Wolf: Obamacare Shouldn't Be Replaced With Gingrichcare

Dr. Milton Wolf has another nice piece in the Washington Times, "Obamacare shouldn't be replaced with Gingrichcare".

He makes the crucial point that the central-planning and nanny-state approaches to health care are wrong, regardless of whether they are proposed by Democrats or Republicans.

Here is an excerpt:

Mr. Gingrich notes that in the 2,409 pages of the Obamacare law, the word "require" appears 198 times. Yet in his own book, the same word appears with a higher frequency, 80 times in the 356 pages. Add words like "encourage," "migrate," "incentivize" and their variants, and Mr. Gingrich's euphemistic requirements total 144. Mr. Gingrich may not like most of President Obama's requirements -- and neither do I -- but he sure loves his own.

On the Gingrich road to universal health care are many stops in the nanny state. Despite claims of "[n]o mandates," his so-called "pro-jobs, pro-growth" health care plan includes micromanaging elementary schools to assure they provide physical education classes five days a week, and he takes time to monitor school breakfasts and lunches and even vending machines. Mr. Gingrich evidently agrees with first lady and food cop Michelle Obama that the government, not parents, should decide what their children eat...

Are we to believe that big government by Mr. Obama is bad but big government by Mr. Gingrich is good?

(Read the full text of "Obamacare shouldn't be replaced with Gingrichcare".)

Americans did not vote for the GOP in the 2010 election because they wanted statism-lite. I'm glad men like Dr. Wolf are reminding them of this important fact.

Quick Links: Wolf, Levy, Hayek

PajamasMedia gives Dr. Wolf's new eBook a nice review. You can purchase it for $1.99 via this Amazon link: "First, Do No Harm".

Cato's Robert Levy has written a detailed position paper, "The Case Against President Obama's Health Care Reform: A Primer for Nonlawyers". Full PDF here.

There's a new Keynes vs. Hayek video!:



If you missed it, here's Part 1:

Quick Links: Forest, Krugman, MA, WI

The Obama administration is trying to blacklist the CEO of Forest Labs (a pharmaceutical company) without any form of due process.

Greg Scanlen rebuts Paul Krugman on consumer driven health care.

Sally Pipes summarizes, "RomneyCare's Unhappy Anniversary"

The Wisconsin State Journal reports, "UW doctors face penalties for writing sick notes for protesters".

We'll see if this will be a genuine penalty or merely a slap on the wrist (as some like David Catron suspect.)

Catron on the SCOTUS Delay

David Catron explains the importance of the Supreme Court decision not to permit an expedited decision on the ObamaCare legal challenges in his latest AmSpec piece, "Supreme Court Allows Obamacare to Metastasize".

Here's an excerpt:

While the lawyers argue over hopelessly arcane points of law and the judges issue dueling opinions, Obama administration apparatchiks will be working furiously behind the scenes to implement Obamacare. They have already introduced a voracious tape worm of regulations that will wind itself so thoroughly around the entrails of the health care system that removal will be a virtual impossibility in a year or so.

The latest example can be found in the rules promulgated by CMS administrator Donald Berwick concerning Accountable Care Organizations (ACO), the government's latest rebranding of the old HMO gambit. Although the section of the law calling for the creation of ACOs is a mere six pages long, Berwick's bureaucrats transmuted them into no fewer than 429 pages of regulations.

The landscape of medical practice is changing dramatically, as a result of such legal and economic pressures for doctors and hospitals to consolidate into large impersonal Accountable Care Organizations.

As the New York Times recently reported, this will lead to the withering away of solo and small primary practices.

Basically, the government is dictating the business model and the practice patterns of American medicine. And as Catron notes:

If Obamacare has another year to metastasize, it may well be impossible to eradicate the disease without killing or at least badly maiming the patient. In fact, it is conceivable that the DOJ will make that very argument when the case finally arrives before the Court, betting that the justices will be loath to strike down Obamacare -- or even the individual mandate -- knowing that such a ruling would create chaos in the midst of an election year.

(Read the full text of "Supreme Court Allows Obamacare to Metastasize".)

Hence, the importance of continued grass-roots educational and political efforts to slow down and/or "defund" the implementation as much as possible in the upcoming year...

Protecting Medical Innovation

Two recent OpEds highlight the importance of protecting free market medical innovation in this country:

"Medical Innovation Critical To Bringing Down Health Care Costs", Sally Pipes, Forbes, 4/18/2011.

