Health Care Reform

FEDERAL HEALTH CARE LAW
(ObamaCare)

Text of Affordable Care Act

November 2013:  Recently Dr. Ezekiel Emanuel has been a guest on television programs, promoting the merits of Obamacare.  Emanuel is one of the architects of the Affordable Care Act.
Flashback:  An August 2009 Wall Street Journal article (“Obama’s Health Rationer-in-Chief”) describes and documents Emanuel’s perspective about health care, including the merits of embracing the “complete lives system,”  which he has explained:

“When implemented, the complete lives system produces a priority curve on which individuals aged roughly between 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

Scroll down for news articles

(Also see: Advance Care Planning and Cost Containment)

US Supreme Court Upholds Obamacare Individual Mandate as a tax.
Full text of decision
(6/28/12)

Transcripts of U.S. Supreme Court oral arguments about the Patient Protection and Affordable Care Act (also called ObamaCare):
Monday, March 26, 2012:
Department of Health and Human Services, et al,, v. Florida, et al. No. 11-398
Tuesday, March 27, 2012:
Department of Health and Human Services, et al,, v. Florida, et al. No. 11-398
Wednesday, March 28, 2012:
National Federation of Independent Business, et al., v. Kathleen Sebelius, et al. No. 113-93 and
Florida, et al., v. Department of Health and Human Services, et al. No. 11-400

………………………….

Senate Bill (H.R. 3590) was unveiled on November 18, 2009 by Senate Majority Leader Harry Reid.  Three days later, the Senate voted 60 – 39 to begin debate on the measure.  The final version of H.R. 3590 passed in the Senate on December 24, 2009 by a vote of 60 – 39.   On March 21, 2010 the bill was approved in the House of Representatives with a vote of 219 – 212.

The Patient Protection and Affordable Care Act was signed into law (Pub. L. No. 111-148) on March 23, 2010.

The new law makes specific reference to assisted suicide in only one section. It does not explicitly prohibit assisted suicide participation, promotion or encouragement.  Instead, it contains a “prohibition against discrimination on assisted suicide,” stating that individuals or institutional health care entities may not be subject to discrimination if they do not provide items or services for the purpose of assisted suicide (Sec. 1553).  Such wording seems to imply that assisted suicide is acceptable and expected, although not something in which health care providers must be involved.

In a July 7, 2010 recess appointment, President Obama named Dr. Donald Berwick to head the Centers for Medicare and Medicaid.  Berwick’s past statements have led to extreme controversy.  Among them was one in a 2008 article in which he wrote:
“Rational common interests and rational individual interests are in conflict….The stakes are high. Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”

The Hill’s Health Roundup explained that Berwick was walking a tightrope because of his praise for the UK’s National Health Service.  Similar reports were contained in Real Clear Politics.

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Articles

“Coverage for End-of-Life Talks Gaining Ground”
(New York Times — August 30, 2014)
Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 60 million Americans on medicare as early as next year.

“Young adults’ privacy potentially jeopardized by insurance plans”
(Medical Xpress — July 11, 2014)
Violations of privacy are increasing as more adolescents and young adults gain coverage on their parents’ health insurance plans, according to a new health policy report from UC San Francisco.
Under the Affordable Care Act (ACA) adult children now can stay on their parents’ health insurance plans until they reach age 26. But because they are dependents on their parents’ health insurance, they are not afforded the same confidentiality protections as if they had individual plans.

“Feds to Consider Paying Doctors for End-of-Life Planning”
(PEW State and Consumer Initiatives — 6/2/14)
The federal government may reimburse doctors for talking to their Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.
Now, quietly, the proposal if headed toward reconsideration — this time through a regulatory procedure rather than legislation.

“The Other Stealthy ObamaCare Menace”
(Wall Street Journal — April 23, 2014)
The Center for Medicare and Medicaid Innovation exists to impose price controls and limit payments to providers….But unlike most of the federal bureaucracy, the agency never has to go back to Congress to get an appropriation.  ObamaCare provided it with $10 billion, upfront, to cover its costs for a full 10 years.

“You’re on the clock: Doctors rush patients out the door”
(USA Today — April 20, 2014)
“Doctors have one eye on the patient, and one eye on the clock,” said David Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons….No one knows exactly why 15 minutes became the norm….”  “We’re all sort of like lemmings,” Lickerman said. [Alex Lickerman is an internist who has taught medical students at the University of Chicago.] “We’ve seen that everyone else is doing it so it must be the right thing to do.”

“Cost of Treatment May Influence Doctors”
(New York Times — April 17, 2014)
In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing…..They [the cardiology societies] plan to rate the value of treatments based on cost per quality-adjusted life-year, or QALY– a method used in Britain and by many health economists.

“Drug Rationing for Seniors Begins”
(American Spectator — February 24, 2014)
Buried beneath the avalanche of recent news reports about the latest Obamacare mandated funding cuts to the Medicare Advantage (MA) program is a related but far more disturbing story — the Centers for Medicare and Medicaid Services (CMS) has taken a major stop toward rationing medications to the elderly.

“Obamacare’s Biggest Whopper”
(Townhall — January 5, 2014)
Section 1311(h)(1)(B) of the health law gives the Secretary of Health and Human Services, a presidential appointee, blanket authority to dictate how doctors treat patients.  Not just patients in government programs like Medicare and Medicaid. But also patients with private plans they pay for themselves.

