The challenge to the individual mandate that the law’s supporters originally ridiculed is now headed to the Supreme Court as the Obama administration appealed yesterday the 11th Circuit’s August ruling that found the mandate unconstitutional. This increases the likelihood that the Court will take the case up in its term that starts Monday, potentially ruling by next June.
There has been a lot of debate about why the administration didn’t delay.
Tom Miller of AEI opines that, with the president’s poll numbers in the tank, the White House may not want to take the chance a Republican administration would be put in a position to defend the law in court in 2013: “If, in fact, [Obama is] not around in 2013, who do they want running the show in terms of putting the last bit of regulations together in 2012, or even making this argument before the Supreme Court?” asks Thomas Miller, health policy expert at the center-right American Enterprise Institute. He adds that a solicitor general is duty-bound to uphold existing law, “but there’s a degree of energy and cleverness that may or may not be there to the maximum if it’s another administration.”
The Obama administration indicated it wouldn’t attempt to argue that a ruling on the mandate’s constitutionality should be deferred until after its implementation in 2014, based on the provisions of the Anti-Injunction Act — the basis for the 4th Circuit’s refusal to speak to the merits of the mandate.
The administration is also going to argue that the mandate is a tax — a gutsy move since it has been rejected over and over by lower courts and the president himself argued that the mandate is absolutely, positively, not a tax.
This is the battle for liberty in our time and the outcome could not be more consequential.
Health costs rising: The Kaiser survey of employer-sponsored coverage quantified what businesses across the country already know in saying that premiums rose this year by an average $1,303 per family — at the rate of 9%, with a family policy now averaging $15,073. This is a far cry from the $2,500 savings that President Obama repeatedly said families would see by the end of his first term.
Did they really think all the early “benefits” of ObamaCare would be free? Preventive care is not free, even if patients are no longer required to pay anything. Raising the ceiling on what insurance pays for is not free. Adding “children” up to age 26 to their parents’ policies isn’t free. And this is only the beginning of the costs of this break-the-bank law.
The case for replace: The most important news of the week, though, was a speech given by House Budget Chairman Paul Ryan at the Hoover Institution at Stanford University. Rep. Ryan is looking toward the future with his speech entitled “The optimist’s guide to repeal and replace: Patient-centered health-care reform for the 21st-century.”
He describes the vision of a health system that will empower Americans to become partners in getting the best value in their health spending and getting our health sector and economy on the right track. Paul says it best. Here are some excerpts:
…we cannot stop at repeal. We also have a responsibility to fix the broken network of government policies that have made such a mess of health care in America…[but] the political hurdles that stand in the way of real, structural health-care reform are daunting.
…The urgent need to repeal and replace the President’s health-care law, coupled with the urgent need to deal with the drivers of our debt, will present us with an unavoidable time for choosing, allowing us to confront health-care inflation head-on.
…badly designed government policies are to blame for much of what is wrong with health care today, and the solution is clear: We need to transition from the open-ended, defined-benefit approach of the past…to market-oriented, defined-contribution reforms that promote choice and competition.
At its core, the health care problem is one of inflation, driven by the overutilization of services, dramatic underpayments, and massive inefficiency…The system that shields us from the cost of services, has actually left us paying much more.
…the President’s law…expands broken government programs, enhances bureaucratic control, and imposes flawed mandates that will continue to drive up the cost of health care.
…Our plan is to empower patients. Their plan is to empower bureaucrats.
…The House-passed budget offers a better way to strengthen Medicare and save it from insolvency. Instead of using cram-downs that simply pay providers less while jeopardizing seniors’ care, our budget proposes real reforms designed to slow the growth of health-care costs economy-wide by promoting true choice and competition. Empowering seniors, not bureaucrats, is the best way to save and strengthen Medicare.
At a House Budget Committee hearing last July, [Medicare] Chief Actuary Rick Foster gave evidence in support of this point: “We’ve estimated for many years that competition among plans in a premium-support setting like this could have advantages and lead to somewhat lower costs for Medicare. It can get you to the lowest cost consistent with good quality of care.”
And not just in Medicare. Choice and competition are critical to controlling costs throughout the health-care system, while improving quality for patients.
…The solution…is to move away from defined-benefit models and toward defined-contribution systems…defined contributions should underpin a system driven by patient choice and centered on patient needs — one that offers real security instead of empty promises.
…Instead of top-down price controls imposed by 15 bureaucrats at IPAB, let’s try bottom-up competition driven by 300 million consumers.
…the case for repeal must be matched with even greater intensity by a case for replace — replacing the law with structural reforms and real solutions to the problems Americans are facing in health care…premium support for Medicare, block grants for Medicaid, and tax reform to correct the inefficient tax treatment of health insurance.
…Look, I understand how daunting the politics of these issues are. But we can clear these hurdles if we combine political courage and clarity of purpose with faith in the American people.
…[In two recent special elections] People listened. They learned that our plan did not affect those in or near retirement; that it guaranteed coverage options like the ones members of Congress enjoy; and that choice and competition would drive costs down and quality up. They also learned more about the Democrats’ plans for Medicare, and they didn’t like what they heard.
And the scare tactics stopped working.
But the point is that we should not fear false attacks again in 2012.