"Don't Let Feds Stifle Next Medical Revolution", Joel White, Washington Times, 4/21/2011.

Medical innovation has (and could continue) to help doctors improve both the length and quality of our lives. Yet the Obama administration is punishing it, as I described in an PajamasMedia piece from last year, "The Deadly Tax on Medical Innovation".

If you want a worthy cause to fight for, the rights of medical device companies to innovate, create, and sell their products free from burdensome taxes and FDA regulations would be a great place to start. And the life you save may be your own...

Quick Links: SCOTUS, Levin, Black Ribbon Project

The Supreme Court has declined the request for an expedited review of the ObamaCare lawsuits. Related story here.

Mark Levin features David Catron's recent essay on the Medicare IPAB rationing panels.

Dr. Beth Haynes reports on her trip to DC with the Black Ribbon Project and Docs4Patient Care. (Disclosure: I used to be practice partners with one of the D4PC leaders, Dr. Jill Vecchio.)

John Lewis Talk on Socialized Medicine

On May 14, 2011, Duke University professor John Lewis will be coming to Denver to give a talk, "Government Medicine: The Metaphysical Attack on a Profession". Details below:

Please join us on Saturday, May 14th for a FROST Supper Talk by historian John Lewis:

• What: FROST Supper Talk by John Lewis on "Government Medicine: The Metaphysical Attack on a Profession"
• When: Saturday, May 14th, 2011, 5 pm cash bar and social, 6-7 pm dinner buffet, 7:15 lecture with Q&A and more socializing afterward, wrap up by 10 pm
• Where: Landry's Seafood, 7209 South Clinton Street, Englewood
• Cost: $65 for regular attendees; $35 for students
• RSVP by Monday, May 9th using the form below. Payment is due upon registration. We cannot accept payment at the door for this event, so please follow the instructions below to register and pay by Monday, May 9th.

About the lecture:

Many people agree that government control of medicine is a vicious attack on individual rights, and that the use of force against doctors is immoral as well as unconstitutional. But, this talk will maintain, the attack is far deeper: it is directed at the very nature of man as a thinking, goal-directed being. Government control of medicine undercuts the ability of doctors to use their minds in a first-handed way, and makes it impossible to project long-range goals on every level. This hard-hitting talk, motivated by first-hand personal experiences in medicine, will ask every thinking person to consider whether they want the United States to stay on a path leading to government control of their own personal health care.

Dr. Lewis is visiting associate professor in the Philosophy, Politics, and Economics Program at Duke University. He is an Anthem Fellow for Objectivist Scholarship, and adjunct associate professor of business at University of North Carolina at Chapel Hill. His recent book is Nothing Less than Victory: Decisive Wars and the Lessons of History (Princeton University Press, 2010).

Sign-up information at the registration page. I hope to see some Colorado-area folks there!

FIRM Blog Redesign

Many thanks to Diana for the FIRM blog redesign!

BTW, I've also added a "Featured Blogs" section on the right-hand sidebar for other health care bloggers who I read regularly. Please feel free to check them out!

Hsieh PJM OpEd on Rationing and IPAB

Today's PajamasMedia just published my latest health care OpEd, "We Call It 'Rationing,' Obama Calls It 'Medicare Independent Payment Advisory Board'".

The basic theme is that we shouldn't let either Obama's IPAB or Congress control our health care.

Here is an excerpt:

Suppose Congress asked Americans: which government officials should decide what foods you would be allowed to eat and what prices you had to pay at the grocery store -- Congress, or an unelected board of nutritional experts appointed by the president?

Most Americans would immediately reply, "Neither!" But that's precisely the debate between Congress and the White House regarding President Obama’s proposed Medicare Independent Payment Advisory Board...

Although the Obama administration stated that the IPAB would not ration medical care, its power to set payments to doctors and hospitals would give it de facto rationing power.

If the IPAB sets the reimbursement rate for services below the cost of providing it, then hospitals and doctors could no longer afford to offer such services -- even if the services are medically best for their patients. Life-saving medical procedures we currently take for granted, such as PET scans to detect early cancers or minimally invasive methods to safely open up blocked vital blood vessels without risky surgery, might no longer be available. Although those services might still theoretically be "covered" by Medicare, in practice doctors would no longer offer them, and their patients would no longer be able to receive them...

(Read the full text of "We Call It 'Rationing,' Obama Calls It 'Medicare Independent Payment Advisory Board'".)

