When is rationing not rationing?

When is rationing not rationing, a mandate not a mandate and price-fixing not price fixing?

When the government says so.

Supporters of the PPACA react to opponent’s charges of rationing by claiming that the Independent Payment Advisory Board (IPAB) can't ration because the law says it can't. 

"The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. [Emphasis added] Pub. L. 111-148, § 3403"

But when the government takes your money to fund a program (e.g. Social Security and Medicare) and then in any way limits your access to the benefits of that program, that's rationing. Since the law prohibits restricting benefit restriction and increased cost sharing by patients, the only effective way left for the IPAB to achieve mandated spending decreases is to lower payments to doctors and hospitals. But if you end up with less access to doctors and medical care because the government pays them less, that’s rationing. No matter how much you try to deny it, or what you call it instead of rationing: a rose is a rose...and government controlled health care is rationing.

The same people who say the IPAB cannot and will not ration will tell you that markets ration through prices. This is a complete misrepresentation of the role of prices in a free market. Free market prices are a signal. They provide information. Prices do not ration any more than a bathroom scale makes you fat or thin. Free market prices give you information about the relative scarcity of resources and then allowyouto decide how to allocate your own private resources. Free market prices are a reflection of what individuals voluntarily pay. Government rationing is an act of force. It's a fundamentally different kind of interaction when the government determines for you how your resources are to be allocated--whether the government expropriates them first, as in the case of Medicare, or simply mandates how you must spend them, as in the case of the individual mandate to purchase health insurance.

While we are talking about mandates—in the legal challenges to the PPACA, the government is currently arguing before the courts that the “requirement to maintain minimal essential coverage” is not a mandate to buy coverage. The government’s top lawyer, Solicitor General Neal Katyal, argued in court:

Congress is not regulating the failure to buy something, but the failure to secure financing.

The New York Times reports:

Mr. Katyal…argued that the law’s insurance mandate, which takes effect in 2014, does not so much require individuals to buy coverage as it does regulate the way they pay for health care they will inevitably consume. 

This is a distinction without a difference. Lawyers are good at word games, but if you look at the actual real life effect of the law, it is a mandate which offers you no real choice: you can either obtain a government-defined product or you can break the law and pay a penalty.

In language similar to the restrictions placed on the IPAB, the new heath care control law also forbids the use of quality-adjusted-life-years (QALYs) “as a threshold to establish what type of health care is cost-effective or recommended.” But thousands of cost-utility studies use QALYs to determine cost-effectiveness.  Realistically, QALYs are the yardstick currently used to measure and compare outcomes to various medical treatments. It is hard to imagine how this ban could be any more meaningful than the ban on rationing discussed above.

Just over a year ago, The Christian Science Monitor reported:

[T]he Antitrust Division, [of the Dept. of Justice] joined by Idaho Attorney General Lawrence Wasden, forced a group of Boise orthopedists to accept price controls for worker’s compensation and HMO contracts as part of a settlement accusing the doctors of “price fixing”… [T]he Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing”… The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices.”

Through a simple decree, the government thinks it can turn prices set by voluntary exchange into price-fixing, and government-determined prices into market prices. Who are they trying to convince? Must be themselves because any one with a bit of common sense can see that changing the terminology can not change the reality.

Other equivocations by government officials and their defenders include denying that clinical guidelines accompanied by sanctions and rewards do not amount to promoting “cookbook medicine.” And that as long as you call it “evidence-based care,” you can ignore the fact that much of the “evidence” is controversial and that many of the guidelines are written or funded by those with vested interests in a particular outcome.

Lest you think that this verbal trickery is restricted to health care, you can find much of the same in the politicization of energy policy. Regarding the elimination of the incandescent light bulb, Penelope Green writes in the New York Times:

The [Energy Independence and Security Act of 2007] does not ban the use or manufacture of all incandescent bulbs, nor does it mandate the use of compact fluorescent ones. It simply requires that companies make some of their incandescent bulbs work a bit better, meeting a series of rolling deadlines between 2012 and 2014.

Yet, a short week later, again in the NYT, Andrew Rice informs us:

[O]ne day very soon, traditional incandescent bulbs won’t be available in stores anymore. They’re about to be effectively outlawed…Conservatives like Rush Limbaugh have denounced the “light-bulb ban” — actually, [it’s] a new set of federal efficiency regulations that the traditional incandescent can’t meet.

You see, a ban on light bulbs isn’t really a ban on light bulbs, because the law doesn’t call it a ban.

As Richard Ralston so aptly warns:

“When the clear meaning of words is replaced with government fiat in this way, all limits on arbitrary government power and its use of force are destroyed.”

