The Logic of the Progressive Healthcare Death Cult

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January 25, 2013

By Daren Jonescu

Let us not waste another breath responding to the mock outrage with which progressives react to accusations such as Sarah Palin's "death panel" remark. Whether ObamaCare's Independent Payment Advisory Board should correctly be described as a "death panel" or a "cost-reduction system" is actually a stale semantics debate, given that when they are not acting outraged, leftists explain their real intentions quite clearly. Cutting to the chase, the proper question to ask is, "Why are progressives willing to condemn the old and infirm to death?"
A man drives up and down the highway looking for hitchhikers. Whenever he finds one, he stops to pick him up. He kindly warns the hitchhiker about the dangers of hitchhiking, and explains that he always stops for hitchhikers because he does not feel comfortable leaving them at the mercy of some strange driver. Then, once he has the hitchhiker securely in his car, he kills him.
Do we describe this driver as a Good, albeit confused, Samaritan trying to protect hitchhikers from the dangers of the highway?
Okay, that one is too easy. Let us suppose that instead of a single crazed killer, there is an entire club -- The Friends of Hitchhikers Society -- that has as its mission the total monopolization of the hitchhiker pick-up industry, in the name of protecting hitchhikers from the dangers of life on the highway. Up and down the roads they roam, thousands of them, trying to get to all the available hitchhikers before any non-Society member picks them up. And they do not kill all of them. Sometimes they faithfully drive the hitchhiker directly to his destination. Other times they drive him where he wants to go, though only after a circuitous, time-wasting trip.
When they are low on fuel, however, and fear they will not be able to reach the desired destination, they just kill the hitchhiker -- after all, they would not want him back out on the highway, endangered by all those unreliable, selfish drivers.
This group could not simply be described as homicidal maniacs. They would have to be regarded as something far more complex, and in a way more sinister. Operating in accordance with a perverse logic of their own, and seeking to sustain their preferred "highway safety" conditions through a cryptic system of rules which they perceive as somehow "just," "objective" and "fair," they would have to be seen as a kind of death cult.
What does this nightmare scenario have to do with government-controlled healthcare? Consider the following remarks from Taro Aso, the deputy prime minister in Japan's new socialist government, made during a government session on social security reform:

Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government.... The problem won't be solved unless you let them hurry up and die.

A few years ago, when Aso was Japan's prime minister, he spoke similarly:

I see people aged 67 or 68 at class reunions who dodder around and are constantly going to the doctor.... Why should I have to pay for people who just eat and drink and make no effort? I walk every day and do other things, but I'm paying more in taxes.

In the U.S., former labor secretary Robert Reich offered an audience of cheering young people the following example of what an "honest" presidential candidate would say about health care:

We're going to have to, if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive... so we're going to let you die.

And of course the more prominent apostles of the death cult's moral code are merely reflecting the white papers and scholarly assessments of the "experts," as exemplified by Michael Lind's eminently "moderate" critique of the issue of health care rationing at Salon, back in October 2012. The talk among some Obama administration officials, such as "car czar" Steven Rattner in a New York Times op-ed, about the need to ration care for the weak and old, is insufficient, argues Lind. (Both Rattner and Lind are members of the leftist New America Foundation.) Rather, Lind suggests that while rationing "may be defended in some cases" -- Rattner's op-ed begins, "We need death panels" -- the most comprehensive solution is for government to set and control all prices for healthcare throughout the public and private spheres, as has been "tried and tested" in "all other advanced countries."
Thus, rationing care is just one very sensible part of a multifaceted solution; the value of denying basic property rights and voluntarism, however, must not be neglected. See how reasonable all of this can be made to sound, if only one ignores the logical perversity at the center of it?
As that perversity is so pervasive in today's public discourse on healthcare, perhaps it has become somewhat obscure. Let us state it clearly: the advocates of government-controlled healthcare wish to create a legal monopoly on the provision of treatment to the sick, and then to deny treatment to some on the grounds that "we" cannot afford to offer treatment to everyone.
When Robert Reich says "we're not going to give you all that technology and all those drugs for the last couple of years of your life," he is beginning from the assumption that "we" -- i.e., the government -- are the only possible or legitimate source of "that technology and those drugs."
When Taro Aso, trying to shame the elderly citizens of his highly honor-based society, says "I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government," he is beginning from the assumption that all treatment will and must be provided by the state.
If you or I had offered to help someone get medical treatment, and then found that some of the costs were beyond our means, we would say, "I'm sorry, I can't afford this; you'll have to find other means of providing for your needs. I dearly hope you succeed."
When progressives believe that some medical treatment is beyond their (i.e., the state's) means, they say, "Sorry, you have to die."
Beginning from an inhuman premise -- namely that no individual has a right to self-preservation, but rather is to be preserved entirely at the discretion of the state -- they follow a train of reasoning that seems quite natural to them, and which leads to a conclusion that is entirely logical, if you accept their initial premise.
By creating an ever-thickening web of "social programs" designed to supplant self-reliance and familial responsibility in the minds and hearts of the people, the progressives gradually engender the habitual, almost instinctive acceptance of the ultimate implication of dependence, namely that the lord who giveth may also taketh away.
If the "we" in Robert Reich's "honest" presidential speech referred to "we, your children" -- as in "It's too expensive; we're going to let you die" -- everyone would recognize the disgusting brutality of the sentiment and the speaker. And if Taro Aso were speaking to his own father, saying, "You should wake up feeling increasingly bad knowing that your treatment is being paid for by your son," we would regard him as a repulsive character of the first order.
The reason these men and others of their ilk think they can get away with passing such lunatic rants off as "hard truth" is that they believe their years of propaganda have inured the broad public to their unstated premise that in the case of healthcare, "we" can only mean the state. As soon as you deny their premise, their reasoning collapses -- as does their mask of "objectivity."
If a government healthcare "board" is unable or unwilling to provide life-preserving treatment to patients judged to be a drain on the socialized system, then these patients must, in the name of the right to life, be allowed to pursue treatment by other means. And this, in turn, means that such "other means" must not be outlawed or restricted in such a manner as to prevent patients from pursuing them freely. In short, the need for rationing (i.e., rationing the days remaining to human beings), cost-reducing "advisory boards," or death panels arises only when government has effectively established a monopoly in the healthcare market.
This brings us back to my imaginary Friends of Hitchhikers Society. Like the progressive advocates of government-controlled healthcare, they are seeking to monopolize all access to a service, and then to use that monopoly as authority to decide which of their patrons will be allowed to live, and which forced to die. The difference, of course, is that the Friends of Hitchhikers cannot entirely prevent their potential victims from taking rides from other drivers, or prevent other drivers from picking up hitchhikers. In other words, they cannot establish a true monopoly.
Only the state can do that. And having done so, it becomes increasingly bold in taking liberties with its monopolistic control of medical treatment. Just look at the development of "end of life care" throughout the socialized medical world. (I have explained this here.)
Socialized medicine, the Mount Olympus of progressivism, does not merely run the risk of leading to "death panels." Death panels are, in a sense, its raison d'être -- specifically in the sense of being the perfect fulfillment of the perverse logic flowing from its initial, anti-human premise.
Progressivism is a death cult.

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The Medicare Distortion

By Yuval Levin
http://www.nationalreview.com
August 13, 2012

It is simply a fact that the United States government is now on track for an unprecedented fiscal disaster — with debt quickly surpassing the size of our GDP and reaching twice that size in the coming decades, crushing any chance for robust growth. It is also a fact that the rising cost of Medicare is at the very heart of that disaster. The program has been growing far faster than the rest of the federal budget for decades, and the trend is only set to accelerate.

