law remain outstanding, and at least a few of them still could result in the court invalidating the entire law at a later date….First, the suit with the largest potential reach – the one perhaps most likely, if the plaintiffs win, to cause the whole law to be invalidated – is a case out of Arizona called Coons v. Geithner. A state think tank called the Goldwater Institute is providing the legal firepower here, while two congressmen are among the plaintiffs. While the lawsuit incorporates challenges to the law on multiple fronts, its most legally explosive issue involves whether something called the Independent Payment Advisory Board (IPAB) is constitutionally permissible….In short, the suit alleges that IPAB amounts to an illegal “delegation” of legislative powers to an unaccountable board.

The U.S. House of Representatives voted 244-185 this afternoon to repeal ObamaCare. 

Five Democrats joined all Republicans in the House to support the repeal measure.  The five Democrats included:

• Rep. Jim Matheson (D-UT)
• Rep. Larry Kissell (D-NC)
• Rep. Mike McIntyre (D-NC)
• Rep. Mike Ross (D-AR)
• Rep. Dan Boren (D-OK)

McIntyre, Ross and Boren all voted for repeal in 2011.  Matheson and Kissell, both facing tough reelection fights, voted against repeal last year and changed their votes today.

Last Friday, the Obama Administration announced that Wisconsin and Washington joined 24 other states as recipients of No Child Left Behind waivers.

The Department of Education claims that Congress’ repeated failure to reauthorize NCLB since it became due in 2007 empowers it to exempt petitioning states from certain requirements in exchange for accepting new rules and policies dictated by the White House.

This links to a chart from Governing.com identifying each state’s waiver status.

Writing in an email commentary about the waivers, Lindsey Burke of the Heritage Foundation summarizes President Barack Obama’s justification of the waiver system as “necessary to provide relief to states that fear drowning in a cascade of sanctions that are forthcoming in 2014,” such as 100 percent of students being proficient in reading and math.

While I agree with Burke that states “should demand genuine relief from NCLB through congressionally approved options that fundamentally reduce federal intervention in education,” her summary of Obama’s justification for waivers got me thinking.

If Mitt Romney gets elected president with less than full (or consistent) control of Congress and can’t repeal ObamaCare, would he resort to granting waivers from its penalties “to provide relief to” individuals “that fear drowning in a cascade of sanctions”?

I certainly hope so.

David Harsanyi points out:

According to the Congressional Budget Office—which can only calculate the narrow data it’s given—the non-tax penalty on Obamacare’s non-mandate will affect 4 million people by the year 2016. Of those paying this ‘untax,’ 75 percent will make less than $120,000—breaking the president’s promise that those making under $250,000 would not have to pay a “penny” more in taxes, which, presumably, includes “shared responsibility payments.”

Anticipating Romney’s inauguration, I’ll go ahead and get in line to ask, “Mr. President, can I have a lifetime waiver from my ‘shared responsibility payment?’”

I think there’s a precedent…

Wesley J. Smith reminds us why with ObamaCare’s individual mandate safe for now, conservative litigators should focus on striking down the Independent Payment Advisory Board, the unelected, unaccountable group of “experts” charged with controlling costs under ObamaCare.

There’s not much time left:

According to the terms of the Affordable Care Act, IPAB must submit its first draft recommendations to the health and human services secretary by September 1, 2013. Its first Medicare cost-cutting goals must become law by August 15, 2014.

Why did I write “must” become law” instead of “may”? IPAB’s unique “fast track” authority divests Congress of discretion regarding the amount of money to be cut from Medicare once IPAB has submitted its “advice.” Get a load of these legislative handcuffs:

• By January 15, 2014, IPAB must submit a proposal to Congress and the president for reaching Medicare savings targets in the coming year.

• The majority leaders in the House and Senate must introduce bills incorporating the board’s proposal the day they receive it.

• Congress cannot “consider any bill, resolution, amendment, or conference report … that would repeal or otherwise change the recommendations of the board” if such changes fail to meet the board’s budgetary target.

• By April 1, all legislative committees must complete their evaluation. Any committee that fails to meet the deadline is barred from further consideration of the bill.

• If Congress does not pass the proposal or a substitute plan meeting the IPAB’s financial target before August 15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.

Not only that, but Congress cannot consider any bill or amendment that would repeal or change this fast-track congressional consideration process without a three-fifths vote in the Senate. And to put the icing on the autocratic cake, implementation of the board’s policy is exempted from administrative or judicial review.

Unlike the rest of ObamaCare, IPAB cannot be repealed easily because its enabling statute “entrenches” it from being altered by later Congresses.  Thus, banking on a President Romney and a Republican Congress to get rid of it won’t work.

I’ve written before about the federal case in Arizona challenging IPAB.  It was on hold awaiting the Supreme Court’s decision on the individual mandate.  With the mandate redefined as a tax, the IPAB litigation will proceed, perhaps with a Supreme Court hearing as early as spring 2013.

Keep an eye on this one.  It’s easy to see how an unaccountable board of bureaucrats empowered to control costs could morph into a health care rationing board.

Pulitzer Prize-winning historian David Maraniss’ new book, Barack Obama: The Story documents nearly three dozen instances where the President misstated facts about his life in Dreams From My Father.

Among other defenses of Obama’s deliberate misstatements reported by Fox News’ James Rosen, this one takes the cake:

Gerald Early, a noted professor of English literature and African-American studies at Washington University in St. Louis, agreed. “It really doesn’t matter if he made up stuff,” Early told Fox News. “I mean, after all, it’s like you going to a psychiatrist and you make up stuff, and the psychiatrist can still psychoanalyze you because they’re your lies.”

My only regret is that Professor Early didn’t tighten up his argument so it can fit on a bumper sticker because it perfectly captures so much of what’s wrong with modern liberalism’s catechism.

Then again, maybe “It really doesn’t matter if Obama made up stuff…” could be understood to mean:

“…since he already got elected.”

“…because he can count on the Supreme Court to bail him out.”

“…because comprehensive health care reform is a BFD.”

“…since voters don’t care about integrity, just a President who can slow jam the news.”

It’s no secret that Chief Justice John Roberts’ opinion in the ObamaCare case last week is already helping President Barack Obama on the campaign trail by giving the unpopular law constitutional legitimacy.

But Fox News reports that Roberts’s opinion may also help the President make another boast: ObamaCare is a job creator.

Much bigger than the mandate itself are the insurance exchanges that will administer $681 billion in subsidies over 10 years, which will require a lot of new federal workers at the IRS and health department.

“They are asking for several hundred new employees,” Dorn said. “You have rules you need to write and you need lawyers, so there are lots of things you need to do when you are standing up a new enterprise.”

For some, though, the bottom line is clear and troubling: The federal government is about to assume massive new powers.

According to James Capretta of the Ethics and Public Policy Center, federal powers will include designing insurance plans, telling people where they can go for coverage and how much insurers are allowed to charge.

“Really, how doctors and hospitals are supposed to practice medicine,” he said.

The health department is still writing regulations, which can be controversial in and of themselves. One already written, for instance, requires insurance plans to cover contraception. It has been legally challenged by Catholic groups in a case likely to end up in the Supreme Court.

So, there are likely to be many more chapters to go in the saga of Obama’s health care law

And none of it would be possible without the Chief Justice.