Repeal The Health Care Law? Not So Fast

Republicans regained control of the House on Tuesday in part with a pledge to "repeal and replace" the new health law. But carrying out that campaign promise won't be as easy as making it was.

"Republicans cannot repeal Obamacare with President Obama wielding the veto pen," says Michael Cannon, director of health policy studies for the libertarian Cato Institute. "I mean that's not within a set of possible outcomes."

That's because as large as the new GOP majority will be come January, it's still not large enough to override a presidential veto. In addition, the Senate will still be controlled by the Democrats, who are unlikely to go along with the repeal effort.

But Cannon, who is no fan of the new law, says House Republicans are not without weapons to do battle with the measure. "They're going to do everything they can to try to cripple the law, throw sand in the gears and make it even more unpopular than it has been for the pass 18 months," he says.

One major way they can do that is by holding oversight hearings. Using subpoena power if necessary, Republicans could end up forcing Obama administration health officials to spend nearly as much time on Capitol Hill as they do in their offices actually trying to implement the law.

Cannon says a barrage of hearings and investigations by Republicans could help solidify public opinion against the measure. "The more they keep the law in the news and the more of a steady drumbeat of bad news they create about this law, the more likely it is that eventually someone with the power to overturn or repeal this law will do so," he says.

Threats Could Backfire

But all those hearings could also have the opposite effect — giving the administration a chance to make its case in favor of the law, a case that often got drowned out during the election campaign.

"The next round of this, while there will continue to be the broad sloganeering on both sides, will presumably get a little bit more into the detail," says Martin Corry, a health care lobbyist and former official at the Department of Health and Human Services during the Bush administration. "So if you're a family with a 22 year old still in college, you may not want to see that provision [that lets grown children stay on their parents' health plans] repealed."

Corry says other threats — such as trying to starve the new law by holding back its funding or preventing agencies from writing regulations needed to implement it — could also backfire.

That's because, he says, "many provisions in the law take effect, regulations or not, implementation dollars or not," so simply cutting off the money or the regulations could end up leaving those who must still comply with the law with even less certainty about what they should do.

Former Republican Sen. Dave Durenberger of Minnesota says he thinks the Democratic-led Senate could try to dampen the House repeal efforts by holding a series of hearings of its own. Among other things they could give health care groups a chance to tell Congress what things in the law they want to see fixed.

"And just putting that 'here are some things that could be improved' on the table, takes some of the wind out of the sail for repeal," Durenberger says.

At a news conference Wednesday, President Obama signaled he was open to some changes to the health law. He even suggested one of his own — repealing an unpopular provision increasing the number of 1099 forms small businesses must file with the IRS.

"It was designed to make sure that revenue was raised to help pay for some of the other provisions," the president said, "but if it ends up just being so much trouble that small businesses find it difficult to manage, that's something that we should take a look at."

Health Reform to Cover Most Young Adults by 2014

More than 12 million of the nation's 15 million uninsured young adults ages 19 to 29 may be able to get health insurance in 2014 as a result of the healthcare reform law, according to a report released Friday by the Commonwealth Fund.

"By providing multiple insurance options for young adults at key life transition points, including graduation from high school and college, the law will significantly reduce both the short- and long-term gaps in health insurance that have historically plagued this age group at all income levels," wrote Sara Collins and Jennifer Nicholson, both of the Commonwealth Fund.

The number of uninsured young adults rose from 13.7 million in 2008 to 14.8 million in 2009. In addition, 5 million insured 20-somethings have very high out-of-pocket costs, leaving them effectively underinsured, the authors noted.

Take a look at reality of health care reform

"A judgment is said to be true when it conforms to the external reality." - St. Thomas Aquinas

I loved the '90s supernatural drama "The X Files," with its ominous, blinking message - "The truth is out there." The "powers that be" seek to hide or distort the truth, that message whispered, but it won't stay cloaked forever.

The first round of Affordable Care Act (health reform) mandates, which took effect in September, reminded me of that message - that external realities exist, no matter how much wishful thinking or righteous indignation we throw at it.

Let's examine two sets of "external realities."

Consider first a young family without family health care coverage. According to the latest census findings, the majority of children live in households making $74,999 per year or less. Focus on the 0.7 percent who reside in households earning $35,000 to $49,999 and the 19.6 percent who live in households earning $50,000 to $74,999. These are typical middle-class households. Imagine for a moment that this family must either choose a sizable payroll deduction for family coverage or a premium for a "child-only" policy. There's the mortgage, taxes, utilities, car payments, car insurance, groceries, clothing, and a little recreation. Living paycheck to paycheck, would you choose to pay a premium for a healthy child who, at most, needs routine immunizations and the occasional office visit for colds? Or would you use that money for some other, seemingly more pressing, need? It is eminently understandable that such families would roll the dice and go without insurance. Before September, however, this was a risk with dire consequences should a child fall ill. Perhaps that risk served to pressure some families into taking the payroll deduction or buying a "child-only" policy.

Now imagine being an insurance company. By definition, insurance is an agreement that one party will assume a risk for a fee paid by the other. With life insurance, the buyer bets he will die, while the insurer, armed by the actuary, believes he will not. The few statistical aberrations are adequately paid for by the vast majority who make no claims. This majority forms a pool, which protects the solvency of the insurer and its continued ability to pay claims. With health insurance, the protective pool is formed by the healthy as a hedge against the claims of the sick. A pool composed entirely of the sick is called bankruptcy.

