Archive for the Health Care Category

  • A A A
  • Charles Blahous

    Today Avik Roy of Forbes kindly provided me with a forum for responding to some of the questions that have arisen about my study showing that the 2010 health care reform law will add substantially to federal deficits.

    The full paper, again, is here.

    The Forbes blog is here.

    Excerpts from the Forbes blog post:

    The paper was subject to a double-blind peer review process, which means I did not know who was reviewing the paper, and the reviewers did not know who had written it.  Prior to this review process, I also independently had the paper reviewed by several fellow federal budget and health care financing experts to confirm that the analysis was correct.  Few of the criticisms of the paper have been substantive. I do not believe the few substantive criticisms hold water for the following reasons:

    Click to read more.

    Print Friendly
    Scott Atlas

    The Picture of Health

    From the facts, we know that Americans enjoy outstanding access and quality in their health care system. The only real “crisis” in America’s health care today is the unsustainable, increasing burden of health care costs on the government budget and the economy. The federal budget is directly affected by the rising cost of health care in two major ways: first, Medicare and Medicaid outlays increase as the population ages and as medical practice expands along with more advanced interventions; and second, tax subsidies for health care are massive, and they increase as the cost of tax-sheltered insurance rises.

    According to the Centers for Medicare and Medicaid Services (CMS), total health spending has reached about $2.6 trillion, amounting to 17.6 percent of GDP in 2010. Although part of the rise results from a predictable growth in the number of aged beneficiaries, more of it is attributed to the way costs per beneficiary are expected to continue growing faster than per capita GDP. National health spending is expected to rise 5.8 percent per year from 2010 through 2020, culminating in a 19.8 percent share of GDP by 2020.

    If such excess growth—as economists call it—continues as projected, federal spending on health care alone will approach the total amount collected in federal tax revenues within fifty years.

    Continue reading Scott Atlas…

    Print Friendly
    Jack Goldsmith

    Just about every player in connection with the President’s remarks about the Supreme Court seem to me to be acting oddly or imprudently.

    What a terrible idea for the President to charge the Supreme Court with an “unprecedented, extraordinary step” of judicial activism if it strikes down parts of the health care law.  It was not a bad idea because it constituted bullying of the Court.  It was a bad idea – at least from the President’s perspective – because it makes it harder for the Justices to rule in favor of the President’s position.  After his very public criticism, a vote to uphold the law by the Justices who sharply questioned the law at oral argument will invariably be seen as cowing to the President – an appearance, I am confident, the Justices very much want to avoid.  In other words, by questioning the Justice’s independence, the President made it harder for the Justices whose votes he needs to act in his favor.  That, I suspect, is why the President has tried to walk back his remarks.

    Also surprising to me are conservative protests that the President has crossed the line in criticizing the Court as activist.  President Obama was entirely accurate when he said: “I’d just remind conservative commentators that for years what we’ve heard is, the biggest problem on the bench was judicial activism or a lack of judicial restraint — that an unelected group of people would somehow overturn a duly constituted and passed law.”  However imprudent and impolitic the President’s remarks, he was in essence mouthing a central conservative complaint about the judiciary since the 1950s.  (I realize that matters are more complicated than this, but during the Obama years many conservatives have indeed been moving away from a jurisprudence of restraint.)  Conservatives were on firmer ground in criticizing the inaccuracy of the president’s claim that striking down the health care law “would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress.”  And of course it is odd for President Obama to implicitly embrace judicial restraint as a matter of principle.

    Continue reading Jack Goldsmith…

    Print Friendly
    Michael McConnell

    O’s ugly ‘warning’

    By all accounts, President Obama’s lawyers did a poor job of defending the constitutionality of his signature health-care-reform law in the Supreme Court last week. So he’s rearguing the case himself. On Monday, he declared that it would be an “unprecedented, extraordinary step” for the court to overturn a law “passed by a strong majority of a democratically elected Congress.”

    This statement is puzzling, to say the least. It is by no means “unprecedented” or “extraordinary” for the court to strike down the act of a democratically elected legislature.

    Has the president not heard of Roe v. Wade (1973), where the court invalidated the democratically enacted laws of all 50 states? And even Marbury v. Madison (1803), which struck down a section of the First Judiciary Act?

    How about INS v. Chadha (1983), where the court invalidated over 200 statutory provisions, many enacted by overwhelming bipartisan majorities?