According to the Congressional Budget Office, Medicare spending as a share of the economy is five times what it was in 1970, while all other federal spending combined (excluding interest) is 1.1 times what it was. By 2035, CBO expects Medicare costs to be nearly twice what they are today as a share of the economy, while all other federal spending combined will actually decline somewhat as a share of the economy. The debt problem is a Medicare problem. There is no way to avert fiscal disaster without significantly reining in the growth of that program. Even President Obama has acknowledged that no other solution, and certainly not his symbolic class-warfare tax proposals, could be sufficient, saying last July that “if you look at the numbers, then Medicare in particular will run out of money and we will not be able to sustain that program no matter how much taxes go up.”
And yet, even though he acknowledges this fact, the president has chosen to do nothing, and indeed to stand firmly in the way of doing anything meaningful to solve the problem. Obamacare’s Medicare cuts and its board of price controllers aren’t a solution — the CBO debt and Medicare growth numbers cited above already include them, and the agency (along with Medicare’s actuary, who works for the president) has said they are very unlikely to work. What is needed is a structural reform of the program, to enable it to deliver coverage to seniors far more efficiently by driving more efficient delivery of care. But seniors who are now in the program don’t want to hear that it’s going bankrupt, and don’t want to think about changes to it, so the politics of Medicare argue strongly against any kind of solution. The president and his party have chosen to make the most of that political reality, quietly raiding Medicare to fund Obamacare but otherwise leaving the program to its sorry fate. They have denied the need for reform. It would take real political courage to do otherwise.
To their enormous credit, congressional Republicans over the past few years have decided that they cannot leave Medicare to collapse and take the government’s finances (and the nation’s economic future) with it, and so they must address the problem despite the standing threat from the left to demonize anyone who tries. Thanks to the creativity, tenacity, and flexibility of Paul Ryan in particular, they have worked through several different versions of a market-based reform of the system, and earlier this year they arrived at one that effectively addresses the key concerns of past critics of such “premium support” reforms — an idea that could dramatically improve the efficiency of Medicare (and so reduce its cost) without increasing risks or out-of-pocket costs for beneficiaries.
Because Mitt Romney (to his own enormous credit) has endorsed that reform, and because Paul Ryan (its architect) is now Romney’s running mate, this idea will come under blistering attacks in the coming weeks and months. Medicare will not be the central issue of this fall’s campaign — economic growth and jobs are far more important to voters. But President Obama and his supporters seem intent on distracting voters from the failed economic policies of the past four years by scaring them about the Romney-Ryan Medicare reform. And it is already perfectly clear that their criticisms of that reform are based on either a misapprehension or an intentional misrepresentation of the actual proposal, and of the very significant ways in which it differs from past Medicare-reform ideas (including those proposed by Ryan in the past). So it is worth taking a moment to understand the proposal — generally known as the Ryan-Wyden reform after its originators, Paul Ryan and Democratic senator Ron Wyden of Oregon — and to see what its critics are missing or misrepresenting.
At first, the idea seems rather similar to past “premium support” reforms, which have basically proposed to transform today’s “defined benefit” Medicare system (in which the government decides on a set of insurance benefits and then pays health-care providers a price the government defines for providing each of those covered services) into a “defined contribution” system (in which the government decides on an amount of money to provide to beneficiaries and then lets them use that money to choose from an approved set of competing private insurance plans that each offers all those benefits at whatever cost it is able or willing to offer). Such a system would use the power of intense competition among insurers seeking Medicare dollars to increase the efficiency of health-care provision and drive down costs. But the foremost criticism of this sort of defined-contribution reform is that if the amount provided to seniors to buy coverage were too low, or if its annual growth did not keep up with the growth of health-care costs, seniors would be left to make up the difference out of their own pockets, and those who didn’t have the money wouldn’t be able to afford insurance.
The Ryan-Wyden idea solves that problem through a clever combination of defined-contribution and defined-benefit insurance. The federal government would still define a package of required benefits that would constitute comprehensive insurance coverage — the same benefits that Medicare covers today. But each year, private insurers as well as a federal fee-for-service insurance provider (akin to today’s Medicare program) would submit bids to the government to provide that comprehensive coverage at the lowest cost they could manage. The government would then provide seniors in each region of the country with a premium-support payment equal to the second-lowest bid in that region or to the bid of the federal fee-for-service option, whichever was lower. That way, every senior would be guaranteed to have at least one comprehensive coverage option that cost no more than the premium-support payment he received (and thus involved no more out-of-pocket costs than Medicare does today), and would also have other options that cost more (whether because the offering companies could not manage to be as efficient in working with their provider networks or because they offered more benefits than the required minimum and thus charged a higher premium).
The market itself, rather than Medicare’s administrators, would set the level of each year’s premium-support payment, which would ensure that the payment was sufficient to pay for comprehensive coverage. A senior who chose a plan that cost less than the premium-support payment would get to keep the difference (deposited into a tax-free health savings account to use for future out-of-pocket health costs), and a senior who chose a plan that cost more than the premium-support payment would pay the difference out of his pocket. Poorer, older, and sicker seniors would get somewhat higher premium-support amounts than the rest.
Such a system would include the key advantages of defined-benefit insurance without its key drawbacks (since there would be a guaranteed comprehensive insurance benefit just as in today’s Medicare, but without the open-ended spending to provide it), and the key advantages of defined-contribution insurance without its key drawbacks (since the federal payment would be set, and so would drive intense competition for consumer dollars among insurers and providers, but, because the set payment would be determined by an annual bidding process, no gap would open up between the cost of coverage and the amount available to seniors to pay for it). It is based on the premise that intense competition in a genuine market could dramatically reduce the cost of Medicare without cutting the actual insurance benefit provided to seniors. And it puts the burden of proving that premise on the government, not the beneficiary: If costs in fact go down, then the cost of Medicare will decline and the government’s fiscal crisis would ease; if they do not go down, then the cost of Medicare will not decline and the fiscal crisis will remain, leaving reformers to find other solutions. Either way, Medicare beneficiaries will have the same comprehensive, guaranteed insurance coverage they have now.
There are some very good reasons for believing competition would indeed dramatically reduce costs. The way markets work in the rest of the economy offers one powerful kind of evidence, of course. But recent research into the Medicare system itself offers another. For instance, on August 1, three Harvard researchers published a study in theJournal of the American Medical Association (you can find it here, but it requires a subscription) that used data from the Medicare Advantage program (a much more limited experiment in insurer competition in Medicare) to consider how the Wyden-Ryan reform would have worked if it had been in effect in 2009. They found that, “nationally, in 2009, the benchmark plan under the Ryan-Wyden framework (i.e., the second-lowest plan) bid an average of 9% below traditional Medicare costs (traditional Medicare was equivalent to approximately the tenth-lowest bid).”
In other words, even under the very constrained competition of Medicare Advantage, in which prices are set by Medicare’s bureaucracy, the Ryan-Wyden approach would have reduced per-beneficiary spending by 9 percent in a single year while still providing seniors with the same comprehensive insurance coverage. With real competition through a bidding system, the reductions in the rate of the program’s growth over time could be enormous. And if those savings don’t in fact materialize, we would just end up where we are today — which is where Democrats seem to want to end up anyway.
In order to be scoreable by CBO, the Wyden-Ryan reform also has a kind of backup: a requirement that Medicare’s growth not be faster than 0.5 percent more than GDP growth per year. That is, not by coincidence, the same maximum rate of growth set in President Obama’s budget. Neither maximum rate is really all that meaningful — it’s a scoring convention, not a reform; if it were exceeded, Congress would almost certainly just suspend it, as it has when past maximum growth rates (like the one in place since 1997) have been exceeded. So in this respect, too, if Ryan-Wyden’s competitive system didn’t keep costs down, we would just be in the same place the Democrats want to end up. It is not the maximum growth rate but the mechanism for remaining below it — the bidding process that allows for the transformation of Medicare into a new kind of intensely competitive insurance system with both a defined benefit and a defined contribution at once — that is the real key to the Ryan-Wyden reform.
The proposal would also have this reform begin only ten years from now, and affect only new entrants into Medicare, so that all current seniors and everyone now over 55 would be left entirely untouched for the rest of their lives, unless they chose to enter the new system. Thus, today’s seniors have no reason to complain about the proposal, since it would not affect them, and tomorrow’s seniors have essentially nothing to lose by it, since they would still be guaranteed a comprehensive benefit at only today’s out-of-pocket costs.
Essentially all of the criticisms of the Ryan-Wyden(-Romney) proposal ignore its innovative combination of defined-contribution and defined-benefit insurance — directing themselves instead to older versions of the premium-support idea — and ignore the fact that it would leave all current seniors and near-retirees untouched. Thus just minutes after Paul Ryan was announced as Mitt Romney’s running mate, Obama campaign manager Jim Messina said in a statement that Ryan’s Medicare plan would “end Medicare as we know it by turning it into a voucher system, shifting thousands of dollars in health care costs to seniors.” Some Democrats even put a particular dollar figure on that supposed cost shift — $6,400. That figure comes from a (rather rough) CBO calculation regarding a prior version of the premium-support idea, not the Ryan-Wyden proposal that Romney has endorsed. CBO would certainly not claim that the figure applies to what is now the Romney-Ryan plan, or indeed that any such shift would occur under that plan.
The Democrats continuing to make such charges either do not know about the difference between Ryan-Wyden and past premium-support ideas or are knowingly lying. And those who argue that “Medicare as we know it” is the alternative to the Ryan-Wyden proposal are also either ignoring or denying reality. The fact is that Obamacare cuts Medicare by $700 billion over its first ten years to fund other programs and imposes a board of price controllers — the Independent Payment Advisory Board (IPAB) — over Medicare to cut costs in ways that (particularly by driving providers out of the business of serving Medicare patients through inadequate payment rates) would reduce the access of both current and future seniors to care. And without further reforms, the Medicare program will soon run out of funds in ways that would either require dramatic benefit cuts or would drive the government bankrupt.
Medicare as we know it is thus not an option. The choice is between, on the one hand, a reform that leaves current seniors untouched for life and offers future seniors a guaranteed comprehensive benefit and more choices about how to get it or, on the other hand, cuts that affect both current and future beneficiaries and yet are still likely to fail to avert the program’s fiscal collapse. Mitt Romney offers the first — a plan for saving Medicare without increasing the risk to seniors. Barack Obama offers the second — a plan for raiding Medicare and watching it crumble.
The only way for Democrats to avoid the political consequences of this painful fact is to deny it, and to insist that the opposite is the case: that Romney and Ryan seek to arbitrarily cut Medicare and increase costs for seniors. In the wake of Paul Ryan’s selection as Mitt Romney’s running mate, some of them have seemed downright giddy at the prospect of unleashing that lie, and perhaps even building their entire fall campaign around it. Many of them surely don’t even know it’s a lie. But it is, and a strategy based on a lie can work only if it is left unchallenged. Romney, Ryan, and their supporters must not leave it so.

