Patterico's Pontifications

6/19/2009

Dialing 911 for Obamacare (updated)

Filed under: General — Karl @ 6:18 am

[Posted by Karl]

More and more people are figuring out that Pres. Obama’s planned government takeover of the American heathcare system, once thought to be a shoo-in, is in “real jeopardy.”  The Opinionator neatly sums up Lefty panic over Obamacare’s deteriorating vital signs:

“Health reform is, I think it fair to say, in danger right now,” wrote Ezra Klein this morning at the Washington Post.

“Attention fellow liberals who want health care reform,” wrote Jonathan Cohn yesterday at the New Republic. “You are in danger of losing the fight for universal health insurance. And it’s not only — or even primarily — because of the public plan.”

“Anyone else think the net result of health reform is going to be that insurance companies have even more political power?,” twittered Atrios this afternoon.

What’s got the pro-reform contingent worried?

“It’s because of the money,” writes Cohn.

I hate to say I told you so, but I told you so.  By the way, Cohn also reported that the Senate Finance Committee has postponed its healthcare markup until after the July 4 recess.  Expect a proposal considerably scaled back from the $1.6 trillion price tag of the committee’s first draft.

Meanwhile, the Blue Dogs and New Democrats have been holding meetings to see where they can agree on an alternative to counter what the “crazy liberal chairs and their crazy liberal staffers” are brewing in the House:

Both sets of principles are geared toward making sure any public plan won’t gain a competitive advantage over private insurance plans.

Of course, a public plan that cannot engage in unfair competition defeats the point of the public plan.  Accordingly, one inference that might be drawn is that these two groups — which make up more than half the House Democratic Caucus — are positioning themselves to be be able to say, “I was not against a public plan… I was just against that public plan…”

As Obamacare’s condition deteriorates, progressives were looking for any bit of good news.  They thought they found it in the latest NBC/Wall Street Journal poll showing that 76 percent of respondents said it was either “extremely” or “quite” important to “give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.”  They are desperate enough to overlook how strangely the possible responses to that question were worded.  They are also overlooking the question’s focus on “choice” in a country that likes choice and tends to associate it with freedom. 

They are certainly not attempting to reconcile those numbers with the even split Rasmussen got when asking people whether it would be a good idea to set up a government health insurance company to compete with private health insurance companies.  After all, Rasmussen is a tool of the Rethuglians.  That the NBC/WSJ poll also showed an even split on the question of whether Obama’s healthcare plan (generously and misleadingly described) is a good idea or a bad one is purely coincidental.

Also coincidental is the latest poll from Stanley Greenberg at Democracy Corps, which could not produce majority support for Obamacare, even after “a robust debate” that somehow did not include the argument that a public plan will cause employers to drop their employees’ private plans.  His deliberative poll shows, among other things, that the public’s basic attitudes on healthcare break down as Democrats vs. everyone else.  It also shows that peoples attitudes on these issues are basically the same as in 1993.  The latest Pew poll shows the same thing, except theat the results are a little worse for the Left today, with 14 percent fewer people thinking the system needs to be rebuilt.

All of which is why Greenberg, Nate Silver and others are dialing 911, by which I mean begging Pres. Obama to get out and sell, sell, sell a government takeover of healthcare.  The White House/DNC internal polling was probably saying the same thing, which is why ABCNews is getting to air Obamapalooza next week — which is going to be super-balanced, with questions submitted through the Lefty-dominated Digg.com.

Unfortunately for Democrats, an Obamamercial will not change the fact that the legislative sausage-making is already moving away from a public plan.  Indeed, the more Congress is forced to scale back its more grandiose fantasies, the less enthusiasm there will be for the effort among the activists and the nutroots.  An Obamamercial will not change the unforgiving math of the CBO.   As Pres. Obama once observed, “You can put lipstick on a pig — it’s still a pig.”

Update: Pres. Obama and VP Joe Biden joined House Speaker Nancy Pelosi, House Majority Ldr. Steny Hoyer and committee chairmen Charlie Rangel, Henry Waxman and George Miller to announce the outline of the House Democrats’ healthcare proposal:

The outline did not include details on how Democrats would pay for the plan.

