The blog of Freedom and Individual Rights in Medicine (FIRM)
I have not been a fan of Obamacare, which I consider to be a highly inefficient form of wealth insurance. Nonetheless, had this decision gone the other way at this point we would have ended up with something worse, or ended back at “Obamacare as know it,” but only after a lot of political stupidity and also painful media coverage. So on net I take this to be good news, although arguably it is bad news that it is good news.
But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.The patient sued and was awarded total damages of $500,000. For more details read the full piece, "Anesthesiologist trashes sedated patient — and it ends up costing her" (Washington Post, 6/23/2015).
In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.
The hacking of the health records of as many as 1 in 3 Americans has awoken the health care industry to an unpleasant reality: After spending billions to install computerized documents in hospitals and networks, it now must spend billions more to make them secure...Yet another "unintended consequence" of government-mandated electronic health records.
[Family physician Dr. Catherine] Krouse says the way health care has evolved, patients often come second to the other demands on doctors: Filling out reimbursement forms. Calling insurance companies to battle for claims. Reviewing and signing off on stacks of patient paperwork.
"You just end up getting drained and drained and drained," Krouse says. "And then when your cup is completely empty, then you just get guarded and angry. And then you put up walls, and that really creates barriers."
So Krouse decided to set up a direct primary care practice. Earlier this month she opened Lotus Family Practice in Falmouth. She doesn't accept insurance. Instead, she charges patients a monthly membership fee. "So it's very direct. It's just patients and doctors. There's no one else in between."
Membership is $60 a month for adults, $20 for kids. It covers an unlimited number of visits, which last about 45 minutes. Patients can also call or text Krouse any time they want. She also provides generic drugs at wholesale cost. Those savings alone, she says, can cover the cost of membership. "Pennies. They cost pennies."The article goes into more detail on how this helps physicians spend more time with patients and get to the root of their health problems. Plus patients need fewer referrals to specialists.
The direct primary care model, [Krouse] says, allows her to move beyond just treating illness to focusing on health, well being, and the individual patient. And that's the kind of doctor that Krouse has always wanted to be.(Article link via Dr. Megan Edison and Dr. Matthew Bowdish.)
I briefly worked at the front desk clerk for an ER at a local hospital. The rule was the anyone that came in complaining of chest pains had to be back and on a machine within 10 minutes of arrival. Once I entered their name into the system a clock started. So I was told not to enter their name until they had already been taken back to essentially make our numbers look better and make it appear as though they were receiving care within the prescribed 10 minutes.(Via White Coat blog.)
Edit: People complaining of chest pains were typically brought back quickly, just not always within the 10 minute guideline, although generally faster than anyone else. This mostly seemed to be just about producing better stats. Although keeping it off the system gave them the ability to delay.
"There are three kinda lies in the world; lies, damned lies, and statistics."
Even as Americans heatedly argue the issue of free speech with respect to cartoon criticisms of Islam, the small drug company Amarin is striking a quieter blow for its free speech rights against the Food and Drug Adminstration (FDA).Of course, drug companies should not be allowed to disseminate false or misleading information about their products. That can and should be punished as fraud.
The key issue is whether drug companies can tell doctors truthful information about their products that pertains to “off-label” uses (i.e., for applications not already explicitly approved by the FDA.)
Most importantly, none of the ten cosmetic procedures in the table above have increased in price by anywhere close to the 88.5% increase in medical care services since 1998. [Emphasis his.]Perry summarizes:
The competitive market for cosmetic procedures operates differently than the traditional market for health care in important and significant ways. Cosmetic procedures, unlike most medical services, are not usually covered by insurance. Patients paying out-of-pocket for cosmetic procedures are cost-conscious, and have strong incentives to shop around and compare prices at the dozens of competing providers in any large city.In other words, the problem we've seen of skyrocketing prices in the traditional medical market can't be blamed on "fee for service". Rather, the issue is the 3rd-party payor system, a point also made by others such as Dr. Richard Amerling in his recent Wall Street Journal piece.
Because of that market competition, the prices of almost all cosmetic procedures have fallen in real terms since 1998, and some non-surgical procedures have even fallen in nominal dollars before adjusting for price changes. In all cases, cosmetic procedures have increased in price by less than the 88.5% increase in the price of medical care services between 1998 and 2014.