“Top 5 O-Care stories to watch”
(The Hill — December 30, 2013)
The healthcare law faced a very tough year in 2013, but that could pale in comparison to what happens in 2014.

“ObamaCare May Devastate the Real Estate and Travel Industries”
(American Thinker — December 18, 2013)
Americans are among the most mobile people on earth, but ObamaCare may soon start freezing them in place. Millions are losing their health insurance policies and being forced onto the ObamaCare exchanges, where most plans only provide local medical coverage. As Americans realize they must pay for all non-emergency medical care when they leave their home county, their decisions may have a profound impact on the real-estate market, particularly the second home sector, and on the travel business.

“Family of Six-Year-Old Cancer Patient Loses Coverage, Now Faces Soaring Premiums”
(Townhall — December 3, 2013)
Paul and Jami Porter of Kaysville learned last week their insurance plan was terminated under the Affordable Care Act, more than 3 1/2 months into their daughter’s fight with undifferentiated sarcoma began.

“Fountain Hills man dropped from health insurance because of new regulations”
(ABC 15, Arizona — October 3, 2013)
In 2006 Michael Cerpok found out he had an incurable form of leukemia that requires ongoing treatment until he dies. In 2012, his treatment bill was more than $350,000 but, because of his insurance, his out-of-pocket cost was only $4,500.  His insurance company has informed him that, because of new regulations under Obamacare, his annual out-of-pocket expense will increase to a minimum of $26,000.

“Will Obamacare Boost Assisted Suicide?”
(National Review — October 3, 2013)
An article in Salon may be onto something — that passage of the Affordable Care Act could boost assisted suicide legislation.

“Buyer Beware on Obamacare”
(Wheeling Intelligencer — September 30, 2013)
Cold reality behind the warm rhetoric on rollout

“‘Family glitch’ in health law could be painful”
(USA Today — September 23, 2013)
A “family glitch” in the 2010 health care law threatens to cost some families thousands of dollars in health insurance costs and leave up to 500,000 children without coverage, insurance and health care analysts say.

“Navigating ObamaCare Outrage”
(Wall Street Journal — September 5, 2013)
HHS regulations don’t require background checks for the navigators but do say they must obey security and privacy requirements, without defining what the requirements will be. Since the navigators will tap into sensitive medical and financial information about individuals, more than a dozen state attorneys general are alarmed about the the potential for fraud and identity theft.

“IRS will Enforce Health Law”
(The Record, Stockton, CA — August 30, 2013)
Starting next year individuals and their dependents are required to have minimum essential health insurance unless they qualify for an exemption. It’s through the federal income tax form that you will have to indicate if you have health insurance or are eligible for an exemption.  But this doesn’t go into effect until you file your 2014 federal return in 2015.

“Administration awards $67M to ‘Navigators’ promoting ObamaCare”
(The Hill — August 15, 2013)
The Health and Human Services (HHS) Department released $67 million in grants Wednesday for “navigators” who will help people make sense of new coverage options under ObamaCare…Republicans have raised questions about the navigators program, warning participants could make off with personal information from people seeking insurance.

“ObamaCare ‘death panel’ faces growing opposition from Democrats”
(The Hill — August 8, 2013)
ObamaCare’s cost-cutting board — memorably called a ‘death panel’ by Sarah Palin — is facing growing opposition from Democrats who say it will harm people on Medicare….”The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor of hospital will perform them,” Howard Dean wrote in The Wall Street Journal.

“Obama Administration Slashes Obamacare ‘Navigator’ Training Requirements”
(Weekly Standard — August 7, 2013)
[T]he Wall Street Journal reports this week that the Department of Health and Human Services has cut back on the number of training hours required for the Obamacare “navigators,” federal workers who under the health care law are tasked with helping consumers purchase insurance through the state exchanges.

“ObamaCare Poses a Massive Privacy Risk”
(Investor’s Business Daily — August  7, 2013)
Despite repeated assurances that the ObamaCare data hub is on schedule, a government audit finds that vital security measures to protect private information likely won’t be ready by Oct. 1.

“Sens. Warner & Isakson Introduce Bipartisan Care Planning Act of 2013″
(Press Release — August 1. 2013)
The Care Planning Act of 2013 (S. 1439) will reimburse a team of healthcare professionals for providing a voluntary, structured discussion about the patient’s goals, illness, and treatment options.
[The measure would provide grants to develop materials and maintain a web site with information about advance directives and POLST forms.  It is similar to that which has been introduced in the House by Rep. Earl Blumenauer.]

“Obamacare data hub a ‘honey pot’ for ID thieves, warn critics”
(Washington Examiner — July 22, 2013)
The data hub President Obama’s health care team is creating to exchange personal health and financial information on Obamacare users will be a ripe  target for computer hackers and identity thieves, charge critics who claim it hasn’t been tested for security flaws.

“The ‘death panel’ bill lives”
(Politico — July 21, 2013)
Rep. Earl Blumenauer wants Congress to talk about death  He was the author of the 2009 bill aimed at encouraging doctors to talk to patients about what kind of care they want near the end of life. It notoriously became known as the “death panel.” The bill is back.  Or rather, it’s never gone away.
Text of bill

“Georgetown Insurance to Cover Contraception”
(Hoya, Georgetown University Newspaper — July 18, 2013)
After revisions to the Affordable Care Act in late June, Georgetown student and faculty health insurance will cover contraception through United Healthcare beginning August 15.

