Sharpening the Pencils & the Debate (VP Ryan)

The selection of Wisconsin Representative Paul Ryan as the Vice Presidential candidate by GOP nominee Mitt Romney changes the Presidential campaign.  While the VP nominee is rarely is a game changer in an election for President, this time around may be different.    To date, the Presidential race has lacked the real debate on the issues facing America:  the US economy, lack of jobs (8%+ unemployment), entitlement reform, limited government and the role of the private sector.    And the campaign debate has failed to address the signature legislative "cram down" by the Obama administration and the government-minded Democrats:  the proposed repeal of ObamaCare by a Mitt Romney administration.
     As the VP candidate, Ryan adds intellectual acumen, budget expertise, youth and the ability to carry the conservative message without apology.   Take the time to pull up some YouTube video clips of Mr. Ryan in action.   Or watch the time that Representative Ryan sliced and diced ObamaCare in his exchange with the President at the joint legislative & executive branch meeting at the White House.   Obama was unable to counter or respond.
     As the Republican Presidential candidate, Romney has changed the subject to the real issues and the "boys from Chicago" will be unable to keep changing the subject away from the obvious.   This President and his liberal expanding of the federal government has failed the American people.   The debate about the true future of limited government vs. unlimited government for the United States now begins in earnest.

(c) 2012, Jasper Welch, Four Corners Media,  www.jasperwelch.org

Whipping Reluctant Democrats into Shape

Whipping reluctant Democrats into shape:

The pressure is on Speaker Pelosi to whip the Democrats into shape.   Meanwhile, the American voter is getting more upset by the day, as they think there voices are not being heard.   So what is going on?

Typically when the “whipping” starts on a major bill congressional insiders say, “The candy store is open.”   For wavering Democrats, that means requesting changes in the legislation in exchange for their support – make this modification, add this or that and I’ll support it. Bargaining like this goes on routinely behind the scenes.  It’s all part of making the great legislative hot dog

The health care bill includes another strange procedural twist.  Democratic leaders in Congress decided to first bring up the legislation the Senate passed in December for a vote in the House.  If it passes, the bill could go directly to the president for his signature.  Democrats are promising wavering House members they will make changes to the bill in a subsequent piece of legislation that will be considered as part of the budget reconciliation process (which requires a simple majority to pass in the Senate).  But it’s unclear when, or even if, this will happen.  As one veteran member of Congress used to say, “Fixing a bill in the Senate is the political equivalent of promising ‘I’ll respect you in the morning.’”  www.weeklystandard.com 

Both parties in Congress elect their respective “whips.” In the House, Rep. James Clyburn of South Carolina holds the position for the Democrats and Rep. Eric Cantor of Virginia for the GOP.  The position has been formally part of the congressional leadership since around the end of the nineteenth century. But because health care is the big enchilada, this one lands on Pelosi’s plate. “She’s the real Democratic whip on this one,” a House Republican leadership aide told me.

The fate of the legislation lies in the accuracy and persuasiveness of the Democratic vote counters. Yet the process is largely unknown to the world outside of congressional insiders.   The Weekly Standard, political blog  March 2010

And if the Democrats are whipped into shape, with many casting a vote that may end up sealing their fate in November of 2010 (and unelectable members of Congress, due to going against the will of their constituents)?    

But the rub is that even if ObamaCare passes, Democrats and President Obama will lose. Republicans have already vowed to make November a referendum on this bill and, by all auguries, Democrats are going to lose big time. The loss of one election if the larger cause succeeds wouldn't be a big deal. But this bill has little legitimacy and for years might be tied up in constitutional challenges against its individual mandate provision--not to mention the provisions that turn insurance companies into public utilities without due process. ObamaCare could well become President Obama's Iraq. Worst of all from the standpoint of his personal life story, it will exacerbate the crisis of the entitlement state, requiring someone else to step forward and clean up the fiscal mess he is creating.  Shikha Dalmia, writing in Forbes Magazine

Shikha Dalmia is a senior analyst at Reason Foundation and a biweekly Forbes columnist.  www.forbes.com 

So as Speaker Pelosi trys to whip her Democrat majority in Congress into line, many members of Congress are listening to their voters back home and realizing that a vote for the monstrous health care bill is political suicide.