Then they piled back into their clown car and sped away.

–Karl

131 Responses to “Dialing 911 for Obamacare (updated)”

  1. Now we’ll just wait a few moments for the cultists like Myron to tell us how impartial the ABC pogrom on healthcare is…one…two…three…

    Dmac (f7884d)

  2. BTW – Karl, excellent post, but you may have made one assumption too many here. Specifically, when has this administration ever paid any attention to the CBO numbers? Don’t you know that their office is mostly staffed by GOP (cough, cough) hacks?

    Dmac (f7884d)

  3. Karl,

    Additional anlysis. DeLong is still cheerleading health insurance (fourth point) but his highlighting of Romer’s fantasy chart and the general tone of the piece indicate an understanding that the Ogabe Regime is in trouble.

    Rick Ballard (f874e3)

  4. ABC is going to massacre Obamacare? OK with me, but I don’t think so. Stick to English, your Yiddish isn’t so good.

    Aubrey (f4abf3)

  5. Aubrey, I think Dmac was trying to say that ABC will begin a pogrom on those that “oppose” the healthcare plan Obomination.

    GM Roper (85dcd7)

  6. Previously in this forum, I’ve expressed some interest in a British or French-style national health plan, and for private insurance firms to be vaporized, but I’ve changed my mind. I’ve concluded he proposed US national health care plans are as badly thought out as the stimulus package. To put it succinctly, to hell with national health care, and to hell with the Democratic party, too, just in case.

    Legions of leftist government officials, journalists, and college professors are proposing and crafting legistlative nonsense for health care not because it would be more efficient, or because it would cover more people, but only because it’s their nature to propose and concoct legislative nonsense. In fact, these are the same people who in effect foisted Obama on America, a grievous mistake.

    Official Internet Data Office (6eaf9e)

  7. Stillborn legislation on health care. Ineffective legislation on “stimulus”. Federal takeover of Chrysler and GM with raping of private investors and sacking of bankruptcy law. Financial regulations that obliterate the relationship between the private Federal Reserve Bank and the US Treasury Department. Pro-Islam and anti-Israel sovereignty.

    Do people need any more proof the Federal Government is psychotically dysfunctional under Barry Soetoro.

    Maybe as Blue Dogs wake up on health care, cap and charade, energy policy, dealer closings and a host of other Soetoro boondoggles, Barry Soetoro will be bound and gagged legislatively.

    Free health care is an oxymoron.

    Bear1909 (abcdd6)

  8. The latest Pew poll shows the same thing, except theat the results are a little worse for the Left today, with 14 percent fewer people thinking the system needs to be rebuilt.

    Does the system needs to be rebuilt, Karl?

    It’s not a trick question.

    Currently, workers and households pay for health insurance through lower wages and higher prices. Employers do not bear the cost of employment-based insurance. It’s one of the most inefficient ways to get people covered and impedes efforts to keep costs down. Is the cost-wage trade-off cycle sustainable?

    steve (d8cd02)

  9. steve,

    I mention the Pew poll — and the others — only to point out that the public is not any more demanding that the system rebuilt than they were the last time a government takeover was floated.

    Is the cost-wage trade-off cycle sustainable? That presumes a cycle that exists, as all cycles do… until they stop. As in our last exchange, the issue is whether the Left can convince the public not only that the cycle is unsustainable, but that their proposals would address the problem. I don’t see much evidence that either is happenning.

    Karl (f07e38)

  10. “If you think health care is expensive now, wait until you see what it costs when it’s free.”

    “The good news is that, according to the Obama administration, the rich will pay for everything. The bad news is that, according to the Obama administration, you’re rich.”

    PJ O’Rourke

    redc1c4 (fb8750)

  11. Steve, what are you talking about? I am serious. I own a business, provide health insurance and work in health care provisioning.

    People think pieces of paper from Congress are going to “undo” years of abuse created by those very people looking to “own” more of the health care industry.

