Medicine Archives

Thoughts on the 2015 Election Results

Not a huge number of results, but some results were huge in this off-year election day.

The “hugest” could be considered the election of a Republican Tea Partier as governor of Kentucky.

Matt Bevin, a Republican political novice, wealthy Louisville businessman and Tea Party favorite, was elected Kentucky’s next governor on Tuesday and swept fellow Republicans into statewide office with him. The stunning victory heralds a new era in a state where Democrats have held the governor’s mansion for all but four of the last 44 years.

In beating his Democratic opponent, Attorney General Jack Conway, by almost nine percentage points, Mr. Bevin, 48, shocked people in his own party, who believed that the climate in Kentucky was ripe for a Republican but feared that Mr. Bevin, a charismatic conservative with a go-it-alone style, was too far out of the mainstream and too inexperienced to win.

A few things about this. First, I have noted before that when Democrats get to run places like the big cities of Chicago, Detroit and Baltimore for decades, with few to no Republicans in that time, and when we see these cities crumbling when they have this free hand, it’s hard to understand why the voters in those cities keep electing folks from the same party over and over. It’s like they think that the same guys who got them into this hole can now dig them out of it using the same shovels. I’m hoping that this signals a change in the voters of Kentucky; that they’ve finally said, “Enough is enough.”

Bevin, as noted above in the NY Times article, was a Tea-Party-type. The Republican establishment was concerned that he was too conservative, or “too far out of the mainstream” to win. It appears that perhaps the “mainstream” isn’t necessarily where those pundits think it is. It may be running more to the political Right.

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The Supreme Court case, King v Burwell, was essentially a question of whether the ObamaCare law would be interpreted as written, or as it was meant to be written, as best as the justices could divine the intent of Congress. The particular issue was whether the IRS could provide subsidies to those who needed them in states where they had their own health insurance exchanges, or in all states, even if they didn’t have an exchange.

What the law said was that the IRS would administer those subsidies through the exchanges “established by the states”. However, what the IRS did was to funnel them through state and federal exchanges, which is not what the law, y’know, actually said. They essentially reinterpreted the law to mean that exchanges not established by the states qualified as exchanges established by the states.

Some states said, no, that’s an unconstitutional reading of the law. There are other places in the law where it specifically refers to the states and the federal government combines, but it does not here. That is true. Here’s something else painfully true; this particular wording was exactly what was meant when the law was written.

How do we know this? Jonathan Gruber, the well-paid architect of the law itself, told us so. It was a classic carrot-and-stick approach. The carrot was billions in tax dollars. The stick was that if you didn’t set up a state exchange, you wouldn’t get any of it. There a link in the show notes to a video explaining all this and him saying, “I hope that that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges.”

This was not a case of trying to read a crystal ball and discover the intent. This was not trying to reach into the minds and writings of the founding fathers and trying to glean what they meant on some obscure constitutional point. You can’t search YouTube to find out what Washington and Jefferson were thinking, But Gruber is all over the Internet, on and off the record.

This was a game of chicken. Would the states blink first, and all setup exchanges, or would the feds blink and change the law. As it turned out, the fed’s blinked, but instead of changing the law, they just did what they wanted, and the IRS (which, last I checked, was not part of the legislative branch of the government) ruled that it would provide subsidies through the federal exchange as well.

And Chief Justice John Roberts and his cohort said, “Eh, seems legit.” OK, the ruling was a bit longer than that – 21 pages longer – but in the end that’s what they did. They claimed that if the subsidies were stopped it would ruin the implementation of ObamaCare, ignoring completely that that was the point all along.

Justice Scalia, writing in his typically entertaining dissent (which is basically the high point of this whole ruling), said that if an exchange not established by a state is actually an exchange established by a state, then words have no meaning. Truer words, that do have meaning, have never been spoken.

I don’t think those who are celebrating and praising this ruling have any idea at all what it could mean in the future for the power government has over us. And by “those who are celebrating”, I mean, generally, Democrats. The process, however fatally flawed and upside down it is, doesn’t matter as long as they get what they want. It’s always about politics.

From this point on, federal government agencies can now interpret the law any way they please. Really. Restrictions that were in place in the ObamaCare law were cheerfully ignored in furtherance of a political agenda, and the Supreme Court gave them 6 thumbs up. George Will, writing at the Washington Post, put it this way.

The most durable damage from Thursday’s decision is not the perpetuation of the ACA, which can be undone by what created it — legislative action. The paramount injury is the court’s embrace of a duty to ratify and even facilitate lawless discretion exercised by administrative agencies and the executive branch generally.

Theprocess has been butchered by this ruling. Sure, ObamaCare proponents got what they wanted, but at a price to their own power as a people that I’m sure they are blissfully unaware of. The political process of a government restrained by law, influenced by the people, which has been slowly eroding anyway, just did a nose dive.

