Ray Harvey

The following is Barack in 2008, campaigning hard against Hillary Clinton. Note how Barack comes out swinging against an individual mandate to purchase health insurance, stating (correctly) that Hillary would garnish workers’ wages and that Massachusetts’ individual mandate has left many residents “worse off.” Watch:

Then, in the following video, he says (and I quote): “If a mandate was the solution, we could try that to solve homelessness by mandating everybody buy a house”:

Were it not for the obvious fact that Barack Obama is a chronic liar, the fact of him signing the individual mandate into law would be virtually incomprehensible. And of course he told us a few short months ago (at around the 3:00 minute mark of the following exchange) that the individual mandate is not a tax:

But that was then, and this is now. From the New York Times:

When Congress required most Americans to obtain health insurance or pay a penalty, Democrats denied that they were creating a new tax. But in court, the Obama administration and its allies now defend the requirement as an exercise of the government’s “power to lay and collect taxes.”…

Administration officials say the tax argument is a linchpin of their legal case in defense of the health care overhaul and its individual mandate, now being challenged in court by more than 20 states and several private organizations.

Says Cato’s Michael Cannon:

The next time Obama is in the mood to reverse himself on the individual mandate, he might consider this statement from June 2009:

When the government makes health insurance compulsory, that is socialized medicine. (Why else would ObamaCare win plaudits from Fidel Castro?) It would be nice to hear the president admit it.

The dynamic Doctor Mariela Resendes (M.D.) is a private practitioner who spent her previous 5 years as the Managing Partner/CEO of the largest Radiology practice in the San Joaquin Valley of California, CMI Radiology Group. Just recently, she wrote an irrefutable and scathing essay on the coming healthcare disaster that Barack Obama and his clownish administration have just unleashed. I reprint it here in full:

As a practicing doctor in California it troubles me that those with the ability to influence health care legislation have either been politically motivated to remain silent, or strikingly inarticulate when it comes to voicing the major issues patients and taxpayers will face with the new health care bill. My own, long-held view has been that any reform should be of the free market variety.

In that sense, I’m increasingly scared as I learn more about what’s inside the health legislation passed by Congress not long ago. Despite the rising level of unhappiness with what has transpired, it dismays me that the general public, like me, is not fully aware of the financial tsunami that is on the way for patients, insurers and hospitals thanks to this legislation, not to mention the irregular way in which it was passed.

In the newspapers we all read that the legislation was passed via reconciliation. Most people do not understand what this represented. What Congress did was to pass this legislation under the Congressional Budget Act of 1984, which allows a loophole to avoid a 60 vote filibuster in laws which refer to changes in revenue and spending amounts; i.e. budgetary issues.

The legislation which Congress passed certainly does affect the budget, but clearly the bill’s intent wasn’t budgetary; rather it concerned dramatic changes for a large portion of our economy: health care. Given the bill’s intent, one can only hope that the upcoming elections bring greater ideological balance so that what promises to be damaging can at the very least be amended.

“Obamacare”, as it is colloquially termed, is financially a disaster for doctors, hospitals, insurers, and will ultimately be a disaster for our nation’s budget. It is also unfortunate for patients needing care.

Obamacare’s proponents tout the legislation’s cost controls, along with expansion of coverage for those who currently do not have insurance. The policy wonks seek cost containment and “efficient” use of resources. More realistically, cost containment could only be achieved if access to care were rationed.

Rationing in mind, Rahm Emmanuel’s brother published a very well received paper in the New England Journal Of Medicine about efficient or optimal deployment of resources in health care. The upshot is that a young man is worth spending a lot of money on, a young child much less, and for seniors, pretty much nothing; all in a calculated return on investment model.

For physicians, Obamacare initially offered promises of tort reform, as well as promises to reverse the Medicare cuts that made it so difficult for physicians to practice. Neither is in the final legislation. As a result, doctors will continue to practice defensive medicine, and for doing so will face 20%+ cuts in their Medicare payments.

Physicians in primary care will initially see an income boost from 2011-2014, thus encouraging them to take on indigent patients the system needs to absorb. Unfortunately, starting in 2014, the payments per patient will fall for primary care doctors too.

Specialists will receive a financial hit right from the beginning. The goal here is to have less in the way of specialists, and more general practitioners. On its face this will drive more doctors into early retirement.

As for the physicians that choose to continue practicing, they’ll have difficulty staying afloat financially, and many will seek employment opportunities similar to those of “foundation” practices (such as those seen in states like California where hospitals can’t employ physicians), or hospital owned practices in other states.