These two realities, of the family and of the insurer, crashed head on in September. As of Sept. 23, insurers are prohibited from denying coverage to children with pre-existing conditions. However, the mandate that everyone must purchase insurance doesn't kick in fully until 2016. If you are the young family, there is now absolutely no reason to worry about insurance. If your child stays healthy, as most children do, you can pocket the premium without guilt. Going without is no longer a gamble, because insurers have to cover your child if, God forbid, he or she should need an organ transplant or chemotherapy or some other treatment that costs in the hundreds of thousands of dollars.

Lagging U.S. life expectancy ranking blamed on health system

The Un­ited States is fall­ing sharply be­hind in world­wide rank­ings of life ex­pect­an­cy, and short­com­ings in the U.S. health care sys­tem may be to blame, sci­en­tists say.

Re­search­ers stu­dy­ing the is­sue con­clud­ed that obes­ity, smok­ing, traf­fic ac­ci­dents and hom­i­cide can’t ac­count for the drop—“lead­ing us to be­lieve that fail­ings in the U.S. health care sys­tem, such as costly spe­cial­ized and frag­ment­ed care, are likely play­ing a large role,” said Pe­ter Muen­nig of Co­lum­bia Uni­vers­ity, lead au­thor of the stu­dy.

In the re­search, which ap­pears in the Oct. 7 on­line is­sue of the jour­nal Health Af­fairs, Muen­nig and co-au­thor Sher­ry Glied of Co­lum­bia cite the grow­ing lack of health insur­ance among Amer­i­cans as a pos­si­ble cul­prit.

The study looked at health spend­ing, be­hav­ior­al risk fac­tors like obes­ity and smok­ing, and sur­viv­al rates for men and wom­en ages 45 and 65 in the U.S. and 12 oth­er in­dus­t­ri­al­ized na­tions.

While the U.S. has achieved gains in 15-year sur­viv­al rates dec­ade by dec­ade from 1975 to 2005, the re­search­ers found that oth­er coun­tries en­joyed even great­er gains. So the U.S. slipped in the rank­ing, even as per cap­i­ta health care spend­ing rose at more than twice the rate of the oth­er coun­tries.

Around 1950, the Un­ited States ranked 5th for life ex­pect­an­cy at birth for wom­en and 10th for men among de­vel­oped coun­tries, ac­cord­ing to re­search cit­ed by Muen­nig and Glied. The most re­cent fig­ures, from the CIA World Fact­book, rank the Un­ited States 22nd among those same coun­tries.

Muen­nig and Glied found si­m­i­lar trends in the 13 coun­tries that they stud­ied, though they only ex­am­ined 15-year sur­viv­al rates for peo­ple at age 45 and 65.

When they com­pared risk fac­tors, they found very lit­tle dif­fer­ence in smok­ing habits be­tween the U.S. and the com­par­i­son coun­tries—in fact, U.S. smok­ing rates de­clined more quickly than most oth­er coun­tries.

And while peo­ple are more likely to be obese in the U.S. than else­where, this was al­so the case in 1975, when the U.S. was less far be­hind in life ex­pect­an­cy, the in­ves­ti­ga­tors not­ed. More­o­ver, they said, the pe­rcentage of obese peo­ple ac­tu­ally grew faster in most of the oth­er coun­tries be­tween 1975 and 2005.

Hom­i­cide and traf­fic deaths, mean­while, have ac­counted for a sta­ble share of U.S. deaths over time, and can’t ex­plain the drop in life-ex­pect­an­cy rank­ing, the sci­en­tists said.

The most likely re­main­ing ex­plana­t­ion is flaws in the health care sys­tem, said Muen­nig and Glied, point­ing to the role of un­reg­u­lat­ed fee-for-service pay­ments and high re­li­ance on spe­cial­ty care amid sky­rock­et­ing costs.

Students 'should consider the value of their belongings' when searching for a house insurance quote

Students searching for a house contents insurance policy to cover them when they are away from their parent's home could do well to evaluate how much their belongings are worth.

This is according to Graeme Trudgill, technical and corporate affairs executive at the British Insurance Brokers' Association (BIBA), who explained that consumers should account for designer clothes, their computer, printer and gadgets like iPads - as when combined their value could be very high.

"People have a lot of stuff and you have got to make sure that you just add it all up. It doesn't take long - you can do a quick check and your insurance broker can help talk you through it to make sure you have covered everything," he continued.

However, students - of which UCAS states there will be 470,789 attending new courses this year - may not have to shell out for their own individual policy, as some providers offer home-from-home deals where parents extend their policy to cover the youngsters' possessions while they study elsewhere.

Aetna gets OK to hike rates on individual health policies in California

More than 1 million Californians will see their health insurance premiums rise Oct. 1 now that regulators have wrapped up their review of a plan by Aetna Inc. to raise rates an average of 19% for 65,000 individual policyholders.



Aetna was cleared Friday by the state Department of Insurance to proceed with its new plan. It was the last of four major insurers to be reviewed by the department, which has OKd double-digit rate increases by Anthem Blue Cross, Blue Shield of California and Health Net Inc. in the last month.



