the salt makers

Regardless of how you feel about the Patient Protection and Affordable Care Act (H.R. 3590), even the most fevered Obama supporter has to give him and the Dems major penalties for either refusing or neglecting to tell the American people what was in the bill and how it would effect their lives over the coming years.

The hysteria, confusion and demagoguery surrounding the highly questionable and clandestine approval of this bill is to be laid solely at their feet.

Dr. Roger W. Evans, a cardiologist in Wichita, Kan., is used to answering patients’ questions about their hearts. But lately, he said, he has spent half his time answering a succession of different questions — about the health care law.

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Donald Moore, 75, one of those patients, expressed his uneasiness about the law recently: “The fact is that I don’t understand it, and no one else I talk to understands it. Every day, you read something different in the paper.”

Mr. Moore’s latest concern was a “rumor that the new health care procedures are going to be monitored and managed by the I.R.S.”

“That’s a turnoff right there,” he said. “How much is true, how much is fiction, out here no one knows.”

Most of the health care law, which President Obama signed last month, has yet to take effect, but for many doctors it is already having an impact.

“We’ve had to add an hour or two to the day because patients want to talk about it,” said Dr. Evans, who travels around the state and said questions often left him scratching his head. “I see 30 to 50 patients in a day, and it is the subject of conversation more than half the time.”

After months of public wrangling and brinkmanship in Washington, the nation’s doctors now find themselves having to answer questions about a 2,400-page law that many do not understand themselves, and which they may have opposed. “Not only is the public confused, but so are our members,” said Dr. Lori J. Heim, president of the American Academy of Family Physicians, which supported the bill. “There’s been a lot of misinformation out in the media. We’ve been trying to get to them simple answers — what does this mean for my practice, what does it mean for my patients, what does it mean for the future?”

Some doctors said their patients were pushing for surgery now, for fear that it will not be covered in the future or that they will end up on a waiting list. “It’s ludicrous to be coerced to perform surgery because of fear of noncoverage in the future,” said Dr. Eustaquio O. Abay II, a neurosurgeon in Wichita. “I refuse.”

Dr. Abay said he had tried to read the law, but gave up because it was all legal jargon to him. “They think we have all the answers, but we don’t,” he said of patients.

While many doctors say they are not besieged, the queries have been particularly robust in states where the plan was unpopular, Dr. Heim said.

Joseph R. Baker III, president of the Medicare Rights Center, a nonprofit organization that operates a hot line for patients with questions, characterized the volume of calls about the bill as moderate. But he said the level of confusion was high, comparable to that created when Medicare added prescription drug coverage in 2004.

Often, Mr. Baker said, callers have been getting their information from media commentators or doctors who opposed the legislation. “They’re being told by their providers, ‘Now I won’t be able to take Medicare patients,’ ” he said.

“People call us confused, panicked, anxious,” he said. “And in most instances, we say there are some benefits in the short term, like closing the doughnut hole,” as the gap in Medicare prescription drug coverage is known, “and that the things that might have a negative impact, like lower reimbursement to providers, will happen over a number of years. Usually that calms people down.”

The questions do not always reflect the actual provisions of the law. The major changes for this year, including coverage on their parents’ policies for adult children under age 26, rarely come up, said Dr. Melissa Gerdes, a family practitioner in Whitehouse, Tex., who said it was not unusual for her patients to discuss politics in the examining room. She said that only one patient had asked about the new law’s provisions on the doughnut hole, and that she could not recall any patient who had inquired about coverage for adult children.

“The big one I get is, ‘Are you going to be able to keep seeing me?’ ” Dr. Gerdes said. (She tells them she will.)

At Dr. Alieta Eck’s free clinic in Somerset, N.J., where all the doctors donate their time, Dr. Eck said many of her patients were excited about the new program. “People say, ‘I can’t wait for Obamacare,’ ” said Dr. Eck, who has been outspoken in her opposition to the program. “They’re already getting free care.”

Dr. Eck said that her office had not been overrun with questions about the bill, but that during visits at her paid practice, “most patients are fearing that everything’s going to cost them more.”

For many doctors, the big frustration comes when they do not know what to say to their patients.

“Quite honestly, I don’t know how to answer their concerns,” said Dr. Deborah A. Sutcliffe, a solo practitioner in Red Bluff, Calif. “Sometimes they’re more informed than I am, sometimes they’re not. I haven’t read the damn thing.”

The judge also says he would rate President Obama as one of the worst presidents in terms of obedience to constitutional limitations.