Americans would never stand for the following false alternative: "Who should decide what foods you are allowed to eat—a panel of unelected bureaucrats or your elected Congressmen?"

We should similarly reject the same false alternative for our health care.

(PJM lightly edited my piece and changed the title, but left the basic meaning intact.)

Catron: IPAB Is an Acronym for 'Death Panel'

In today's AmSpec, David Catron cuts through all of the Obama administration's double-speak and explains why, "IPAB Is an Acronym for 'Death Panel'".

Here is an excerpt:

IPAB [Independent Payment Advisory Board] was created pursuant to section 3403 of the ironically named Patient Protection and Affordable Care Act (PPACA), and its ostensible purpose is to "control costs." In reality, it will do nothing at all about costs. Instead, the board's fifteen "experts" will impose old-fashioned price controls. Before Obamacare was signed into law in March of 2010, only Congress had the power to make changes to Medicare's reimbursement rates. But PPACA, for all intents and purposes, transfers that power to this tiny cadre of presidential appointees who will have no accountability to the voters.

In theory, IPAB can only propose changes to Medicare's payment rates. In practice, however, the board's proposals will take effect automatically unless Congress passes contrary legislation and the President signs it into law...

Catron notes how progressives like Jay Bookman support these price controls precisely because it will lead to rationing:

"Death panels exist, they will exist in any conceivable system of health-care delivery, and we all know they are necessary but prefer to ignore it."

For these people, it's either us or Granny: "Somebody has to say no to the terminal patient who refuses to acknowledge that he or she is terminal and demands hopeless if expensive treatment... Somebody has to have the power to rule that Procedure A or Drug A is more cost-effective than Procedure B or Drug B... Even Heaven has a gatekeeper."

(Read the full text of, "IPAB Is an Acronym for 'Death Panel'".)

In essence, the supporters of IPAB (and of ObamaCare in general) take the approach of, "Because government has to pay for everyone's health care, the government has to decide who is allowed to get what".

This is why medical rationing will be the dead end of any kind of government-run "universal health care" -- both figuratively and literally -- as Catron makes abundantly clear.

Colorado and Wisconsin Updates

Brian Schwartz reports on the current state legislation at, "Politically-controlled Colorado health benefits exchange bill reaches Senate".

Linda Gorman explains why this is a bad idea at, "Should Colorado Establish an ObamaCare Health Benefits Exchange?"

The Wisconsin doctors accused of writing fake sick notes are under investigation. More here.

The IPAB vs. Congress False Alternative

The New York Time reports that Congressmen of both parties are skeptical of President Obama's plan for an Independent Payment Advisory Board (IPAB) to determine payment and coverage decisions for Medicare: "Obama Panel to Curb Medicare Finds Foes in Both Parties".

But that's because the Congressmen want to retain that authority for themselves -- not cede it to the executive branch.

There are many problems with an bunch of unelected "independent" bureaucrats making such decisions for all senior citzens, as the Wall Street Journal points out in "The Other Medicare Cutters". The lack of accountability is dangerous and would quickly lead us down the road to explicit rationing.

But the solution is not to have these decisions made by politicians subjected to pressure-group tactics. That will merely lead to a feeding frenzy of lobbyists seeking to have their pet benefits covered by Medicare (and those of their competitors excluded from coverage).

In other words, there is a false alternative in the question, "Which branch of government should decide what health care benefits should be covered and what the payment should be -- the Congress or the executive branch?"

Instead, the answer should be, "Neither!" Government shouldn't be making such decisions at all. Rather doctors, patients, and insurers operating in free market should decide.

Massachusetts Unravelling

Because of the "unintended consequences" of the Massachusetts plan, costs continue to skyrocket.

Hence, the 4/15/2011 Washington Post notes, "Massachusetts, pioneer of universal health care, now may try new approach to costs".

But regardless of whether you call it "Accountable Care" or "bundled payments" or "integrated care", it all amounts to the same thing -- the government will mandate payment systems that reward limiting care to patients. Just don't call it rationing.

Of course, many doctors naturally recoil at the thought of such government pressures dictating how they are allowed to practice. The 4/17/2011 Boston Globe thus reports, "More doctors gravitate toward boutique practice".

And as more doctors opt out of the more heavily regulated sector of medicine, it will merely make the problems worse for those who remain. If these trends continue, cconomist Mark Perry predicts a coming doctor shortage -- not just in Massachusetts, but eventually in the rest of the country.