Regulators stepped up their scrutiny of the insurers after Anthem announced plans earlier this year to raise premiums by as much as 39%, triggering a backlash among policyholders, lawmakers and the White House. The insurer canceled the hikes and sought smaller increases that were allowed.



The insurance department has no authority to block rate hikes as long as they comply with California law, which requires insurers to devote at least 70 cents of every premium dollar to medical claims.



Aetna's plan met that threshold, the state concluded Friday. All of the hikes reviewed by the state take effect Oct. 1.



"The Department of Insurance in no way condones or supports these insurance rate increases on California policyholders, but the unfortunate reality is that legally insurers are entitled if their rate filings are found to be in line with state law," spokesman Ioannis Kazanis said.



Aetna welcomed the insurance department's decision and defended its rate increase as a necessary move to keep up with rising healthcare costs. The company said its maximum increase for a fraction of its members would be 30%.



"We are pleased that, after extensive and thorough review, the [department] has accepted the rates for Aetna's individual products in California," said Beth Anderson, president of Aetna's west region.



"Rate increases are never easy, but the growing market trends we are seeing in California — such as the increasing prices for hospital care, prescription drugs, doctor's visits and other healthcare services — directly impacts what our members pay."



Some Aetna policyholders voiced alarm at the coming increase, saying double-digit hikes each year could soon put insurance beyond their reach. Dave and Jo Nixon, for example, will see their annual cost rise 23%, to $17,676 from $14,340. The San Jose couple also have a $3,000 deductible.



"The trend is just crazy," said Dave Nixon, 56. "In two or three years, I'll be paying more for my health insurance than my rent."



Aetna and the other insurers had put their rate increases on hold since July while an outside consultant to the insurance department reviewed their paperwork.



Aetna announced last month that it was going forward with its Oct. 1 increases before the consultant had finished his review. The state would not give its consent until that work was finished.

Learning About Health-Care Reform

With new health-care reform legislation being hotly debated nationwide, it’s not surprising that a meeting on the subject Friday at the Surry County Senior Center in Mount Airy drew a crowd.

“The new health-care reform is confusing to a lot of people, so if you feel confused, you’re not alone,” Annalisa Davis, the center coordinator, said at the start of a meeting attended by about 50 people, mostly retirees.

They came to hear Bill Wilson of the AARP in Raleigh discuss the various provisions of the bill and what it means not only for senior citizens, but younger families and individuals as well as employers.

“I have yet to see the perfect piece of legislation,” said Wilson, who has many years of experience in public-policy work in the N.C. General Assembly, and gave a similar presentation Friday afternoon in Pilot Mountain.

“And this does not break that mold,” he added of health-care reform. “This is a 2,000-plus-page bill.”

While its passage was controversial and continues to be resisted by many although it has become law, Wilson told the local gathering that some of the bill’s provisions represent an improvement over the present situation.

“But what people really want to know is ’how does this affect me?’”

Medicare Changes

Given the makeup of the audience, a major focus of Friday’s program was Medicare, the federal government program that provides health-care coverage to persons 65 and older and the disabled.

Wilson assured those gathered that guaranteed benefits offered under this program will be continued under the new health-reform legislation. It also is expected to add 10 years to Medicare’s financial solvency, ensuring its continued availability.

One positive way in which Medicare will be affected, Wilson said, is by expanding wellness and preventive care coverage, which will allow annual checkups — and tests and screenings, such as bone-density screenings — at no out-of-pocket costs.

“There are huge improvements in preventive care,” Wilson continued, which are aimed at reducing costs of medical treatment by catching major problems earlier. “That’s an important part of the new bill.”

Wilson also addressed another well-documented concern related to Medicare — the so-called “donut hole” seniors have fallen into which is associated with the Medicare Part D program that subsidizes the cost of prescription drugs.

The donut hole occurs when seniors exceed $2,700 in total drug expenses in a plan year, which then requires them to pay 100 percent of their prescription costs until $4,300 is spent out of pocket. The “hole,” which 3.4 million Americans fall into annually, can appear in a hurry when extremely expensive medications are involved.

Wilson said certain provisions in the new health-care legislation are aimed at lowering out-of-pocket costs for prescription medications, gradually leading to the planned closure of the donut hole by 2020. This will include rebates being offered to Medicare beneficiaries to help offset the drug costs.

“It is still complicated, but hopefully by 2020, we’re going to simplify this a little bit,” Wilson told the audience Friday.

The health-care-reform legislation also seeks to reduce Medicare costs through such measures as identifying fraudulent providers, eliminating overpayments and implementing a vendor-certification program.

Those who attended Friday’s program had plenty of follow-up questions for Wilson regarding Medicare.

Arvid Simmons of Mount Airy wondered what will happen with reimbursement rates for medical providers under the program; specifically if people enrolled in Medicare will have to make up the difference between what a doctor or hospital charges and what’s allocated.

According to Wilson, efforts to reduce the reimbursement rate by 22 percent — as a means of keeping costs of care down — have fallen by the wayside. “I don’t know of any provider who could take a 22-percent hit,” the speaker added.

A related question concerned the problems seniors are experiencing in some locations in finding doctors who no longer will accept Medicare patients because of the paperwork and financial issues involved.