"I believe we have a one party system in this country, called the big-government party," Napolitano says. "There is a Republican branch that likes war and deficits and assaulting civil liberties. There is a Democratic branch that likes welfare and taxes and assaulting commercial liberties.

"President Obama obviously is squarely within the Democratic branch. The president who had the least fidelity to the Constitution was Abraham Lincoln, who waged war on half the country, even though there's obviously no authority for that, a war that killed nearly 700,000 people. President Obama is close to that end of lacking fidelity to the Constitution. He wants to outdo his hero FDR."

I had no idea how bad MassCare solvency was. Guess we can look forward to this...from the state treasurer of Massachusetts.

White House Senior Adviser David Axelrod hailed the Massachusetts health-care program as "the template" for the national health-care reform legislation the president signed into law earlier this week. That should be cause for serious concern about this law's ability to improve our health-care system at an affordable cost.

As state treasurer, I can speak with authority about the Massachusetts pilot program. It has been a fiscal train wreck.
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The universal insurance coverage we adopted in 2006 was projected to cost taxpayers $88 million a year. However, since this program was adopted in 2006, our health-care costs have in total exceeded $4 billion. The cost of Massachusetts' plan has blown a hole in the Commonwealth's budget. Just last Thursday, Gov. Deval Patrick's office announced a $294 million shortfall related to health-care costs.

If not for federal Medicaid reimbursements and commitments from Washington to prop up this plan, Massachusetts would be broke. The only reason MassCare has survived is that we have been repeatedly bailed out by the federal government. But that raises the question: Who will bail America out if we implement a similar program?

While everyone should have access to affordable health care, our experience in Massachusetts tells us that the new federal entitlement will burden future taxpayers with unfunded liabilities they cannot afford. Health-care inflation will continue. Mandates will increase insurance premiums. And the deficit will reach frightening levels as the law's costs greatly exceed the projections of its advocates.

As lawmakers push for changes in the bill, they should start by being honest about its costs and focus on making health care more affordable without bankrupting the country.

The Republican attorney general's move reveals how far into the past America's New Nullifiers want to push the nation. They don't just want to abandon a more than seven-decade-long understanding of the Constitution's interstate commerce clause that has allowed the federal government to regulate a modern, national economy.

They also want to resurrect states' rights doctrines discredited by President Andrew Jackson during the nullification crisis of the 1830s and buried by the Civil War.

Companies are already warning about higher health-care costs.

Democrats dragged themselves over the health-care finish line in part by repeating that voters would like the plan once it passed. Let's see what they think when they learn their insurance costs will jump right away.

Even before President Obama signed the bill on Tuesday, Caterpillar said it would cost the company at least $100 million more in the first year alone. Medical device maker Medtronic warned that new taxes on its products could force it to lay off a thousand workers. Now Verizon joins the roll of businesses staring at adverse consequences.

In an email titled "President Obama Signs Health Care Legislation" sent to all employees Tuesday night, the telecom giant warned that "we expect that Verizon's costs will increase in the short term." While executive vice president for human resources Marc Reed wrote that "it is difficult at this point to gauge the precise impact of this legislation," and that ObamaCare does reflect some of the company's policy priorities, the message to workers was clear: Expect changes for the worse to your health benefits as the direct result of this bill, and maybe as soon as this year.

Mr. Reed specifically cited a change in the tax treatment of retiree health benefits. When Congress created the Medicare prescription drug benefit in 2003, it included a modest tax subsidy to encourage employers to keep drug plans for retirees, rather than dumping them on the government. The Employee Benefit Research Institute says this exclusion—equal to 28% of the cost of a drug plan—will run taxpayers $665 per person next year, while the same Medicare coverage would cost $1,209.

In a $5.4 billion revenue grab, Democrats decided that this $665 fillip should be subject to the ordinary corporate income tax of 35%. Most consulting firms and independent analysts say the higher costs will induce some companies to drop drug coverage, which could affect about five million retirees and 3,500 businesses. Verizon and other large corporations warned about this outcome.

U.S. accounting laws also require businesses to immediately restate their earnings in light of the higher tax burden on their long-term retiree health liabilities. This will have a big effect on their 2010 earnings.

While the drug tax subsidy is for retirees, companies consider their benefit costs as a total package. The new bill might cause some to drop retiree coverage altogether. Others may be bound by labor contracts to retirees, but then they will find other ways to cut costs. This means raising costs or reducing coverage for other employees. So much for Mr. Obama's claim that if you like your coverage, you can keep it—even at Fortune 500 companies.