I applaud Eichenwald for asking some hard questions about the ABIM.My wife is an internist. My brother is a pediatrician at a major academic institution. So was my father. My best friend is a surgeon. I regularly see an internist for my medical care, and I like her very much. I also should mention that this article is an opinion column.And it is my opinion that the American Board of Internal Medicine (ABIM) has hidden managerial incompetence for years while its officers showered themselves with cash despite their financial ineptitude and the untold damage they have inflicted on the health care system...
The real cause is the institution and growth of direct third-party payments. Inflation in health care was trivial until the mid-1960s, when Medicare and Medicaid were thrust into existence. The other big driver is the morphing of health insurance into a prepayment model, where even routine, low-cost care is covered. When neither the consumer nor the provider “feels” the cost of the service offered, it promotes overuse of medical services and high levels of spending. Government data show that 48% of health dollars were “out of pocket” in 1960. By 2008, this was down to 12%...But I highly recommend reading both sides of this debate, "Should the U.S. Move Away From Fee-for-Service Medicine?"
In other professions that feature fee for service but where third-party payments play a much smaller role, such as in law, dentistry or veterinary medicine, there is little excessive price inflation. Similarly, in areas of medicine outside the third-party-payment system, such as cosmetic surgery, Lasik eye surgery, and direct pay practices, prices have actually declined over time.
It is impossible to eliminate self-interest, which is embedded in human nature. But if some doctors and hospitals over time get away with unnecessary tests or padding bills, it isn’t because of fee for service. It’s because the patients are shielded from the impact by third-party payments.
Fee for service directly aligns payments with care, which is what most patients want, especially when facing serious illness. It’s incentive-based and increases the likelihood of quality care in a timely manner...
1) Is it the government’s job to stop legal adults from making unhealthy life choices?People don't always make the best choices for themselves. But in a free society, they should be able to do so, provided they aren't violating the rights of others.
2) Is it right for the government to restrict the freedom of adults over 18, because others under 18 might be more tempted to smoke?
3) Whose body is it, anyways?
A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. “I had seen him a few years ago and I liked him,” he told me. “But this time was different.” A computer had entered the exam room. “He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it’s tap-tap-tap-tap.”The NYT piece correctly describes how mandatory electronic medical records are putting a barrier between patients and physicians, impeding good medical care.
“What did you do?” I asked.“I found another doctor."
It breaks my heart whenever a patient tells me that one of the reasons they love our practice is that we look at the patients rather than a computer screen. Little do they know that we already have electronic health records although are holding on full implementation. Not only has the current EHR paradigm almost destroyed our business, it also risks robbing us of our humanity in caring for patients. The promise of technology is huge and necessary. These govt-mandated, tools of Big Insurance are not.
Are physicians in the United States getting dumber? That is what one of the most powerful medical boards is suggesting, according to its critics. And, depending on the answer, tens of millions of dollars funneled annually to this non-profit organization are at stake.The provocative question is a rhetorical weapon in a bizarre war, one that could transform medicine for years. On one side is the American Board of Internal Medicine (ABIM), which certifies that doctors have met nationally recognized standards, and has been advocating for more testing of physicians. On the other side are tens of thousands of internists, cardiologists, anesthesiologists and the like who say the ABIM has forced them to do busywork that serves no purpose other than to fatten the board’s bloated coffers...
In the 1950s, when the president of the United States had a heart attack, he got the absolute state of the art treatment from some of the top doctors in the country: blood thinners, painkillers, and bed rest.For more examples of progress that we don't always fully appreciate, read the full text of "It's Complicated. But Hopeful."
Today, he would have had an array of scans and blood tests to diagnose his problem, and then his physicians would have been able to choose from an array of treatments—stents, coronary bypass, balloon angioplasty—to prevent future heart attacks. And thanks to epidemiology, public health campaigns, and an array of smoking cessation aids, he probably wouldn’t have had a four-pack-a-day cigarette habit, either.