Lights out for U.S.-style Big Government

No advanced society has ever attempted Big Government for a third of a billion people – because it cannot be done without creating a nation with the black-hole finances of Stockton, California, and the recent Black-Hole-of-Calcutta fetid, airless, sweatbox utility services of Rockville, Maryland.


By Mark Steyn
The Orange County Register
http://www.ocregister.com/
July 6, 2012

This weekend, I am thousands of miles from home in a remote and isolated part of the world with erratic communications and lack of basic services. No, not Washington, D.C. Things aren't that primitive, thank God. I'm in a rude Highland croft way up a far Scottish brae, enjoying the simple life by choice, rather than because the capital region of the global superpower is incapable of turning the lights back on within a week.

Which is by way of saying that news from the imperial metropolis has reached me in fits and starts. The other morning it was the intriguing tidbit that Chief Justice John Roberts had written both the majority opinion in the Obamacare decision and the dissent. He is literally his own worst enemy. He's apparently the Mike Myers of the Supreme Court, able to play both Austin Powers and Dr. Evil, although it has to be said that he seems rather more at home as the bumbling swinger. If I understand correctly, the Chief Justice wrote the dissent back when it was the 5-4 majority opinion, and then, after switching sides, wrote the new majority opinion, and the four guys left holding the old majority opinion decided to leave it as is, presumably as a way of not so subtly underlining their total contempt for their squishy Chief. Fascinating stuff, I'm sure. An enterprising legal scholar should pitch it to Paramount as a high school musical or a particularly dysfunctional reality show.

Meanwhile, back in the real world, East Coast municipalities were canceling Fourth of July celebrations because of lack of electricity. In a novel, this would be rather too obviously symbolic of the hyperpower at twilight, but truth is crasser than art. So we had the spectacle of Martin O'Malley, governor of Maryland, turning up on CBS' "Face The Nation" last Sunday as part of his not-so-subtle campaign for the 2016 Democratic presidential nomination. Across Montgomery County, his delirious constituents would have cheered, "President O'Malley? There's the answer to our nation's woes!" – except that their TVs weren't working, so they never saw him. Unless they jumped in their Chevy Volts and drove to ...oh, no, wait.

I live in the North Country, so in a light breeze our power goes out. As I tell bewildered foreign visitors, "Think of rural New Hampshire as Baghdad outside the Green Zone." But suburban Maryland is inside the Green Zone, and still the power goes out. America's dysfunctional utility companies have a zillion explanations for this, but years ago I rode through the outskirts of D.C. with a Dutch tourist who marveled at the men digging up the sidewalk in densely populated neighborhoods to bury the new cable-TV wires while the sagging electric lines overhead continued to string their way from pole to pole, dodging tree branches, across town. It's a very American sight: "Telegraph cables sing down the highway, and travel each bend in the road..." ("Moonlight In Vermont"). "I hear you singin' in the wire, I can hear you through the whine..." ("Wichita Lineman"). In the rural hinterlands, power lines are a sign of civilization. A stone's through from the imperial metropolis, they're an emblem of civilizational decay.

In recent years, speaking to audiences hither and yon, I'm wont to say something on the lines of "The lamps are going out on liberty all over the world." It's my update on a famous observation by Edward Grey, British Foreign Secretary, on the eve of the Great War. In August 1914, Sir Edward stood at his window in the summer dusk, and said, "The lamps are going out all over Europe." He was speaking metaphorically. After all, his remark was prompted by the sight of London's lamplighters going about their evening routine lighting the lamps in Whitehall. Metaphorically speaking, the lights of liberty were certainly dimmed by Roberts' hideously convoluted Supreme Court decision: I don't see why I should be fined $695 for declining to participate in an overpriced and dysfunctional "insurance" "market."

But that's a philosophical argument, and most folks just want to get on with their lives. And in that sense last week's power outages are more relevant to where the U.S. is headed than what passes for John Roberts' thinking in his Obamacare opinion. It was a reminder, as if you needed one, that in the American twilight the lights will be going out, literally. Last week, as the East Coast was fading to black, the West Coast was sinking deeper into the red: Stockton, California, became the largest U.S. city to date to file for bankruptcy. America is seizing up before our eyes, and the action necessary to reverse the sclerosis is stymied at every turn by rapacious unions, government micro-regulators, dependency-spreading social engineers and crony capitalists who know how to weave their way through the bureaucracy.

Insofar as it works at all, Big Government works best in small, highly developed, northern Continental nation states with a sufficiently homogeneous population to have sufficiently common interests. You can get by with it for a while in Mediterranean Europe, mainly because of a somewhat desultory attitude to the rule of law: in Italy and Greece, there are prohibitions against everything, but nobody obeys them and so, after a fashion, life goes on. Anglophone nations are generally disposed to abide by the law, and so, if there are a bazillion regulations, the average citizen will make a sincere effort to comply. But if you're, say, Australia and you're attempting to design a health care system for 20 million people across an entire continent, it's just about doable.

But no advanced society has ever attempted Big Government for a third of a billion people – for the simple reason that it cannot be done without creating a nation with the black-hole finances of Stockton, California, and the Black-Hole-of-Calcutta fetid, airless, sweatbox utility services of Rockville, Maryland. Thanks to Obamacare, in matters of health provision, whether you're in favor of socialized medicine or truly private health care, Swedes and Italians are now freer than Americans: They have a state system and a private system, and both are relatively simple. What's simple in micro-regulated America? In health care, we now have what's nominally a private system encrusted with so many statist barnacles that it no longer functions as either a private or state system. Thus, Obamacare embodies the strange no-man's-land of statism American-style: The U.S. is no longer a land of republican virtue and self-reliant citizens but it's not headed for the sunlit uplands of Scandinavia, either.

In their book "The Size Of Nations," Alberto Alesina and Enrico Spolaore argue that, if America were as centrally governed as France, it would have broken up long ago. But hey, that's no reason not to try it! In a land where everything else is supersized, why not government? Obituaries for the late Andy Griffith generally glossed over his career finale as a pitchman for Obamacare. But he was a canny choice to sell the unsellable, for is not "health" "care" "reform" the communitarian virtues of beloved small-town Mayberry writ large? The problem is, you can't write Mayberry large. And, if you attempt it, it leads not to Mayberry but to Stockton, California, and to a corrupt, dysfunctional swamp. A large Sweden is a contradiction in terms. It cannot be done, and the more determinedly you try to do it, the more you will preside over a ruined wasteland. The road to hell isn't paved at all, and the street lamps went out long ago.