“Think NSA Spying is Bad? Here Comes ObamaCare Hub”
(Investor’s Business Daily — June 25, 2013)
[T]he HHS said the ObamaCare data hub will “interact” with seven other federal agencies: Social Security Administration, the IRS, the Department of Homeland Security, the Veterans Administration, Office of Personnel Management, the Department of Defense….
And what sort of data will be “routed through” the Hub?  Social Security numbers, income, family size, citizenship, immigration status, incarceration status, and enrollment in other health plans.

“Get Ready for Obamacare Premium Defaults”
(American Spectator — April 4, 2013)
Everyone buying insurance on the exchanges will have no choice but to buy the one-size-fits-all “essential benefits package” that includes treatment for drug addiction, maternity care, and dental and vision care for children.  Only 2% of current plans currently include these services. It’s like passing a law that your auto insurance cover wiper blades and oil changes, or that the only car you’re allowed to buy is a fully loaded Cadillac.

“Taking up end-of-life care”
(Roanoke Times — April 1, 2013)
Sen. Mark Warner will reintroduce the Senior Navigation and Planning Act, a bill he first offered in 2009.  Among other things, it would require doctors to tell patients with specified diseases about advance directives and other end-of-life planning tools.

“What Obamacare Isn’t”
(Commentary — March 31, 2013)
Insurance began in the 17th century when merchants wanted to protect themselves against the loss of a ship and its cargo….Thus insurance, properly understood, is meant to protect against a catastrophic loss that would be financially ruinous, such as a lost ship. It didn’t pay for a parted topsail halyard. And that’s why if your grandson throws a baseball through a living room window, you call the guy who fixes windows, not the insurance company. It’s when the roof blows off in a storm that you call the insurance company.

“ACA-Driven Changes in Individual Market Composition Could Lead to 32 Percent Average Increase in Cost: Wide Variability among States”
(Society of Actuaries — March 26, 2013)
With less than a year to go before the major provisions of the ACA take effect, new research published by the Society of Actuaries predicts that expected changes in member composition of the individual health care market could drive up costs by an average of 32 percent nationally by 2017….[T]he model projects that currently low-cost states, such as Ohio and Wisconsin, could see increases of 80 percent….

“Dr. Manny: I am completely against this new medical ‘death test’”
(Fox News — March 6, 2013)
I am somewhat confused as to the purpose of this new “mortality index.” A new study from the University of California, San Francisco with funding from the federal government revealed 12 specific items physicians can use to help them determine whether costly screenings or medical procedures are worth the risk for patients unlikely to live 10 years or more….[T]he way I read this is that doctors using this point system will decide what patients may or may not get in terms of their future medical treatment — and that’s not right.

“Under Obama Health Care Law: Government-Controlled Private Insurance”
(International Business Times — February 27, 2013)
Sec. 1311 of the law empowers the Secretary of Health and Human Services to dictate how doctors treat privately insured patients and what questions patients must be asked. Your doctor will enter your information into an electronic data base; your doctors decisions will be monitored for compliance with federal guidelines….

“Scared of Obamacare’s IPAB? Meet the USPSTF!”
(American Spectator — February 27, 2013)
Those unelected boards are coming into their own, making decisions for doctors and patients alike.

 “Blumenauer turns again to end-of-life care, after mom’s death”
(Oregonian–February 16, 2013)
“In a bill Blumenauer plans to introduce by spring, Medicare and Medicaid would pay for voluntary consultations between doctors and patients about end-of-life wishes The bill would Provide grants to promote ‘physician orders for life-sustaining treatment’ [POLST]….”  Text of draft bill.
(Congressman Earl Blumenauer’s earlier attempt, included in Obamacare, was deleted prior to final passage after being labeled as promotion of death panels. Blumenauer is a supporter of Oregon’s assisted-suicide law and has been a featured keynote speaker for Compassion & Choices.)

“The Doctor’s Office as Union Shop”
(Wall Street Journal — January 29, 2013)
The Obama administration, by intent or accident, has effectively driven a major change in the status of physicians.  By reducing the reimbursement for certain office-based specialists while enhancing related payment to hospitals, the administration is compelling more and more physicians — many of them with an any-port-in-a-storm fatalism — to seek employment with health systems or large physician groups.

“George Will: Affordable Care Act may contain seeds of its own extinction”
(Portland Press Herald — Maine — January 21, 2013)
Chief Justice John Roberts rescued the Affordable Care Act — aka Obamacare — from being found unconstitutional. But the manner in which he did this may have made the ACA unworkable, thereby putting it on a path to ultimate extinction.

“Fiscal Cliff Deal Repeals CLASS Act”
(Forbes — January 2, 2013)
The New Year’s Day budget agreement permanently repealed the CLASS Act, an Obamacare provision that would have created a new national, voluntary long-term care insurance system.