1950s health care isn’t expensive; this same regimen would be a bargain at today’s prices. What’s expensive is things that didn’t exist in 1950. You can say that “health care” has gotten more expensive—or you can say that the declining cost of other things has allowed us to pour a lot more resources into exciting new health products that give us both longer and healthier lives...
The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.The shortage did not originate with ObamaCare, but the ObamaCare health law will make the shortage worse in two ways. First, there will be an influx of new patients without a corresponding increase in the number of doctors. Second, many doctors are already demoralized by the pressures of the new health law -- and as they retire, we may not see the same caliber of new physicians entering the medical profession.
The nation's shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer...
The Court will hear oral arguments this Wednesday in King v. Burwell. The petitioners in this case want the justices to rule that the Obama administration must abide by the provisions of PPACA that govern insurance subsidies. The text of that law, better known as Obamacare, requires that all subsidies must flow through exchanges established by the states. But due to the refusal of 36 states to set up such “marketplaces,” the Obama administration cobbled together federal exchanges in those states through which it is now issuing illegal subsidies.Or as he notes, "The Supreme Court is about to decide whether we are a nation of laws or men."
In other words, the President conducts himself in a manner utterly inconsistent with republican principles and his constitutional oath. Obama obviously believes the law is what he says it is, a delusion evidently shared by his party and the press. He behaves as if he possesses the power to unilaterally change laws and create new ones merely because the opposition party actually opposes his agenda. Adams characterized such behavior as that of “a despot, bound by no law or limitation but his own will; it is a stretch of tyranny beyond absolute monarchy.”
This is, at its core, what King v. Burwell is about. It has nothing do with any “plot to kill health care,” as the New York Times recently put it. Nor does it involve a surreptitious conspiracy to reinvigorate the “states’ rights” movement, as it was described last week in Politico. It isn’t even an attack on Obamacare, though a ruling in favor of David M. King and his fellow plaintiffs would obviously have a profound effect on the future of the “reform” law. It is rather an attempt to prevent the President from doing further violence to the Constitution...
Diego Morris said he’s alive today because he used experimental drugs to treat his cancer even though they weren’t approved by the FDA.Click through to see related video.
In 2012, Morris was diagnosed with osteosarcoma. But because the medicine needed to treat it was not approved in the US, he traveled to Europe with his mother to get it.
Now he’s cancer-free and he flew to Oregon to join Rep. Knute Buehler to support the Right To Try bill...
Last week, the White House took to Twitter for purposes of publicizing its latest Obamacare enrollment blarney. Far more informative than the tweet’s fictitious sign-up numbers was the schmaltzy video to which it was linked. Staged in the Oval Office, this one-act farce features a simpering HHS Secretary briefing our Thespian in Chief, who then delivers the following soliloquy: “The Affordable Care Act is working. It’s working better than we anticipated. It’s certainly working a lot better than many of the critics talked about early on.” In Obama’s 27-word script, “working” appears three times. The President doth protest too much, methinks.And:
Ask the folks who learned last Friday that Obama’s bureaucrats sent them erroneous tax information relating to PPACA. AP reports, “Officials said the government sent the wrong tax information to about 800,000 HealthCare.gov customers, and they’re asking those affected to delay filing their 2014 returns.” And, as with most government blunders, the price will be paid by those who can least afford it. Robert Pear points out in the New York Times, “[T]housands of lower-income Americans who qualified for subsidized insurance had hoped for tax refunds and now must wait for weeks to file their taxes.”For more, read the full text of "No, Mr. President, Obamacare Isn’t Working".
Unlike conventional drugs, these cell therapies are created from scratch, one patient at a time, and many of the tools used to create them are simple, compact, and cheap enough to land in laboratories that serve hospitals, small clinics, and doctors in private practice. They have been landing there in growing numbers in the last decade, and Washington has been trying to keep pace.The scientific aspects are fascinating. And the regulatory aspects are infuriating.
The Food and Drug Administration (FDA) has taken the position—upheld in February 2014 by a federal appellate court—that a patient’s cells become a “drug” when extracted and manipulated in a laboratory, and may not be used to treat the patient without FDA approval. But it is far from clear how the agency should set about approving a custom-made drug that will be prescribed to only one patient, in whom its safety and efficacy will be largely determined by how the patient’s molecular biology interacts with itself....