As always, under "universal health care" people will have theoretical "coverage". They just won't be able to get actual medical care.

Quick Links: Wolf, SCOTUS, Slush Fund

You can now pre-order Dr. Milton Wolf's ePamphlet, "First, Do No Harm: The President's Cousin Explains Why His Hippocratic Oath Requires Him to Oppose ObamaCare".

The US Supreme Court has delayed consideration of a request for expedited hearing of the ObamaCare lawsuit until later this week.

I'm sure this will in no way compromise their objectivity in health policy reporting: "Washington Post and CBS receiving money from Obamacare 'slush fund'". (Via Brian Schwartz.)

Latest FDA Gag Rule

Stella Zawistowski of ReasonPharm describes the latest FDA gag rule:

...I didn't know until today that the FDA's coercive power extends to journalists as well -- the agency forbids reporters from consulting outside experts with regard to embargoed news.

Let's talk about what a news embargo is, first. A company or organization wants certain news released, but it wants to control the timing of when that news is released. So it enters into voluntary agreements with reporters: You get the scoop in exchange for promising not to release that news until an agreed-upon date. So far, so good; we have a voluntary agreement between reporters and companies or trade groups...

But the FDA has decided to meddle with this process, forbidding reporters to consult with third-party experts about embargoed news. This means that the reporter, who is likely a well-educated layman with respect to the drug or device he's reporting on, is not allowed to verify the story he's about to print with someone who is more qualified to evaluate the claims being made.

As the Association of Health Care Journalists puts it, "Reporters who want to be competitive on a story will essentially have to write only what the FDA wants to tell the world, without analysis or outside commentary." That's a clear violation of free speech...

I hadn't heard of this restriction before, but I find it deeply disturbing.

Whenever the authorities forbids journalists from disseminating or discussing anything other than the government-approved version of an issue, we're one step closer to tyranny.

Wolf: Obama's Spray-On Hair Of Fiscal Policy

Dr. Milton Wolf's latest OpEd for the Washington Times debunks the latest Obama plan to "soak the rich". Here's an excerpt from, "Obama's spray-on hair of fiscal policy":

President Obama, in addition to his new Obamacare taxes, now calls for tax increases on "the rich" -- the very taxes he proudly prevented just four months ago. In a deeply dishonest speech, the class-warrior-in-chief proclaimed that "we cannot afford $1 trillion worth of tax cuts for every millionaire and billionaire in our society." He repeated, "We can't afford it."

First, Americans earning $200,000 are not "millionaires and billionaires." Second, to claim we can't afford to permit free citizens to keep their own earnings is to claim that those earnings belong not to the Americans who earned them but to the government that did not. And third, the "$1 trillion worth of tax cuts" is a flat-out fabrication. Tax revenues under President Bush were actually much greater than those collected under President Clinton -- nearly $5 trillion more.

Once again, economic reality makes fools of class-warfare politicians and their dishonesty about tax rates and tax revenues, but Americans are finally catching on.

(Read the full text of "Obama's spray-on hair of fiscal policy".)

Wolf's second point is especially critical. Wealth is created by private citizens who produce goods and services through rational thought and labor. It is not created by the government.

Punishing those who produce and create goods to redistribute to those who do not will not solve the federal debt. But it is a good way of destroying production and wealth-creation in any economy. Instead, the solution is to scale back government to its proper limited functions.

For a related take, see this video by Bill Whittle, "Eat The Rich":

Lucidicus On RomneyCare

The Lucidicus Project has a new video on the 5th anniversary of the Massachusetts RomneyCare plan, highlighting a few facts that the rest of America should know:



(Learn more about the Lucidicus Project.)

Catron SCOTUS Update

In today's AmSpec, David Catron has a nice explanation of the importance of tomorrow's Supreme Court hearing at, "Supreme Court to Consider Obamacare Case Friday".

We may find out soon whether the legal challenges to ObamaCare will be fast-tracked to the Supreme Court or not.

Scherz and Pipes on the Doctor-Patient Relationship

The 4/12/2011 Washington Examiner carried an OpEd by Dr. Hal Scherz (of D4PC) and Sally Pipes, "How Obamacare undermines the doctor-patient relationship".

One excerpt:

Finally, patient-doctor relationships are slowly deteriorating as physicians leave private practice for salaried employment at hospitals. Last year, for the first time ever, more doctors worked for hospitals than for themselves.

