Sunday, April 1, 2012

Health Care Reform Articles-April 1, 2012

Steven Pearlstein: Eat your broccoli, Justice Scalia

By Published: March 31

If the law is an ass, as Mr. Bumble declares in “Oliver Twist,” then constitutional law must surely be the entire wagon train.
Like most Washington policy wonks, I spent too much of last week reading transcripts of the Supreme Court arguments over the constitutionality of the new health reform law. This was to be a “teaching moment” for the country, an opportunity to see the best and the brightest engage in a reasoned debate on the limits of federal power. Instead, what we got too often was political posturing, Jesuitical hair-splitting and absurd hypotheticals.
My first thought on perusing the briefs filed in the combined cases was to notice what wasn’t there: any involvement on the part of Corporate America.
For the past 20 years, big business has complained endlessly about escalating health-care premiums, which they correctly blamed on “cost-shifting,” including paying indirectly for the free care provided to the workers at firms that did not provide health benefits. They wanted an end to fee-for-service medicine that rewarded doctors for providing more care than necessary. Some even talked of reforms that would begin to move the country away from an employer-based insurance system.

If Obamacare is overturned, will that lead to single payer? And would that be a good thing?

By Published: March 29

Jonathan Ernst Reuters Buttons reading 'Repeal Obamacare' are displayed at the American Conservative Union's annual Conservative Political Action Conference (CPAC) in Washington, Feb. 9, 2012. Last week, I wrote a column envisioning a world in which the Affordable Care Act is repealed and the Ryan budget is implemented. Here’s how I saw it going:

It’s unlikely that the model in the Republican budget will prove sustainable. That legislation would repeal the Affordable Care Act, cut Medicaid by a third and adopt competitive bidding for Medicare. The likely result? The nation’s uninsured population would soar. In the long run — and quite possibly in the short run — that will increase the pressure for a universal system. Because Republicans don’t really have an idea for creating one, Democrats will step into the void.

In reply, Will Wilkinson snarked:

Even if the Republicans win, they lose, and Democrats get everything they always really wanted! This sort of thinking is so wishful it’s almost touching.

This is, I think, part of the unfortunate tendency for disputes over health-care reform to be framed in terms of which political party they benefit. As the thinking goes, if the Supreme Court overturns the Affordable Care Act and then Medicaid gets cut by a third, that’s bad for President Obama and the Democrats and good for Republicans.

The Wall Street Journal: Unwitting Advocates of Single-Payer


It beggars comment. The Wall Street Journal editorial board today urges the overturn by the Supreme Court of the Affordable Care Act as ... wait for it ... an act of "judicial restraint."

Justice Antonin Scalia chimed in to note that severing would require the Justices to comb through ObamaCare's 2,700 pages and pick out the parts that are connected to the mandate and those that aren't—essentially asking them to play omniscient time travellers, if not legislators. Striking it down altogether would paradoxically be a gift of judicial modesty by avoiding the legal invention of a new law. A clean slate gives Congress the most options.

Take It From Me: Defending Obamacare is Super-Hard

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It so happens that I'm packing up my apartment and moving out of Washington today after eight years of residence, most of which were spent in politics and government. One of the items I just bubble-wrapped is a framed copy of The L.A. Times front page from March 22, 2010, in which I can be seen, blurrily, clapping in the background as Barack Obama watches the House pass the Affordable Care Act. In between stowing keepsakes like this, I've been taking procrastination breaks to monitor news from today's oral arguments. The consensus seems to be that we should crap on Solicitor General Don Verrilli for struggling to defend the individual mandate.
Don is someone I worked with and respected, so I will leave dissection of his efforts to those who are farther removed and better schooled in Supreme Court procedure. But I will say this: having spent a year of my life getting paid to defend the ACA as the White House spokesman on health care, I feel for the guy. Health care reform is very much worth defending, but going about that defense is where things get, well, difficult.
It would have been easy for Verrilli—or any of us—to explain single-payer health care. "Look," we could have said, "the government is paying for everyone to have coverage." End of story. But single-payer is not what our brilliant, world-leading political system gave us. What it gave us is essentially a halfsy—an extraordinarily confusing patchwork in which some novel legislative mechanisms are used to induce individuals, businesses, insurance companies, and states into doing things that add up to concrete good.

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Young: What's really wrong with Obamacare

The fight against "Obamacare" -- which played out before the Supreme Court this week -- has galvanized libertarian and conservative critics of big government. The 2010 bill, particularly its requirement that nearly every American buy health insurance or pay a penalty, is seen as a symbol of socialism and loss of freedom.
The legislation unquestionably has serious flaws that illustrate the pitfalls of government overreach. But in many ways, the champions of liberty have picked the wrong battles -- ones that may yet backfire against their own cause.

If the Mandate Fails, Single Payer Awaits

There is much consternation in liberal circles this afternoon, as the arguments before the Supreme Court about health care reform’s crucial individual mandate don’t seem to have gone very well. “A bad day for Obamacare’s supporters,” writes Ezra Klein. “I think this law is in grave, grave trouble,”said Jeffrey Toobin.
I tend to give more credence to the accounts that things weren’t actually that bad—the questioning during these proceedings is not predictive of the final outcome, and Justice Anthony Kennedy has plenty of room to side with the government—but it’s worth considering what would happen if, indeed, the individual mandate is junked.

Kucinich: Single-payer healthcare on its way regardless of how Supreme Court rules

By Julian Pecquet 03/26/12 04:13 PM ET
The Supreme Court's review of President Obama's healthcare reform law is just another step on the inevitable path toward a single-payer medical system, Rep. Dennis Kucinich (D-Ohio) said Monday.

8:46 AM 

Obama's insurance requirement not the only mandate

The Associated Press
WASHINGTON — The individual insurance requirement that the Supreme Court is reviewing isn't the first federal mandate involving health care.

Maine’s example is worst case for health-care decision, insurers say

Posted March 31, 2012, at 1:45 p.m.
WASHINGTON — The worst-case scenario for insurers in the Supreme Court review of the U.S. health-care law — eliminating the mandate that everyone have insurance while other changes remain intact — has been tested in Maine, New York and Vermont.
It failed, insurers say.
The three states were among nine in the 1990s that tried to force insurers to sell policies to anyone who asked, regardless of health, without also mandating that other residents maintain coverage. As a result, as many as 90 percent of those under age 30 dropped their plans, knowing they could always pick them back up if they got sick. Premiums in some cases doubled.
By last year, six of the nine states had repealed the laws, according to Blue Cross & Blue Shield Association, a federation of insurers in Washington.

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