    Is the president unaware that the court in recent years has declared unconstitutional the Line Item Veto Act (struck down in 1998), major portions of the Sentencing Reform Act (2005), the Religious Freedom Restoration Act (1997) and two different attempts at campaign-finance law (in 1976 and 2010) — just to name some of the most prominent?

    Continue reading Michael McConnell…

    Print Friendly
    Paul Gregory

    As a writer on Soviet planning, I am struck by its parallels with Obama Care.  Both believe their planning is “scientific” and executed by “the best of the best,” who know what is best for ordinary people. Both types of planning commissars suffer Hayek’s “fatal conceit” – the belief that they can plan incredibly complex economic systems. Their “scientific” plans, however, fall apart under the weight of unintended consequences as ordinary people circumvent their genial rules and instructions.

    The New York Times’ Mr. Health Care Mandate features economics professor cum scientific planner, Jonathan Gruber. After the Supremes’ brutal questioning, the Times probably felt that Obama Care needed a boost from Gruber, who, by his own admission, “knows more about this law than any other economist.” It was to Professor Gruber that the White House turned to design its new health care law.

    Continue reading Paul Gregory…

    Print Friendly
    Richard Epstein

    Observations on ObamaCare

    There are a number of constitutional and logical slips in the seductive argument that Paul Krugman puts forward in favor of the constitutionality of the individual mandate.  First, the question why any form of health insurance involves a question of “interstate commerce” at all.  Under the current elastic and indefensible definitions of interstate commerce, any form of local activity that influences the quantity and price of goods in interstate commerce becomes itself a form of interstate commerce, at which point there is precious little that lies outside that domain.

    Note the potential reach of this argument  by the standard definition that Krugman embraces, getting sick and buying insurance influences the ability of the United States to deal with foreign nations, so that Congress can presumably regulate it as a form of commerce with foreign nations.  More impressively, since the health of their populations influences health in this country, why not say that the Constitution gives the Congress the power to expand the health care benefits that Canada, Great Britain and the rest of the world supplies to their own population.  It is a form of constitutional newspeak to treat all these local activities as though they were commerce among the several states, when they are, most emphatically anything but.

    Continue reading Richard Epstein…

    Print Friendly
    Richard Epstein

    By now everyone knows that the Supreme Court will take up the watershed case of this century, when it examines the constitutionality of the Patient Protection and Affordable Care Act—the ACA or ObamaCare to both the friends and enemies of the Act. I have coauthored with Mario Loyola of the Texas Public Policy Foundation a brief that sets out our case against the constitutionality of the Act.  I have also written elsewhere about the complex historical evolution of the commerce clause.

    I am relieved to learn, after all, that the case against the individual mandate is so trivial that three eminent legal authorities, Jeffrey ToobinLinda Greenhouse and Dahlia Lithwick, found it easy to put me out of my intellectual misery by announcing that the act is manifestly constitutional on the indubitable authority of Wickard v. Filburn, which in their view has become the constitutional pillar of a boundless federal power.  Indeed, their collective wisdom is such that the case for the constitutionality of ObamaCare is so self-evident that only dark political motives can account for the willingness to overturn a statute whose impeccable social credentials make it the culmination of a long overdue reform movement.

    Let me confess to be one of the unpersuadables.  There is of course a powerful correlation between those who praise ObamaCare and embrace its constitutionality.  There is none of the typical posturing which says that we’ll leave it to Congress to deal with the wisdom of the laws while we merely determine their constitutionality.  However on this question, turnabout is fair play, for we should look at the wisdom of statutes, or their lack thereof,  in order to orient ourselves with respect to their constitutionality.

    Start with Wickard, which in soothing terms had as its objective the “stabilization” of agricultural markets under the Agricultural Adjustment Acts, by allowing the government to even out prices during good times and bad.  All that is a polite way of saying that the government should get into the business of organizing agricultural cartels, which can then reduce output by burning excess crops or forcing land to remain idle in order to reduce supply. At the other end of these cartels lie consumers, who suffer manifestly from the high prices and reduced supply that made it all the harder for them to weather the 1930s depression.  Roscoe Filburn was a cartel-breaker because he sought to escape the regulation and increase supply by feeding his own grain to his own cows.

    Continue reading Richard Epstein…

    Print Friendly
    Richard Epstein

    This week, the United States Supreme Court has on its plate the defining legal issue of our time—the constitutionality of the Patient Protection and Affordable Care Act (ACA), which I have already commented on from a doctrinal and historical perspective. In this column, I will show how fatal defects in Obamacare’s structure undermine the constitutional case for key provisions found in Title I of the law (“Quality, Affordable Health Care for All Americans”), which regulates the private insurance market.