Physicians increasingly worry that a combination of government regulations and plummeting reimbursements for their services will force them out of business. Hospitals have seized upon this widespread fear and are buying up physician practices, placing the practice of medicine nationwide under their institutional control.

As a result, private practice as we know it could be extinct within a decade.

Obamacare is hastening these transactions by pushing for the creation of "accountable care organizations" whereby doctors and hospitals are paid not according to how much care they deliver but in bundles according to nebulous government "quality" standards.

ACOs are simply the 21st century version of HMOs. This time, though, doctors will be forced to serve their hospital paymasters -- not their patients...

(Read the full text of "How Obamacare undermines the doctor-patient relationship".)

A physician being employed by a hospital is not inherently bad. But when hospitals are subjected to financial sticks-and-carrots by the government to require their doctors to practice according to government algorithms, and when government also creates incentives to drive doctors away from private practice and into hospital chains (such as with burdensome new electronic medical record requirements), this can be a deadly combination.

In that case, the hospitals are merely the intermediaries for the government -- serving as the indirect agents of rationing. But for the patient, the end result will be just as bad.

Graham: Romneycare a Big Bust

In the 4/12/2011 Boston Herald, Michael Graham describes how the Massachusetts "RomneyCare" health plan has been a big bust.

A few excerpts:

As a health care plan, Romneycare is an unmitigated fiasco. It has caused costs to skyrocket, insurance premiums to soar and nonprofit providers like Blue Cross to suffer hundreds of millions of dollars in losses...

Taxpayers now spend $2.5 billion more on our state’s health care budget. The direct cost of Romneycare has gone from less than $100 million a year to at least $400 million -- and even that number is suspect...

If you want to know why Romneycare's costs keep rising, check out this simple statistic from the Patrick administration: In 2006, 85 percent of the insured in Massachusetts got their coverage through private group coverage at work. Today that’s down to 79 percent.

Meanwhile the percentage on the MassHealth dole has doubled, and more than 150,000 people are now subsidized through Commonwealth Care.

Romneycare supporters like Brandeis University health policy professor Stuart Altman brag that "the basic reason for the reform was to extend coverage, and on this, we have done amazingly well." But that's only if you use the phrase "extend coverage" to mean "the government forced you to buy your own insurance."

Romneycare hasn’t made that insurance more affordable -- just the opposite. Many people have seen their premiums double in the past five years. Supporters also never mention that when Romneycare was signed, Massachusetts already had one of the nation's lowest rates of uninsured...

(Read the full text of "Romneycare a Big Bust".)

Why would we ever want to adopt this failed scheme at the national level?

(Via Dr. Matthew Bowdish and Instapundit.)

Hsieh PJM OpEd: The Homer Simpson Approach to Social Security

The April 12, 2011 edition of PajamasMedia published my latest OpEd, "The Homer Simpson Approach to Social Security".

My theme is that the economic and moral bankruptcy of Social Security is becoming increasingly obvious to all. And that the proper question is not how to "reform" it, but rather how to phase out and eventually eliminate Social Security.

Here is the opening:

In a classic episode of The Simpsons, a hungry Homer Simpson runs out of donuts and breaks into his emergency stash. But when he opens the box, it's empty except for a note that reads: "Dear Homer, IOU one emergency donut. Signed, Homer." Homer curses his earlier self: "Bastard! He's always one step ahead."

It's easy to laugh at Homer Simpson's folly, but America is doing the same thing with Social Security financing, and the end result won't be amusing...

(Read the full text of "The Homer Simpson Approach to Social Security".)

I'd also like to thank Tony Donadio and Milton Wolf for their earlier blog posts that helped inspire this piece. In particular, I recommend reading Tony's piece in its entirety:

Tony Donadio, "On Eliminating Social Security"

Milton Wolf, "The United States of Greece: The Welfare State's Death Spiral"

Chicago-Style Food Paternalism

Some Chicago public schools are now forbidding students from eating lunches brought from home.

Students must eat the lunches provided at the school cafeteria (at prices set by the government-run schools) or go hungry. The only waivers granted are for medical reasons -- such as a food allergy.

Of course, the restrictions on eating lunches packed at home is based on a new version of paternalism. The school system is saying that they know better what's healthy for the children than the parents.

Although not directly related to the national health care "reform", these petty school bureaucrats share the same mindset of wanting to restrict your freedoms, supposedly for noble purposes -- in this case "for the children".