The recent www.rasmussenreports.com   Rasmussen polling shows why the Health Care bill is in big trouble, and why wavering members of Congress have a voter support problem (especially Democrats who vote for the bill):

Fifty-four percent (54%) of voters believe passage of the proposed health care legislation will lead to higher health care costs. Just 17% believe it will achieve the stated goal of reducing the cost of care.

Forty-nine percent (49%) also think passage of the plan will reduce the quality of care, while only 23% believe it will improve the quality of care.   3.08.10 Rasmussen Reports

And while the President is not up for reelection in 2010, all 435 members of the House and 1/3 of the US Senate have to face an angry electorate in November 2010.     Will the blue dog Democrats hunt for Obama-Pelosi-Reed?   It doesn’t look like the Democrats have the majority of votes to pass the Health Care bill.

© 2010, Jasper Welch, Four Corners Media, www.jasperwelch.org   

An Impossible Situation: Reid's Unhealthy Care

An Impossible Situation: Reid’s Unhealthy Care

Several leading legal scholars and professors of law have made the strong case that the US Senate’s version of “unhealthy care” legislation is not likely pass Constitutional challenges.     In essence, the legal argument is made that the proposed Health Care insurance mandates and excessive regulation coupled with “defacto price controls” on health insurance create a scheme in which the health insurance business is regulated like a public utility.    Given that perspective, in light of case law in the United States at the US Supreme Court level, it is likely that significant legal challenges will result based on the regulatory framework of Reid’s unhealthy care legislation. 

The combined impact of these interconnected provisions is clear: there is no feasible way that an insurance carrier can respond to the increased costs of servicing of its book of business either by declining coverage or by reducing services. With all escape hatches closed; the critical question is whether the health insurance issuer is in a position to raise rates in order to offset the risks in question. On this question, section 2794 introduces a complex system of de facto price controls that depends on the close cooperation of state and federal officials. The initial process that goes into effect in 2010 requires the Secretary and the states to develop a plan to look for “unreasonable increases” in charges for insurance coverage. At this point, all health-insurance issuers must submit to the state insurance commission authority “a justification for an unreasonable premium increase prior to the implementation of the increase.” (It is not stated as to how one justifies increases that are, by definition, unreasonable.) Thereafter, once the information has been submitted and evaluated, it appears that the state insurance commissioner shall make appropriate recommendations “to the State Exchange about whether particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases.” In effect, it appears that the State Exchanges can exclude health-insurance issuers from offering their plans through the Exchanges, at which point the subsidies to insurers will be lost.     Richard A. Epstein

Given the preceding argument by Mr. Epstein, he goes on to state why this conundrum for the health insurers combined with case law on the regulation of public utilities will set the stage for numerous legal challenges, of both the legislation and the administration by state and Federal agencies.     Simply, the complex scheme of “defacto price controls”, heavy regulation, government mandates and bureaucratic red tap found in the Reid bill that came out of the US Senate is likely not to pass the “reasonable person” or US Constitutional test.

There is, moreover, no quick fix that will eliminate the Reid Bill’s major constitutional defects. It would, of course, be a catastrophe if the Congress sought to put this program into place before its constitutionality was tested. Most ratemaking challenges are done on the strength of the record, and I see no reason why a court would let a health-insurance company be driven into bankruptcy before it could present its case that the mixture of regulations and subsidies makes it impossible to earn a reasonable return on its capital. At the very least, therefore, there are massive problems of delayed implementation that will plague any health- care legislation from the date of its passage. I should add that the many broad delegations to key administrative officials will themselves give rise to major delays and additional challenges on statutory or constitutional grounds.   Richard A. Epstein

Excerpt from Article: Impermissible Ratemaking in Health-Insurance Reform: Why the Reid Bill is Unconstitutional   By Richard A. Epstein  Manhattan Institute, NY

Richard A. Epstein is the James Parker Hall Distinguished Service Professor of Law at the University of Chicago, the Peter and Kirstin Bedford Senior Fellow at the Hoover Institution, a visiting professor at the NYU Law School, and a visiting scholar at the Manhattan Institute.