Rationing, mandates, price-fixing, and bans are al terms with precise meanings in plain English. Shame on us if we are fooled by the deliberate distortion of these simple definitions. Stick and stones can break our bones, and words can actually hurt us --when they are used to obscure instead of clarify our understanding of reality.

(This post was published in Townhall.com in a shorter version here.)

Amicus Brief filed to FL v HHS

Docs 4 Patient Care, Benjamin Rush Society, and Pacific Research Institute,

File Amicus Brief Against Obama Care

May 12, 2011 – Docs 4 PatientCare, the Benjamin Rush Society, and the Pacific Research Institute issued the following statements after filing an amicus brief in the U.S. Court of Appeals for the 11^thCircuit supporting the district court’s decision that Obama Care is unconstitutional.

Hal Sherz, MD, FACS, FAAP, President and Founder of Docs 4 Patient Care said: “We believe that it is vitally important for a physician group to stand up and speak out on behalf of all of the doctors in this country who oppose this law, but feel disenfranchised and disheartened. As opposed to other medical organizations that have failed to stand up for its constituents and have instead urged them to accept the onerous changes being forced upon them by a statist administration, we are conveying hope by challenging the legality of this law and the brazen attempt of the government to control healthcare.”

Sally C. Pipes, founder of the Benjamin Rush Society and President and CEO of the Pacific Research Institute said: “We believe that the district court was correct that the mandates imposed by the federal government in the PPACA are not a constitutional exercise of governmental power. Forcing Americans to purchase expensive health insurance or face a penalty is not the responsibility of government. Doctors and patients – not the government -- should be in charge. Only then will America achieve affordable, accessible, quality care for all.”

Google docs web link of amicus brief

(Addendum: better link)  Amicus Brief

That's the official press release.

In my new role as Senior Health Policy Analyst for Docs 4 Patient Care, I was able to contribute behind the scenes by providing a comprehensive bibliography of peer-reviewed articles on cost-shifting in health care, as well as participate in strategy discussions while the brief was being written. Very exciting--and educational--process.

Although the D4PC leadership initially wanted to argue from fundamental principles, we were advised that such arguments, especially at the appellate level, would be dismissed almost out-of-hand because of the past 70 years of Supreme Court rulings on Commerce Clause interpretation. The more effective place for those more fundamental arguments is in the media and the political arena--places we are doing our best to speak out frequently and consistently.

If we are to rid ourselves of the PPACA and its disastrous effects on personal health care freedom, popular discontent must be loud and clear. Chances for complete repeal )after a successful 2012 election), as well as Supreme Court comfort with over-turning legislative action, both depend on public opinion of the law.

I am convinced that the more people know about the details, the more they will oppose the law.

Continue to write letters to the editor.

Speak up and speak out.

Invite conversations by wearing the Black Ribbon.

The battle for the sanctity of the private doctor-patient relationship is still going strong.

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The Fight Against Tyranny Never Ends

On the 4th of July, we must remember why we celebrate. Today I will rejoice in the freedom we have in this country--but not for a second will I forget the fact that there are many who do not understand what a precious and fragile gift we have inherited.

The eight pillars of the federal government healthcare takeover:

1. Federal mandates on individuals
2. Federal mandates on employers
3. Expanding federal entitlements
4. Squeezing funds out of Medicare and choking off private plan choices'5. New federal taxes
5. New federal taxes
6. [federally controlled] Health insurance exchanges
7. Federal government-sponsored health plans [public options]
8. Federal control over private health insurance 

from Why ObamaCare is Wrong for America

The new government mandated cigarette labels:

“If they’re going to take truthful, non-deceptive advertising and put extraordinarily evocative and gruesome pictures on them and force the companies to use their money to present the government’s message, that’s a big step in a free society,” says Dan Jaffe, executive vice president of government relations with the advertisers’ association.--Shawn Zeller, CQ.com

ObamaCare also requires insurance companies participating in exchanges to have their marketing approved by the government.

What we can expect if the individual mandate to purchase health insurance is upheld:

“Mandatory Life Insurance,” Cries California Congress Person

BROADMOOR, CA. June 29, 2011: “Tomorrow I plan to introduce the Affordable Life Insurance Empowerment Act in Congress,” said Arly Esperson, Congressperson from California’s 54^th Congressional District. “Now that the Sixth Circuit Court of Appeals has ruled the health insurance mandate is constitutional, I think it’s time we take the next step.”--[Not a real bill, but it could be.]-- DaveRacer, posted at The COHR Man

Supporters of ObamaCare may find that title offensive, but it is a more accurate and neutral moniker than a title which claims the law is affordable or that it protects patients.