I think I liked the old-style Chicago thuggery better, where they didn't pretend they were using force against you for your own good.

Or as Abraham Lincoln once said, "When it comes to this I should prefer emigrating to some country where they make no pretense of loving liberty -- to Russia, for example, where despotism can be taken pure and without the base alloy of hypocrisy."

Quick Links: Tourism, Insurance, Entitlements

The 4/4/2011 Washington Post reports, "Medical tourism draws growing numbers of Americans to seek health care abroad".

The author, a physician, visited a facility in India and was surprised to see that the care was comparable in quality to a good American hospital -- but much cheaper. Some reasons:

Devon Herrick, a policy expert at the National Center for Policy Analysis, a think tank based in Dallas, identified other factors that make foreign hospitals less expensive: lower labor costs certainly, but also fewer third-party payments, price transparency, limited malpractice liability and fewer regulations.

Stella Zawistowski at ReasonPharm shows, "How insurance encourages us not to ask questions: An example":

...[T]here was no incentive at all for the doctor to charge a low price, or for me to question the bill afterward. After all, I'm not paying it -- my insurance company is. Except that, when this kind of decision is made by millions of people, guess what? Premiums go up!

Remember, we owe this distorted system to the tax policy that makes it advantageous for our employers to buy us generous health benefits rather than raising our salaries. In a free market -- free of coercive taxation -- most of us would likely buy far less comprehensive health care policies in order to save money, and then we'd scrutinize our health care expenses far more closely in order to save more money.

Dr. Richard Fogoros explains the deeper meaning of the court ruling that essential prevents senior citizens from opting out of Medicare at, "'Entitlements' Can No Longer Be Rejected".

One critical quote:

...[W]hen one has at last devised a centrally-controlled, "universal" healthcare system (again, for the purpose of maximizing the public good), then allowing individuals to spend some of their own money on healthcare services that have not been officially sanctioned for them by the Central Authority will wreck the very legitimacy of that system.

That is, to permit such individual prerogatives is tantamount to admitting that, perhaps, the Central Authority is actually NOT providing all useful healthcare services to all people (when, by definition, it is). Allowing individuals to purchase "extra" healthcare is a signal to the unwashed masses that there is "extra" healthcare to be had, and that the Central Authority may be holding out on them.

To say it another way, an essential feature of any Progressive healthcare system will be to carefully manage the expectations of the subject citizenry. To have certain subjects running around purchasing extra healthcare will fatally damage those managed expectations, and thus will fatally damage the Progressive healthcare system itself. Hence, it is imperative that individuals be constrained...

Catron: King Barack's Waivers

David Catron's latest column at AmSpec discusses the continuing problem of ObamaCare waivers. Here's an excerpt from "King Barack's Waivers":

The only major litigation relating specifically to the Obamacare waivers is the Freedom of Information Act (FOIA) suit filed by Crossroads Grassroots Policy Strategies pursuant to the repeated failure of HHS to provide information about its processing of waiver applications. This lawsuit "seeks judicial enforcement of a FOIA request for 'any and all memoranda, guidance, directives, instructions and other documents… relating to the criteria to be applied by HHS in deciding whether to grant or deny applications for waiver of the annual limit requirements' ordered by the Obamacare law."

This is all well and good, but the waiver problem deserves far more legal attention than does a mere violation of FOIA. Indeed, it is in some ways a greater affront to our basic liberties than Obamacare's egregious individual mandate. The latter is deservedly the primary target of myriad lawsuits, one of which is serious enough to have been scheduled by the justices of the Supreme Court for an April 15 discussion concerning whether they should hear the case prior to appellate review. But Obamacare and its mandate, as outrageous as they are, were at least passed by a duly elected Congress and signed into law according the general procedure set down by the framers. Even if the individual mandate is eventually found to be unconstitutional, it came into being pursuant to a (more or less) legitimate legislative process.

But the waivers have no such claim to legitimacy.

Rather, Catron notes:

Obamacare does not contain any provision allowing the President, or any other member of the executive branch, to issue special dispensations at his or her pleasure.

...Yet King Barack I, as errant conservative Andrew Sullivan recently dubbed him, continues to issue special dispensations through his retainers at HHS. The total has now gone well above 1,100, and nearly half of the latest batch of 128 waivers went to various unions that support the President and his party with manpower and money. This, to quote Professor Hamburger again, "raises questions about whether we live under a government of laws… how can the executive branch relieve some Americans of their obligation to obey it?"