You say lobbyists have too much power? I’d agree, because they just had to go to one place – Congress – to spend their dollars budgeted for graft. Now, they can bypass the middleman and go straight to the IRS or any other federal agency and bribe an unelected bureaucrat. And that bureaucrat doesn’t have a campaign coffer he or she needs to keep funded, so it’ll be cheaper for the lobbyist. It’s a win-win! But remember, you don’t figure into either of those two wins.

Some folks, when I bring this up, claim I’m just mad because my side lost. Well, I don’t deny that I don’t like the outcome of the ruling, but even beyond that, and looming larger, is the power grab I see in DC. Unfortunately, all I get in dissent is, “Blah blah blah. Too bad. You lost. I don’t care.” Yes, literally, those words.

(Yes, it’s been a while since I blogged here. I’ve been busy with my podcast “Consider This”. However, I just had to come out of blogging semi-retirement to comment on this.)

Being argued today at the high court is King v Burwell, a lawsuit against ObamaCare (also known in some circles as the Affordable Care Act). This is a set of questions and answers that I imagine many people have about this.

Q: What is this case all about?

A: The crux of the issue is a 4-word phrase inside the massive law; “established by the States”. The subsidies supplied by the IRS, according to the text of the law, were to only go to those who applied for insurance via exchanges “established by the States”. If they used the federal exchange (HealthCare.gov), that is not “established by the States” so the subsidies wouldn’t apply.

That’s according to the plain language of the law, and according to Jonathan Gruber, a major influence in the creation of the law.

What happened was that the IRS gave out subsidies to those without state exchanges anyway. The lawsuit is saying that the government broke the law in doing so.

Q: What case is the government making?

A: That the rest of the law, taken as a whole, makes it clear that withholding subsidies from those who didn’t get their insurance via exchanges “established by the States” was not the intent.

Q: Does it actually say in the law somewhere, specifically, that those people should get subsidies?

A: Not that I’ve read. In fact, those articles I’ve seen that have written in defense of the subsidies (like this article by Robert Schlesinger in USA Today) don’t cite any other text that would buttress that opinion. Rather, they argue about the results if the subsidies were overturned.

To me, that sounds like they’re arguing that a law should say what the implementers want it to say, regardless of what the law itself says. That’s a precedent I don’t think we want to create. For example, if a Republican President vetoes legislation, and a Democratic Congress overrides that veto, is the President free to implement the provisions of the law he or she likes and ignore others? I’d say No, and I think those arguing for the ObamaCare interpretation would agree with me if the parties today were reversed.

The IRS did issue a ruling saying that they would, in fact, give subsidies to those in states without exchanges, but as far as I’m aware, the IRS is not part of the legislative branch.

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What Works and What Doesn’t: Health Care

(This is part of the script for the latest episode of my podcast, "Consider This!". You can listen to it on the website, or subscribe to it in iTunes, Stitcher Radio, Blubrry, Player.fm, or the podcast app of your choice.)

Liberal columnist Ezra Klein, writing in the Washington Post, June of 2009:

If you ordered America’s different health systems worst-functioning to best, it would look like this: individual insurance market, employer-based insurance market, Medicare, Veterans Health Administration.

Yeah, he really said that, and it was obviously untrue back then. But that didn’t stop his love of socialized medicine. Here he is again in 2011:

The thing about the Veteran’s Administration’s health-care system? It’s socialized. Not single payer. Not heavily centralized. Socialized. As in, it employs the doctors and nurses. Owns the hospitals. And though I think there’s some good reason to believe its spending growth is somewhat understated — it benefits heavily from medical trainees, for instance — accounting for that difference still means a remarkable recent performance.

He also called the VA system, “the program is one of the most remarkable success stories in American public policy.” Of course now everyone’s saying that the system has been awful for decades, so you can’t blame Obama for it. While that’s certainly true, you can blame liberal pundits who have been trying to suggest for years that the performance of the VA means that ObamaCare ought to work. It seems like they’ll say anything to get their policies enacted. Never mind reality.

And they’re making the same claim as a certain presidential candidate did 6 years or so ago. So in a sense, you can blame the President for foisting on us a system based on one that was, and is, a money pit and an abject failure, and which is utterly dishonest about those failures. They can, or should, be able to see what works and what doesn’t, but I guess Obama is going with the idea that this time, it’s gonna’ work.

More Money for Medicare?

One of the alternatives to ObamaCare that the Left suggested is that Medicare should just be expanded to cover everyone. It “worked”, so they said, and thus that would be a simpler way to get health care coverage expanded.

But an investigation by the inspector general of the Department of Health and Human Services said that the program spent $6.7 billion (with a “b”) too much for office visits and other services. And that’s just in 2010; just one year’s worth of fraud, abuse and/or incompetence.