In its employee note, Verizon also warned about the 40% tax on high-end health plans, though that won't take effect until 2018. "Many of the plans that Verizon offers to employees and retirees are projected to have costs above the threshold in the legislation and will be subject to the 40 percent excise tax." These costs will start to show up soon, and, as we repeatedly argued, the tax is unlikely to drive down costs. The tax burden will simply be spread to all workers—the result of the White House's too-clever decision to tax insurers, rather than individuals.

A Verizon spokesman said the company is merely addressing employee questions about ObamaCare, not making a political statement. But these and many other changes were enabled by the support of the Business Roundtable that counts Verizon as a member. Verizon CEO Ivan Seidenberg's health-reform ideas are 180 degrees from Mr. Obama's, but Verizon's shareholders and 900,000 employees and retirees will still pay the price.

Businesses around the country are making the same calculations as Verizon and no doubt sending out similar messages. It's only a small measure of the destruction that will be churned out by the rewrite of health, tax, labor and welfare laws that is ObamaCare, and only the vanguard of much worse to come.

The Senate parliamentarian dims GOP hopes on a reconciliation bill that contains even more onerous taxes and even a financial incentive to lay people off. No wonder Speaker Pelosi is laughing.

We'll acknowledge that the signing of ObamaCare into law is a historic event, but we think the Weather Channel broadcasting the signing ceremony was a bit much. On the other hand, stormy political weather and more dark clouds lay ahead.

The cries of "repeal" and "remember in November" are rising, and state attorneys general are taking the feds to court over the unconstitutional mandates and usurpation of rights contained in reform's first incarnation. The bad news is that things are going to get worse before they get better.

On Monday, as House Speaker Nancy Pelosi had a good laugh celebrating her coup d'etat, Senate Parliamentarian Alan Frumin, who gets paid out of Senate Majority Leader Harry Reid's office, issued informal guidance to Republicans that on at least one issue their plans to use the reconciliation process as a last stand had hit a snag.

According to a spokesman for Senate Minority Leader Mitch McConnell, Frumin sent word that he feels that the so-called "Cadillac tax," a proposed tax on high-end health insurance plans from which union members would be exempt, does not have an impact on the Social Security trust fund and therefore does not violate reconciliation rules under the 1974 budget act by changing contributions to the trust fund.

Republicans had hoped Frumin would be some profile in courage, but the Senate parliamentarian is one of the spoils of victory. The courts hold some hope, but in the end the only way to stop this promised fundamental transformation of America will be at the ballot box starting in November.

Meantime, put down your wallet and back away slowly, especially those of you who put people to work. An analysis of the House Reconciliation Act of 2010 (HR 4872) by the Heritage Foundation shows it to be as much of a job-killer (except for those 17,000 new IRS agents) as the Senate bill President Obama signed into law.

HR 4872, Heritage reports, would "force companies to pay a tax penalty if that business employs 50 or more workers as soon as one worker qualifies for, and opts to accept, a health insurance premium subsidy."

That $3,000 penalty is on top of the $2,000-per-worker penalty for all workers beyond the first 30 for such companies not offering a "qualified" health plan or paying 60% of employee health premiums. Such companies would be faced with a $3,000 penalty for hiring a single parent, the very kind of person desperately in need of employment.

Here's where it gets even more bizarre. According to Heritage, under the reconciliation bill, if Company A lays off an employee with a working spouse, this could generate a $3,000 tax penalty for the other spouse's employer, unless Company B also lays off the other spouse.

We're not making this up. This byzantine legislation is a job-killer that will destroy small business, the major creator of new jobs. Some 77,000 businesses in the U.S. have 50 to 200 workers that could face the $2,000-per-employee tax penalty. An additional 116,000 businesses have 35 to 49 workers.

This nonsense will stunt economic growth and worsen the economic downturn by actually providing financial incentives to not hire people. It's not worth the trouble. Businesses that might have expanded will stop at 49 employees. Those already considered a "large" business will face a minefield of taxes and penalties due in some cases to events beyond their control.

The power to tax is indeed the power to destroy. As we have said, this is not about health care. This is about power and the redistribution of wealth. And the IRS will be making a list and checking it twice to see who's being naughty and who's being nice.

Responding to an inquiry from Rep. Paul Ryan, the Congressional Budget Office has confirmed that when you remove certain accounting gimmicks from the Democrats' health care legislation, it actually increases the deficit.

Democrats have touted a CBO report that found that their health care bill would reduce the deficit by $138 billion from 2010 to 2019. But that number assumes that hundreds of billions of dollars in Medicare cuts would be used to pay for the new health care entitlement. In a letter to Ryan, the CBO estimates that if the Medicare cuts were used to help shore up the effectively bankrupt Medicare trust fund instead, then the Democrats health care bill would run $260 billion in deficits over the next decade.