Affordable Care Act — proposed IRS rule states that spouse is not a dependent (FOX News — January 2, 2012 — video)

“ObamaCare Will Bring Bureaucracy, Endless Rules And Coercion, But Improve Nothing”
Most towns in the North County now have fewer doctors than they did in the 19th century, and the smaller towns have none…This great medical advance is supposed to be fully implemented by 2014, so the government is providing incentives for doctors to comply. Under the EHR Incentive Program, if a doctor makes “meaningful use” of electronic health records (EHR), he’s eligible for “bonuses” from the feds — a mere $44,000 from Medicare, for example, but up to $63,750 from Medicaid.
(Investor’s Business Daily — December 14, 2012)

“Byron York: Get ready for the costs and chaos of Obamacare”
Amid the other momentous events coming in 2013, the biggest story of the year, and of 2014 as well, will be the arrival of Obamacare in the lives of every American….[C]urrent policies are going to see premium increases on the order of 25 to 30 percent….[I]t will charge employer and individual plans a $63 “fee” for every person they cover…. a 2.3 percent tax on medical devices.
(Washington Examiner — December 13, 2012)

“Senate Democrats Urge Undoing of ObamaCare”
Many powerful Democrats, even some of the most liberal among them are supporting what amounts to a dismantling of President Obama’s signature health care law.  Using “Republican” language to make their case, these Democrats are attempting to repeal some of the funding mechanisms as well as the cost-containment measures that were purportedly inherent in the law.
(Breitbart.com — December 12, 2012)

“Democrats continue to find out what was in ObamaCare — and try to dismantle it”
[S]ince the passage of ObamaCare, the cost-controls and offsets have one-by-one been stripped out.  First, Democrats killed the ill-conceived long-term insurance measure known as the CLASS Act.
(Washington Examiner — December 11, 2012)

“UMass Memorial Tests Software to Curb Hospital Readmissions”
(Wall Street Journal — December 3, 2012)
Until Oct.1 this year, the Centers for Medicare and Medicaid (CMS) paid hospitals a flat rate when a patient was admitted with a heart attack, heart failure or pneumonia….Now, the Hospital Readmissions Reduction Program, a section of the Patient Protection and Affordable Care Ac, has begun penalizing hospitals if their 30-day readmission rates for patients exceed national averages.

“Study: Hospice Rules May Keep Away Patients”
(
Kaiser Health News — December 3, 2012)
The study found 61 percent of hospices would not accept patients who wanted chemotherapy, which can be used to help ease their pain in their dying days. Fifty-five percent would not accept patients who could only be fed intravenously, and 40 percent would not accept patients who were receiving blood transfusions.

“Long-term care: A problem the Affordable Care Act didn’t fix”
(Colorado Springs Business Journal — November 21, 2012)
The Patient Protection and Affordable Care Act failed to solve one health care riddle: how to pay for long-term care for the rising tide of the nation’s aging population [with the CLASS Act]. The government tried to crack the code in the Obamacare legislation.  But, after 19 months, Secretary of Health and Human Services Sibelius threw in the towel. She cited difficulty in sorting out legal issues, solvency problems and rising health care costs as the reason….

“Obama faces huge challenge in setting up health insurance exchanges”
(The Hill — November 25, 2012)
The Obama administration faced major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems….Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits all failsafe.

 ”Menu Labeling: Another Job-Killing Regulation in ObamaCare”
(Townhall — November 26, 2012)
[T]he government is addressing the nation’s growing obesity epidemic with a regulation: Section 4205….The provision requires chain restaurants with 20 or more locations, including franchises and perhaps some grocery stores, to post calorie information for all products on in-store menu boards.

“A Parable of Health-Care Rationing”
(Wall Street Journal — November 1, 2012)
As for whether America will remain the first destination for medical advances in the age of ObamaCare, Mr. Ford cautions, “Anything that moves toward one of anything, you’re going to have less innovation — one provider, one payer, one manufacturer.”

 “IPAB: President Obama’s NICE Way To Ration Care To Seniors”
(Forbes — October 21, 2012)
The reality is that the IPAB represents an unprecedented shift of power from individual Americans and their families to a centralized authority, a controlling Board of political appointees that is virtually unaccountable, and destined to become President Obama’s version of the NICE rationing board in Britain’s socialized medical system, the National Health Service.

 “Medicare IPAB: Rational or rationing?”
(American Medical News — October 15, 2012)
The Independent Payment Advisory Board is designed to control runaway Medicare costs without cutting benefits, but physicians warn of unintended effects of cutting patient access. IPAB, authorized by the Affordable Care Act as a cost-containment provision, eventually might enable its commissioners to wield swift, significant power to change the course of Medicare policy without the need for congressional approval. ….To physicians and other opponents of the panel, the law establishing IPAB granted it unprecedented, dangerous authority to cut Medicare pay rates and strangle access to care.

“Supreme Court Shocks Life into Obamacare Challenge”
(Townhall — October 8, 2012)
The High Court shocked the legal community by opening its new term with an order giving the Obama Justice Department just 30 days to respond to Liberty Counsel’s petition for rehearing. Liberty Counsel filed the petition on behalf of Liberty University and two private individuals.

“Power Grab: Our technocratic future”
(Weekly Standard — October 1, 2012)
Leading the charge is the Independent Payment Advisory Board, governed by 15 “experts” appointed by the president and confirmed by the Senate. Established to control Medicare costs, IPAB possesses the raw power to force Congress to legislate via its “fast track authority”: IPAB’s financial targets must be enacted into law by August 15 of each year, beginning in 2014. Not only that, if Congress refuses to legislate the level of cost containment demanded by IPAB )or if the president vetoes the bill), IPAB’s original recommendation is automatically imposed.

 “Obama’s health care plan negatively impacts seniors”
(Centre Daily — State College, PA — September 20, 2012)
President Barack Obama’s Affordable Health Care Act, also known as Obamacare, will seriously impact the health care and health insurance of 40 million American seniors on Medicare.  I am one of them.  Those of us older than 65 represent 13 percent of the population but we consume 36 percent of the $2 trillion of the annual cost of health care.  This is how we are to be dealt with.