©MARK STEYN

A lie makes Obamacare legal

By Mark Steyn
The Orange County Register
http://www.ocregister.com/
June 29, 2012

Three months ago, I quoted George Jonas on the 30th anniversary of Canada's ghastly "Charter of Rights and Freedoms": "There seems to be an inverse relationship between written instruments of freedom, such as a Charter, and freedom itself," wrote Jonas. "It's as if freedom were too fragile to be put into words: If you write down your rights and freedoms, you lose them."

For longer than one might have expected, the U.S. Constitution was a happy exception to that general rule – until, that is, the contortions required to reconcile a republic of limited government with the ambitions of statism rendered U.S. constitutionalism increasingly absurd. As I also wrote three months ago (yes, yes, don't worry, there's a couple of sentences of new material in amongst all the I-told-you-so stuff), "The United States is the only Western nation in which our rulers invoke the Constitution for the purpose of overriding it – or, at any rate, torturing its language beyond repair."

Thus, the Supreme Court's Obamacare decision. No one could seriously argue that the Framers' vision of the Constitution intended to provide philosophical license for a national government ("federal" hardly seems le mot juste) whose treasury could fine you for declining to make provision for a chest infection that meets the approval of the Commissar of Ailments. Yet on Thursday, Chief Justice John Roberts did just that. And conservatives are supposed to be encouraged that he did so by appeal to the Constitution's taxing authority rather than by a massive expansion of the Commerce Clause. Indeed, several respected commentators portrayed the Chief Justice's majority vote as a finely calibrated act of constitutional seemliness.

Great. That and $4.95 will get you a decaf macchiato in the Supreme Court snack bar. There's nothing constitutionally seemly about a court decision that says this law is only legal because the people's representatives flat-out lied to the people when they passed it. Throughout the Obamacare debates, Democrats explicitly denied it was a massive tax hike: "You reject that it's a tax increase?" George Stephanopoulos demanded to know on ABC. "I absolutely reject that notion," replied the President. Yet "that notion" is the only one that would fly at the Supreme Court. The jurists found the individual mandate constitutional by declining to recognize it as a mandate at all. For Roberts' defenders on the right, this is apparently a daring rout of Big Government: Like Nelson contemplating the Danish fleet at the Battle of Copenhagen, the Chief Justice held the telescope to his blind eye and declared, "I see no ships."

If it looks like a duck, quacks like a duck, but a handful of judges rule that it's a rare breed of elk, then all's well. The Chief Justice, on the other hand, looks, quacks and walks like the Queen in Alice In Wonderland: "Sentence first – verdict afterwards." The Obama administration sentences you to a $695 fine, and a couple of years later the queens of the Supreme Court explain what it is you're guilty of. A. V. Dicey's famous antipathy to written constitutions and preference for what he called (in a then-largely unfamiliar coinage) the "rule of law" has never looked better.

Instead, constitutionalists argue that Chief Justice Roberts has won a Nelson-like victory over the ever-expanding Commerce Clause. Big deal – for is his new, approved, enhanced taxing power not equally expandable? And, in attempting to pass off a confiscatory penalty as a legitimate tax, Roberts inflicts damage on the most basic legal principles.

Still, quibbling over whose pretzel argument is more ingeniously twisted – the government's or the court's – is to debate, in Samuel Johnson's words, the precedence between a louse and a flea. I have great respect for George Will, but his assertion that the Supreme Court decision is a "huge victory" that will "help revive a venerable tradition" of "viewing congressional actions with a skeptical constitutional squint" and lead to a "sharpening" of "many Americans' constitutional consciousness" is sufficiently delusional that one trusts mental health is not grounds for priority check-in at the death panel. Back in the real world, it is a melancholy fact that tens of millions of Americans are far more European in their view of government than the nation's self-mythologizing would suggest. Indeed, citizens of many Continental countries now have more – what's the word? – liberty in matters of health care than Americans. That's to say, they have genuinely universal government systems alongside genuinely private-system alternatives. Only in America does "health" "care" "reform" begin with the hiring of 16,500 new IRS agents tasked with determining whether your insurance policy merits a fine. It is the perverse genius of Obamacare that it will kill off what's left of a truly private health sector without leading to a truly universal system. However, it will be catastrophically unaffordable, hideously bureaucratic, and ever more coercive. So what's not to like?

To give Chief Justice Roberts' argument more credit than it deserves, governments use taxes as a form of incentive. There is mortgage-tax relief because the state feels homeownership is generally a good thing. Conversely, not buying health insurance is a bad thing, so such antisocial behavior should be liable to a kind of antisocial tax. But, as presently constituted, the Supreme Court's new "tax" is a steal – $695 is cheaper than most annual health insurance policies. Especially when, under Obamacare, you're allowed to wait till you get ill to take out health insurance, and you can't be turned down. Which is why the cost of insurance is already rising, and will rise higher still down the road.
Which means that, in a few years' time, paying the penalty will look even more of a bargain, at least until you fall off the roof or acquire an uncooperative polyp. Right now, many Americans are, by any rational measure, overinsured. That will be far less affordable in the future. Some are already downgrading to less-lavish policies. Those with barebones policies might likewise find it makes more sense to downgrade to the $695 penalty. What Chief Justice Roberts sees as the Alternative Mandate Tax, millions of Americans will see as a de facto Alternative Minimum Health Plan.

Who knows? Chances are I'm wrong, and the justices are wrong, and the government's wrong, and the consequences of Obamacare will be of a nature none of us has foreseen. But we already know Obama's been wrong about pretty much everything – you can keep your own doc, your premiums won't go up, it's not a tax, etc. – and in the Republic of Paperwork multitrillion-dollar cost overruns and ever-greater bureaucratic sclerosis seems the very least you can bet on. It should also be a given that this decision is a forlorn marker on a great nation's descent into steep decline and decay. Granted the dysfunctionalism of Canadian health care, there's at least the consolation of an equality of crappiness for all except Cabinet ministers and NHL players. Here, it's 2,800 unread pages of opt-outs, favors, cronyism, and a $695 fine for those guilty of no crime except wanting to live their lives without putting their bladder under the jurisdiction of Commissar Sebelius.
And the Constitution is apparently cool with all that.

So be it. It's down to the people now – as it should be. But, meanwhile, a little less deference to judges wouldn't go amiss. The U.S. Supreme Court is starting to look like Britain's National Health Service – you wait two years to get in, and then they tell you there's nothing wrong. And you can't get a second opinion.

©MARK STEYN

ObamaCare Ruling: Pure Fraud and No Due Process

By Andrew C. McCarthy
http://pjmedia.com/
June 28, 2012

Led by Chief Justice John Roberts, the Supreme Court decided that Americans have no right to due process. Indeed, the Court not only upheld a fraud perpetrated on the public — it became a willing participant.

The assessment charged for failure to comply with ObamaCare’s “individual mandate,” which requires Americans to purchase health insurance, was presented to the country by the administration and the Democratic Congress as a penalty assessed for lawlessness — i.e., for refusing to honor this new legal requirement. It was strenuously denied by proponents that they were raising taxes.

The Obama administration, in particular, was adamant that the assessment was a penalty, not a tax: the president himself indignantly objected to a suggestion to the contrary in an ABC News interview with George Stephanopoulos. Obama officials also vigorously maintained that there had been no violation of the president’s oft-repeated campaign pledge not to raise taxes on the middle class. Moreover, as stingingly noted in the joint dissenting opinion of Justices Scalia, Kennedy, Thomas and Alito, the Democratic majority in Congress rejected an earlier version of the bill that became ObamaCare precisely because it imposed a tax — lawmakers intentionally substituted a mandate with a penalty for failure to comply so they could continue to contend that no one’s taxes were being raised.

Chief Justice Roberts claims that Congress simply used the wrong label. That is legerdemain. This is not a case in which Congress was confused, or inadvertently used the wrong term under circumstances where the error wasn’t called to its attention. The tax-or-penalty question was a hotly contested issue. As the dissent points out, it is one thing for a court to construe as a tax an exaction that “bore an agnostic label that does not entail the significant constitutional consequences of a penalty — such as ‘license’…. But we have never — never – treated as a tax an exaction which faces up to the critical difference between a tax and a penalty, and explicitly denominates the exaction a ‘penalty.’”