In an earlier version of the House bill, Democrats included a measure to avoid scheduled cuts in doctors' payments under Medicare. They removed the measure when they couldn't get the numbers to add up, but they have continued to pass temporary delays of the cuts and have vowed to tackle the issue separately from the current health care bill. In the letter, CBO projects that if the so-called "doc fix" were added to the legislation, it would produce deficits of $59 billion from 2010 to 2019.

Earlier CBO estimates also asume that future lawmakers would actually enact some of the unpopular measures, such as the Medicare cuts and the "Cadillac tax." These are crucial to Democrats' claims that the bill will reduce deficits even more -- by $1.2 trillion -- in the second decade. But in the letter, the CBO says that without the changes, deficits would actually increase -- by a quarter of a percent of GDP, or $600 billion -- in the second decade.

Liberals have tried to portrat any criticism of the Democrats' deficit reduction claims as an attack on the integrity of the CBO itself. But as this letter demonstrates, this isn't about attacking the CBO. It's just simply acknowledging that CBO analysis can vary greatly based on the questions you ask them. And clearly, Democrats kept tweaking the language until they were able to get the CBO score they wanted.

According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%

In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims—a big improvement, but outpaced better still by the private insurers. The prior year’s high private denier, Aetna, reduced denials to 1.81%—an astounding 75% improvement—with similar declines by all other private insurers, to average only 2.79%.

Maybe there’s something to be said for the need to keep your customers satisfied in order to make that profit after all.

It has been shown that the so-called "public option" for low-premium health insurance is sure to significantly crowd out, and perhaps even eliminate, the private provision of health insurance. Thanks to Senator Joseph Lieberman's courageous stand, it appears that the public option will not be a part of any bill that passes the Senate. Unfortunately, HR 3962 includes regulations that will destroy the ability of private firms to provide marketable insurance, with or without a public option.

To understand the devastation that will be wrought by this bill, one must understand how health insurance functions on a free market to transfer individuals' financial risk to large "risk pools" with less variation across time. Consumers who are risk averse pay "premiums" to insurers each month for the removal of that risk, and in turn insurers assign their clients to different pools according to their risk of large claims.

An Already-Regulated Industry

Insurance companies have already been strictly limited in their ability to assign individuals to different risk pools and charge them varying premiums. By forcing high-risk and low-risk groups into the same pool, existing regulations increase premiums for low-risk consumers and decrease premiums for high-risk consumers. This is nothing more than a coerced subsidy to the less healthy, and it drives low-risk consumers away from purchasing health insurance. This is why the majority of the uninsured are not poor and dying, but in fact healthy young people who are at almost no risk of unanticipated healthcare costs.

To cope with their inability to partition along risk levels, profit-seeking insurance companies must cut costs by excluding the highest-risk patients from insurance. In a free market, these individuals would be offered insurance at a higher premium aligned with their high risk of major claims. In human terms, this leads to the exclusion of people with preexisting conditions and those with significant claims on past insurance plans. Once again, we see how leftist economic policy harms the very class of society that its supporters desire to help.

Obamacare is a Welfare Program

Not oblivious to the exclusion of these unfortunate citizens, on page 95 of the bill, House Democrats have proposed to completely outlaw the exclusion of any customer on any of the following grounds: "health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, or source of injury (including conditions arising out of acts of domestic violence) or any similar factors."

Thus, it will become illegal to refuse to insure any consumer on any grounds, including evidence of insurability. In addition to being unable to exclude future enrollees, insurers will be prevented by page 29 from legally dropping any consumers from their plans on any grounds other than "clear and convincing evidence of fraud."

The effect on the structure of insurance is obvious; this new law will turn health insurance into a legally-enforced entitlement program, and the new entitlement will be used by those who are too costly to be insured under the current restrictions on risk-pool partitioning. Again, it is important to remember that these patients would have the option to buy insurance on a free market, but that their plans would carry premiums that actually reflect their personal health risk.

While risk-pool separation is considerably limited by national and state regulations, the little separation that is allowed would still be able to mitigate the heavy costs of forcing insurers to cover literally every customer who wishes to buy insurance. While the high-risk individuals would not pay as much in premiums as they would on a free market, insurance companies would still be able to use slightly lower premiums to attract low-risk customers.

However, this inequality in premiums is offensive to politicians hell-bent on equality. Therefore, in the very next page of the bill, House Democrats propose to outlaw all variations in premiums except according to geographical area, age group, and whether the plan in question covers an individual or a family.