ObamaCare is more than an attack on our healthcare freedom. If allowed to stand, it will push us further toward the collectivist end of statism. Either a man owns his own life, or he does not. Our country was rightly founded on the belief that he does. ObamaCare is premised on the collectivist premise than a man's life is held hostage to the will of the majority and needs of "society." Compassion for the sick, poor and disadvantaged are essential parts of being human but can never justify initiating force. To maintain a peaceful, prosperous and civil nation, we must devise solutions to our problems while ruthlessly respecting every individual's right to life, liberty and the pursuit of happiness.

Have a glorious 4th of July.

Book Review: The Truth About ObamaCare

The Truth About ObamqCare by Sally Pipes Regnery Pub. Inc., 2010


This book provides an easy to read synopsis of the recent health care reform. Pipes does a good job of bringing up the counter arguments to those who defend ObamaCare as a necessary step in the right direction. 

1. She provides a brief summary of the history of health care in the US which brought us to our current situation. 
2. She presents the data to show the problem of the uninsured is not 15% of our population but closer to 3%. 
3. She explains how the PPACA (aka ObamaCare) will exacerbate rising health care costs because it misidentifies the causes of rising costs. 
4. She provides a succinct explanation of how laws, government policies and regulations make medical care unaffordable for a significant segment of our population. 
4. She explains how ObamaCare will increase the problems of inaccessibility to medical care, restrict our choices and eventually lead to rationing. 

But no need to despair. In her last chapter, Pipes offers some alternative solutions which will increase choice, increase affordability and set us back on the path of ever-improving medical care. 

For anyone who has been closely following the health care debate and the development of PPACA, this book adds nothing new. It does put into one easy-to-read place a brief outline and introduction to the major issues involved. 

For those just getting interested in the topic, it's a great place to start. 

220 pages. Large type. Well referenced.

Why You CAN'T Keep Your Current Coverage

No time to write a post myself on this important topic--especially as Chris Jacobs has already written on it so well.

From today's email:

The Wall Street Journal has coverage today of Monday’s McKinsey study suggesting that more than half of all employers could decide to drop coverage by 2014 – both a news article and an op-ed by Grace-Marie Turner (copied below).  The op-ed notes that if half of all employers dump their employees in Exchanges, that will meanabout 78 million Americans would lose their current plan.  As the news article notes, this potential change by employers is entirely rational: While the health care law does include a modest $2,000 penalty for employers who do not offer “affordable” coverage, as the article notes, “Health-policy experts have questioned whether that is high enough to discourage companies from health coverage.”  Indeed, Credit Suisse in a Monday note to clients reiterated that employers dropping coverage is “exactly what was intended” by the law in the first place.

The White House was quoted in the news article as saying the McKinsey study was “an outlier amid other research suggesting that employers overwhelmingly would keep coverage.”  But in reality, the studies saying that employers will drop coverage continue to mount:

·         A PWC survey of employers released just two weeks ago found that nearly half of all employers “indicated they were likely to change subsidies for employee medical coverage” thanks to the law.

·         Former Congressional Budget Office Director Doug Holtz-Eakin’s analysis confirmed that many more firms than originally projected will have a rational economic basis for dropping their plans come 2014 – resulting in up to $1 trillion more in new federal spending on insurance subsidies than official estimates.

·         An Associated Press story from last fall, titled “Employers Looking at Health Insurance Options,” included quotes from a Deloitte consultant saying that “I don’t know if the intent was to find an exit strategy for providing benefits, but the bill as written provides the mechanism” and from the head of the American Benefits Council claiming that the law “could begin to dismantle the employer-based system.”

·         Former Tennessee Governor Phil Bredesen – a Democrat – wrote an op-ed explaining very succinctly why employers will drop their existing coverage options.  Gov. Bredesen noted that Tennessee could drop coverage for its state employees, pay the $2,000 per employee penalty to the federal government, give their workers cash raises to compensate for the loss in health benefits, and STILL come out at least $146 million per year ahead.

Even worse than the prospect of 78 million Americans losing their current health coverage would be the trillions of dollars in new federal spending on the taxpayer-funded insurance subsidies many of these individuals would receive.  At a time when America faces a looming entitlement crisis regarding Medicare and Medicaid, these recent developments illustrate just how significantly worse Obamacare will make our fiscal predicament.