“It’s a real problem for people moving into the state, especially urban areas,” Wilson said. While a physician in Raleigh or Winston-Salem might continue to see a longtime patient, new retirees to North Carolina are having trouble finding doctors willing to treat them through the Medicare program.

Effects On Individuals

Wilson also addressed the matter of how the recent legislation will impact the uninsured or those who buy their own coverage.

Beginning in 2014, the new health-care program will provide a one-stop shopping opportunity for them to obtain coverage through “state exchanges.”

These plans will offer a standard plan of comprehensive benefits, with four levels of coverage in all. There will be no discrimination based on pre-existing conditions, according to the AARP official.

Until 2014, temporary coverage can be obtained through “high-risk pools,” but these will still be expensive compared to most plans.

“This is a temporary program to help people who have trouble buying insurance, until we get to the state exchanges in 2014,” Wilson explained.

He also pointed out that the health-reform legislation will equalize the costs of coverage, which now can be higher based on someone’s gender, health status or the fact they are older adults. “Now if you’re a female, you’ll pay exactly the same premium as a male does,” Wilson told audience members.

The measure further eliminates coverage limits for medical care, which can soon be met if a catastrophic illness strikes someone. The main reason people lose their homes is because of high health-care expenses, Wilson said. “This will go a long way toward eliminating those bankruptcies and foreclosures,” he said of the new legislation.

Tax credits are in place to assist consumers in paying their premiums, to couples earning less than $58,280 and individuals with incomes lower than $43,320.

Also, the new plan expands eligibility for Medicaid coverage, which is available to low-income persons.

Families who are part of an employer-provided health plan can have their unmarried children covered under the same policy until they reach age 26. “That starts this year,” Wilson said.

“This will cover a lot of young people who think they are invincible,” he added, but don’t realize that they might be hurt in a car accident and need coverage.

Penalties Possible

Individuals are required to have basic medical coverage under the reform package, and will face penalties otherwise, according to Wilson.

Beginning in 2014, those who are eligible to buy insurance through a state exchange and don’t will be assessed a penalty of $695 per year or 2.5 percent of their taxable income, whichever is greater.

The penalties are designed to generate funds to offset some of the costs of those who remain uninsured and then require care.

Employer Impact

The guest speaker also discussed the new legislation’s effects on employers Friday. “This is a big sticking part in the bill,” he said.

Under its provisions, small businesses are exempt. “For any company with less than 50 employees, there’s no requirement that you provide health insurance coverage at all,” Wilson added.

However, tax credits are available to assist those businesses in paying for coverage for eligible employees.

Around 80 percent of American businesses employ fewer than 10 people.

About 2 percent of businesses across the country will be subject to some increase in costs under the recently passed bill.

Wilson responded Friday to rumors that employees will have to pay taxes on insurance provided through company plans. “Not true,” he said.

No Dental

In response to another question from an audience member, Wilson said dental coverage remains a “big gap” in terms of the overall health-care picture. “You’re out of luck,” he told the woman who inquired about that aspect.

While there is some coverage for dental services under Medicaid, that is not the case for Medicare, Wilson said.

“It’s one of the biggest problems we have right now in this state,” the speaker said of lack of dental-care coverage. “It just impacts your entire health,” Wilson added, explaining that tooth problems can affect a person’s nutrition, for example, and lead to other medical difficulties.

Those attending Friday’s presentation seemed to come away with a better understanding of the new legislation.

“I thought it was very good,” said Nancy Walker, who believes the program was interesting as well as informative.

“We are a small business owner,” explained Walker, a Mount Airy native who know lives in Rural Hall and co-owns an electrical firm. She said she came to Friday’s meeting concerned about how health-care reform will affect her personally and her business.

“What’s in this program that we don’t know about yet, us as a little guy?” she asked.

Affordable health insurance – What you should know

There has been quite a few changes to the health-insurance industry in 2010, and there will be many more to come throughout the rest of the year. Many of the rules that currently control health insurance industries could well be changed.

It may be difficult to start looking for health insurance. Now the term “Affordable health insurance” may seem a contradiction in terms.as due to high premiums it’s not easy to believe that the coverage is actually worth the money.

The cost of health insurance coverage is small when you look at the cost of health care without the insurance.

The best way to find cheap health insurance is by checking the prices of a whole host of health insurance providers. Health insurance companies will charge you depending on many aspects such as if you are a smoker, your current weight and any existing health problems.

What you really need to know is how you can save money on health insurance. Taking the first offer that comes along will, most of the time, leave you paying more then you have to. You should also remember, just because one company has the lowest premium, this does not mean they are offering the best value for money.

Find out which physicians and hospitals are covered in your health insurance. Make sure your health care plan includes hospitals that are located nearby. Try not to be enticed by higher deductibles. Remember that a higher deductible could lower your possible monthly premium but it can also make you pay more for standard care.

Now the best tool you have available when you want to buy health insurance is to use the Internet. If you are ready to start looking for cheap health insurance, you can go online and get an online quote. Its important that you do proper research as many people are paying too much for their medical plan as some providers may charge for coverage which is unnecessary.

It's war on the wards of China's hospitals

FORGET the calls by many Chinese patients for more honest, better-qualified doctors. What Shenyang's 27 public hospitals really need, officials have decided, is police officers.