Let’s say that, back when I was a prosecutor, I tried and convicted a man on a charge of conspiring to sell narcotics. I can prove he was conspiring, but it was really to sell stolen property. I convict him but, on appeal, the court holds, “The prosecutor’s evidence that it was drugs the defendant conspired to sell is wholly lacking.” At that point, the conviction has to be dismissed, and if I want to try him a second time, this time for conspiring to sell stolen property, I’ve got to indict him and start the whole process over again.

Let’s suppose, however, that the appeals court instead said, “Eh, drugs, stolen property, what’s the big whup? You just wrote the wrong commodity into the indictment. So let’s not bother with a whole new trial at which you’d have to prove the correct charge to a jury. Let’s just rewrite the indictment and pretend that it says ‘stolen property’ instead of ‘narcotics.’ Then we can uphold the conviction and call it a day.”

That would never be permitted to happen — not even to a crook of whose guilt we were certain. It would be an outrageous violation of due process, a conviction obtained by false pretenses, that would not be allowed to stand.

Yet this is essentially what Chief Justice Roberts & Co. did. They said the American people are not entitled to an honest legislative process, one in which they can safely assume that when Congress intentionally uses words that have very different meanings and consequences — like tax and penalty — and when Congress adamantly insists that the foundation of legislation is one and not the other, the Court will honor, rather than rewrite, the legislative process. Meaning: if Congress was wrong, the resulting law will be struck down, and Congress will be told that, if it wants to pass the law, it has to do it honestly.

Just as an appeals court may not legitimately rewrite an indictment and revise what happened at a trial, neither may it legitimately rewrite a statute and fabricate an imaginary congressional record. But today, the Supreme Court rewrote a law — which it has no constitutional authority to do — and treated it as if it were forthrightly, legitimately enacted. Further, it shielded the political branches from accountability for raising taxes, knowing full well that, had Obama and the Democrats leveled with the public that ObamaCare entailed a huge tax hike, it would never have had the votes to pass.

The ObamaCare mandate was enacted as a penalty flowing from Congress’s Commerce Clause power. It has been upheld as a tax flowing from Congress’s power to tax-and-spend under the General Welfare Clause. As the dissent sharply demonstrates, the contention that the mandate could have been enacted as a tax is frivolous. Meanwhile our country, trillions of dollars in debt and rapidly sinking further, desperately needs a debate about the limits of Congress’s power to tax and spend for the general welfare.

Madison — correctly in my view — thought the General Welfare Clause (which is in the preamble to article I, section 8 — it is not a separate, enumerated power) was simply an affirmation that Congress had the power to tax and spend to achieve the specific grants of power exactingly set forth in that section. Hamilton, by contrast, argued that the General Welfare Clause was an independent (i.e., not restricted to the enumerated powers), open-ended grant of authority to the national government to tax and spend on anything that would support someone’s idea of the overall betterment of society.

Madison rightly contended that Hamilton’s interpretation would defeat the purpose of enumerating Congress’s powers — namely, to limit it to only these functions and no others. It would also usurp the rights and authority of the states and the people, in whom were retained all rights and authority not expressly assigned to the national government by the Constitution.

During the New Deal, under FDR’s court-packing threats, the Supreme Court adopted Hamilton’s view — enabling Congress to enact the New Deal, the Great Society, Social Security, Medicare, Medicaid, and innumerable other programs for which there is no enumerated power in the Constitution. These programs are unsustainable and leading us over the economic cliff, besides intruding on the domain of state power. Had ObamaCare been honestly presented as a tax, or had the Court acted properly by striking it down as an illegitimate use of the commerce power and telling Congress that if it wanted to pass the bill as a tax it would have to pass the bill as a tax, our dire financial straits might have forced this much needed debate about the limits of congressional welfare power.

We have now lost that opportunity through fraud: fraud in the legislative action, and fraud in the judicial review. Due process would not allow this to be done to a criminal, but the Supreme Court has decided that Americans will have to live with it.

Roberts’s Ruling Took Guts

The chief haruspex reads the entrails expediently.

By Jonah Goldberg   

http://www.nationalreview.com

June 29, 2012 

Why not just cut open a goat and be done with it?

In ancient Rome, a special kind of priest called a haruspex would “read” the entrails of sheep to divine the will of the gods, the health of the growing season, or whatever else was weighing on the minds of men. Because animal guts don’t, in fact, impart that much information about, say, next year’s wheat harvest, the haruspices could pretty much make it up as they went along. The same went for the auspices, priests who studied the flight of birds and derived signs or omens called auguria (from which we get “auguries”). Ultimately, the haruspices and auspices made their decisions based upon the whims, vicissitudes, and demands of politics in one form or another. If the rulers were happy with the result, they didn’t much care what the guts actually said.

Fast-forward to chief haruspex John Roberts.

In the majority opinion written by Roberts, the Supreme Court held that the mandate to buy health insurance under the Affordable Care Act (Obamacare) is unconstitutional under the Commerce Clause and the Necessary and Proper Clause. But Roberts also found that it’s constitutional under Congress’s power to tax. It is on these grounds that Roberts upheld the constitutionality of Obamacare, siding with the four liberal justices of the bench.

The upshot is that Congress cannot use the Commerce Clause to force you to eat broccoli, but it can tax you into doing so. Huzzah for liberty!

To reach this decision, Roberts had to embrace a position denied by the White House, Congress, and vast swaths of the legal punditocracy: that the mandate is a tax for the purposes of constitutional consideration but not a tax according to the Anti-Injunction Act (which bars lawsuits against taxes until after they’re levied). Roberts’s effort, wrote Justice Antonin Scalia in dissent, “carries verbal wizardry too far, deep into the forbidden land of the sophists.”

Let the record show that the sophists were valued defenders of entrail-reading.

Of course, there are substantive arguments in favor of Roberts’s reasoning. But as far as I can tell, no one is confident, never mind certain, that Roberts actually believes his own position. And among supporters of Obamacare, from the White House on down, no one cares whether he does.

President Obama — self-praised constitutional scholar — mocked those who called the fees and penalties under Obamacare a tax. Now he celebrates a decision that mocks him back. Democratic National Committee executive director (and former White House aide) Patrick Gaspard seemed to summarize the depth of concern on his side of the aisle when he responded to the ruling on Twitter:
“it’s constitutional. B—-es.”

More sober-eyed liberal legal experts took similar positions. Roberts’s opinion was “statesmanlike,” they claimed, and, more bizarrely, “apolitical.” Some, such as constitutional scholar Jeffrey Rosen, speaking on National Public Radio, even celebrated Roberts’s brilliance at finding a way to save the reputation of the court by deploying what Thomas Jefferson called “twistifications.”

Indeed, before and after the ruling, much of the journalistic and legal establishment argued that a 5–4 ruling to overturn Obamacare would be “political” because the majority would be comprised entirely of Republican appointees. But a 5–4 ruling to uphold Obamacare would be apolitical because, well, it just would be.

In other words, if five conservative justices rule according to their well-known convictions, it’s illegitimate. But if Roberts twists himself like an illustration in the Kama Sutra to find a way to uphold the law, then that amounts to “leadership.”

Now, I don’t know what’s in Roberts’s heart, but no court watcher I’ve heard from puts much weight on the idea that Roberts did anything other than reason backward from the result he wanted in order to buy respect from the court’s critics at the expense of his own beliefs.

At least that’s one thing both fans and critics of this ruling can largely agree on.

Some of Roberts’s defenders claim he’s outmaneuvered everyone. By upholding Obamacare, he’s made future conservative decisions unassailable. He’s poisoned the well of the Commerce Clause for liberals. He’s removed the court from being an election-year issue. He’s gift-wrapped for Mitt Romney the attack that Obama has raised taxes massively, violating a host of promises and assurances. And, again, he’s saved the legitimacy of the court.

That’s all very interesting, but it leaves aside the real issue: None of those concerns are what was asked of the court. That so few people seem to care augurs poorly for the rule of law and the auspices of our republic.

— Jonah Goldberg is editor-at-large of National Review Online, a visiting fellow at the American Enterprise Institute, and the author of The Tyranny of Clichés. You can write to him by e-mail at JonahsColumn@aol.com, or via Twitter @JonahNRO. © 2012 Tribune Media Services, Inc.