    1. Everyone wants the best health care and want insurance to pay for it. So in essence Consumers/Voters are to be ignored in the discussion since they simply want a freebie. Government has created this belief that Health Care is an entitlement.

    2. Medicare has instituted Price Controls already and the result — less and less MDs who want to practice the type of medicine needed to make people healthier. But surgeons to do expensive procedures are being minted daily. Again Gov.t failure.

    3. The Paradox of Health Care is the better it is the more we spend on it. Simply put a healthy 90 year old is much more expensive over a lifetime than a 50 year old Lung Cancer Victim. Yet, Government propogates the BIG LIE which is that healthy people lower costs. Global Warming II.

    4. The US funds health care technology world wide with the profits it creates for Companies that engage in medical innovation. No US, less technology and worse health care. Where is the US Government to create a Cartel to squeeze better prices from Russia, China, Brazil, England for all that great innovation we fund??

    5. Lawyers are slime and want to keep living off the honest work of Physicians. MDs will continue to practice defensively and order whatever they need to protect themselves. Where is Gov.t here???

    All the feel good NONSENSE is that and Obama is NONSENSE.

    Get after the five points above and maybe you start to have a solution.

    Obama care creates not one more MD, does not prevent one more lawsuit, does not reign in entitlement mentality of consumers, continues subsizing world-wide health technology and seems to have the goal of simply redistributing a smaller and smaller pie.

    HeavenSent (1e97ff)

  12. steve – Don’t you think that President Obama should put forth his detailed plan?

    JD (0ecdbf)

  13. Is the cost-wage trade-off cycle sustainable? That presumes a cycle that exists, as all cycles do… until they stop.

    I think it’s pretty safe to say the cycle exists. Relatively flat wages for 30 years while health care costs have risen 300%, adjusted for inflation. The health-care inflation rate for corporations significantly outpaces overall inflation.

    Health care costs to rise 9% in 2010:

    Employers who offer health insurance coverage could see a 9% cost increase next year, and their workers may face an even bigger hit, according to a report Thursday from consulting firm PricewaterhouseCoopers.

    Costs will rise in part because workers worried about losing their jobs are using their health care more while they still have it, the firm said in the report released to the Associated Press. The report also said rising unemployment is driving up medical costs.

    [PWC Principal Michael Thompson] noted that the intense focus on health care may slow price increases.

    We’re left to wonder why an “intense focus on health care” would slow price increases.

    steve (d8cd02)

  14. i think Congress should give Ear Leader whatever he wants in the way of health care reform, but then again, i think they should also pass his “cap and trade” program, and everything else he wants, and they need to do so sooner, rather than later.

    redc1c4 (fb8750)

  15. $1.6 trillion and still 34 million would be uninsured

    Neo (46a1a2)

  16. […] 19, 2009 by gunservatively Patterico is calling out 911 on the ObamaCare debacle legislation. More and more people are figuring out that […]

    “It’s still a pig.” « Gunservatively! (962ecf)

  17. steve – What is the President’s plan? What will it do to control costs? What will it do to ensure the same or better level of service that the consumer expects today? How will it be paid for? While you are at it, could you give us examples where the US government has been able to provide healthcare where they have been more efficient than the private sector, controlled costs, with the same level of service or better.

    JD (0ecdbf)

  18. The bottom line that steve likes to ignore here is that the President has provided no leadership, only self-promotion.

    That’s all that Obama knows how to do, self-promote in a way that looks like he’s doing something but always happens to actually fail to lead anyone on anything specific.

    He’s a cheerleader who has convinced himself that he’s a quarterback.

    SPQR (72771e)

  19. How much would it cost to simply buy health insurance for every single uninsured person? I would suspect it could be done for less than the uber-conservative $1,600,000,000,000 estimate.

    JD (0ecdbf)

  20. Excellent piece, as always, Karl…

    I really do hope that this crazy train of Obama-care is coming off the rails…

    I am worried about the Obamapalooza coming up though, and especially how no Dissent! will be brooked, not even for national advertising spots run during the event!