Chris Jacobs

Health Policy Analyst

Republican Policy Committee

(202) 224-2946

Doctors Speak to Congress on behalf of Patient Care

Dr. Jane Orient, executive director of AAPS, congressmen Dr. Burgess (TX-R)  and Dr. Amerling testified last week before the House in support of freedom of choice for doctors and patients.

This clip is just shy of an hour long but is well worth the time to watch. The PPACA is tragically misnamed: it neither protects patients, nor will it bring down costs. Entitlements are driving federal and state budgets over the cliff, and the PPACA adds significantly to the momentum.These three doctors provide explanations for why this is true.

The new law is specifically designed to disrupt the direct doctor-patient relationship which is the foundation of private practice medicine. This fact is illustrated by what Dr. Berwick, the current head of Medicare, wrote in his book New Rules:

Today, this isolated [doctor-patient] relationship is no longer tenable or possible. Health care has become an industry, with numerous loci of authority well beyond the doctor’s office. In many ways, the relationship of the patient to the doctor is less important. Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care.

In place of a direct doctor-patient relationship, Berwick advocates (and the PPACA strengthens) our current dysfunctional third party payment system which places a bureaucrat into the middle of our medical decisions. More and more, doctors are being required to make treatment decisions based on population-based clinical guidelines rather than the customized needs of individual patients.

Regulatory requirements  are making it more difficult for physicians to survive as small businesses, driving physicians to either retire early or work as employees. It is possible that the physician-as-employee model is less expensive (which is not the same as more efficient or cost-effective,) but shifting to that model should occur voluntarily through a free market, not by the government stacking the deck against the option of private medicine.

For more details on how the new health care control law will take away freedom of choice without solving problem of rising costs, watch the video clip below.
If you prefer to read their statements instead of watch, you can find them here: Dr. Orient's, Dr. Amerling's. I don't have a link to Br. Burgess' statement, but he comes first in the video after a brief introduction by Dr. Orient.

Advancing Liberty, Creating Change, Part 2

See here for Part 1

Randy Barnett was the speaker I came to hear at the recent symposium, Advancing Liberty, Creating Change, --and he did not disappoint.

Mr. Barnett is a constitutional law professor, author of Restoring the Lost Constitution, argued before the Supreme Court in Gonzalez v. Raich (a key case in Commerce Clause precedent), written multiple amicus briefs in support of the unconstitutionality of the individual mandate, and is now the legal representative for the NFIB in the appeals case of Florida v. HHS (the same case in which Docs4PatientCare has filed an amicus brief).

Barnett briefly summarized how the case against the mandate developed, illustrating how a small number of people can make a big difference. A conversation between Barnett and someone from the Heritage Foundation led to a paper on the unconstitutionality of the individual mandate. The paper was published just before the bill was passed Dec. 23, 2009, setting out the terms of the debate, and providing Senate Republicans with a basis to place on record a constitutional objection to the mandate.

Currently, there are five individual mandate legal challenges on expedited repeal. The government has ramped up the seriousness with which it is defending the mandate by having the Solicitor General argue the case at the appeals level. This is a very unusual move as the government's top lawyer usually only becomes involved, if at all, when a case is before the Supreme Court.

Barnett expects the cases on appeal will wrap up around August or September allowing for a petition to the Supreme Court in the fall. Oral argument would then be heard by SCOTUS in January of 2012 with a decision by the end of its term in June. You can read Barnett's estimate of how the judges may rule in his article Commandeering the People.

Barnett emphasized the importance of having a viable alternative to the PPACA pass in the House. It doesn't have to become law, but something must exist as an expression of Congress' will and a potential means to prevent the total dislocation of health care reform. He also maintains that if we win, the gains are important but not that large. If we loose this battle, however, we lose the nature of this country as one of limited government (and I would argue, because of the gigantic regulatory power delegated by the PPACA, Rule by Law takes a crippling blow.)

At the reception after the talks ended, I spoke briefly with Mr. Barnett, thanking him for all of his work defending health care freedom. He recommended the ACA Litigation Blog as a good source of information for those interested in following this case closely. The site also has links to the official documents of the 5 legal challenges making their way to the Supreme Court.

If you are interested in delving further into the constitutional issues, I would recommend starting with three documents: Judge Vinson's ruling of FL v. HHS (which provides a concise and cogent summary of the history of Commerce Clause cases), Barnett's brief to the 9th Circuit Court of Appeals (which presents the key arguments of the unconstitutionality of the mandate consistent with current legal precedent), and his article "Commandeering the People" which takes a closer look at the role of the Necessary and Proper Clause in light of the current constitutional debates.