The explicit goal here is to slow the move toward private practice. Doctors in foundation types of practices act more like union or shift-workers, and less like professionals. Their productivity tends to be lower than in traditional private practices; ergo more doctors are needed for a similar number of patients. Considering a scenario of rising physician retirement alongside a large increase in the number of patients, it is unclear how treatment and diagnosis will occur in a timely fashion.

Hospitals are similarly not going to fare well, and many will simply go under. Previously, hospitals took in higher payments from privately insured patients in order to care for those who couldn’t pay, or for those covered by Medicaid. At the same time, hospitals which had a higher number of indigent patients also received what is called disproportionate share funds from state and federal governments. Rural hospitals in particular received extra funds.

But with Washington’s new mandate, the expectation is that all of the previous non-paying patients will now pay for themselves such that subsidies for indigent-care will be eliminated. Unfortunately, this will occur in concert with reduced inflows from privately insured patients whose costs will be reduced to Medicaid levels.

In short, the money from the increased volume of “paying” patients is not enough to counter the loss of disproportionate funds and decreased classic private insurance payments. The net result will be a deficit for many hospitals. They will not be able to keep their doors open if they sustain persistent losses, which is what is expected.

Many insurance companies will be squeezed out of existence thanks to rules that will bar them from denying coverage for pre-existing conditions. And unlike the federal government they won’t be able to operate in the red forever. The end result points to a single-payer system run out of Washington.

Looking ahead, it is increasingly apparent that by 2020 we will have severe cuts in service thanks to rising retirement among doctors, a decrease in the number of private insurers, and a reduction in the number of hospitals due to federal mandates that fail to marry costs with services. The end result will be rationing and delay of elective procedures, denial of expensive but effective treatments a la England, and most likely a single-payer system the likes of which is seen in other, less advanced health care systems around the world.

Here is more on how our healthcare crisis began.

And here is the real solution.

It’s become very difficult now to keep up with the sheer multitude of lies told by Barack Obama and his clownish administration, but here’s a recent one that should give everybody pause:

In order to protect the new national health care law from legal challenges, the Obama administration has been forced to argue that the individual mandate represents a tax — even though Obama himself argued the exact opposite while campaigning to pass the legislation.

Late last night, the Obama Department of Justice filed a motion to dismiss the Florida-based lawsuit against the health care law, arguing that the court lacks jurisdiction and that the State of Florida and fellow plaintiffs haven’t presented a claim for which the court can grant relief. To bolster its case, the DOJ cited the Anti-Injunction Act, which restricts courts from interfering with the government’s ability to collect taxes.

The Act, according to a DOJ memo supporting the motion to dismiss, says that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is the person against whom such tax was assessed.” The memo goes on to say that it makes no difference whether the disputed payment it is called a “tax” or “penalty,” because either way, it’s “assessed and collected in the same manner” by the Internal Revenue Service.

But this is a characterization that Democrats, and specifically Obama, angrily denounced during the health care debate. Most prominently, in an interview with ABC’s George Stephanopoulos, Obama argued that the mandate was “absolutely not a tax increase,” and he dug into his view even after being confronted with a dictionary definition:

OBAMA: George, the fact that you looked up Merriam’s Dictionary, the definition of tax increase, indicates to me that you’re stretching a little bit right now. Otherwise, you wouldn’t have gone to the dictionary to check on the definition. I mean what…

STEPHANOPOULOS: Well, no, but…

OBAMA: …what you’re saying is…

STEPHANOPOULOS: I wanted to check for myself. But your critics say it is a tax increase.

OBAMA: My critics say everything is a tax increase. My critics say that I’m taking over every sector of the economy. You know that. Look, we can have a legitimate debate about whether or not we’re going to have an individual mandate or not, but…

STEPHANOPOULOS: But you reject that it’s a tax increase?

OBAMA: I absolutely reject that notion.

At the time Obama made that statement, the Senate Finance Committee had just released its own health care bill, which clearly referred to the mandate penalty as an “excise tax.” But in later versions, the word “tax” was stripped, because it had become too much of a political liability for Democrats. The final version that Obama signed did not describe the mandate as a tax, and used the Commerce Clause — not federal taxing power — as the Constitutional justification for the mandate.

“”This is an about face from what is laid out in the law,” said Karen Harned of the National Federation of Independent Business, which joined the Florida lawsuit against ObamaCare. “In the text of the healthcare law, the findings for passing an individual mandate specifically rely on the effects of individuals on the national economy and interstate commerce. Nowhere in the findings is the mandate referred to as a tax. The Justice Department is now calling it a tax to try and convince the court not to rule on whether or not Congress exceeded their authority under the Commerce Clause by legislating that all citizens must purchase private health insurance or face a penalty.”

Put another way, the administration is now arguing in federal court that Obama signed a massive middle-class tax increase, in violation of his campaign pledge.