    For openers, the ACA is subject to the law of unintended consequences. The law may proclaim that it protects patients when it in fact it restricts the health-care options of those it’s intended to protect. The ACA says that it will increase access to affordable care when in fact its endless mandates will drive up the cost of care. The false advertising of the ACA’s title conceals a wealth of difficulties with its internal design, which make its scheme unsustainable in the long run.

    One unfortunate byproduct of the obsessive emphasis on the individual mandate—the requirement to have health-care insurance or pay a fine—is that it diverts attention away from the many other unsound provisions of the law. The Supreme Court need not fear that striking down Title I of the ACA will deny Americans needed health care. Rather, its implementation will have that effect.

    Continue reading Richard Epstein…

    Print Friendly
    Henry Miller

    The Cigarette Smokescreen

    Cigarette smoking is one of the major preventable scourges of human health. Public health experts and regulators—and yes, even smokers—know it. But by being politically correct and focusing on unproven or misguided approaches, the FDA is passing up a historic opportunity to mitigate the health effects of cigarette smoking. Specifically, FDA officials are struggling to reconcile science and politics in applying their new powers to regulate tobacco. They aren’t succeeding.

    As a result of the landmark 2009 Family Smoking Prevention and Tobacco Control Act, the FDA was tasked with regulating not just cigarettes, but a range of tobacco products. The agency’s oversight of tobacco is fundamentally different from any other product it regulates simply because tobacco is an inherently, irredeemably dangerous product. Unlike drugs, it isn’t beneficial in any way; and unlike food, it isn’t a necessity.

    The legislation gives the FDA the authority to review and ban proposed new products unless they are proven to significantly improve public health. This has already led to unanticipated legal and scientific arguments over so-called “reduced harm” products.

    The director of the FDA’s Center for Tobacco Products, Dr. Lawrence Deyton, seemed to be on the right track, at least in principle, when he told the Society for Research on Nicotine and Tobacco last year that “complex problems require multi-faceted, comprehensive approaches based on the best available science.”

    However, the agency’s approach to several regulatory issues belies Deyton’s homage to science (a traditional trapping of many a regulator assuming a new office).

    Continue reading Henry Miller…

    Print Friendly
    Richard Epstein

    (photo credit: TexasGOPVote.com)

    Print Friendly
    James Huffman

    The Contraception Hawks

    For decades American politics has been poisoned by the great abortion debate. Never mind that the economy is in the dumps, the national debt is spiraling out of control, the nation’s infrastructure is crumbling, health-care costs are rising (even faster with the onset of Obamacare), and each year our kids learn a little less than they did the year before. So candidates for public office better know where they stand on abortion, because they will be asked again and again. And they better not flip-flop on the issue.

    Now, lo and behold, contraception has yet again surfaced as the social policy issue of the day. So, candidates for President of the United States better know where they stand. Making contraception center-most in the campaign for president in 2012 is like making a black-and-white, silent movie in the twenty-first century: Who would guess that it would win the Oscar for best picture? And who would guess that forty-seven years after Griswold v. Connecticut, contraception would make a return to the silver screen of national politics.

    Before candidate Rick Santorum resurrected the long moribund topic of the acceptability of contraception, the question du jour was whether the Obama administration’s newly promulgated rule on the provision of contraception services violates religious freedom or supports the freedom of women to control their reproductive lives. Now the question is whether the government has a role in regulating contraception. The response to that question should be: “You’ve got to be kidding! Of course there is no role for government.” But given that the question is now on the front page of every paper in the land, perhaps we can make some lemonade from this lemon.

    Continue reading James Huffman…

    Print Friendly
    Richard Epstein

    There are many horrible features about the President’s birth control mandate, with respect to religious institutions.  The Catholic Church, rightly in my view, regards this federal imposition as a mortal threat of its right to follow Church teachings on core issues of belief, which seems to be an interference with the guarantee that the Congress will do nothing to prohibit the “free exercise” of religion.

    To that claim, there are several replies.  The first is that the operation of medical facilities in accordance with Church teachings is not the exercise of religion, which only encompasses matters of worship and ritual.  That view is hopelessly narrow, given that the exercise of religion has to do with the way in which religious institutions interact in the world.  Indeed the recent Supreme Court decision Hosanna-Tabor Evangelical Lutheran Church v. EEOC makes clear that the choice of teachers for religious education fall within that core.  The issues of abortion, contraception, and sterilization get far closer to the core.