    Now Tapper seems to dismiss this by saying that opponents could simply buy time on local affiliates; but that ignores the fact that organizing a widespread rebuttal is much harder, logistically, due to this policy. That said, ABC is a private business and can do as they like. But the White House should not enter into such an incestuous deal in the first place; one that openly attempts to engage that network as an official, as opposed to de facto, propaganda arm of the administration…

    ACE had his usual, witty, summary of this bias yesterday, comparing and contrasting with what would be done if an ethnic or racial minority was complaining about being locked out of the debate, instead of eeeeeevil RethugliKKKans…

    http://ace.mu.nu/archives/288727.php

    This whole disgusting practice of not allowing dissenters a voice in the debate is not only intellectually dishonest, but oh so reminiscent of the Hillary care fiasco in the 90’s. Funny how the public opinion hasn’t increased in the way that the socialist would like it to either since then…

    Let’s all hope that this issue, especially the strongarm tactics of slanting the discussion in an almost propagandistic way, will have the same effect for the Democrats mid-term election prospects as it did all those years ago…

    Be Cool!

    Bob (99fc1b)

  21. Obama is rapidly establishing himself as the worst of Carter (kiss terrorist’s behinds) PLUS the worst of Clinton (Hillarycare) PLUS the worst of Nixon (serial lying and abuse of power).
    I’m growing in the belief that there may very well be a revolution in this country. Too bad for Bill Ayers and his ilk, they will be the targets, not the leaders.

    either orr (6c9faf)

  22. C’mon, steve. Those should be simple questions to answer.

    JD (0ecdbf)

  23. How well would Los Angeles County run health care?

    Michael Ejercito (833607)

  24. The White House/DNC internal polling was probably saying the same thing, which is why ABCNews is getting to air Obamapalooza next week — which is going to be super-balanced, with questions submitted through the Lefty-dominated Digg.com.

    ABCNews knows, as do we all, that there is a much greater downside to being too hard on Obama in the show next week than there is in being too easy on him.

    Is ABC willing to be treated the way Fox News is treated by this administration and the netroots? We’ve seen how the Obama administration and its supporters treat contentious media people and outlets– and nobody defends those criticized. That would surely hurt the bottom line at ABC.

    It seems to me a poor business decision for ABC if they don’t make this turn out nicely for the President.

    MayBee (cca412)

  25. Even Obama’s personal Chicago G.P. is less than supportive,

    David Scheiner, an internist based in the Chicago neighborhood of Hyde Park, has a diverse practice of lower-income adults from the nearby housing projects mixed with famous patients like U.S. Sen. Carol Mosely Braun, the late writer Studs Terkel and, most notably, President Barack Obama.

    Scheiner, 71, was Obama’s doctor from 1987 until he entered the White House; he vouched for the then-candidate’s “excellent health” in a letter last year. He’s still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. “I’m not sure he really understands what we face in primary care,” Scheiner says.

    Scheiner takes a few other shots too. Looking at Obama’s team of health advisors, Scheiner doesn’t see anyone who’s actually in the trenches. “I have a suspicion they pick people from the top echelon of medicine, people who write about it but haven’t been struggling in it,” he says.

    Of course Obama does not want an opposing view aired on the ABC special, nor inquiries about those pesky specifics that seem to be lacking. And what’s funny is he knows he can’t afford being exposed for the naked emperor he is quickly becoming. My question is: when this massive plan fails, who will he blame? Surely not Bush.

    Dana (aedf1d)

  26. MayBee – this is their idea of a full and robust debate. Actually, their debate is only amongst those that believe the government should be doing this, can control costs, and the debate will center on only the differing views as to how far the government should go in this. I cannot wait to see all of the sob stories that they will trot out. Misery pimps, they are.

    JD (0ecdbf)

  27. There are a few basic principles that would help to control spending and get more bang for the buck. I work part-time now in reviewing workers comp claims. I was talking to a neurosurgeon the other day and he was surprised when I told him that only about 25% of the doctors I deal with are honest and doing their best for patients. Of course, if the care being monitored is straightforward and appropriate, I don’t see it. The stuff I see is either unusual or exceeds basic guidelines. Work comp is as filled with fraud as Medicaid.