[R]igidly scripted trials remain the norm at the FDA. Responding to the advent of drugs precisely designed to modulate specific molecular targets, the FDA has gradually come to accept that the drug-approval process must take into account the relevant patient-side molecular factors as well.
The FDA has, however, been slow to accept trial protocols that systematically investigate those factors and incorporate them into prescription protocols that increase the likelihood that the drug will be effective. With rare exceptions, the agency requires that the molecular factors that might affect a drug’s efficacy be identified by studying the disease before a clinical trial begins, or by analyzing the drug’s performance in short, early-phase trials that involve few patients—far too few to provide a full understanding of how variations in patient chemistry may affect a drug’s performance. This has already been recognized as a serious problem in the testing of certain categories of conventional drugs...
When: March 27, 2015 @ 6:00 pm – 8:00 pm
Where:Georgetown U. School of Medicine - New Research Building AuditoriumGeorgetown University
3900 Reservoir Road Northwest, Washington, DC 20007
USA
Cost:Free, but RSVPs requested.
Please RSVP through the green “Tickets” link on the announcement page.
The event is free but we want to plan the right amount of food! There is a parking garage located under the Leavey Center accessible from Reservoir Road, or there is the Southwest Parking garage accessible from Canal Road.
Debate Venue Details:
Date: Friday, March 27, 2015
Time: [Eastern]
6:00 PM Reception with soft drinks and hors d’oeuvres; Registration and initial voting
6:30 Debate Begins
7:45 Debate Ends. Final voting, tally.
8:00 Announcement of results.
Place: Georgetown University School of Medicine
Room — New Research Building Auditorium
3900 Reservoir Road Northwest,Washington, DC 20007
Moderator: Michael Ramlet (Morning Consult)
Arguing the Affirmative:
Dr. Josh Umbehr MD (AtlasMD)
Dr. Lee Gross, MD (Epiphany Health, Inc.)
Arguing in Opposition:
Dr. Dennis McIntyre, MD
Dr. Adriane Fugh-Berman, MD
NBC's Brian Williams has gone from being a respected news anchor to the butt of Internet jokes after he recanted a false story about being shot down in a helicopter over Iraq. As a result of the subsequent controversy, NBC has suspended Williams without pay for 6 months -- essentially costing him $5 million.During my research for this piece, I learned that "40-80% of medical information provided by healthcare practitioners is forgotten immediately" and "almost half of the information that is remembered is incorrect" (!)
But whether or not Williams' story was an innocent "false memory" or a deliberate lie, it is the case that false or unreliable memories are a surprisingly common phenomenon. In a health care setting, patients' false memories of medical conversations might cost them more than money -- it might even endanger their lives. Hence, patients may wish to record their doctors' visits to protect themselves...
"You have a card saying you have health insurance, but if no doctors take it, it's almost like having one of those fake IDs," he said. "Your medication is all paid for, but if you can't get the pills, it's worthless."Similarly, in California:
Richard Holstein, his father, is a Long Branch psychologist who has watched his son struggle to get care. Yet he no longer accepts Medicaid in his own practice because the managed care payment of about $40 is half of what regular insurance pays, and a quarter of his full fee, he said.
"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."A common theme in both stories: Patients were promised "coverage" under ObamaCare. But they have a very difficult time finding a physician willing to see them, especially at the low rates that Medicaid pays. Doctors essentially lose money on these patients, which means there is no way they can "make it up in volume".
Joanna DeProspero was desperate to find a pain management doctor for her adult daughter, who works part-time at Home Depot despite back pain. When she proposed paying cash, she learned it's illegal for a doctor to accept such a payment. Doctors who participate in Medicaid cannot bill a patient anything extra, said Downs, of the medical society -- even if that payment is freely offered by the patient.One unfortunate side effect is that the patients end up going to the local emergency rooms instead (for care that isn't strictly an emergency), thus worsening the overcrowding situation in the ERs.
"I've literally cried at the end of the day after six or eight phone calls," said DeProspero...