“Beyond Obamacare”
(New York Times — September 16, 2012)
We need death panels.  Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing by its proper name — the exploding cost of Medicare will swamp the federal budget.

“ObamaCare and Laptop Medicine”
(American Thinker — September 8, 2012)
The next logical ObamaCare cost-saving step would be to have the patient fill out his own yes-no computer-questionnaire.  There are not enough primary care physicians to fulfill the law’s mandate and dispensing with the physician interview would conserve scarce resources.

 “A Systemic Approach to Containing Health Care Spending”
(New England Journal of Medicine — August 30, 2012)
National health spending is projected to continue to grow faster than the economy….These trends could squeeze out critical investments in education and infrastructure, contribute to unsustainable debt levels, and constrain wage increases for the middle class.

American Bar Association urges Congress to amend the Patient Self-Determination Act
(ABA — Resolution 106A)
The ABA is calling on Congress to amend a 1991 law to require health care organizations to provide advance care planning similar to that which was rejected during the debate over the Affordable Care Act.  This includes the controversial requirement that advanced care planning information be part of annual Medicare wellness examinations.

“Guest Commentary: What’s the cost of freedom?”
(Denver Post — August 1, 2012)
What’s the cost of freedom for one Colorado family?  Apparently, according to the Obama administration, it’s nearly $10 million per year….Protecting freedom of conscience is in keeping with Colorado’s long-held frontier spirit, as well as the ethics that have guarded our markedly Western mindset.  If we lose that freedom, it will cost all of us dearly, and for the Newlands, that starts with nearly $10 million.

 “Health law gives expanded role to IRS”
(New Haven Register — July 8, 2012)
The Supreme Court decision to uphold most of President Barack Obama’s health care law will come home to roost for most taxpayers in about 2 1/2 years, when they’ll have to start providing proof on their tax returns that they have health insurance.
The health care law “includes the largest set of tax law changes in more than 20 years,” according to the Treasury inspector general who oversees the IRS>

“Opponents Of Secondary Provisions in Health Care Law Look To Lower Courts”
(Vermont Public Radio — June 30, 2012)
Let’s look at two of the biggest challenges to aspects of the law:
1) Suits brought by dozens of Catholic dioceses, schools and organizations that assert the health care law’s provision on contraception violates their religious freedom.
2) The legal challenge to a 15-member panel created by the health care law that would make annual medicare spending control recommendations to Congress and the administration.

“SCOTUS Ruling Means Bigger, More Intrusive IRS”
(FOX Business — June 29, 2012)
The IRS now gets to know about a small business’s entire payroll, the level of their insurance coverage — and it gets to know the income of not just the primary breadwinner in your house, but your entire family’s income, in order to assess/collect the mandated tax.

“ObamaCare’s Other Mandate Threatens Religious Liberty”
(Investor’s Business Daily — June 29, 2012)
First amendment: The bizarre ObamaCare decision leaves unresolved the separate issue of whether government can define what a church is and what it can do. Will the courts also redefine the “free exercise” of religion?
So if the Supreme Court has ruled that the government can impose a tax in the form of a penalty on those who refuse to buy health insurance, can it also impose a “tax” on those who refuse to provide contraceptive services in violation of their religious beliefs?

 “Solicitor General’s Third Backup Argument Is a Winner in Health Law Case”
(ABA Journal — June 28, 2012)
Chief Justice Robers wrote that Congress had the authority to adopt the mandate under its taxing power, but not under its commerce clause authority.
Solicitor General Donald Verelli cited the taxing power in the administration’s in the administration’s third argument.  The first was that the law could be enacted under the commerce clause and the second was that it was authorized under the necessary and proper clause.

 “SCOTUS Notebook: A Minute by Minute Account from Inside the Courtroom”
(ABA Journal — June 28, 2012)
Outside the U.S. Supreme Court building this morning, some of the circus atmosphere returned from the days in March when the Affordable Care Act cases were argued.

 “Supreme Court upholds Obama health care plan”
(USA Today — June 28, 2012)
The justices said that while Congress did overreach in part with the individual mandate — the requirement that most Americans buy health care insurance or pay a fine 00 the provision is held constitutional as a tax.

“IPAB is not the way to lower Medicare costs”
(The Hill — June 5, 2012)
In the text of the healthcare law, it states that while the law prohibits “any recommendations to ration health care,” it does not prohibit slashing payments to physicians and other medical providers.  Even supporters of the law agree that the IPAB could harm seniors with dangerous Medicare cuts.  AARP said the board could “have a negative impact on [seniors'] access to care.

 “End-of-Life Medical Advice: Devaluing Patients in Name of Greater Good”
(Forbes — June 1, 2012)
How horrible it would be for elderly and the sick patients, who already have so much to worry about, to have to begin to ask about whether their doctor’s advice is truly in the best interest of the patient, or reflects an effort to sacrifice the patient in the name of the greater good. How horrible for the patients, and how destructive for medicine.

 “Pelosi: Give Us ObamaCare Or Give Us Death
(Investor’s Business Daily — March 23, 2012)
As the Supreme Court hears oral arguments on the constitutionality of ObamaCare, the former House speaker says its purpose is to guarantee our inalienable rights of life, liberty and the pursuit of happiness.