To rid ourselves of this onerous law, popular discontent must be the dominant mood of the country. To maintain discontent, we must avoid resignation by keeping the hope of affecting a change alive. One way to do this is to announce to each other support for repeal by wearing or displaying the Black Ribbons. The more Black Ribbons that are out there, the more people can see they are not alone, that there is hope of change.

Let's make a difference, now.

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Advancing Liberty, Creating Change

Two days ago I had the wonderful opportunity to attend a symposium co-hosted by the Institute for Humane Studies and the Mercatus Center. Held on the 25th floor of the Hotel Nikko, the views were as stunning as the speakers were inspiring.

The formal part of the symposium was opened by economist Dr. David Henderson who described the almost miraculous success of the Liberal Party in Canada which, through real and significant cuts in government spending, brought Canada back from the precipice of economic disaster. In 1995, the WSJ called the Canadian dollar the "peso of the north" and Moody's put Canadian credit on watch. At that time, Canada had a debt-to-GDP ratio of 70%. Following these cuts and important changes in unemployment benefits, Canada then ran budget surpluses from 1997 until the international recession of 2008. The big lessons from this Canadian experience for U.S. politicians are the following:

You can cut spending and still get reelected.

You can cut spending and the world does not fall apart.

You can cut spending and grow the economy.

As our Congress continues the Budget Debates, let's work to remind them that these truths will also hold for health care spending.

Next, Adam Thierer spoke on the very important battle to preserve internet freedom. Although his talk was equally fascinating as the others, it wasn't as directly relevant to health care so I refer you to his written body of work for the details of his ideas.

Adam was followed by Matt Mitchell, speaking on the growing problem of unsustainable trends in state government spending and debt. The two largest contributors to this problem are Medicaid and the effects of public employee retirement benefits. From his talk, I took away two key points.

Unions in the private sector increase the wages of some workers at the expense of other workers, but are limited in what they can demand from their employers because of business' need to make a profit. (What came to my medical mind was the fact that a successful parasite doesn't kill off its host.) If profits decrease too much, the business (and the jobs) will disappear. Unions in the public sector don't have customers paying for goods and services--they have taxpayers, who can't choose to go away. Also, in the public sector, unions get to vote for and select the people with whom they negotiate for their benefits. In the private sector, unions don't get to vote for their employers (other than with their feet.) The fundamental incentives for public unions have no brakes. To improve the situation, we need to change the rules and alter the incentives. Tweaking the numbers will never be enough.

With regard to Medicaid, Matt showed that the problem goes beyond the incentives for expansion that the current system holds. (Because of Federal matching funds which shift state costs to the country as a whole, States have the incentive to continually expand Medicaid programs.) He also pointed out that whenever government funds a program, it creates a powerful vested constituency which pushes for continued spending and expansion. Data shows that when the Federal government reduces payments for state programs--the programs don't shrink or go away. The states just continue to fund them through state debt or raising taxes. A looming danger of the PPACA is the enormous new entitlement constituency it creates, not only through the expansion of Medicaid, but also through insurance premium subsidies.

The formal talks were punctuated with opportunities to talk personally with the speakers and fellow attendees. It was an exciting chance to meet face-to-face several people whose works I have admired from afar, or have met only in the cyber-world of Yahoo groups. In spite of the very real and significant challenge to individual rights which our country currently is facing, the general mood of the speakers and the audience was decidedly optimistic. I left encouraged and inspired, knowing that people of such intellectual caliber and integrity are fighting for the cause of freedom.

(Report on the symposium will be continued next post.)

Update: New paper out from the Mercatus Center-"Public Sector Unionism: a Reivew"
Update: Paper on-line by David Henderson CANADA’S REVERSED FISCAL CRISIS

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"Quality Bonuses"--Grease for the Squeaky Wheels

One hand giveth while the other taketh away--and both hands live in the White House.

— Millions of seniors in popular private insurance plans offered through Medicare will get a reprieve from some of the most controversial cuts in President Obama's healthcare law.

--LA Times 4-20-11

The ability to arbitrarily punish and reward groups and individuals is one of the key problems with politicizing an economic activity. Rule by Men instead of Rule of Law.

Once power is concentrated in the hands of the few, the threat to liberty accelerates--Newton's laws of motion applied to political power instead of mass.

While I was in Washington DC last week, several different people remarked that a key strategy for supporters of the health care control law will be to keep potential complainers happy---and quiet. The waivers, and now out-right hush money like Medicare Advantage "quality bonuses" are just two ways this will be accomplished.

There are only two ways to rid ourselves completely of this terrible law--either the Supreme Court rules it unconstitutional, or opponents take control of the government in 2012. Both of these pathways require continued popular discontent.