Read Philip Klein’s full article here.

Dr. Jack Cassell is a urologist in Florida. Just recently, he put the following notice on his Mount Dora practice:

“If you voted for Obama, seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Cassell told reporters that he wasn’t refusing care to patients; he wanted only to educate them on how the new healthcare takeover would affect them:

I came across the timeline for implementation of Obamacare and I got a little discouraged when I got to next year when I found that most of the ancillary services and nursing homes and diagnostic imaging, all these things start to fade away,” he told Fox News’ Neil Cavuto. “And I felt that my patients really need to know about this. And the more I thought about it, the angrier I got until I finally felt like I’m going to put a little splash page on my front door and just get people thinking a little bit.

As it turns out, Doctor Cassell — and I applaud you for your efforts and think that every doctor in the country should go on strike right now, this very moment, to show that their lives and their labor are their own and do not in any belong to the state or to other people — there’s a painfully simple way to demonstrate how and why urologic care, like all healthcare, is not a right:

Rights by definition are immutable and timeless. They apply as much to humans now — and for the same reasons — as they did to humans five or ten thousand years ago. If healthcare is a right, then, where was your right to a heart transplant 200 years ago?

Where is your right to be completely cured of cancer today?

Where is your right to kidney dialysis if there are no kidney dialysis machines?

Where is your right to medical care if there are no doctors anywhere near you because young people are no longer studying the science of medicine, since to be a doctor means to be a slave to the state?

The 2000-plus-page ObamaCare legislation would of course obliterate any remnants of free-market medicine that still exists in this country, and in so doing it would not lower the cost of medicine a bit, nor would it improve medical quality, nor would it ultimately insure more people, as the democrats themselves admit. The reason American medicine is so expensive in the first place is because of the massive bureaucratic apparatus that has gripped the American medical industry, an apparatus that was initially put in place in the mid-1930′s, under FDR and his horrific tax discrimination laws (which created employer-sponsored healthcare), and then expanded drastically in the 1960′s under LBJ.

The obvious question, then, is this: if government intervention created the problem, how is more government intervention going to help?

Answer: it’s not.

In fact, it’s going to compound the problem astronomically.

The following, however, which comes to us via Richard E. Ralston, Executive Director of Americans for Free Choice in Medicine, would help solve the problem, and it would do so without the unconstitutional coercive measures ObamaCare explicitly endorses.

Seven Simple Rules for Health Care Reform

The first simple rule: Make all medical services, insurance and personal savings for such expenses exempt from all federal, state and local income and payroll taxes. Those who complain about the cost of medical care and insurance must be confronted with the fact that if we cannot afford medical care, we surely cannot afford to pay taxes on the money we set aside for it.

The second simple rule: Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.

The third simple rule: Pass legislation now proposed in the U.S. Congress that would give every individual or business the ability to purchase insurance in a national market, from insurance companies in any state. That would allow for ownership of health insurance that is more affordable and can follow individuals from job to job and state to state. The increased competition between insurance companies would restrain the cost of insurance.

The fourth simple rule: Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles. That, more than anything, would make insurance premiums more affordable for Americans who fear the financial consequences of health misfortune.

The fifth simple rule: Broaden the availability of optional coverage provided by Medicare Advantage, but allow for additional tax-deductible premiums to be paid by those seniors who elect such options. More choices from more options should be available to retirees—but not paid for by taxpayers. This would allow for expanded and more efficient coverage, and reintroduce an element of competition to those who seek to provide health care to seniors.

The sixth simple rule: Allow Medicare patients to utilize their Health Savings Accounts to pay for services from their Medicare physicians. This could bring thousands of doctors back into the Medicare program overnight and eliminate the ridiculous and unjust prohibition on those who want to spend their own money on their medical care.

The seventh simple rule: Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation). This would wring the bonanza for a few law firms out of the current ocean of litigation—and the high cost of “defensive medicine” now practiced by providers as protection against such legal extortion. The effect would be a reduction in the cost of medical care and insurance for everyone.

(Link)

For more on the atrocity exhibition of cradle-to-grave healthcare, please read Dr. Yuri N. Maltsev’s account of socialized medicine in Russia. Dr. Maltsev was for many years an economist for Mikhail Gorbachev’s economic reform team. He now teaches economics at Carthage College, in Kenosha, Wisconsin.

Read also medical doctor Paul Hsieh’s limpid explanation of how ObamaCare will prevent good doctors like him from upholding their Hippocratic Oath.

Staff of Asclepius, symbol of healing

What is now termed modern medicine actually began in the early 1920s when science — in particular, germ theory — culminated to a point that sickness and disease were at last being treated reliably. It was then that doctors and hospitals got much better at the business of saving lives. This more highly developed service and expertise raised the value of their work, and they charged accordingly for their increased skill and labor.