And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

Officials in this north-eastern industrial city of nearly eight million people have a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

"The police should have a permanent base here," said a neurosurgeon at Shengjing Hospital. "I always feel this element of danger."

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer.

Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A paediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organised protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a three-year-old boy was refused treatment because his grandfather could not pay £50 in upfront fees. The child died.

Doctors and nurses say the strains in the relations between them and patients' relatives are often the result of unrealistic expectations by poor families who, having travelled far and exhausted their savings on care, expect medical miracles.

We're Headed Straight Off a Cliff If Health Care Passes

Pork is the preferred legislative meat for members of Congress, but this weekend they opted for bologna as they tried to convince the public – and themselves – that their so-called “health care” or health insurance “reform” monstrosity will be good for us. At least Castor oil was supposed to work even though it tasted awful. This bill not only tastes bad, it will curdle the best health care system in the world, which could be made a lot better, but will be made much worse with many of the provisions in this legislation.

Democrats now readily admit that Medicare is full of waste, fraud and abuse, but they want us to believe they can run an even larger venture without throwing additional money away. Amazing!

President Obama again claimed in Saturday remarks to the House Democratic caucus that the bill will reduce the deficit by $1.3 trillion. He must know that isn’t true because the money “saved” from Medicare cuts will go to pay for new spending. Only in Washington can you save money and spend money at the same time.

Addressing critics of the bill, President Obama said no one is “going to pull the plug on grandma.” They won’t have to. Grandma will be denied treatment because she will be too much of a financial burden on government. It’s called rationing. Grandma had better start working out, eating lots of oatmeal and hope she doesn’t get sick. Why do you think the president kept mentioning sick children? It’s because children are the ones who will get the most – and best – treatment. Rahm Emanuel’s brother, Ezekiel, has said government has a right to decide how many health care dollars you are worth. And if children with a lifelong taxpaying potential are worth more than grandma who is taking more from the tax pot than she is contributing, that’s too bad for grandma.

The president also said the bill will save money by requiring only one test by the doctor “not five tests.” But what if the first test doesn’t reveal the nature of an illness? Suppose a cancer is hiding in one organ and the test is for cancer in another organ? A second (or fifth) test might reveal the location of the disease, but under Obamacare, a government bureaucrat will allow just one test. -- It’s a form of Russian roulette.

The president promised again “you can keep your doctor.” But what if the doctor quits because he or she can’t afford to accept reduced fees mandated by government to keep costs down, while paying ever-increasing premiums for malpractice insurance to protect the doctor from lawsuits, which, by the way, is another reason the doctor did so many tests.

Companies sometimes test-market new products in regions of the country to see how well they sell. Government-run health care has been test-marketed in Massachusetts and it is a disaster. The cost of the state’s insurance program has ballooned by 42 percent, or almost $600 million. According to an analysis by the Rand Corporation, “in the absence of policy change, health care spending in Massachusetts is projected to nearly double to $123 billion in 2020, increasing 8 percent faster than the state’s gross domestic product.”

The cost of insurance in Massachusetts is the highest in the nation. Double-digit rate increases are expected again this year. Yet, President Obama claimed Saturday that under the Democrats’ plan, rates will go down. How is this possible? If Massachusetts can’t run a cost-effective health program, how can the federal government? And by the way, the only reason Massachusetts has not gone broke (but is headed there) is because Washington has conducted large transfusions of cash because it has a vested interest in protecting the illusion of Massachusetts’ success.

The president said we should support the health insurance bill out of “a sense of neighborliness and community.” When I was growing up, that meant you, not government, helped your neighbor. Government was a last resort, not a first resource. Never has “I’m from the government and I’m here to help you” sounded more like an empty promise.

Remember when Democrats used to care about debt as a burden to our children and grandchildren? They claimed to care about debt when it was a “mere” $450 billion under George W. Bush. Now it’s headed toward the trillions. Where are the green eye-shade Democrats now? They’re spending us into debt as fast as the Treasury can print the money – or the Chinese will lend it to us. The interest on the national debt now exceeds the GDP of some countries.
Total U.S. debt has soared to an all-time high of 370 percent of yearly economic output. That far exceeds its peak of 300 percent during the Great Depression.

Jobs will be lost because of this bill. Already, Caterpiller Company is laying-off workers because it estimates the health care bill will cost the company $100 million.

Why should we believe the promises of politicians? While the president and Speaker Nancy Pelosi touted Medicare, what they forgot to mention was that the cost of that program (and the waste, fraud and abuse that is rampant in it) was supposed to be a fraction of today’s cost. In fact, it was sold on the basis of low cost.

There are no such things as cheap government programs. They become like the "Blob That Ate Tokyo," gobbling up everything in their path.

President Obama quoted Abraham Lincoln, who said he was “bound to be true” and suggested that he, too, was bound to be true. This legislation is so full of budget gimmicks, tricks and lies that the only thing true about is that it will make health care in America worse, not better.

Obama Urges Dems to Come Together for Health Care

Victory within reach, President Barack Obama exhorted House Democrats on Saturday to stay true to their party's legacy and make history by bringing health insurance to millions of struggling families now left out. Leaders exuded confidence as they defused thorny problems in the countdown to a landmark vote.