    It has been often been stated that even if these activities are covered, the Constitution does not protect their exercise when they are limited by a neutral law passed for nonreligious purposes that impacts religious and nonreligious institutions alike.  The position of neutrality is taken inUnemployment Division v. Smith, a decision written by Justice Scalia.  That decision does cut against the claim of religious liberty because it indicates that the size of the burden of religious choice has nothing to do with the free exercise claim.

    Continue reading Richard Epstein…

    Print Friendly
    Russ Roberts

    The insanity of health insurance

    I just received a lovely email from my old friend, Donna Brazile. OK, we’re not old friends. For some reason she has decided to put me on her email list. She writes:

    This week, the Senate votes on a GOP amendment that would let your employer decide what health care you can receive. If they morally object to birth control, it’s gone. If some corporation thinks cancer screening is too expensive, forget it.

    This amendment is dangerous, and the people pushing it need to lose their jobs.

    It is insane that we get our health care from our employers. That happens because we have given a tax advantage to in-kind compensation such as health care. It’s a horrible idea and it leads people to complain about our employers deciding what health care we can receive. Our employers are just a conduit for government mandates, rent-seeking and inefficiency related to health care. What the government has done is tax-advantage health care via employers and then tell them what has to be covered. So the real outrage is that because of this, the government mandates the mix of my compensation package, biasing it toward a luxury health-care package that is the result of special interest clamoring.

    Insane.

    The people who think it’s normal–the ones who work in the big white domed building downtown from where I live–should lose their jobs.

    Print Friendly
    Russ Roberts

    Mitch Daniels’ news flash

    There was actually a news-worthy moment in Mitch Daniels response to President Obama’s State of the Union address. He said:

    Decades ago, for instance, we could afford to send millionaires pension checks and pay medical bills for even the wealthiest among us.  Now, we can’t, so the dollars we have should be devoted to those who need them most.

    The mortal enemies of Social Security and Medicare are those who, in contempt of the plain arithmetic, continue to mislead Americans that we should change nothing.  Listening to them much longer will mean that these proud programs implode, and take the American economy with them.  It will mean that coming generations are denied the jobs they need in their youth and the protection they deserve in their later years.

    I would prefer to slowly dismember Social Security and Medicare and instead let us re-learn how to take care of ourselves and our neighbors without going through Washington.

    Continue reading Russ Roberts…

    Print Friendly
    James Huffman

    The ‘Commerce Clause Mandate’

    In “Obamacare vs. The Commerce Clause,” Richard Epstein provides a devastating critique of Supreme Court commerce clause case law since the New Deal. Because it is “an indefensible line of cases,” Epstein argues “[t]he United States Supreme Court should confess error and acknowledge that its past decisions are bad both as a matter of constitutional history and constitutional theory.”

    Professor Epstein is right. Despite recurrent claims by the Supreme Court that there are, in fact, limits on Congress’ commerce clause authority, the case law described by Epstein demonstrates the opposite. If the federal system conceived by the framers of the United States Constitution is to survive in anything more than name, the Supreme Court must push the restart button.

    But Epstein does not think the Court will admit to three-quarters of a century of intellectual confusion, so he urges a far more modest result in the Supreme Court’s review of the constitutionality of the Patient Protection and Affordable Care Act. The Court should accept, says Epstein, “the sensible claim that commerce does not apply to transactions that people never entered into.” The Court would thus draw a line in the commerce clause sands by acknowledging the “indefensible pedigree” of Wickard v. Filburn, but would not undertake to correct for past errors.

    Continue reading James Huffman…

    Print Friendly
    Henry Miller

    When Bureaucarts Stymie Science

    “If we can save only one child’s life…” is a phrase frequently used to justify one initiative or another. It has been invoked in recent years to promote causes ranging from the installation of seatbelts in school buses to anti-alcohol campaigns directed at pre-teens. But when it comes to saving lives through certain infant vaccinations, public health officials seem not to grasp the concept.

    Consider meningococcal disease, a rare but devastating bacteria-caused illness that primarily affects infants and children. Its elimination has been on the U.S. Centers for Disease Control’s list of priorities since 1999, but in early 2010, around the same time that a vaccine to prevent meningococcal disease in infants was submitted to the FDA for approval, the CDC began to show signs of retreating from its earlier resolve. Its motives are unclear.