And that, really, is when the situation started: for when lives can be saved and health can be gained because of developments in technology, everyone suddenly believes that it’s his or her right to have that thing. We see the same principle at work in, for example, the platitude “No one should go hungry when Americans are throwing away food.”

The error in both cases is the fraudulent notion that survival should be assured. This notion neglects the singular fact that abundance and technology are produced — and produced, moreover, by individuals.

No one has the right to the life and labor (i.e. production) of any individual, including the life and labor of doctors.

An easy way to demonstrate this truth is by asking the following: where was that right before these goods and services were produced or invented?

Fact: American medicine is already 50 percent socialized; there is a clear and incontrovertible correlation between rising healthcare costs and the socialization of medicine in this country. More government intervention will only compound the problem.

In the 1920s, when advancing healthcare became more expensive (though still very reasonable), the administrator of Baylor Hospital in Dallas, one Dr. Justin Ford Kimball, created a system called Blue Cross. The Blues (so-called) were nonprofit health insurers. They served local organizations like the Rebeccas and the Elks Club, and — please pay attention — they kept their premiums low in exchange for tax breaks.

Tax breaks are one of the main components to our current healthcare crisis. They’re what initially created the problem.

Blue Cross, you see, was successful because of these tax breaks. Up until then, commercial insurers had always regarded medicine as a mediocre market, and therefore commercial insurers didn’t deal too much in medicine. But when commercial insurers saw that the Blues were making money, it convinced them to enter the medical field. This was not a problem, at first — until the 1940s, when private insurers increased their efforts to get around wartime wage controls, thus:

During World War II, Franklin Delano Roosevelt’s price-and-wage people, who didn’t generally permit wage increases or price increases (regardless of market forces) sanctioned a form of tax discrimination: specifically, they allowed employers to pay for employee medical insurance with pretax dollars.

This quickly became one of the few ways employers could attract new and better employees, since FDR had actually mandated that employers were no longer permitted to pay out higher wages. (How this ridiculous idea came about is another story, for another time.)

To this day, those who get employer-financed healthcare are purchasing their healthcare coverage with pretax dollars. On the other hand, those who buy their own healthcare are purchasing it with after-tax dollars.

As far as the employer was (initially) concerned, this wasn’t any different from additional labor costs — which is to say, medical insurance was not, from the employers perspective, any different from a rise in wages, and yet FDR’s price-and-wage control people did not at all see it as a wage increase. They therefore allowed it, which may seem surprising in light of FDR’s desire to control the entire economy.

Likewise, the IRS bureaucrats under FDR did not regard this maneuver as a wage increase, and for this reason they didn’t slap a tax on it. Neither did the employees see it as a real raise in wages — a fact that is singular to how this whole horrible precedent was set — because these costs are what economists call hidden costs.

The upshot: people didn’t and very often still don’t know that it is, after all, their own money paying for this prepaid medical coverage, and that medical coverage isn’t free.

In fact, health insurance today isn’t even really health insurance. It’s more properly called prepaid healthcare. But — and this is an absolute crux — it gives the appearance of being free or substantially free to the user, and it therefore substantially increases the demand for it and therefore its cost. Of course, the root of this whole problem is the misbegotten notion that healthcare is not a good and service to be traded on the open market, but a right.

Let us remember what insurance actually is:

Insurance, properly defined, is what you purchase in order to avoid financial ruin in the case of a rare emergency.

Under the dangerous system FDR created, employees came to regard their healthcare coverage as a kind of blessed phenomena which came without cause or consequence. Quickly, this phenomena was absorbed into the working culture and as quickly was taken for granted: employees got used to receiving free goods, which goods, however, were not actually free. Employees just could not see that they were paying for them, and paying for them, furthermore, with pretax dollars.

A family in the bottom fifth of the income distribution pays about $450 more in taxes than insured families at the same income level. For families in the top fifth of the income distribution, the tax penalty is $1,780. On average, uninsured families pay about $1,018 more in federal taxes each year because they do not have employer-provided insurance. Collectively, the uninsured pay about $17.1 billion in extra taxes each year because they do not receive the same tax break as insured people with similar income. If state and local taxes are included, the extra taxes paid by the uninsured exceed $19 billion per year (“Are the uninsured freeloaders?” National Center for Policy Analysis, Brief Analysis No. 120).

Among other things, this illustrates again why entitlements are such a deadly precedent: once they’re entrenched, it’s virtually impossible to retrogress. Why? Because people acclimate to entitlements and in no time cannot imagine life without them.