“Independent Payment Advisory Revolt”
(Wall Street Journal — March 9, 2012)
Public opposition to the Affordable Care Act has grown in surprising and unpredictable ways since the entitlement passed two years ago, but few would have predicted then that so many Democrats would repudiate so many of President Obama’s core promises.

 “Meet the ObamaCare Mandate Committee”
(Wall Street Journal — February 16, 2012
Offended by President Obama’s decision to force health insurers to pay for contraception and surgical sterilization?  It gets worse: In the future, thanks to ObamaCare, the government will issue such health edicts on a routine basis – and largely insulated from public view. This goes beyond contraception to cancer screening, the use of common drugs like aspirin, and much more.
Under ObamaCare, a single committee – the United States Preventative Task Force – is empowered to evaluate preventive health services and decide which will be covered by health-insurance plans.

 “Obama’s breach of faith over contraceptive ruling”
(Washington Post — January 29, 2012)
One of Barack Obama’s great attractions as a presidential candidate was his sensitivity to the feelings and intellectual concerns or religious believers. that is why it is so remarkable that he utterly botched the admittedly difficult question of how contraceptive services should be treated under the new health care law.

“Attacking religion”
(New York Post — January 22, 2012)
Friday’s ruling by the department of Health and Human Services proved yet again that ObamaCare’s critics are right. It’s a breathtaking attack not only on the first amendment’s guarantee of religious freedom, but also on the separation of church and state.

 “PCORI: Funny acronym, serious work”
(Washington Post — January 18, 2012)
The health reform law established the Patient-Centered Outcomes Research Institute (PCORI) as an independent advisory board with a #3 billion budget to support comparative effectiveness research….But comparative effectiveness research can be tricky. Study methods can be faulty and results contradictory: a particular medical intervention may work for one subset of patients but not for a larger population. These studies can also be controversial, and they sometimes meet with accusations of rationing.

 “Health Official Takes Parting Shot at ‘Waste’”
(New York Times — December 3, 2011)
The official in charge of Medicare and Medicaid for the last 17 months says that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency.

 “Mediscare: The Surprising Truth”
(Wall Street Journal — May 27, 2011)
The Obama administration has repeatedly claimed that the health-reform bill it passed last year improved Medicare’s finances. Although you’d never know it from the current state of the Medicare debate –with Republicans being portrayed as the Medicare Grinches — the claim is true only because ObamaCare explicitly commits to cutting health-care spending for the elderly and the disabled in future years.

IPAB Is an Acronym for ‘Death Panel’”
(American Spectator — April 22, 2011)
The Independent Payment Advisory Board (IPAB) was created pursuant to section 3403 of the Patient Protection and Affordable Care Act, and its ostensible purpose is to “control costs.” In reality, it will do nothing at all about costs. Instead, the board’s fifteen “experts” will impose old-fashioned price controls.

“The case for rationing healthcare”
(Los Angeles Times — April 21, 2011)
An 82-year-old woman suffered a massive heart attack while visiting her daughter…Her doctors quickly concluded that her prognosis was dismal…Yet she remained awake, alert and chatty…The daughter began paying close attention to clinical details. She questioned the doctors about their intentions. The doctors, in turn, grew annoyed…Four weeks later, the 82-year-old patient left the hospital on foot…But as a society, we also have to set limits when it comes to individual treatment.

“Don’t take health care for granted”
( Star Tribune – - February 6, 2011 )
Responding to a commentary about health care rationing, Nussbaum writes,”Dale repeatedly belittles the high quality of our health care system….I suspect the tens of thousands of survivors who are now five-plus years free of breast cancer, lymphoma or childhood leukemia — diseases which not that long ago carried uniformly fatal prognoses — would beg to differ.”

Federal District Court Judge Roger Vinson declares the health care law unconstitutional (1/31/11). In his decision, Vinson ruled that the law’s mandate that everyone must carry insurance or pay a fine is outside Congress’ Commerce Clause power and that the entire law “must be declared void.”

“You have to choose”
( Star Tribune – - January 22, 2011 )
Minnesota pathologist Virginia Dale writes, “The new health care law may be a fine first step, and it is high time we took a first step. But we continue to ignore the elephant in the room. We should ration health care so everyone can have some. And we should limit health care so we can have more well-being.”

“Feds to decide what benefits health insurers must cover”
( McClatchy Washington Bureau – - January 10, 2011 )
Even as House Republicans vow to repeal the health care law, government advisers are preparing this week to wade into one of the most contentious questions the legislation raises. What benefits must insurers cover? The answer will affect tens of millions of Americans….While the law outlines 10 broad categories of coverage, it leaves specifics to the government.

Author of advance care planning provision is hopeful in spite of setback
“Blumenauer hits another wall on end-of-life planning”
( The Oregonian – - January 5, 2011 )
Once again, Portland Congressman Earl Blumenauer is on the losing end of his fight to get Medicare to allow doctors to be paid for doing advance planning on end-of-life care….Blumenauer said he understands the administration’s reluctance to engage in a fight over advance planning but said he’s hopeful Medicare can eventually get the regulation in place.

The assisted-suicide advocacy group, Compassion & Choices has acknowledged its work with Blumenauer to promote end-of-life provisions in the original House Bill.  Blumenauer also drafted provisions in Obamacare relating to patient decision aids.