    Continue reading Henry Miller…

    Print Friendly
    Robert Service

    The Next Russian Revolution?

    Twenty years ago, Mikhail S. Gorbachevannounced the end of a huge global experiment. After seven decades, the Soviet Union would be dismantled, its 15 republics becoming independent countries, and capitalism replacing the planned Soviet economy. Lenin’s embalmed corpse was left undisturbed in the Red Square mausoleum in Moscow, but the cause for which he led the October 1917 revolution no longer held the affection of hundreds of millions of Russians and millions more around the world.

    For two decades since, the Russian people have largely endured in silence the oppressive and corrupt system of power that ensued — until blatant irregularities in parliamentary elections earlier this month sent an estimated 50,000 people out in protest. These protesters have planned what is expected to be the biggest demonstration since the fall of Communism for Saturday in Moscow. Vladimir V. Putin, the once and future president, is at last facing trouble from the streets.

    Continue reading Robert Service…

    Print Friendly
    Clint Bolick

    Following the passage of the massive federal health-care bill, inquiring minds wanted to know the dimensions of the new bureaucracy it had created. So the question was put to the Congressional Research Service (CRS): How many new agencies, boards, and commissions were created by the law? Estimates ranged from fifty to the low hundreds. The CRS, with perhaps more research resources available to it than any other entity on earth, scoured the bill and its surrounding context, and finally came up with an answer: The number of new agencies created by Obamacare is “unknowable.”

    That is a scary pronouncement. Not only don’t we know the number of new agencies, but we don’t know which ones are the same or separate entities, what the contours of their jurisdictions are, or the extent to which they will intrude upon some of the most important and intimate decisions we make as individuals.

    Continue reading Clint Bolick…

    (photo credit: Brett Tatman)

    Print Friendly
    Glenn Hubbard

    After two months of talks, the super committee announced failure on Monday to agree on reducing federal deficits by $1.2 trillion over the next decade. But as the late economist Herb Stein once remarked: If something cannot go on forever, it won’t. That applies to the mounting budget shortfalls. But how?

    President Obama’s answer is higher taxes. But he can’t be serious. Just accommodating his spending plans over the next decade requires across-the-board tax increases of 20%. Over the next 25 years, taxes would need to rise across the board by 60%.

    Instead, what is needed is spending reform that offers goals, specifics and ways to blend fiscal responsibility with modernizing government. This includes near-term action on discretionary spending and longer-term action to reform entitlements and reduce the growth of Social Security and Medicare. Then revenue contributions can be addressed in the context of tax reform.

    The first goal is to reduce federal spending to a healthier 20% share of GDP from today’s bloated 25% within a decade. A tall order, yes, given the profligacy of the last few years. But it can be accomplished by eliminating unnecessary federal programs, empowering states, and reforming and streamlining government.

    Continue reading Glenn Hubbard…

    Print Friendly
    Richard Epstein

    ObamaCare vs. The Commerce Clause

    As everyone knows, the dispute over the individual mandate under the Patient Protection and Affordable Care Act (also known as ObamaCare) is due before the Supreme Court. The case will be argued this coming March, with a decision to be expected by June 2012—just in time to ignite political passions before the November presidential election. At this point, the bet has to be that the mandate will be affirmed, especially in light of the recent decision by Judge Laurence Silberman of the District of Columbia in Susan Seven-Sky v. Holder, which held that the individual mandate—whereby all persons must either purchase health-care insurance or pay a government penalty—falls within the power of Congress to regulate interstate commerce.

    The political tea-leaves could not be clearer. Judge Silberman is a distinguished conservative jurist, whose views could easily be read to presage the votes of Justices Scalia and Kennedy. His decision represents a defection from the conservative to the liberal position on this issue, which puts the challengers on an uphill battle. In this essay, however, I do not want to speculate about the political issues. Instead I will address the merits of case.  The key point is that the debate over the individual mandate is a diversion from the central historical issue.  The real objection to the health-care mandate is that it puts Congress deeper in the business of regulating health care when it really should have, under our original constitutional design, only a marginal role. In making this broad claim, it is necessary to expose the deep cleavage between the Commerce Clause as it came down from the Constitutional Convention in 1787, and the faux Commerce Clause that emerged out of the New Deal.

    Continue reading Richard Epstein…

    Print Friendly