We must do everything we can to keep this issue fresh in the minds of voters. It truly has life and death consequences--for both our liberty and our access to affordable, trust-worthy medical care.

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Why the ACA is wrong and must be repealed.

The Black Ribbon Project is participating in the Independent Women's Voice ObamaCare Video Contest. The deadline of midnight March 19th is approaching fast, but it's not too late to add your own original contribution. First prize is $5000---but the competition is pretty stiff. All entries will be posted on their website, however, so it's a great way to spread your personal message.

The Black Ribbon Project supports repeal of the ACA because of the way it tramples on the doctor-patient relationship--but more than that, it endangers the roots of civil society.

What a great challenge to get to meat of the matter in under one minute!

Be sure to check out the website and vote for your favorite. Some are really quite good!

IWV You Tube Channel

Shameless request: Vote for my video. From what I can tell, the winner is whoever gets the most viewer votes. Any winnings I receive will go to The Black Ribbon Project.

How to Defend Health Care Freedom

Last fall, I was invited to speak about the Black Ribbon Project at the annual meeting of the American Association of Physicians and Surgeons. I took the opportunity to share a few of my thoughts on the principles we need to promote to effectively defend health care freedom and the doctor-patient relationship. I am pleased with how much I was able to cover in just 25 minutes. Let me know what you think!

Testimony on Fiscal Consequences of PPACA

Richard Foster, Chief Actuary, Center for Medicare and Medicaid.
1/26/11 Testimony before the House Committee on the Budget


McCLINTOCK: “True or false: The two principle promises that were made in support of Obamacare were one, that it would hold costs down. True or false?”

FOSTER: “I would say false, more so than true.”

McCLINTOCK: “The other promise… was the promise that if you like your plan, you can keep it. True or false?”

FOSTER: “Not true in all cases.”

A Tale of Two Emails on repeal of the PPACA

I recently received two emails. One is from the White House with the Orwellian title, "Protecting Your New Freedoms Under the Affordable Care Act." The other, "What Repeal Really Means" was from Chris Jacobs of the Republican Policy Committee.

Read both releases carefully.

Our President claims he can offer people the chance to be free from the demands of reality by making others pick up the tab.

But no one can be free from the requirements of reality---the necessity of creating the values you need to sustain your life. Freedom is not a metaphysical concept but a political one, one whose true meaning is to be free from the coercive acts of others.

If allowed to stand, the PPACA will extend the power of government, further depriving us of the freedom we need to sustain our lives: the freedom to use our own minds, set our our values and priorities, and to act on our own choices. The PPACA will extend the current erroneous legal precedent that government can rightfully dictate the contents of private contracts and exchanges, along with regulating items we produce for our own private use as "interstate commerce" (see Wickard v. Filburn.) In addition, the government will be allowed to dictate what we must and must not purchase, and with whom, and for what price.

The PPACA is one of the biggest intrusions into our economic freedom in recent years. No individual or business will be left unaffected--and few, if any, restrainsts will be left on the power of government over our economic lives. And since freedom is of a piece, loss of economic freedoms will eventually require the erosion of freedom in all other realms.

What does repeal of ObamaCare really mean? It means resurrecting the Rule of Law and reasserting the Constitution as a limit on government power, and the purpose of government as the protector of individual rights.

The main issue is not whether or not repeal will add to the deficit, or if repeal will save jobs.

The main issue is that repeal will restore essential freedoms and take a step in the right direction of limiting the intrusion of government into our private lives.

ObamaCare must go so we can live our lives in freedom.

A solution which destroys freedom, is no true solution at all.

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Federal Judge Rules Individual Mandate Unconstitutional

U.S. District Judge Henry E. Hudson ruled today that the individual mandate of the ACA (a.k.a. ObamaCare) is unconstitutional.

“Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market. In doing so, enactment of the (individual mandate) exceeds the Commerce Clause powers vested in Congress.” from newsok.com

I have previously read that due to the lack of a severablity clause, if any part of the law is ruled unconstitutional, the whole bill will have to be thrown out. Unfortunately, it turns out to be more complicated than that.

Here is the best explanation I have yet come across:

A Guide to Severability and ObamaCare

[T]he lack of a severability clause wouldn’t necessarily result in the overrule the rest of the legislation, which mostly have to do with spending and rationing — the expansion of Medicaid, Medicare cuts, and sweeping regulatory authority — and isn’t wrapped up in the mandate. This has been the Court’s approach to other issues, such as the recent Sarbanes-Oxley ruling, another law which lacked a severability clause, where they invalidated a portion of the law and allowed the rest to stand.