Obama evoked Abraham Lincoln's moral compass and extolled Democratic achievements such as Social Security and Medicare — once controversial, now an essential part of the social fabric — on a day marked by a frenetic hunt for votes inside the Capitol and angry tea party demonstrations at the door. Some protesters hurled racial insults at black members of Congress.

"Is this the single most important step that we have taken on health care since Medicare?" Obama asked rank-and-file Democrats far from the chanting crowds. "Absolutely. Is this the most important piece of domestic legislation, in terms of giving a break to hard working, middle-class families out there since Medicare? Absolutely.

"It is in your hands," Obama said, bringing lawmakers to their feet. "It is time to pass health care reform for America and I am confident that you are going to do it tomorrow."

In a carefully orchestrated appeal to unity ahead of a career-defining vote, Obama and House leaders were joined by Senate Majority Leader Harry Reid, D-Nev., who brought a pledge from more than 50 of his Democratic colleagues to promptly finish the bill after the House votes Sunday. House Democrats have been wary of being left in the lurch by the famously unpredictable Senate.

A series of last-minute flare-ups threatened to slow the Democrats' march to passage, after more than a year of grueling effort.

The most intense focus was on a small group of Democrats concerned that abortion funding restrictions in the legislation don't go far enough. Determined to avoid votes on such a charged issue, Democratic leaders raised the possibility of addressing the concerns of abortion foes through an executive order from Obama. It would reaffirm existing federal law barring taxpayer funded abortions except in cases of rape, incest or to save the life of the mother.

Fear of absorbing health insurance costs hit San Diego’s youth

Health care reform remains a hotly debated issue. It makes sense. The U.S. Census Bureau reported 46.3 million people had no health insurance in 2008.

Still, the debate has failed to highlight a key group: young people even though the health care package will affect them just as much. The issue is more so prominent in college town, San Diego.

In 2008, people age 18 to 24 had the highest rate of no health coverage at 28.6 percent, according to data compiled by the U.S. Census Bureau. The second highest uninsured group included people 25 to 34 years old at 26.5 percent. Thus, young people constitute more than half of all uninsured people in the U.S., according to the report.

If the proposed health care reform is passed, college students would be greatly impacted and in multiple ways.

First off, the millions of people who are uninsured, which includes college students, would have to obtain insurance, said San Diego State University political science professor Brian Adams.

In fact, he said this is one of the positive aspects of the legislation.

“Young people should probably get insurance anyway, because even if you’re healthy you can get into a car accident or you can have some catastrophic illness,” he said. “If you get into a car accident and you have $200,000 of health care debt, it can bury you for decades.”

SDSU journalism and media studies senior Natalie Scott is thankful to have health insurance through her parents’ plan while she is in school. She is concerned, however, about being covered once she graduates.

“I want to be covered even when I’m done with college and have my first real life job,” she said. “I won’t be getting paid too much so it is important to me that I get coverage and can afford it while I am working on my career.”

Other students, like Mary Zhong, have no health insurance. Her health care was terminated under her parents’ health plan when she recently turned 20. Zhong, who is a political science major, said she is “immensely” concerned about health care and hopes to purchase coverage through her part-time job.

“I recently studied abroad in Oxford University in England and was in awe of their universal health care system,” she said. “The U.S. is a highly industrialized nation, and yet I find it baffling that we are without some form of universal medical access. Everyone needs health care, and it should be easy to access.”

New Rules Promise Better Mental Health Coverage

WASHINGTON — The Obama administration issued new rules on Friday that promise to improve insurance coverage of mental health care for more than 140 million people insured through their jobs.

In general, under the rules, employers and group health plans cannot provide less coverage for mental health care than for the treatment of physical conditions like cancer and heart disease.

Insurers cannot set higher co-payments and deductibles or stricter limits on treatment for mental illness and addiction disorders. Nor can they establish separate deductibles for mental health care and for the treatment of physical illnesses.

Such disparities are common in the insurance industry. By sweeping away such restrictions, doctors said, the rules will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

For decades, many health plans have had limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other types of care.

Kathleen Sebelius, the secretary of health and human services, said the rules guaranteed that people with debilitating mental disorders would not suffer “needless or arbitrary limits on their care.”

The rules, which take effect on July 1, carry out a 2008 law that was adopted with bipartisan support. They significantly expand the rights of people with mental illness, much of which goes untreated because of insurance restrictions.

Under the rules, insurers can still review claims for “medical necessity,” can still require prior approval of some services and can still charge consumers more for using doctors and hospitals that are not on a list of preferred providers.

But under the rules, insurers cannot use these techniques in a more restrictive way for mental health care than for other medical services.

The administration said the new requirements could increase premiums by four-tenths of 1 percent, or $25.6 billion over 10 years. Businesses with 50 or fewer employees are exempt.

The rules apply to group health insurance plans of the kind typically offered by employers. Federal health officials said the rules did not apply to the individual insurance market, where policies are sold directly to individuals and families. However, some states have laws that apply to the individual market.

Irvin L. Muszynski, a lawyer at the American Psychiatric Association, praised the government’s decision to require a single deductible for mental health and medical-surgical coverage.

“Patients with mental illness often have general medical conditions like diabetes or high blood pressure that require treatment at the same time,” so a combined deductible makes sense, Mr. Muszynski said.