(Read the full text of "King Barack's Waivers".)

At the Volokh Conspiracy, there's a related series of posts such as, "Hamburger on Waivers".

The 3/19/2011 New York Times covers this issue at "Health Law Waivers Draw Kudos, and Criticism". One quote caught my eye:

...[W]aivers have gone to entities as diverse as the Waffle House and Ruby Tuesday, health plans run by Aetna and Cigna, and labor unions representing Teamsters, electrical workers, plumbers, carpenters and food and commercial workers.

Administration officials said the waivers showed a pragmatic, flexible approach to carrying out the law. Without the waivers, said Kathleen Sebelius, the secretary of health and human services, many employers would have increased premiums, and some would have dropped coverage altogether.

Edmund F. Haislmaier, a health policy expert at the conservative Heritage Foundation, said the waivers "result in unequal application of the law and create a temptation to engage in political favoritism."

Republicans like Representative Darrell Issa of California said that in granting waivers, the administration had favored political allies, including labor unions.

Such selective enforcement (or exemptions) pushes us even further from the rule of law, and towards the rule of men.

The end result will be open tyranny.

Wolf on Big Government vs. Prosperity

Dr. Milton Wolf has a new OpEd in the 4/6/2011 Washington Times, "Big government crushes American standard of living". In this piece, he takes a step back from narrower topic of health care and discusses broader issues of the proper role of government in people's lives.

Here's an excerpt:

Actually, I'm indifferent to the success or failure of... particular companies, but I champion the free market -- a meritocracy -- that allows more efficient and effective methods or companies to earn our business. That a major corporation such as Smith-Corona couldn't marshal its enormous resources to stave off what some students like Bill Gates, Steve Jobs and Michael Dell could create in their dorm rooms and garages is fascinating but inconsequential to society.

What's important is that the best ideas prevailed no matter whose they were while, just as importantly, less effective ideas, no matter how good they were in an earlier era, were set aside. This is the precise mechanism by which a nation's standard of living is improved.

Ironically, it's the same politicians who talk the loudest about vague notions of change who want to stop this changeover to more effective methods and companies. Admittedly, it may be temporarily difficult for workers who once built fine typewriters to change, but unless Smith-Corona lets them go, how else will Dell find enough workers to build our computers? Surely we can agree that the workers are better off in a company that makes something we want rather than something we don't.

He contrasts with the politically-driven bailouts, where the government picked winners and losers according to its criteria -- rather than the free choice of individuals acting in a marketplace. In particular, he notes:

Think about it. When was the last time someone had to be bribed to buy an iPhone or a Ford F-series pickup or a Big Mac? Good products and services follow the "Field of Dreams" rule: If you build it, they will come. Meanwhile, every bailout, stimulus, targeted tax break, subsidy and even "protective" tariff are all forms of crony corporate welfare that are attempts to bribe you with your own money to buy whatever the government busybodies think you need.

(Read the full text of "Big government crushes American standard of living".)

History has shown time-and-again the linkage between human freedom and prosperity.

Unfortunately, too many statists know all to well that their proposed regulations will harm economy and dampen our prosperity. But they don't care -- for them that's a feature, not a bug. That's a damned good reason to keep them out of office -- and prevent them from having power over the rest of us.

UK Rationing Update

UK surgeons are sounding a new alarm about the long waits for surgery under the British National Health Service.

In particular:

Surgeons have described the delays faced by patients as "devastating and cruel". Peter Kay, the president of the British Orthopaedic Association (BOA), says they've become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings...

"GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery."

He says that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate.

"The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early."

The article also describes how the NHS administrators "game" the numbers to make the waiting times seem shorter than they really are.

Remember, this is the system that men like Medicare chief Donald Berwick has praised as a moral ideal to emulate here in the US...

(Via Doug R.)

Wolf eBook on Health Care

Dr. Milton Wolf has a new book out, "First, Do No Harm: The President's Cousin Explains Why His Hippocratic Oath Requires Him to Oppose ObamaCare"

As he notes in his blog announcement, it's part of the new Voices of the Tea Party series. I look forward to reading it!

Baehr Mythbusts WHO

The April 4, 2011 PajamasMedia published a nice OpEd by Rich Baehr, "WHO Study Used to Justify ObamaCare a Scientific Fraud".

He describes how an oft-quoted study by the World Health Organization that purportedly "proved" the inferiority of American medicine was based on loaded and politically biased criteria.