“A Physician’s Take on the ‘Death Panel’ Revelation”
( Reason Magazine – - January 5, 2011 )
“As a physician, I can tell you that we doctors do routinely have end-of-life discussions with our patients.But we do it when it is appropriate and indicated by the clinical situation.,, The whole idea [of required end-of-life counseling] is to get younger, healthier Medicare patients to give advance directives that will be used at a later time to deny them care.”

Advance care planning out only days after it went into effect (1/04/11):
“U.S. Alters Rule on Paying for End-of-Life Planning”
( New York Times – - January 4, 2011 )
The Obama administration will revise a Medicare regulation on end-of-life planning. This reversal takes place only days after the new policy took place on Jan. 1. “We will amend the regulation to take out voluntary advance care planning,” explained an administration official.

“State ‘Death Panels’ Attributable to Single-Payer”
( National Review – - January 3, 2011 )
Medicaid budget limits lead to what some call “death panels.” Medicaid is a single payer system in which budgets are limited. When the money runs out, people’s options shrink. Government can get away with treatment restrictions that would never be countenanced within a market-based system in which regulators would be on the side of patients, rather than the government funder.

“Has Regulation Put an End to Rule of Law”
( Investor’s Business Daily – - December 27, 2010 )
An end run around the Constitution put “end of life consultations” back into the new health care law. Congressman Earl Blumenauer, an author of the original provision that was later dropped from the legislation, expressed his pleasure with the development but warned: “While we are very happy with the result, we won’t be shouting it from the rooftops because we are not out of the woods yet.” In other words, don’t let the masses know about it.

Advance care planning out only days after it went into effect (1/04/11):
“U.S. Alters Rule on Paying for End-of-Life Planning”
( New York Times – - January 4, 2011 )
The Obama administration will revise a Medicare regulation on end-of-life planning. This reversal takes place only days after the new policy took place on Jan. 1. “We will amend the regulation to take out voluntary advance care planning,” explained an administration official.

“Obama Returns to End-of-Life Plan That Caused Stir”
( New York Times – - December 25, 2010 )
End-of-life planning that caused a political storm over “death panels” was dropped from the health care plan that passed, but now it’s back through the rule-making process. Rep. Earl Blumenauer of Oregon authored the original end-of-life planning section that was deleted. Blumenauer is pleased to see the provision back in but cautioned supporters to keep it quiet. “The longer this goes unnoticed, the better our chances of keeping it,” he wrote in an e-mail.

“Our New Obamacare Masters: Meet the Independent Payment Advisory Board”
( Weekly Standard – - November 29, 2010 )
Peter Orszag asserted that the Patient Protection and Affordable Care Act is a money saver. “Perhaps most important, the legislation creates an Independent Payment Advisory Board” that will look for more ways to improve Medicare’s cost-effectiveness. Orszag said, “Under the law, any policy that the board issues takes effect unless legislation to block it is passed by Congress and signed by the president.”

“Real death panels coming our way”
( Jewish World Review – - November 24, 2010 )
During a discussion on balancing the federal budget, Nobel Prize winner in economics Paul Krugman said that the way to solve the problem of budget deficits is though deeply cost-effective health care rationing. Some years down the pike,” he said, “we’re going to get the real solution, which is going to be a combination of death panels and sales taxes.”

“To Save Money, Save the Health Care Act”
(New York Times — November 3, 2010)
Perhaps most important, the legislation creates an Independent Payment Advisory Board [IPAB], a panel of independent medical experts who will look for more ways to improve Medicare’s cast-effectiveness. Under the law, any policy that the board issues takes effect unless legislation to block it is passed by Congress and signed by the president. This way, inertia works in favor of cost containment rather than against it.

“Killing Marcus Welby”
( New York Post – - October 18, 2010 )
Under ObamaCare, an Accountable Care Organization (ACO) is supposed to take accountability for local Medicare patients, who in turn get most care from providers working inside the ACO’s network. In many ways, the ACO concept builds on the 1990s approach to “capitation.” The concept lowered spending but was unpopular with patients, leading to a backlash against managed care.

“The Deadly Pact: How ObamaCare will ‘Save’ Money”
( American Thinker – - August 9, 2010 )
Although media reports covering ObamaCare have centered mainly on the health insurance mandate and hidden tax increases, the real danger of ObamaCare is the limit imposed on hospital readmissions for those using Medicare.

“We Don’t Need Health-Care Rationing”
( Kitsap Sun – - August 4, 2010 )
Obamacare is dependent on cutting nearly $500 million from Medicare in order to partially fund the rest of the new health-care system. With his embrace of the British rationing model, Dr. Berwick may be the right person to achieve that objective.

“Obamacare Only Looks Worse Upon Further Review”
( Bloomberg News – - August 1, 2010 )
Based on the administration’s own numbers, as many as 17 million people might have to change their health plans by 2013 as their employer-provided coverage loses its grandfathered status and becomes subject to the new Obamacare mandates.

“Welcome to Washington, Dr. Berwick”
( The Leaf Chronicle – - July 18, 2010 )
Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services. praised the British National Healthcare System (NHS) at its 60th anniversary meeting for implementing a socialized health care system – rather choosing America’s plan. But a 2009 NHS audit found that health care managers put cost cutting ahead of patient care and cited that “appalling standards of care” may hae contributed to the deaths of up to 1,200 people in just one hospital.