Conservatives’ consolation prize

By George F. Will
The Washington Post
http://www.washingtonpost.com
June 28, 2012

Conservatives won a substantial victory Thursday. The physics of American politics — actions provoking reactions — continues to move the crucial debate, about the nature of the American regime, toward conservatism. Chief Justice John G. Roberts Jr. has served this cause.

The health-care legislation’s expansion of the federal government’s purview has improved our civic health by rekindling interest in what this expansion threatens — the Framers’ design for limited government. Conservatives distraught about the survival of the individual mandate are missing the considerable consolation prize they won when the Supreme Court rejected a constitutional rationale for the mandate — Congress’s rationale — that was pregnant with rampant statism.

The case challenged the court to fashion a judicially administrable principle that limits Congress’s power to act on the mere pretense of regulating interstate commerce. At least Roberts got the court to embrace emphatic language rejecting the Commerce Clause rationale for penalizing the inactivity of not buying insurance:

“The power to regulate commerce presupposes the existence of commercial activity to be regulated. . . . The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. . . . Allowing Congress to justify federal regulation by pointing to the effect of inaction on commerce would bring countless decisions an individual could potentially make within the scope of federal regulation, and — under the government’s theory — empower Congress to make those decisions for him.”

If the mandate had been upheld under the Commerce Clause, the Supreme Court would have decisively construed this clause so permissively as to give Congress an essentially unlimited police power — the power to mandate, proscribe and regulate behavior for whatever Congress deems a public benefit. Instead, the court rejected the Obama administration’s Commerce Clause doctrine. The court remains clearly committed to this previous holding: “Under our written Constitution . . . the limitation of congressional authority is not solely a matter of legislative grace.”

The court held that the mandate is constitutional only because Congress could have identified its enforcement penalty as a tax. The court thereby guaranteed that the argument ignited by the mandate will continue as the principal fault line in our polity.

The mandate’s opponents favor a federal government as James Madison fashioned it, one limited by the constitutional enumeration of its powers. The mandate’s supporters favor government as Woodrow Wilson construed it, with limits as elastic as liberalism’s agenda, and powers acquiring derivative constitutionality by being necessary to, or efficient for, implementing government’s ambitions.

By persuading the court to reject a Commerce Clause rationale for a president’s signature act, the conservative legal insurgency against Obamacare has won a huge victory for the long haul. This victory will help revive a venerable tradition of America’s political culture, that of viewing congressional actions with a skeptical constitutional squint, searching for congruence with the Constitution’s architecture of enumerated powers. By rejecting the Commerce Clause rationale, Thursday’s decision reaffirmed the Constitution’s foundational premise: Enumerated powers are necessarily limited because, as Chief Justice John Marshall said, “the enumeration presupposes something not enumerated.”

When Rep. Nancy Pelosi (D-Calif.), asked where the Constitution authorized the mandate, exclaimed, “Are you serious? Are you serious?,” she was utterly ingenuous. People steeped in Congress’s culture of unbridled power find it incomprehensible that the Framers fashioned the Constitution as a bridle. Now, Thursday’s episode in the continuing debate about the mandate will reverberate to conservatism’s advantage.

By sharpening many Americans’ constitutional consciousness, the debate has resuscitated the salutary practice of asking what was, until the mid-1960s, the threshold question regarding legislation. It concerned what James Q. Wilson called the “legitimacy barrier”: Is it proper for the federal government to do this? Conservatives can rekindle the public’s interest in this barrier by building upon the victory Roberts gave them in positioning the court for stricter scrutiny of congressional actions under the Commerce Clause.

Any democracy, even one with a written and revered constitution, ultimately rests on public opinion, which is shiftable sand. Conservatives understand the patience requisite for the politics of democracy — the politics of persuasion. Elections matter most; only they can end Obamacare. But in Roberts’s decision, conservatives can see that the court has been persuaded to think more as they do about the constitutional language that has most enabled the promiscuous expansion of government.

georgewill@washpost.com

Why Roberts Did It

By Charles Krauthammer
The Washington Post
http://www.washingtonpost.com
June 28, 2012

It’s the judiciary’s Nixon-to-China: Chief Justice John Roberts joins the liberal wing of the Supreme Court and upholds the constitutionality of Obamacare. How? By pulling off one of the great constitutional finesses of all time. He managed to uphold the central conservative argument against Obamacare, while at the same time finding a narrow definitional dodge to uphold the law — and thus prevented the court from being seen as having overturned, presumably on political grounds, the signature legislation of this administration.

Why did he do it? Because he carries two identities. Jurisprudentially, he is a constitutional conservative. Institutionally, he is chief justice and sees himself as uniquely entrusted with the custodianship of the court’s legitimacy, reputation and stature.

As a conservative, he is as appalled as his conservative colleagues by the administration’s central argument that Obamacare’s individual mandate is a proper exercise of its authority to regulate commerce.

That makes congressional power effectively unlimited. Mr. Jones is not a purchaser of health insurance. Mr. Jones has therefore manifestly not entered into any commerce. Yet Congress tells him he must buy health insurance — on the grounds that it is regulating commerce. If government can do that under the commerce clause, what can it not do?

“The Framers . . . gave Congress the power to regulate commerce, not to compel it,” writes Roberts. Otherwise you “undermine the principle that the Federal Government is a government of limited and enumerated powers.”

That’s Roberts, philosophical conservative. But he lives in uneasy coexistence with Roberts, custodian of the court, acutely aware that the judiciary’s arrogation of power has eroded the esteem in which it was once held. Most of this arrogation occurred under the liberal Warren and Burger courts, most egregiously with Roe v. Wade, which willfully struck down the duly passed abortion laws of 46 states. The result has been four decades of popular protest and resistance to an act of judicial arrogance that, as Justice Ruth Bader Ginsburg once said, “deferred stable settlement of the issue” by the normal electoral/legislative process.

More recently, however, few decisions have occasioned more bitterness and rancor than Bush v. Gore, a 5 to 4 decision split along ideological lines. It was seen by many (principally, of course, on the left) as a political act disguised as jurisprudence and designed to alter the course of the single most consequential political act of a democracy — the election of a president.

Whatever one thinks of the substance of Bush v. Gore, it did affect the reputation of the court. Roberts seems determined that there be no recurrence with Obamacare. Hence his straining in his Obamacare ruling to avoid a similar result — a 5 to 4 decision split along ideological lines that might be perceived as partisan and political.

National health care has been a liberal dream for a hundred years. It is clearly the most significant piece of social legislation in decades. Roberts’s concern was that the court do everything it could to avoid being seen, rightly or wrongly, as high-handedly overturning sweeping legislation passed by both houses of Congress and signed by the president.

How to reconcile the two imperatives — one philosophical and the other institutional? Assign yourself the task of writing the majority opinion. Find the ultimate finesse that manages to uphold the law, but only on the most narrow of grounds — interpreting the individual mandate as merely a tax, something generally within the power of Congress.

Result? The law stands, thus obviating any charge that a partisan court overturned duly passed legislation. And yet at the same time the commerce clause is reined in. By denying that it could justify the imposition of an individual mandate, Roberts draws the line against the inexorable decades-old expansion of congressional power under the commerce clause fig leaf.

Law upheld, Supreme Court’s reputation for neutrality maintained. Commerce clause contained, constitutional principle of enumerated powers reaffirmed.

That’s not how I would have ruled. I think the “mandate is merely a tax” argument is a dodge, and a flimsy one at that. (The “tax” is obviously punitive, regulatory and intended to compel.) Perhaps that’s not how Roberts would have ruled had he been just an associate justice and not the chief. But that’s how he did rule.

Obamacare is now essentially upheld. There’s only one way it can be overturned. The same way it was passed — elect a new president and a new Congress. That’s undoubtedly what Roberts is telling the nation: Your job, not mine. I won’t make it easy for you.

letters@charleskrauthammer.com

OBAMA'S PUBLIC SECTOR FULL EMPLOYMENT PLAN

By Ann Coulter
http://www.anncoulter.com/
June 13, 2012

Last week, President Obama said "the private sector is doing fine." This was not reassuring to those of us who suspect the Democrats haven't the first idea what "private sector" means.

He did not help matters by becoming lachrymose over the suffering of public sector employees: "Where we're seeing weaknesses in our economy have to do with state and local government. ... And so, if Republicans want to be helpful, if they really want to move forward and put people back to work, what they should be thinking about is, how do we help state and local governments ..."

When Democrats say the public sector is suffering, they mean public sector employees have half the unemployment rate of the rest of the country -- 4.2 percent compared to 8.2 percent.