We keep hearing about how this politician or another wants to save the government and the taxpayer money by eliminating this kind of waste, but it never happens. Here’s one reason why. The Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn’t plan to review the excess billing payments that account for this because it isn’t cost-effective to do so. Essentially what they’re saying is that it would cost more than $6.7 billion to save that $6.7 billion. Really? Is…is that job opening available? Because if it is, I think I could do it for half that cash. Or, at least I’d like to try.

See, this is a prime example of the problems of big government. It can waste billions – billions – and then claim that it’s not cost effective to deal with the waste. And then the recipients of that fraud have nothing to worry about. Their scam is safe within the walls of a massive bureaucracy. Oh sure, it’s helping the poor and elderly, but really, is there no way at all for that to happen without flushing away billions every year? Really?

This is also a prime example of what happens to centralized government programs. They become bigger and costlier, and, as Ronald Reagan observed, they wind up being the closest thing to eternal life we’ll see this side of heaven. They are a power unto themselves, and any attempt to rein them in has to deal with that inertia, not to mention that, as I said earlier, any attempt to curb such waste gets those attempting it the injustice of being considered hateful, racist, and whatever else the Left can come up with today.

There’s a trend here on the issue of big government programs, both in the money they cost, and the way they’re defended in spite of their results. And yet, we just keep adding to their numbers. If one definition of insanity is doing the same thing over and over but expecting different results, it’s time to have the government committed.

It has been a tenet of the Left that government can be a force for good, and no one’s really denying that. It’s just that there are places for it, and places where it shouldn’t be, and if you overextend government’s reach, prepare for these very consequences. The Constitution was written to keep those kinds of folks in check. Unfortunately, there’s not been enough pushback, and now too many Americans expect this sort of overreach, but they want others to pay for it.

More Money for the VA?

(This is part of the transcript of my latest podcast episode, "Consider This!")

In an opinion piece at the Huffington Post by H. A. Goodman, he argues that Republicans have been complaining about how bad the VA is, but hypocritically voted against a bill for various funding for the VA back in January.

Here’s a problem with that, and it’s not something you’ll hear on most newscasts. For the last 5 years, the VA has not spent its full health care budget; as much as $1.163 billion extra to as “little” as $450 million in medical-care funding from this past fiscal year. And still vets have been waiting too long for care, some paying with their lives. Clearly, clearly, throwing more money at the problem has done nothing whatsoever to fix it.

The Republicans, back in January, said that if the huge catch-all bill were split up into separate bills, there were plenty of items they would vote for. The issue was fiscal responsibility. Democrats, on the other hand, really do have the mindset that enough greenbacks will solve any problem, especially if the problem is one that makes liberalism look bad. And the single-payer VA medical system absolutely fits that particular bill. Creating a single source of a particular product or service (in this case, health care) inevitably leads to scarcity (in this case, waiting lines). If vets could choose any hospital they wanted, and if the government still picked up the tab, would we have this problem? No. But this would be an indictment of a system that Democrats want to see implemented all over, and so it cannot be seen to fail.

Remember this when Democrats like Mr. Goodman accuse Republicans of “hating the poor” or of being “racist” because they don’t want to throw more money at programs that are similarly flawed. Since the mid 60s, when the “War on Poverty” began, the poverty rate has been bouncing around between 10 and 15% of the population. Nothing has changed. Prior to that, the poverty rate had been steadily decreasing, from 30% in 1950 to 15% when we went to war on it. We were gaining ground, but since “going to war”, it’s been nothing but a stalemate, even though the programs have been costlier every year. But just look askance at the programs, just try to reign in some of that continue rise in cost, and you get accused of all manner of hate and villainy. For nearly half a century we’ve been pouring more and more money into it, just like the VA. And, just like the VA, it is not doing what it is supposed to be doing, or doing it incredibly inefficiently.

But if you want to change the flat tire and try to get things done better, you’re accused of hating the car. The flat’s got us this far, it can go further, right?

The Real Issue With the VA

(This is part of the script for the latest episode of my podcast, "Consider This!". You can listen to it on the website, or subscribe to it in iTunes, Stitcher Radio, Blubrry, Player.fm, or the podcast app of your choice.)

Presidential candidate Barack Obama, back in 2007, gave a speech titled “A Sacred Trust”. It was a speech about the military; his plans for it, and for the veterans who came home from it. Here is one thing he said in it, “No veteran should have to fill out a 23-page claim to get care, or wait months – even years – to get an appointment at the VA.”

How was he going to fulfill that goal? Here was his promise, “It’s time for comprehensive reform. When I am President, building a 21st century VA to serve our veterans will be an equal priority to building a 21st century military to fight our wars. My Secretary of Veteran’s Affairs will be just as important as my Secretary of Defense.” He followed that with specific changes he was going to make. But, whether he made those changes or not, whether or not vets are means-tested for care, whether or not VA budgets were passed on time every year, the result is still the same; long waits, and deaths due to them.