“Cash crisis in NHS leaves patients lying on operating tables”
( Telegraph – - July 18, 2010 )
A cash crisis in the NHS leaves patients lying on operating tables before doctors realised vital equipment had not been ordered….Women in labour have been forced to wait while epidural equipment was borrowed from other hospitals….vital equipment is regularly not ordered.

“Health Care Rationing Obama Believes In”
( Real Clear Politics – - July 12, 2010 )
Nat Hentoff, a nationally recognized authority on the First Amendment and the Bill of Rights, discusses Donald Berwick. Berwick, as the new head of Medicare and Medicaid, will be involved in the government-controlled health care of more than 100 million Americans.

“GOP says Obama avoiding questions about CMS head’s ties to industry”
( The Hill – - July 8, 2010 )
A Republican memo charges the Obama administration with avoiding questions, including whether Donald Berwick had links to Compassion and Choices, the former Hemlock Society.

“The President’s One-Man Death Panel”
( Investor’s Business Daily – - July 8, 2010 )
Donald Berwick has praised the U.K.’s health system. If he wants to imitate Britain’s model, perhaps he can explain whybreast cancer in America has a 25% mortality rate while in Britain it’s almost double at 46%. Prostate cancer is fatal to 19% of American men; in Britain it kills 57% of those it strikes.

“Obama’s New Medicare Head: A Fan of Health Care Rationing?”
( Forbes – - July 8, 2010 )
David Berwick has commented on where Comparative Effectiveness Research (CER) fits into national health policy. When asked if it would lead to rationing of health care, he said that the social budget is limited….The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open.

“Obama to Bypass Senate to Name Health Official”
( New York Times – - July 7, 2010 )
President Obama is bypassing Congress, naming controversial Dr. Donald Berwick in a recess appointment to run Medicare and Medicaid. Berwick has supported efforts to ”reduce the total supply of high-technology medical and surgical care” and has expressed great admiration for the British health care system.

“Obama nominee heralded despite ‘honorary’ titles”
( Washington Times – - July 6, 2010 )
When the White House announced Dr. Donald Berwick as President Obama’s choice to lead the $800 billion Medicare and Medicaid agency in April, officials hailed his long list of credentials. But Dr. Berwick hasn’t seen a patient for years.

“Rethinking Comparative Effectiveness Research”
( Biotechnology Healthcare – - June 1, 2009 )
Asked if Comparative Effectiveness Research will lead to rationing of health care, Dr. Donald Berwick said, ”The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open.”

“Health care rationing is bound to come”
( Desert Dispatch – - June 29, 2010 )
Critics of Obamacare were severely attacked for using allegedly overheated rhetoric such as “death panels.” But given the fact that an 18-member Independent Payment Advisory Board will be established to set “quality and efficiency” standards that doctors will be forced to follow after 2015, that rhetoric does not appear to be so overheated after all.

“Special Report: Health Care Law: New Words, Same Meaning”
( ITF Update - – June 2010 )
Words that caused a firestorm during the debate over health care reform can’t be found in the law as passed, but the practices they referred to are in the law.  New words, same problem.

“Why Donald Berwick is Dangerous to Your Health”
( Real Clear Politics – - May 26, 2010 )
President Obama’s nomination of Donald Berwick M.D. to head HHS’s Center for Medicare and Medicaid Services eliminates any lingering doubt he seeks to impose state-run medicine and a European style health care system on America. According to Berwick, “Any healthcare funding plan that is just, equitable, civilized and humane, must redistribute wealth…. There needs to be global budget caps on total healthcare spending for designated populations.”

“ObamaCare High School: Reading, Writing, and Suicide Assistance?”
( American Thinker – WA, USA- April 14, 2010 )
In Washington State, an 18-year-old high school senior could be “qualified” for assisted suicide at a school-based health clinic. Within two weeks, she could be referred to an assisted suicide advocacy group and provided with a prescription for a lethal drug overdose. She could take it. And die – without her parents even knowing she was ill. It would all be perfectly legal.

“Special Report: In the name of health care reform”
( ITF Update - – February 2010 )
Senate and House bills contain expansive social programs.

“Deja vu a nightmare for Dems?”
( Politico – - January 31, 2010 )
Senate and House leaders looking at three different options to gain approval for health care overhaul. More

“Democrats quietly working to resuscitate healthcare overhaul”
( Los Angeles Times -  January 30, 2010 )
The campaign to overhaul the nation’s healthcare system is officially on the back burner as Democrats turn to the task of stimulating job growth, but behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation. More

“Talking Seniors to Death”
( American Thinker – September 6, 2009 )
Seniors will have less money to spend next year but they may not have to live on such meager funds for long. The government is going to help them plan how they want to die….Section 1233 of the current House bill (HR 3200) didn’t just show up on the doorstep of health care reform, but was packaged and delivered by Compassion & Choices, the assisted-suicide advocacy group previously known as the Hemlock Society. More

“Obama’s Health Rationer-in-Chief”
(Wall Street Journal — August 27, 2009)
Ezekiel Emanuel, an architect of the health care bill is an advocate of the “complete lives system” which he wrote about in the Lancet,  According to Emanuel, “When implemented, the complete lives system produces a priority curve on which individuals aged roughly between 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.”

Can we afford “America’s Affordable Health Choices Act”?
What does Section 1233 of HR 3200 do? What does the “continuum of of end-of-life services” mean? Why is Compassion & Choices (the former Hemlock Society) leading the charge for Section 1233?