Obama's monumentally idiotic statement has led his media defenders to recycle Mitt Romney's alleged "gaffe" from several months ago, when he said: "I like being able to fire people who provide services to me."

But that was not a gaffe at all -- except as deceptively edited by the media to end after the word "people." (Only Donald Trump enjoys firing people, and by the way, people love watching Donald Trump fire people.)

Far from a gaffe, Romney's actual sentence is the key to understanding the nation's health care crisis -- which happens to be exactly what he was talking about.

Nearly every product you can think of has gotten better and cheaper in the last 20 years because of market competition: cell phones, television sets, computers, food delivery, airline tickets (constrained by the cost of fuel), express mail, and on and on.

There aren't a lot of restaurants serving lousy food or dog walkers who lose your dog because they'd go out of business pretty fast if they provided rotten services. They're not the only game in town.

But you know what is the only game in town? The government, including putatively private businesses that are heavily regulated by the government. Only with the government do we continuously get worse service for a higher price.

Take away the ability to fire people, and you have airport security, public schools, Veterans Administration hospitals, the Postal Service, General Motors and Pinch Sulzberger, New York Times family scion.

Health insurers may technically be private companies, but they are required by law to cover a slew of services, making them an extension of monopolistic government. (Similarly, the old AT&T was a "private" company, but in reality it was just a government-run monopolistic phone company providing no choice, poor service, little innovation and obscenely high prices.)

In most states, you can't choose a health insurance plan that doesn't cover gambling and sex addictions, psychological counseling, speech therapy and prenatal care -- even if you plan on never having children.

Health insurance companies don't need to compete for your business -- they're all offering the same product, anyway. Moreover, because of government regulation concerning how health insurance is taxed, most people aren't choosing their insurers. Their employers are.

As a result, insurance companies have become outrageously unresponsive to both patients and doctors. Insurance companies need only concern themselves with satisfying government regulators and corporate purchasers. Meanwhile, doctors have to please only the insurance companies, which don't particularly care how patients are treated, as long as it's cheap.

This is a third-party-payer problem, or as the proverb goes, "He who pays the piper calls the tune." All third-party-payer systems are disasters. The customer is trapped, forced to pay for something he doesn't want, with no one to complain to and no possibility of taking his business elsewhere.

An example frequent travelers will recognize are the online discount hotel brokers. These can be great -- unless you arrive at a hotel and there's no WiFi, or there's massive construction going on, or your room isn't available until four hours after check-in time. But you've already paid the full price to the booking company.

If you had paid for the room yourself, you could walk away and find another hotel. (Even if you used a credit card, you can reverse the charges because, again, credit card companies would go out of business if they didn't refuse payment for scams.) But if you booked through a third party, the hotel tells you, "Sorry, take it up with Expedia."

Ironically, Romney is proposing that all Americans have the same ability he has to hire and fire insurance companies and doctors. The rich already can do this. Why can't the rest of us? We hire -- and fire -- our own appliance stores, pet groomers, restaurants, hairdressers and computer companies. Why not health providers?

And why are the media so desperate to avoid that conversation?

We need a free market in health insurance, which Congress could accomplish with a one-page bill stating, "There shall be interstate commerce in health insurance." Once we were allowed to purchase health insurance across states lines -- prohibited by law today -- everyone would be buying insurance from companies based in states such as Utah, which have the fewest mandates about what health insurers must cover.

Insurance companies would be responsive to us, the people buying their services, and not the government or corporations. Most people would choose to buy insurance only for what insurance is intended for -- catastrophes -- while paying for regular checkups themselves, the same way we pay for our own cell phones, computers, baby sitters, manicures and everything else that's been getting better and cheaper, unlike all government-regulated services.

Doctors would then have to be responsive to us, not to our insurance companies. Nothing improves the quality of a service like being able to fire the people providing it. The media don't want you to think about that, so they edit Romney's remark and call it a "gaffe."

For better service right now, for example, the American people need to fire Barack Obama and hire Mitt Romney.

COPYRIGHT 2012 ANN COULTER

The Mandate War

At stake is nothing less than the future of civil society in the United States.

By George Weigel

http://www.nationalreview.com

May 21, 2012

University of Notre Dame President Rev. John Jenkins and President Barack Obama walk together at the university's 2009 commencement.

The battle for religious freedom between the Catholic Church in the United States and the Obama administration just entered the second quarter.

The first quarter was bureaucratic and rhetorical. The debate began with the January 20 announcement that the administration’s implementation of Obamacare would require Catholic institutions and individual Catholic employers to provide “preventive health services” (including contraceptives, sterilization, and abortifacient drugs) that the Church rejects as gravely immoral. It was a clumsy attempt at coercing consciences, and it drew widespread condemnation across the spectrum of Catholic opinion.

The debate intensified after the administration announced, on February 10, a future “accommodation” of Catholic concerns; but the proposed “accommodation” was an accounting shell game that would change absolutely nothing in either the moral or the legal structure of the issue. Showing a remarkable degree of unanimity, the Administrative Committee of the United States Conference of Catholic Bishops rejected the “accommodation” at its March meeting and insisted that the issue at stake was not birth control, but religious freedom: The federal government was trying to compel the Church and individual Catholic believers to do something the Church’s settled teaching considers immoral. That same point was underscored a month later by the bishops’ Ad Hoc Committee on Religious Liberty in its Easter-week statement, “Our First, Most Cherished Liberty.”

Throughout the first quarter of this deadly serious game, the administration did not move a millimeter, the claims of its flacks and some of its Catholic apologists notwithstanding. The “contraceptive mandate” (which, remember, is also a sterilization and abortifacient mandate) is now law, without any “accommodation.” The administration continues to insist on provision of the services in question; it continues to define a “religious exemption” that is so stringent that it is not clear whether any Catholic entity (or Orthodox Jewish entity, or Mormon entity) would qualify; its narrow definition of “religious ministry” puts the Church in legal and financial peril for serving people who are not Catholics, which is another requirement of the Catholic conscience.

But the debate is not only about religious institutions; it is about the rights of conscience of employers (Catholic or otherwise) whose convictions require them not to include contraceptives, abortifacient drugs, and sterilizations in the health-insurance coverage they provide their employees. These men and women, like the numerous Catholic entities (including dioceses and educational institutions) that are self-insuring, are all put in grave legal and moral peril by the administration’s intransigent determination to impose its concept of “reproductive health” on the entirety of American society — and to force those who oppose that concept to provide the very means by which the concept is imposed.

Now comes the game’s second quarter, which will be legal, as the battle for religious freedom moves into the federal courts. A dozen lawsuits challenging the administration’s mandate are being filed today on behalf of more than 40 plaintiffs: Catholic dioceses, including the archdioceses of New York and Washington; Catholic social-service and health-care agencies; Catholic educational institutions, including the Catholic University of America, the Franciscan University of Steubenville, and the University of Notre Dame; and Catholic publications. These suits, in addition to those already filed by the Becket Fund for Religious Liberty and the Alliance Defense Fund on behalf of other religious litigants, ought to help clarify several sometimes-confused points in the months ahead.

• This is not an argument about birth control, nor is it part of some “War on Women” waged by misogynistic clerics and their political allies from the fever swamps of the Right. The mandate is being legally challenged, in twelve different federal district courts, on the grounds that it violates the provisions of the Religious Freedom Restoration Act and the First Amendment’s guarantee of the free exercise of religion. If those legal protections mean anything, they must mean that neither religious institutions nor individuals can be compelled to provide “services” that are readily available through means other than coercing religiously informed consciences. Contraceptives are more readily available in the United States in 2012 than either cigarettes or beer. There is no compelling public need to dragoon institutions and individuals who conscientiously object to providing them into doing so — with the threat of ruinous financial penalties if they do not.

• This argument over the meaning of religious freedom was not initiated by the Catholic Church; it was initiated by an administration that seems to regard “religious freedom” as merely a privacy right to certain kinds of recreational activities (like worship). As in its international human-rights policy (which speaks exclusively of “freedom of worship”), the administration seems unwilling or unable to grasp an elementary truth: Religious convictions are community-forming, and those communities, like the individuals whose conscientious convictions form them, are the subject of genuine religious freedom.