Some proponents of the ACA believe that the health of the individual mandate would move us closer to implementing a single payer system. (See Ezra Klein's article in today's Washington Post.) The danger of this is only too real.

The best way to prevent that from happening is to continue to speak out against ObamaCare as a whole.

Even a Supreme Court ruling that the individual mandate is unconstitutional will not save us from the multitude of other violations of life, liberty and property intimately woven throughout the ACA.

Preservation health care freedom and the sanctity of the doctor-patient relationship requires the complete REPEAL of the ACA, and the extraction of government from the business and practice of medicine.

For more analysis on today's reading see:

Individual Mandate in Heath Reform Law Ruled Unconstitutional by Federal Judge on Medscape.com

ObamaCare Is Unconstitutional by Grace-Marie Turner

Full Text of the Opinion

Health Reform Will Survive it Legal Fight by Eric H0lder and Kathleen Sebelius

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Debt Reduction and Health Care Freedom

Two for the price of one.

With the national debt rising to dangerous levels, serious cuts to government spending are paramount. President Obama’s debt commission has made some interesting recommendations–but even better are the following proposals…

Read more here.

Regulations and Arbitrary Rule

Last month, federal officials granted dozens of one-year waivers that were aimed at sparing certain employers, including McDonald’s, insurers and unions who offer plans that sharply limit the coverage they provide...

Concerned about the potential disruption that would be created by enforcing the new rules, the administration has granted dozens of additional waivers and also made clear that it would modify other rules affecting these policies. Last week, the Department of Health and Human Services issued more guidance, saying it would use a different method of calculating spending for these plans so they would be able to meet new regulations dictating how insurers should use the premium dollars they collect. NYT 11/9/10

This is what was meant when Speaker Pelosi infamously informed us "We have to pass the bill so we can see what is in it." So many details have been left up to regulatory rule making, even if Congressmen had read the bill, there would be no way to know its actual meaning. Far too much was left up to the discretion of yet-to-be-created agencies, and the Secretary of HHS.

And that is the way it has to be. It is the nature of central planning.

Command and control economic planning can not function through legislating. Legislative reaction time is too slow and the decision making process to cumbersome and contentious. The only way to allow for the necessary responsiveness and flexibilit is to delegate a significant portion of the decision making power to regulatory agencies. The broader the regulatory mandate, the more the decisions become sway to special interests and the arbitrary whims of the regulators and rule-makers.

One of the first casualties of regulation is Rule by Law--which is replaced with Rule by Men. The second casualty is usually Equality Before the Law--which is replaced with Rule by Special Favor. This is the nature of central planning, and of the regulatory behemoth which it spawns. Everybody has to follow the rules...except those who Sebelius decides to let off the hook.

Special waivers are now up to 111.

UpDate: Here is the current waiver list.

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White House Healthcare Stories Ignore Hazlitt's Lesson

The ink is barely dry. The electrons have barely been tallied. The lessons of the election have yet to be learned.

Yet, the White House continues blindly down the path of promoting its unwanted, hopelessly flawed health care law by committing the economic fallacy of ignoring what is unseen. (But I guess that goes hand-in-hand with being blind.)

Today I received the following in an email from Nancy-Ann DeParle, director of the Office of Health Reform:

Health Care Updates

Health care is an issue that’s important to all of us and the new health care law is already helping Americans across the country. Visit the 50 States/50 Stories map to find stories of how the new law is affecting people in your area -- people like Jim Houser, who will be receiving a small business tax credit that will enable him to continue providing health insurance to his employees or Adrienne Lowe who can now stay on her parents’ plan after graduating from college. You can also watch as the President makes a surprise phone call to Gail O’Brien who was without insurance when she was diagnosed with lymphoma and has been able to get coverage through the newly established Pre-Existing Condition Insurance Plan.

These are just a few of the examples of Americans who are benefitting from the Affordable Care Act. Across the nation, the new law is making health care better for millions of Americans.

The Fifty Stories are only the tip of the ice berg--and unless Obama et al start paying attention to what lies below the surface, our country's finances and health care are headed for the same fate as the Titanic.

What is NOT mentioned, of course, are all the jobs which will NOT be created because labor costs will be too high due to the tax and regulatory burdens the law places on employers and businesses.

Or the medical devices, medicines and cures that will NOT be invented.

Or the aspiring young adults who will NOT choose medicine as a career because of decreasing incomes and job satisfaction---caused by government price fixing, paperwork and billing hassles, --to say nothing of the repeated vilification of physicians as greedy and incompetent (in need of ever more practice guidelines and government oversight.)