These provisions will be catastrophic to the insurance market. The bill only allows for premium variation across age by a ratio of two to one between the highest and lowest premiums. In real terms, elderly patients who cost several times as much to insure can only be charged twice as much as 20-somethings who often go entire years without claims. That this is a subsidy for the elderly hardly needs to be explicitly stated.

The bill leaves the determination of the maximum difference between individual and family plans at the discretion of the "health choices" commissioner, who is likely to find himself bombarded with visits and letters from family-centered lobbying organizations seeking subsidized health insurance paid for by singles and nonparents. This rent seeking will inevitably end up in subsidies handed out according to political objectives, whether the goal is to attract more young, single voters or more parents of children.

Turning any transaction into a subsidy both induces the subsidized class to enter the transaction and induces the subsidizing class to attempt to avoid it. In this case, it means that an even greater number of young and healthy individuals (and, most likely, nonparents) will drop their increasingly expensive insurance plans and attempt to prepare for healthcare risks on their own. This terrible result of coercive price-fixing decreases the benefit of the subsidy to high-risk consumers and decreases the ability of the insurance companies to control and reduce average payouts.

Democrats are aware of this effect of their policy, and have legislated accordingly. Pages 296–300 amend federal tax law to create a new tax on all citizens who fail to purchase health insurance. Depriving these individuals of the ability to opt out of the new, undifferentiated insurance pool is an atrocious affront to individual choice, and requires the threat of imprisonment. This new tax will help achieve the statistical goal of universal coverage, but it will do so at an incredible cost to the income and liberty of the relatively young and healthy, most of whom, ironically, voted for Obama and Democratic congressional candidates.

Soaring Costs

Not only will high-risk individuals who are now forced out of the market by regulation be legally entitled to purchase the bill's minimum standard of coverage, but both these excluded consumers and those who are now in high-risk pools will have financial incentives to buy higher levels of insurance. Facing new, subsidized prices, high-risk individuals will purchase plans with lower deductibles. Paying for a higher percentage of the price of more claims will massively increase the cost of insuring the new general pool of clients.

One of the only remaining ways for insurers to cut their costs, then, is to limit the amount that individuals are able to receive in claims. Indeed, insurance companies already use lifetime claims limits to cope with risk-partition laws and deliver lower-price packages to low-risk consumers. Predictably, page 50 of the House bill prohibits insurance companies from imposing any such limits on lifetime benefits.

Outlawing lifetime limits guarantees that all consumers will have the incentive to undergo drastically more treatments in their lifetimes, because the bill ensures that they will not be moved into a higher premium group until they enter a different age group or move to a different area. For the already-subsidized elderly, this creates incentives to undergo many more life-extending treatments in the final year of their lives. Such treatments are several times more expensive than general care for other elderly patients.

Astute readers will correctly object that while the Democrats' healthcare proposal will drastically increase the costs facing every insurance provider, the bill also requires all individuals to buy the minimum package of insurance, or to enroll in the public option. Especially because in the current discussion we are ignoring the effects of the public option, it is possible to argue that if there were no public option this bill would actually be a boon to private insurers, who are virtually guaranteed that every American will buy their plans. To survive this bill, then, insurance companies will simply increase the premiums of the packages that are forced onto every citizen.

This would indeed be true, were it not for further regulations effectively barring premium increases. Page 31 of the bill would require insurance companies to "submit a justification" for any projected future increase in premiums for any group to the secretary of Health and Human Services as well as state-level authorities.

The secretary of HHS and the state "health czars" would then annually review and approve or deny any increase in premiums. In various sections of the bill, the health choices commissioner is given power to determine the cost-accounting and other ratings methods that will determine whether a price increase is "justified" in the eyes of the DHHS Secretary.

Public officials operating under a Congressional mandate to achieve universal coverage are hardly likely to approve price increases, even though that means slowly bankrupting private insurers. Even if they are not made to "compete with" and be strangled by a public option that consumers have already funded with their tax dollars, private insurers will be absolutely ruined by restrictions on their ability to control and separate costs and to increase prices to account for their ever-rising costs.

Conclusion

While a public option would certainly hasten the death of the private-insurance market in America, it is not a necessary means to that end. By destroying the economic structure of insurance, House Resolution 3962 would convert an already-overregulated industry into a pseudo-private welfare program. Even without a public option, insurance companies would be kept from controlling costs or adjusting their prices. The inevitable result will be the complete dissolution of the private health-insurance market.