• More than free exercise is at stake here, though. For the administration is arguably violating the intent of the “no establishment” provision of the First Amendment, which (among other things) means that the federal government is incompetent in theological matters. Yet that is precisely the turf onto which the administration is intruding with its attempts to define religious institutions, ministries, and employers so narrowly that Jesus and the Twelve would almost certainly not qualify, having fed five thousand people who were not “church members.”

• While the media’s attention to this battle has typically focused on the U.S. bishops’ conference and the administration, with Cardinal Timothy Dolan (the conference president) in one corner and President Obama and HHS Secretary Kathleen Sebelius in the other, the number and character of the litigants now challenging the administration’s mandate ought to make it clear that this is not “the bishops vs. the administration” during an election year; it is the administration vs. the Catholic Church on an issue of first principle. That one of the litigants is the University of Notre Dame, which in 2009 gave President Obama an honorary doctorate of laws and invited him to address its commencement ceremony, ought to underscore the point that the mandate is regarded as a threat to religious freedom far beyond the boundaries of the bishops’ conference. As Notre Dame’s president, Father John Jenkins, C.S.C., put it, “this [suit] is about the freedom of a religious organization to live its mission.” Period.

• The clock is ticking, and the pace of the battle will now accelerate. The mandate was finalized “without change” on February 12; it is now law. The mandate is scheduled to go into effect on August 1, with a “safe harbor” for some entities until August 1, 2013 — a “safe harbor” famously described by Cardinal Dolan as “a year in which we’re supposed to figure out how we can violate our consciences.” Even those entities to which the administration extends this “safe harbor,” however, remain vulnerable to private action to enforce the mandate (affording Ms. Sandra Fluke her second 15 minutes of fame?). Thus it would seem important that one part of the litigation strategy be the pursuit of a preliminary injunction that would prevent the mandate from going into effect this August. That would not only relieve pressure on Catholic institutions and Catholic employers to decide whether to shut down their schools, hospitals, and social-service agencies in response to the mandate; such an injunction would also signal clear concerns from the federal bench about the legality of the mandate.

• While Obama supporters (including some Catholics) will contend that this is partisan politics, it isn’t — except insofar as the administration has made it so. It was the administration that refused to countenance Catholic concerns before and after the mandate was issued. It was the administration whose apologists (including Secretary Sebelius) bent every effort to turn what was clearly a religious-freedom issue into a “War on Women.” It has been the administration and its Senate allies, like Majority Leader Harry Reid, who have refused to enter into any sort of serious discussion aimed at mitigating Catholic concerns. It is the administration that seems willing to drive the Catholic Church out of health care, education, and social services if that is what is required to enforce the administration’s notions of “reproductive health” and “reproductive choice.” If the administration pays a price for this in November, it will have no one to blame except itself.

Legal victory in the third and fourth quarters of this battle is not certain, but it seems likely. For it is very difficult to see how the administration can justify this burdening of Catholic employers (and other employers with religiously informed moral objections to the mandate) under the provisions of the Religious Freedom Restoration Act. As the battle continues, it will be important, amidst the litigators’ argument and the administration’s attempts to reply, to remember that what is at stake here is nothing less than the future of civil society in the United States.

A victory in the lawsuits filed against the administration’s mandate will be more than a victory for religious freedom, important as that will be. It will be a victory in defense of the social architecture of American democracy. Government is not the only custodian of the common good. The institutions of civil society bear a significant and irreducible responsibility for the common good, a responsibility they must be able to fulfill freely, without unwarranted interference from an overweening state that is ignorant of the limits of its legitimate reach. That is the truth for which today’s Catholic litigants are contesting — and they are doing so on behalf of all Americans.

— George Weigel is distinguished senior fellow of Washington’s Ethics and Public Policy Center, where he holds the William E. Simon Chair in Catholic Studies.

Obamacare’s Patient-Dumping, Privacy-Meddling Scheme

By Michelle Malkin
http://michellemalkin.com/
May 16, 2012

President Barack Obama plays golf with longtime friend Dr. Eric Whitaker on the 10th green of the course at Grove Park Inn in Asheville, N.C., Friday, April 23, 2010. (AP Photo/Alex Brandon)

The stench of Chicago cronyism over the White House just got fouler. Inhale this:

A shadowy $10 billion Obamacare agency with zero oversight just awarded first lady Michelle Obama’s pet patient-dumping scheme at the University of Chicago Medical Center a $5.9 million taxpayer-funded grant. It will enable Mrs. Obama’s cronies to build a government-sponsored electronic medical record-sharing system.

The Chicago program, known as the Urban Health Initiative, is run by one of President Obama’s closest golfing buddies, scandal magnet Eric Whitaker, who has been entangled with Illinois corruption celebrities Rod Blagojevich and Tony Rezko over the past decade.

Fun fact: Whitaker recently was named by author Edward Klein as the man who purportedly offered hate-mongering Rev. Jeremiah Wright $150,000 in hush money during the 2008 campaign. (More here.)

The nearly $6 million grant was announced last week by the “Center for Medicare and Medicaid Innovation” at the Department of Health and Human Services. White House watchdog journalist Keith Koffler notes that “some 3,000 applications were received for a share on the $1 billion in 3-year grants available. Only 26 programs were included in the first batch of awards doled out.” The administration grants circumvent any and all congressional deliberation as part of Team Obama’s election-year “We Can’t Wait” initiatives.

The grant recipients will help fulfill the mandated Obamacare vision of a centralized patient-record database with unprecedented federal oversight. The provision is being challenged in court by the Goldwater Institute for forcing Americans to share “with millions of strangers who are not physicians confidential private and personal medical history information they do not wish to share.”

HHS denies any favoritism, citing a “competitive, objective” process. But as I first reported in March, a Congressional Research Service analysis concluded that Obamacare’s Innovation Center is subject to no administrative or judicial review. The Innovation Center director is, in effect, a super-czar without any checks or balances on his grant-making decisions, methods or results.
I warned two months ago that the Obamacare Innovation Center and its multibillion-dollar slush fund smacked of “another pipeline for political payoffs and Chicago-style boodle that will result in less patient autonomy, fewer health-care choices, more government intrusion and lower-quality care.”

The University of Chicago Medical Center grant walks and talks like just such a political payoff. I have reported extensively on how Mrs. Obama helped engineer the Urban Health Initiative’s plan to offload low-income patients with non-urgent health needs. With consulting help from Obama senior adviser David Axelrod’s Chicago-based PR firm and the blessing of fellow Chicago pal Valerie Jarrett (who chaired the hospital’s board of trustees), Mrs. Obama sold the scheme to outsource low-income care to other facilities as a way to “dramatically improve health care for thousands of South Side residents.”

The program guaranteed “free” shuttle rides to and from the outside clinics. In truth, it was old-fashioned cost-cutting and favor-trading repackaged by a nonprofit, tax-exempt hospital as minority aid. Clearing out the poor freed up room for insured (i.e., more lucrative) patients.

The American College of Emergency Physicians (ACEP) blasted MichelleObamacare, expressing “grave concerns that the University of Chicago’s policy toward emergency patients is dangerously close to ‘patient dumping.’” The group concluded that the Urban Health Initiative “reflected an effort to ‘cherry pick’ wealthy patients over poor.” That practice was made illegal by the Emergency Medical Treatment and Active Labor Act (EMTALA) signed by President Ronald Reagan.

Bipartisan complaints about impoverished South Side Chicago patients getting the shaft led GOP Sen. Charles Grassley of Iowa and Democratic Rep. Bobby Rush of Chicago to challenge the crony hospital’s abuse of its nonprofit status and lucrative tax breaks. But the probe went nowhere.

And now, Whitaker will have $6 million more to play with when he’s not vacationing with Obama or grappling with subpoenas over possible kickback and pay-for-play schemes while he served as a top health official under now-jailed Illinois. Gov. Blagojevich. One of the probes involves Whitaker’s oversight of medical facilities construction projects exploited by now-convicted real-estate shark Tony Rezko. Whitaker was also under federal investigation for misuse of funding for faith-based minority programs. President Obama recommended Whitaker to Rezko, who was a top Blago’s bagman.

Anyone who isn’t concerned about the privacy implications of this government-funded records-sharing network hasn’t been paying attention to how Team Obama and its surrogates are digging for dirt on private citizens who donate to GOP campaigns.

Nothing to see or smell here? Discerning eyes and nostrils beg to differ.

***

Related: The $4 Billion Obamacare Slush Fund for Progressives

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