Or employers who respond to the law's strong financial incentives to drop health insurance coverage for their employees.

Also not mentioned are the number of insurance companies which must either discontinue significant benefits, (unless they get a waiver) raise premiums or go out of business due to the PPACA.

So don't be fooled when the White House tells stories.

Be sure you understand the lesson that Obama, DeParles and the rest of the White House gang either refuse to understand, or worse, understand but choose to ignore:

This is the persistent tendency of men to see only the immediate effects of a given policy, or its effects only on a special group, and to neglect to inquire what the long-run effects of that policy will be not only on that special group but on all groups. It is the fallacy of overlooking the secondary consequences.

In this lies the whole difference between good economics [or politics] and bad. The bad economist [or politician] sees only what immediately strikes the eye; the good economist looks beyond. the bad economist sees only the direct consequences of a proposed course; the good economist looks also at the longer and indirect consequences. The bad economist sees only what the effect of a given policy has been or will be on one particular group; the good economist inquires also what the effect of the policy will be on all groups.

The distinction may seem obvious...Yet when we enter the filed of public economics, these elementary truths are ignored."

--Henry Hazlitt, Economics in One Lesson

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Health Care Rights and Wrongs

For Patient Autonomy: Repeal ObamaCare

Dr. Alieta Eck of AAPS, and Drs. Pegg, Hansen and Lovett of Docs4PstientCare assisted the Independant Womens Forum in making this commercial prompting voters to ask their candidates to pledge to repeal ObamaCare if elected.

Listen carefully to their message, because it gets right to the heart of the matter: ObamaCare takes control away from patients and doctors and gives it to government bureaucrats. The PPACA may be primarily insurance reform, but whoever controls insurance, controls the payment for medical care and will eventually have to control what gets paid for. That means deciding what your treatment options will be.

The solution?

Repeal ObamaCare.

Restore choice and accountability--for patients, doctors, hospitals and insurance companies.

In a free country, we all have our part to play.

Then, to make sure we don't simply go back to the problems which prompted health care reform, the next steps include:

1. End government policies which give preferential tax treatment to employer-based insurance with first-dollar coverage. Instead, all medical expenditures must have the same tax advantage or disadvantage. This will increase the availability of insurance for individuals, and insurance portability for everyone.

2. Allow insurance companies to complete across state lines. Insurance companies from states with the least intrusive regulations are already less expensive than those in heavily regulated states, so prices for insurance will rapidly drop. (For an Oct. 2010 report on health insurance mandates by state, see here.)

3. Remove legal limits and hindrances to purchasing catastrophic health care combined with a Heathcare Savings Accounts so people can more easily take advantage of this form of insurance which has repeatedly demonstrated its superiority in lowering health care spending and maintaining patient satisfaction. A significant part of the cost problem in health care relates to the perverse incentives which occur in a third-party payer system.

4. Allow balance billing for Medicare to end the massive amount of cost-shifting doctors and hospitals have to do in order to make up for the inadequate payments they receive from the government. When doctors are able see Medicare patients without losing money, the doctor shortage for Medicare patients will disappear.

5. Encourage states to enact real tort reform. Defensive medicine increases testing and procedures and drives up costs.

But first, we have to repeal ObamaCare.

Take the Pledge.

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ACOs Threaten Quality Medical Care

The PPACA is "nudging" doctors out of independent practice and into working as employees of large practice groups or hospitals. This move is occurring because of the bundled payment structure of Accountable Care Organizations (ACOs) which favors "vertical integration" of doctors, hospitals and health plans.

The only problem is that bundled payments are simply capitation rewritten, and employee physicians face divided loyalties between the needs of their employers and the desires/needs of their patients.

This arrangement is especially insidious when coupled with the ethics of "social justice" which gives a physician the moral OK to sacrifice his patients to the "greater good" of society. What is good medicine for the masses is often at direct odds with what is good for the individual patient--and thus, quality medical care suffers.

Resources:

For more on the PPACA effects on private practices see "Killing Marcus Welby: How ObamaCare stifles private practices" by Scott Gottlieb, MD, NY Post 10/18/100

For more on problems with the underlying assumptions for ACO's see "On Being Politically Incorrect and Realistically Correct about ACOs" by Richard Reece, MD at Medinnovation, 10/7/10

For more on the destructive effects of the concept of "Social Justice" on the availability of quality medical care, see Dr. Rich Fogoros at The Covert Rationing Blog.(multiple posts)

See also:'"Deconstructing ACOs" by John Goodman at John Goodman's Health Policy Blog, 8/18/10