The medical theory of “herd immunity” posits that enough vaccinated individuals in a population can reduce the risk of contracting a disease — even for those who aren’t vaccinated. From the experience in Illinois and around the country, a relatively small number of armed people can similarly reduce the risk of crime — even for those who aren’t armed.The "payoff" may be even better for gun ownership than vaccination. In the case of Illinois, even a relatively small 1% of people with new concealed carry licenses has resulted in a dramatic decrease in violent crime rates.
Such is the genius of our Beltway masters. They pass a law that distorts the insurance market so badly that coverage becomes unaffordable, then fine people for failing to buy it. Next, of course, these brilliant statesmen will try to escape the consequences of their meddling by giving special dispensations to those whose lives they have disrupted. Robert Pear continues, “The White House has already granted some exemptions and is considering more to avoid a political firestorm.” The Obama administration is like a drunk driver offering money to someone he has sideswiped so she won’t telephone the police.His piece peels back more of the pro-ACA narrative we've been seeing in the news. For more details, read the full text of "Uninsured Balk At Obamacare Bite".
Meanwhile, beyond the walls of the Washington rehab ward, the Kaiser Foundation survey contains more bad news about the President’s “signature domestic achievement.” Contrary to the claims of Obama and his media mouthpieces, the fortunate few who can still afford coverage have continued to experience problems finding their way through the labyrinthine Obamacare sign-up process: “Nearly two-thirds of uninsured adults who sought ACA coverage said they had some difficulty with finding out how to apply, filling in the information, assembling the paperwork, or submitting the application.”
And mere eligibility combined with the perseverance to navigate the application process is by no means a guarantee that an uninsured individual can sign up for an “affordable” health insurance policy. The Kaiser survey continues, “Among those who did try to get ACA coverage, the most common reason people gave for not having ACA coverage was that they were told they were ineligible.… This pattern holds among those who appear eligible for financial help under the ACA.” In other words, the HHS bureaucrats who “help” enrollees remain as clueless as they were the day Healthcare.gov was launched.
(1) Protecting a patient's right to pay with their own money for medical services.
(2) Protecting a physician's right to decline to accept insurance (i.e., forbidding the state from requiring physicians to accept insurance.
(3) Forbidding the state from requiring physicians to provide medical care just because state orders it.In other words, those provisions help protect the doctor-patient relationship and the individual rights of patients and physicians.
Part of what we want to do with this bill is to educate people, including legislators, about how poorly these plans protect people financially, in the event of medical catastrophe. That should be one of the main functions of health insurance. Many people might see their $2500.00 deductible on an exchange plan, and not realize that their annual cap is actually $19,050.00. Patients don't always get to choose in-network in an emergency.And:
Our hope, if this passes, is that it would allow a "space" in the out-of-network arena for real price competition to occur. We are going to be seeing narrow networks, and doctors becoming involuntarily out-of-network. We want being kicked off the network to be a survivable event for the doctor or medical group.
It isn't perfect, but I think it is a decent strategy in a David vs Goliath battle. The best thing would be removal of lots of regulations so that insurance companies would have to provide choices in order to compete. If that happens, this bill won't be needed.
Another important point, is that subscribers and doctors get top-down control of their medical care by the payer, along with their financial benefits, when in-network. You cannot buy a policy without this. Furthermore, when there are only one to three insurers in a state, this in-network/out-of-network differential creates a huge leverage tool for the companies to ratchet down the rates they pay to "providers". I guess that is what some people call "competition". Not me.Both are excellent points worth considering.
1) Your life is your own.For more details, please read the full text of "Does Your Right To Life Include The Right To Die?"
2) The state has a legitimate (even vital) role to play in assisted suicide.
3) Physicians must not be required to participate
It’s easy to take for granted that we have the ability to detect early problems with babies—not thinking that absent the machine that can detect those problems and the energy to power that machine, human beings past and present have lost untold millions of babies. It’s easy to take for granted that we have the ability to keep a three-and-a-half-pound baby alive—not thinking that absent the machine that can incubate it and the energy to power that machine, most of people’s beloved children who were born underweight would have died.(Epstein is the author of the recent book, The Moral Case For Fossil Fuels.)
If the machines that move modern medicine don’t have energy, they are useless...
Since May, a string of states have passed laws that give critically ill patients the right to try medications that have not been approved by the Food and Drug Administration.