The rules were developed by the Labor Department, the Department of Health and Human Services and the Internal Revenue Service, which share responsibility for their enforcement.

The government said the rules would benefit 111 million people in 446,400 group health plans offered by private employers, and 29 million people in 20,000 plans sponsored by state and local governments.

In the new rules, the government says a health plan would be violating the law if it “imposes an annual $250 deductible on all medical-surgical benefits and a separate annual $250 deductible on all mental health and substance-use disorder benefits.”

The rules say that an insurer may require “prior approval that a course of treatment is medically necessary.” But the insurer cannot enforce this requirement in different ways for medical benefits and mental health services. For patients who receive treatment without prior approval, the penalty must be the same.

A number of companies specialize in managing mental health benefits. The Obama administration said the techniques used by these companies would hold down the cost of complying with the new rules.

But, it said, the standards and techniques used to manage mental health benefits must be comparable to those for other medical care and cannot be applied more stringently.

In a preamble to the rules, the Obama administration said that patients had typically faced higher co-payments for visiting mental health professionals than for visiting primary care physicians.

The rules are likely to reduce this disparity, so more people will be treated by mental health professionals, the administration said. This, in turn, “could lead to more appropriate care and thus better health outcomes,” it said.

The law requiring parity in the coverage of mental and physical illnesses is named for its sponsors, former Senators Paul Wellstone, Democrat of Minnesota, and Pete V. Domenici, Republican of New Mexico.

What About Health Care Reform?

President Obama mishandled the important topic of health care reform during his State of the Union speech on Wednesday night.

He spent little time discussing the issue, but when he did, he showed no sign of changing his method or learning from his opponents, insisting once again, "Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan." But where is the evidence of this? Both major bills before Congress include clauses which dictate exactly the kind of insurance you can have and what you can't.
And where is the incentive for doctors to keep accepting this insurance? More than 50% of practicing doctors already don't accept Medicaid, according to a 2005 survey, and the Medicare Payment Advisory Commission determined in 2008 that 28% of Medicare patients were unable to find primary care doctors. The yearly doctor dropout rate in private insurance exceeds 10% in many places, including New York.

President Obama went on to state that the health reforms would "reduce costs and premiums for millions of families and businesses," but how so? In Massachusetts, for example, insurance premiums went up when companies were compelled to cover pre-existing conditions and not drop anyone when they were sick. Noble ideals, but costly. And the rate of unnecessary ER admissions has remained steady at 15% even after universal health coverage passed in the bay state. "Patients will be denied the care they need" if health reform doesn't pass, the president reiterated last night, but there is no proof that increasing coverage expands access to health care. In Canada and Europe, the opposite is true.

The American public is no longer accepting the same tired platitudes, as evidenced by the Massachusetts election and the current climate around the country.

There are crucial problems not being addressed by health reform: First, there is a big shortage of doctors throughout the country, which will interfere with access to health care no matter your insurance coverage. The Association of American Medical Colleges estimates a shortage of 150,000 doctors by 2025.

Second, a one-size-fits-all HMO-style insurance is expensive and easily overused. It lacks the built-in disincentive for overuse of cheaper, higher-deductible insurance. Extending low-deductible insurance (a central principle of all the health reform bills) will lead to higher premiums, especially without portability to promote competition.

Third, even if you already have insurance it will be choked by government regulations and oversight under the new health insurance system, and it isn't likely to cover the high tech solutions you need. Lastly, doctors are already overwhelmed with too many patients. With no tort reform and decreasing reimbursements, they are likely to quit or at least quit taking insurance.

By not acknowledging America's concerns about health reform Wednesday night, the president appeared inflexible and incapable of real compromise. And by not spending much time on a topic that was front and center just a few weeks ago, he looked more like a politician than a leader.

Marc Siegel, MD

Unions Rally to Oppose a Tax on Health Insurance

When millions of blue-collar workers were leaning toward John McCain during the 2008 campaign, labor unions moved many of them into Barack Obama’s column by repeatedly hammering one theme: Mr. McCain wanted to tax their health benefits.

But now labor leaders are fuming that President Obama has endorsed a tax on high-priced, employer-sponsored health insurance policies as a way to help cover the cost of health care reform. And as Senate and House leaders seek to negotiate a final health care bill, unions are pushing mightily to have that tax dropped from the legislation. Or at the very least, they want the price threshold raised so that the tax would affect fewer workers.

Labor leaders say the tax would hit not only wealthy executives with expensive health benefits, but also many rank-and-file union members who have often settled for lower wage increases in exchange for more generous health benefits.

The tax would affect individual insurance policies with annual premiums above $8,500 and family policies above $23,000, which by one union survey would affect one in four union members.

The House bill does not contain such an excise tax, and many House Democrats oppose adding it to the combined House-Senate legislation. But the tax is a critical revenue component in the Senate’s bill. If the bill does too little to cover its costs, it might be defeated. Many economists support the tax, saying it will help hold down costs.

With labor groups warning that the tax will infuriate a key part of the Democratic base — union members — President Obama has agreed to meet with several top labor leaders on Monday to address their concerns and try to defuse their anger. The group includes the presidents of the A.F.L.-C.I.O., Teamsters and the steelworkers’ and service employees’ unions.