…In health care, we owe the American people a defining choice, and that choice is: Who is in charge: The government or the patient?
What we need in health care is more efficiency and productivity, so that the pace of rising costs slows in coming years. How will that come about? Certainly not with more bureaucratic control. HHS can’t engineer a more efficient health care system from Washington, D.C. They have been trying for decades, and they have only made things worse.
What will work is empowered consumers looking for value. Giving patients and consumers control over health care resources would make all Americans less dependent on big business and big government for our health security; give us more control over the care we get; and force health care providers to compete for our business.
This is how…we will unite the country to do what’s right, both for this generation…and for the next.
Paul’s leadership is absolutely vital. The whole speech is really worth reading as he outlines a vision for a 21st century, patient-centered health sector. But, it is of course, already coming under attack. Here is a link to a fact sheet his office prepared yesterday with the rebuttal.
I’m on a speaking tour that has taken me from coast to coast over the last two weeks. More on my travels in my next report…
CLIP OF THE WEEK
Grace-Marie Turner on FOX Business
In this video, Grace-Marie Turner discusses health care reform and the rising cost of insurance on Varney & Co.
Watch now >>
GALEN IN THE NEWS
CLASS Is Out
National Review Online: Critical Condition, 09/26/11
Obamacare is collapsing. The latest example is the brouhaha over the maybe-it’s-closing, maybe-it’s-not office that is tasked with implementing the CLASS Act. Bob Yee, the actuary charged with the impossible task of making the program work, sent out a clearly unauthorized e-mail last week telling colleagues his office was closing. The White House denied it, but a Senate Appropriations Committee staffer earlier had told reporters that the administration had asked Senate Democrats not to provide any funding for the long-term care program offices for the next fiscal year. Connie Garner, a former staffer to the late Sen. Ted Kennedy and architect of the CLASS Act, pointed out that the program was created by law, and that the administration can’t just terminate it. So where is the money going to come from to make up the difference? Good riddance to this program, but Congress still needs to ask the question.
Read More »
The Census, ObamaCare and the Uninsured
Sally C. Pipes, The Wall Street Journal, 09/26/11
Beyond ‘Repeal and Replace’
The Wall Street Journal, 09/28/11
D.C. Appeals Court Points the Way to the Defeat of Obamacare’s Individual Mandate
Avik Roy, Forbes: The Apothecary, 09/29/11
The President’s Latest Health Care Proposals Don’t Constitute Entitlement Reform
James C. Capretta, e21, 09/26/11
The Failure of Health Care Reform: An Insider’s View
Merrill Matthews, Forbes: Right Directions, 09/29/11
States Should Return Obamacare Grants, Pursue Own Health Care Reforms
Edmund Haislmaier, The Heritage Foundation: The Foundry, 09/28/11
Employer Health Benefits 2011 Annual Survey
Kaiser Family Foundation and Health Research & Educational Trust, 09/27/11
2011 Health Confidence Survey: Most Americans Unfamiliar With Key Aspect of Health Reform
Paul Fronstin, Employee Benefit Research Institute, 09/11
Building a Better Military Health Care System
Baker Spring, The Heritage Foundation, 09/29/11
Health insurers buy majority stake in Bloom Health, will launch national private insurance exchange
Chris Anderson, Healthcare Payer News, 09/23/11
Making Workers Pay as the Cadillac Tax Looms
Margaret Collins, Bloomberg Businessweek, 09/22/11
The Economic Effects of Massachusetts Health Care Reform
David G. Tuerck, Ph.D., Paul Bachman, MSIE, Michael Head, MSEP, The Beacon Hill Institute, 09/11
National Health Care Reform: The Impact on Tennessee
Steven L. Coulter, M.D. and William T. Cecil, MBA, BlueCross BlueShield of Tennessee Health Institute, 09/11
Obama’s Pharmaceuticals, Inc.
Scott Gottlieb, National Review Online, 09/22/11
AP Impact: Hospital drug shortages deadly, costly
Linda A. Johnson, Associated Press, 09/23/11
INTERNATIONAL HEALTH SYSTEMS
NHS told to abandon delayed IT project
Denis Campbell, The Guardian, 09/21/11
£7bn NHS electronic records ‘achieving little’ for patients
Nick Triggle, BBC News, 05/18/11
The Misguided War against Medicines 2011
Mark Rovere and Brett J. Skinner, Fraser Institute, 09/26/11
MEDICARE AND MEDICAID
Low-Income & Rural Beneficiaries with Medigap Coverage, 2009
America’s Health Insurance Plans, 09/28/11
Low-Income & Minority Beneficiaries in Medicare Advantage Plans, 2009
America’s Health Insurance Plans, 09/28/11
Prescription Drug Shortages
Food and Drug Administration Webinar
Friday, Sept. 30, 2011
11:00 a.m. ET
Long-term Services and Supports: A Rebalancing Act
Alliance for Health Reform and The Commonwealth Fund Briefing
Monday, October 3, 2011
12:15pm – 2:00pm
The Oregon Health Insurance Experiment and Evidence-Based Health Reform
Cato Institute Policy Forum
Wednesday, October 5, 2011
Grace-Marie Turner on The Small Business Advocate
Nationally Syndicated Radio Broadcast
Thursday, October 6, 2011