Deemed “Right to Try” laws, they have passed quickly and often unanimously in Colorado, Michigan, Missouri, Louisiana and Arizona, bringing hope to patients like Larry Kutt, who lives in this small town at the edge of the Rocky Mountains. Mr. Kutt, 65, has an advanced blood cancer and says his state’s law could help him gain access to a therapy that several pharmaceutical companies are testing. “It’s my life,” he said, “and I want the chance to save it.”...The Colorado law, which is similar to ones in other states, permits terminally ill patients who have exhausted their treatment options — including clinical trials — to obtain therapies that have passed at least the first of three F.D.A. investigation phases. The law does not require companies to provide the treatment, nor does it mandate that insurance companies cover it; the law also allows insurance companies to deny coverage to patients while they use drugs under investigation.
Copy-and-paste is a necessary evil to save time during documentation of daily notes, but whatever is pasted must also be edited to reflect the current situation. Too often, the note makes reference to something that happened “yesterday.” For example, the sentence “Patient presented to ED with chest pain yesterday…” is pasted over the next two weeks in the daily progress note. An even more telling example is a sentence like “Patient’s admitting lab is normal…” being perpetuated while the actual creatinine levels rise every day.Every physician obliged to work with EMRs should read Dr. Klein's piece.
In one case, the judge commented about copy-and-paste issues: “I cannot trust any of the physician notes in which this occurred and the only conclusion I can reach is that there was no examination of the patient … it means to me that no true thought was given to the content that was going into ‘the note.’”
Checkboxes, particularly those that pre-populate, can be a physician’s nemesis. It’s easy to click on checkboxes, and often they are pre-checked in templates. EMRs have been presented in court that show, through checkboxes, daily breast exams on comatose patients in the ICU, detailed daily neurological exams done by cardiologists, and a complete review of systems done by multiple treating physicians on comatose patients. Questioning in court as to how long it takes to do a review of systems and a physical examination, the patient load of the physician for that day, and how many hours the physician was at work cast doubt on the truthfulness of the testifying physician. A time analysis showed that there was no way the physician could have accomplished all that was charted that day.
Welcome to the brave new world of U.S. health care as reformed by the President and congressional Democrats. It is precisely the opposite of what most Americans wanted from reform. Eight months before Obamacare passed, Gallup conducted a survey in which a majority of the public unequivocally stated that controlling costs was its highest priority. Obamacare is actually increasing costs for both patients and providers, while reducing access for the former. And this is just the beginning. The pain will continue to increase until this malignant tumor is cut out of our health care system.As always, theoretical "coverage" does not equal actual medical care. Governments can promise the former, but not the latter. For many Americans, this won't be quite so happy of a New Year.
In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven by health care reform,” otherwise known as the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.Some related commentary:
Michael Cannon, Forbes, "Is The Faculty Of Harvard University Irrational?"Right now, I'm playing a teensy-weensy violin for the Harvard faculty. (Image below from Amazon.)
Megan McArdle, Bloomberg View, "Whining Harvard Professors Discover Obamacare".
Recent news coverage concerning Obamacare’s legal difficulties has been dominated by King v. Burwell, which challenges the controversial IRS decision to issue subsidies and penalties through federally created insurance exchanges in 34 states that refused set up PPACA “marketplaces.” The Supreme Court announced last month that it would take up King, and it will hear oral arguments in March. The alacrity with which the Court took up the case, upon which it will hand down a ruling in June, has rendered the law’s supporters nearly hysterical. But King is by no means the only legal threat Obamacare will face next year.As Catron notes, none of these are "frivolous" lawsuits. For more details, read the full text of his piece, "Obamacare's Coming Year of Living Dangerously".
Ironically, considering the number of apocalyptic headlines it has produced, King v. Burwell probably presents less danger to the “reform” law than either of two additional lawsuits the Court could take up in 2015. The justices have already received a cert petition to hear Coons v. Lew, whose plaintiffs hold that Obamacare's Independent Payment Advisory Board (IPAB) constitutes a violation of the separation of powers doctrine. And it is a virtual certainty that the Court will also be asked to take up Sissel v. HHS, which challenges the law on the grounds that its passage violated the Constitution’s origination clause...