Obama knew of the problems in the VA before he became President. At least 5 years ago, he was warned about the specific wait time issue. What has changed? Nothing. And now he claiming he was shocked to hear about it; not from his advisors, but from the media. Let’s not forget that he was shocked about the IRS targeting conservatives, up until the point where he claimed that there was “not a smidgen of corruption”. I guess his views on that “evolved”.

There is another line from that speech that I think bears considering. His plans for the VA were a blueprint for something else. “The VA will also be at the cutting edge of my plan for universal health care, with better preventive care, more research and specialty treatment, and more Vet Centers, particularly in rural areas.” That’s right. ObamaCare was the next step, and what’s happening now with the VA is the future of what’s going to be happening with you. Centralized health care, or passing laws to create facilities and doctors out of thin air, doesn’t work.

And honestly, this has been the issue for decades. It didn’t start when Obama was elected. Presidents from both parties have presided over this long-running debacle, some say as far back as the Kennedy administration, because the fundamental problems are always there. On MSNBC, one of their military analysts, Army Col. Jack Jacobs, spoke on The Reid Report about how Veterans Affairs Sec. Eric Shinseki was a good guy and was doing a good job, but in the end, the VA’s system of health care itself cannot give us what we need from it, regardless of how much money you throw at it.

Yeah, that really aired on MSNBC. But if the VA is the blueprint for ObamaCare, then the question is this: If we can’t take care of those we are the most indebted to, how is it going to work for all of us? Centralization like this – one of the pillars of the liberal view of government – is a failure. It has been shown not to work, specifically with regards to health care, and yet we just keep doing it bigger and costlier. Vets are dying in service to this social and political experiment. That’s certainly not the war they signed up for.

And in the meantime, Army Private and convicted felon Bradley Manning has been on the fast-track to get his sex change. Got to have your priorities.

The White House vowed to withdraw all U.S. troops from Afghanistan by year’s end. That’s if they agree to leave. Comedian Argus Hamilton says, if given the choice between surviving Taliban attacks in the Afghan mountains and surviving VA care when they get home, they like their chances in the mountains.

Unique Lawsuit Against ObamaCare

George Will, writing in the Washington Post, highlights a very novel lawsuit working its way through the courts. Essentially, the thought process of the suit goes like this:

  1. The Constitution says explicitly that, “All bills for raising reveornue [that’s the 1700s spelling of “revenue”] shall originate in the House of Representatives”.
  2. The ObamaCare bill originated in the Senate. No problem there, but…
  3. The Supreme Court, in what Will calls a “creative” reading of the law, called the bill a “tax” on certain activity (or, in the case of ObamaCare, inactivity).
  4. As a tax, it is therefore a revenue bill, but it did not originate in the House, and is therefore unconstitutional.

Ya’ gotta’ wonder if Chief Justice John Roberts played rope-a-dope with the liberals on the bench in creating this particular interpretation, and was hoping someone out there would notice.

There are some other issues with how the bill was created, and reading this short piece, from a link in the show notes, is incredibly enlightening. Keep an eye on Matt Sissel and the Pacific Legal Foundation’s lawsuit. We may be hearing about it more prominently in the months to come.

From the "Now They Tell Us" Department

The Associated Press is breaking news that those of us who were paying attention knew about at least 6 months ago.

The first thing Michelle Pool did before picking a plan under President Barack Obama’s health insurance law was check whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.

Pool’s $352 a month gold plan through Covered California’s exchange was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn’t taking her new insurance.

"It’s not fun when you’ve had a doctor for years and years that you can confide in and he knows you," Pool said. "I’m extremely discouraged. I’m stuck."

Stories like Pool’s are emerging as more consumers realize they bought plans with limited doctor and hospital networks, some after websites that mistakenly said their doctors were included.

Now we know why her policy’s cheaper. You get what you pay for.

Health Care Coverage vs. Health Care

There’s a difference between getting heath care coverage, and actually getting health care. In the US, you could always get health care. Emergency rooms had to see you whether or not you could pay them. And there were various free clinics, like one in Mountain View, California.

The Rotacare clinic was happy to help out their patients in getting ObamaCare coverage so they’d no longer need the free clinic. Months later, however, the same people are coming back. Why? They can’t find a doctor taking more patients or who are accepting the plans.

Conservatives warned that exactly this thing would happen, years ago. It was handwaved away as scare tactics. But it’s Californians who are scared now, about having to pay premiums, subsidized though they may be, and not be able to actually use what they paid for.

Millions of Californians have been added to the ranks of the insured, but 1/3 of California primary care physicians are set to retire. What are we going to do now? We passed a law that said insurance should be magically cheaper. That didn’t work. So then let’s pass a law to make doctors magically appear!

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