But whether the tax is negotiable remains unclear. Not only has Mr. Obama specifically endorsed the idea, but the White House and Senate leaders see the tax as pivotal in paying for the health care overhaul and addressing runaway health care costs.

Many Democrats and union officials fear that if both sides dig in on the issue, it could create a rift between the White House and labor — with some union leaders hinting they might lobby aggressively against the entire health care bill if it contains such a tax.

Union leaders have repeatedly warned the White House about the strong rank-and-file dismay, which could hurt the Democrats in Congressional elections this fall, especially in battleground states like Ohio, Pennsylvania and Wisconsin.

Ron Gay, an AT&T repairman in Youngstown, Ohio, who spent much of the summer of 2008 urging co-workers to vote for Mr. Obama, said, “If this passes in its current form, a lot of working people are going to feel let down and betrayed by our legislators and president.”

The Congressional Budget Office estimates that 19 percent of workers — or about 30 million employees — would be affected by the tax in 2016. Economists say most of them would be nonunion, although it is organized labor that has the lobbying clout to take a stand.

In recent days, labor’s strategy has become clear. Unions are urging their members to flood their representatives with e-mail messages and phone calls in the hope that the House will stand fast and reject the tax. The A.F.L.-C.I.O., a federation of nine million union members, has declared next Wednesday “National Call-In Day” asking workers to call their lawmakers to urge them not to tax health benefits. The International Brotherhood of Teamsters is urging members to tell their representatives that “such a tax is simply a massive middle-class tax hike that this nation’s working families should not be forced to endure.”

Many Democrats fear that enacting the tax will hurt their re-election chances.

“This would really have a negative impact on the Democratic base,” said Representative Joe Courtney, Democrat of Connecticut, who has enlisted 190 House Democrats to sign a letter opposing the tax. “As far as the message goes, it’s a real toughie to defend.”

While union leaders would prefer killing the tax, some say privately that they could live with it if the threshold is lifted to $27,000, say, or $30,000. They argue that many insurance policies above $23,000 are typical of the coverage in high-cost areas like New York or Boston, or policies that cover small businesses or employers with older workers.

According to a union survey, one in four members would be hit by a $23,000 threshold, but only one in 14 if the threshold were raised to $27,000.

White House officials, however, voice concern that raising the threshold that much would lose $50 billion of the $149 billion in revenue that the tax is expected to generate over 10 years.

Health overhaul bill facing court challenges

It now appears that some form of a health care bill will be passed unilaterally by congressional Democrats. But the fat lady has yet to warm up. Key provisions in the bill could be unconstitutional and need to be challenged. It could be a close constitutional call, as there are arguments on both sides.

Those who framed and ratified the Constitution intended to create a system of enumerated powers where all powers not specifically delegated to the federal government remained with state and local governments, and the people. Defenders of the individual mandate, requiring all Americans to have health insurance, cite the taxing power of the 16th Amendment and the commerce clause as the enumerated powers for this mandate.

In 1994, the Congressional Budget Office (CBO) opined: “The mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States.” But the CBO is a budget office, not a legal office issuing a historical statement about policy.

Individuals not carrying health insurance will be fined and possibly subjected to other penalties by the Internal Revenue Service. However, Congress has been careful not to call this a “fine,” but rather a “tax,” permissible under the 16th Amendment that authorized the federal income tax (“the Congress shall have power to lay and collect taxes on incomes, from whatever source derived”).

Such a tax would be discriminatory against individuals without health insurance, but defenders would counter that a graduated, discriminatory income tax schedule has been in effect since 1913, with those in higher-income tax brackets paying more taxes at a higher percentage rate. Hence, the 14th Amendment's equal protection clause may or may not be applicable to the individual mandate.

The 5th Amendment's takings clause may also be operative in that the government is, in a very real sense through the individual mandate, taking the individual's private property, in the form of his or her income, to buy insurance.

The commerce clause was initially intended by the framers to free up interstate commerce, specifically trade among the 13 Colonies, which had erected trade barriers. Following the New Deal and the Supreme Court-packing scandal, federal courts frequently defined the commerce clause as permitting regulations governing all commercial activity, far beyond the scope of interstate trade.

However, several recent decisions have revived some limits on the clause, such as United States v. Lopez. In this 1995 case, the Supreme Court held the commerce clause does not authorize a federal law banning guns in local school zones.

Critics of the Senate health care bill have also argued that the bill violates the equal protection clause by legislating unequal treatment among the states. Several “sweetheart” deals were arranged to secure passage of the bill — for example, the so-called “Cornhusker Kickback” in which the state of Nebraska was given a permanent waiver for any expanded state Medicaid costs mandated by the bill. Poor states will subsidize this discriminatory bailout.

But defenders of the bailouts will counter that state earmarks have been business as usual for decades by both Democrats and Republicans.

Even if Congress passes a health care bill on the grounds that it passes constitutional muster under the equal protection clause, the takings clause and the commerce clause, Congress does not have the final say: The courts do. We learned this from Marbury v. Madison, where the Supreme Court ruled an act of Congress unconstitutional. The courts today could indeed rule portions of the health care bill in violation of the 14th and 5th Amendments and/or the commerce clause.

The bill must be challenged in court. Forcing Americans to buy a certain private-sector product is an overdose of big government that may be toxic to the plain meaning and intent of the Constitution.