Of course, none of this matters for the statists. But it should matter to ordinary Americans who still value their lives and their freedoms. Baehr's article should provide them with much-needed intellectual ammunition for the fight ahead.

DeLong: Smothering Medical Innovation

In his 4/2/2011 PajamasMedia OpEd, James DeLong warns how ObamaCare will resulting in "Smothering Medical Innovation".

I'm very glad that he makes some critical points, including the fact that:

1) Technology and innovation is not the source of rising health costs. In fact, technological innovation generally leads to decreased costs in every other sector of the economy. It's only the regulatory regime that prevents market forces from operating that keeps costs for high tech medicine artificially high.

2) We shouldn't look at health spending as if it were a collective pot of money spent by "society". That's the trap the statists want Americans to fall into, which allows them to "justify" ever-increasing government restrictions.

3) He also echoes the point made by Dr. Beth Haynes, "that once health care expenses are collectivized, rationing is inevitable."

A socialized medical system will necessarily restrict innovation because it will save money -- even though it will kill thousands of patients. But to effectively oppose socialized health care, we must first challenge its advocates' presumption that it is scientifically and morally superior to the free market. DeLong's piece is a nice step in that direction.

Hype Vs. Reality

A few recent stories highlight the gulf between pro-ObamaCare hype and reality.

1) The 4/1/2011 New York Times reports that "Cuts Leave Patients With Medicaid Cards, but No Specialist to See".

Many of these patients are learning the hard way that "coverage" does not equal actual medical care. From the NYT article:

"Having a Medicaid card in no way assures access to care," said Dr. James B. Aiken, an emergency physician in New Orleans...

"My Medicaid card is useless for me right now," [patient Nicole] Dardeau said over lunch. "It's a useless piece of plastic. I can't find an orthopedic surgeon or a pain management doctor who will accept Medicaid."

Expanding Medicaid was one key element of ObamaCare's promise to improve "access" or "coverage". However, many states are setting Medicaid reimbursement rates so low that doctors cannot afford to see these patients. The big question will be whether cash-strapped states like Louisiana will respond by compelling physicians to accept Medicaid patients at the state rates (i.e, price controls).

Something similar has already been proposed in Massachusetts, namely compelling physicians to accept certain state-sanctioned insurance plans as a condition of retaining their MA medical license. Fortunately, that law did not pass -- but it may inspire similar proposals elsewhere.

2) In contrast, the 4/2/2011 Associated Press reports, "High-end medical option prompts Medicare worries".

More patients who can afford it are seeking "concierge physicians" who will actually take the time to listen to their problems, answer their questions, and provide individualized high-quality health care -- rather than the cookbook-style medicine being demanded by ObamaCare with its government practice guidelines.

Many middle-class patients are finding the $1500-$1800/year retainer fees to be affordable. But this trend is also arousing a backlash by the statists who want to limit people's ability to opt out of any government-run system. This is no different from the socialists in East Germany wishing to limit the ordinary citizens from seeing how much better life was in West Germany. Hence, we can expect increasing rhetorical and political attacks against the idea of concierge medicine, arguing that (as many already do) that it creates a "two-tiered" system, or that it's "inegalitarian".

3) Finally, physician-blogger Kevin Pho notes, "Electronic medical records and pay for performance don't improve care". These are major initiatives of ObamaCare. Men like Medicare chief Donald Berwick argue that electronic medical records (EMRs) and "pay for performance" (P4P) will improving health outcomes.

Evidence is mounting that this is false. What they will do is allow the government to more closely control how doctors practice medicine. These mechanisms facilitate future rationing by creating the mechanisms for tracking what tests and treatments doctors prescribe -- and punishing those who fail to adhere to the government practice guidelines.

Americans wouldn't tolerate a government that required them to log all their meals with a central database, and punished them for eating foods the government didn't approve of. They shouldn't tolerate the government doing the same to their doctors.

UK Ironic Headline Of The Day

Not an April 1 joke:

"Former NHS director dies after operation is cancelled four times at her own hospital":

A former NHS director died after waiting for nine months for an operation -- at her own hospital.

Margaret Hutchon, a former mayor, had been waiting since last June for a follow-up stomach operation at Broomfield Hospital in Chelmsford, Essex.

But her appointments to go under the knife were cancelled four times and she barely regained consciousness after finally having surgery.

(Via Rand Simberg.)