    As long as care is free, it has to be rationed. In the old days of the County Hospital, we had so many days a week to operate and we scheduled cases as we had time. Some people would wait three months to have a hernia repaired. Cancer didn’t wait.

    By the way, when I graduated from medical school in 1966, my class had 65 graduates. Now, USC graduates over 180 every year. Lyndon Johnson decided to triple the number of medical graduates and did so in the 60s but it did not reduce cost. The same thing is happening now with PAs and nurse practitioners.

    My suggestions would follow the French model:

    1. Insurance pays on a fee schedule and only for those services based on science. Patients are free to pay doctors more than the fee schedule.
    2. All doctor patient transactions are fee-for-service except for the poor who could be treated in clinics. The patient pays the doctor, then is reimbursed from the health plan less a 20% co-pay. That is how France does it.
    3. Hospitals are also free to bill more than the insurance payment schedule but the patient pays.
    4. There is free choice for all parties.

    The French have a program called tiers payant, or “one-third to pay,” in which the hospital bill does not have to be paid in advance of reimbursement but the patient has to pay the co-pay.

    There are a couple of barriers to such a reform: 1. people will complain about the co-pays and the payment in advance of doctors. However, the first dollar coverage that so many corporate plans include is a big source of moral hazard. 2. People will insist that the poor cannot be asked to pay these fees. Co-pays can be scaled on income,. The whole French system is computerized and the patients carry a debit card-like card that is swiped in the doctor’s card reader. It bills the health plan and sets the co-pay. It would be easy to scale the co-pay. Without a co-pay, you will never control unnecessary utilization.
    3. The alternative medicine practitioners will howl and politicians will listen. They have been the source of much of the mandate problem in state regulation of insurance.

    If you want to solve the problem, that is some of what you have to do.

    Doctors will be unhappy with the fee schedule but they are already dropping out of Medicare and going to cash fees. One way to deal with that is to start a program for younger docs, who often have $250,000 in loans, of loan forgiveness if they follow the fee schedule.

    Anyway, trying to generate more docs is not going to work because it’s been done. Older docs are dropping out of practice much faster than they used to.

    The French have 85% approval rating for the health system.

    Mike K (90939b)

  28. The bottom line that steve likes to ignore here is that the President has provided no leadership, only self-promotion.

    In which case prospectively calling it “Obama’s planned government takeover of the American healthcare system” is irrational.

    Republicans need to be wrapping their arms around the party’s alternative. Karl Rove is correct. Just pick one.

    Our annual health insurance premiums jumped 119 percent from 1999 through 2008, according to Kaiser data. Health care isn’t working just fine as it is.

    The “road to socialism” sand in the gears will probably carry the day. But check out Rove’s Coburn-Ryan bill summary if you’re thinking about, you know, possibly taking an affirmative position.

    steve (d8cd02)

  29. Its not irrational, steve, since Obama will take credit for anything that passes regardless of how little he contributed to its substance

    Just like the Porkulus. A bill he had little input to the substance of but claims as his own. It is his practice. He’s a cheerleader who calls himself the quarterback.

    And there is nothing irrational about calling it a government takeover given how Obama is carrying out takeovers of so many other parts of the economy.

    SPQR (72771e)

  30. I would like to know who the uninsured are, since these numbers are high. How did they come up with these numbers? Are these people illegals, poor, just don’t want to buy a policy, unemployed? They should cap these malpractice lawsuit amounts, and the govt should stop telling insurance companies what they have to cover..maybe cheaper plans can be developed. As it stands people have policies that cover a host of things they don’t need or want. Make people pay for wellness appts and physicals ..there are so many ways to cut costs. Look into how to get some sort of coverage for the uninsured and leave the private plans alone, and let them be flexible private plans such as one does with car insurance.

    Krystal (321f7e)

  31. Mike K-
    Perhaps I don’t understand something here, but:

    1. Insurance pays on a fee schedule and only for those services based on science. Patients are free to pay doctors more than the fee schedule.
    2. All doctor patient transactions are fee-for-service except for the poor who could be treated in clinics. The patient pays the doctor, then is reimbursed from the health plan less a 20% co-pay. That is how France does it.
    3. Hospitals are also free to bill more than the insurance payment schedule but the patient pays.
    4. There is free choice for all parties.