Doctor Rationing Emanuel

Doctor Rationing Emanuel:

With nationalized health care on the discussion table in the US, the topic of rationing and who goes to the back of line continues to dog the proponents of Obamacare. Dr. Ezekiel (Rationing) Emanual, health advisor to the President, clearly supports turning our present Hipprocratic Oath based medical care delivery system over to rationing by bureaucrats and decree. Rather than the doctor & patient relationship being sacred, the needs of society would trump the medical needs of the individual. The Wall Street Journal Editorial below makes it clear that Obamacare is focused on socialism goals and societal change, not actually improving health care for US citizens. www.onlinewsj.com

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

"Principles for Allocation of Scarce Medical Interventions" The Lancet, January 31, 2009

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (thelancet.com, Jan. 31, 2009).

To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . ." He writes that one drug "used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy." (JAMA, June 13, 2007).

Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom's rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.

Dr. Emanuel's assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: "The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.

This is untrue, though sadly it's parroted at town-hall meetings across the country. Moreover, it's an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel's views.

Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

Is this what Americans want?

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.

Madison Slow Down Obamacare

US Founder Madison Slows Down President Obama

So what exactly happened in the health care debate this summer? The founding fathers, wary of kings and divine rulers, and willing to sacrifice their own personal gain for the formation of a fledging democracy, wrote a Constitution that featured checks and balances. And their vision for a system of American government for the people and by the people has withstood the onslaught of Washington insiders for over 225 years. The founding fathers created a document; known as the US Constitution that has guided our Republic. Our Constituion includes the 10^th Amendment (1791): The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. It could be argued that the nationalization of health care by the government is prohibited based on this amendment. Exactly where does it say that health care is within the exclusive jurisdiction of the US Government? Just being the President, doesn’t make it so. Not in America.

During this national debate on health care, a rookie President with a majority of the Congress has failed to fully understand the American process. And now he is blaming the American people for being…. well American.

To put Madison’s work into the modern perspective, we feature the work of Peter Wehner, a former presidential advisor and current think tank fellow, who wrote the following in the Weekly Standard:

But Madison has thwarted others who possessed grand, even utopian, designs. And so we are now getting the debate on health care Obama desperately wanted to avoid--with the result that support for his plan is sinking like a stone in the sea. Whatever plan finally emerges, if any plan emerges, will be quite different from what Obama originally had in mind.

None of this is going down very well with our chief executive. The man who promised us a new style of politics, civil and uplifting, is now unleashing his top aides and congressional allies to "punch back twice as hard" against critics. They are attempting to paint opposition to Obamacare as the work of fringe elements, mercenaries, and automatons. If Team Obama actually believes this explains the groundswell of public concern about its health care plan, they are living in a White House even more hermetically sealed than usual.

But the fundamental problem is the Obama view of politics--romantic and even quasi-revolutionary--in which men of zeal remake the world. This is not the American way. Ours is a system of government in which, as Madison noted, "ambition must be made to counteract ambition," where there are more brakes than accelerators, and where massive overhauls and centralized control are discouraged and most of the time defeated. Whatever its limitations, the Constitution remains, in the words of Gladstone, "the greatest work ever struck off at a given time by the brain and purpose of man." It does not bow before a president in a hurry--even a young, charismatic, and impatient one. Excerpt from the Weekly Standard online at www.weeklystandard.com

Peter Wehner, former deputy assistant to President George W. Bush, is a senior fellow at the Ethics and Public Policy Center.

© 2009 Jasper Welch, Four Corners Media, www.jasperwelch.org