    Sounds very much like what goes on with most insurance plans. How is it different?
    How are these programs in France paid for/funded?

    MayBee (cca412)

  32. Krystal, the bulk of the uninsured are people who have decided to allow their health insurance to lapse not because they can’t pay it, but because they’ve decided to spend the funds on other things they consider more important. They are usually young people who can take such risks given their low rate of health problems. Similarly people between jobs who elect not to pay for COBRA continuation of job-provided health benefits.

    SPQR (72771e)

  33. steve – Were those questions too difficult, or do you prefer to argue by anecdote?

    JD (0ecdbf)

  34. Apparently there’s a bit of a movement on DaiylKos encouraging people to cancel their health insurance.

    Genius.

    MayBee (cca412)

  35. #12 — Comment by JD — 6/19/2009 @ 8:39 am

    steve – Don’t you think that President Obama should put forth his detailed plan?

    No reply

    Asked again in:

    #17 — Comment by JD — 6/19/2009 @ 9:04 am

    No reply

    #22 — Comment by JD — 6/19/2009 @ 9:34 am

    No reply

    Too funny!

    JD, you do know what the President meant by transparency –so transparent, it is invisible.

    Pons Asinorum (9fb321)

  36. which is why ABCNews is getting to air Obamapalooza next week — which is going to be super-balanced, with questions submitted through the Lefty-dominated Digg.com

    Good piece Karl. I think the above is the answer. If a real public debate is going to happen (especially on the ABC infomercial), then sign-up, get on board and send along some good questions to ABC (and Digg).

    If enough people ask the pointed questions (like how will this program support the uninsured without competing with private insurance, etc.) they may actually ask it. If not asked, at least it might show up on Digg as a highly rated question.

    Just a thought.

    Corwin (ea9428)

  37. Krystal:Are these people illegals, poor, just don’t want to buy a policy, unemployed?

    All of the above. But I believe the biggest chunk is “don’t want to buy a policy”. Do you remember that family they tried to use as poster children for SCHIP? They could afford health insurance, they just didn’t bother to buy any until they already had a medical problem.

    Our current system is partly an artifact of WWII wage and price controls, companies couldn’t offer worker more pay but they could offer them medical insurance as a benefit, and pay for it with pre-tax money. The two biggest things we could do to control medical costs are; tort reform, and medical savings accounts a la the 401(k). But the Democrats oppose both.

    LarryD (feb78b)

  38. Comment by Michael Ejercito — 6/19/2009 @ 9:45 am

    ObamaCare…A King-Drew in every neighborhood.

    Time to go into the mortuary business.

    AD - RtR/OS! (67897f)

  39. Sounds very much like what goes on with most insurance plans. How is it different?
    How are these programs in France paid for/funded?

    Comment by MayBee

    The difference is that the schedule is national, not fragmented among 1300 insurance companies that have varying requirements and schedules. When I retired I had 276 contracts with various carriers, all with different co-pays, fee schedules and requirements for authorization.

    The vast majority of French health plans are funded by payroll deduction, just like employer health plans, except the plan is NOT employer based. The schedule also requires the sort of evidence based approval that is being bandied about by the Obama people. I think they call it effectiveness research or some such. The trouble is that the process will be political. The French are very cold blooded about some things, like health care and electric power (85% nuke).

    I have a lengthy analysis on my blog under Health Reform.

    The French are having problems with funding but it is because their employment is screwed up. They have very high unemployment, short work weeks and much fewer average hours per week because of long vacations. Their system in our country would save billions, if not trillions. Of course, they have a different legal system, too.

    Mike K (90939b)

  40. Pons – I am nothing if not persistent ;-). I have been asking that of the Leftists in every discussion on this topic. Not one has even attempted to answer.

    JD (0ecdbf)

  41. steve – Were those questions too difficult, or do you prefer to argue by anecdote

    Let’s see if you’re willing to embrace one of the aforementioned GOP alternatives. Or articulate one of your own. Is that too difficult?

    I have no clue why Obama’s plan isn’t finalized.

    Karl Rove favors rebates ($2200 for individuals and $5700 for families) to make health insurance more affordable, especially for young people, and more portable. He also claims Medi-Choice “helps the hard-to-insure and chronically ill because it shares their risk across all insurance companies.”

    Thoughts?

    steve (d8cd02)

  42. steve,

    The GOP plans, whatever their merits, primarily exist because Frank Luntz and Karl Rove have told the GOP they have to have an alternative. And that’s been borne out. While Obama doesn’t have a real plan himself, his response has been the same as yours: “What’s your plan”?

    Given that any plan I might like has zero chance of becoming law any time soon, my second preference is that the government not make things worse than it already has. And, as noted earlier, the Dems aren’t going to get what they want until they can convince people that they won’t make things worse.

    Karl (f07e38)

  43. steve writes:

    I have no clue why Obama’s plan isn’t finalized.

    No kidding. Consider the theory that it’s because when he — or the Dems in Congress — are forced to actually come up with one, it will offend enough constiuencies that it won’t pass.

    Elections have consequences. The GOP (and thus the Right) has no power to pass anything. The burden falls, as it always does, on the majority. The Left now has the burden of production and persuasion, and so far, they are failing at both.

    Karl (f07e38)

  44. steve – I do not think there should be any plan, so I do not support the Luntz/Rove plan.

    I reiterate my above questions, that you failed to address for about the 40th time. I am kind of slow, but I think I see the vague outlines of a pattern emerging here.

    Pons – SHOCKA, huh?

    JD (0ecdbf)

  45. The Federal Government needs to straighten out their own messes first: Native-American med care, Veterans med care, Medicare/Medicaid.

    For the rest of us, they need to change the tax code so that health-care insurance costs are deductable on an individual basis (the McCain Plan – which was originally advocated by someone who is now an Obama advisor on health-care issues) would go a long way to remove the distortions that are inherent within the current system.

    We in America do not have a health-care crisis, we have a health-care insurance affordability crisis!

    AD - RtR/OS! (67897f)

  46. Obama’s Doctor Knocks ObamaCare

    Scheiner, 71, was Obama’s doctor from 1987 until he entered the White House; he vouched for the then-candidate’s “excellent health” in a letter last year. He’s still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. “I’m not sure he really understands what we face in primary care,” Scheiner says.

    Neo (46a1a2)

  47. As the plan hasn’t been finalized, no one can logically divine what it “will do to control costs” or “ensure the same or better level of service.” Much less how it will be funded. Was that not obvious?

    I do not think there should be any plan, so I do not support the Luntz/Rove plan.

    Neatly absolving you of any affirmative position on the conservative alternatives. No sensory overload. I may join you in the bleacher seats.

    steve (d8cd02)

  48. The vast majority of French health plans are funded by payroll deduction, just like employer health plans, except the plan is NOT employer based.

    Can I assume your payroll deduction is made, whether you think you can afford it or not?
    I think the French plan sounds workable.
    I’m just thinking of the people in America who have decided they can’t afford insurance and so are among the uninsured, and are calling for government health care.

    If Congress comes up with a similar plan, I certainly hope they make public the amount they plan to deduct from people’s paychecks before the vote takes place. I wonder how the people in the DailyKos diary I linked to earlier would respond to mandatory premium deductions.

    MayBee (cca412)

  49. steve don’t you think that things like the questions I posited are legitimate concerns to be addressed?

    JD (0ecdbf)

  50. Funny how conservative Republicans in Congress have yet to denounce their own life long publicly funded government healthcare coverage while insisting the public option in no good for the rest of Americans.

    DCSCA (9d1bb3)

  51. steve don’t you think that things like the questions I posited are legitimate concerns to be addressed?

    I sure do.

    steve (d8cd02)

  52. That’s because they are not planning to give us their plan. They should be made to use the other plans they already have:

    Fix the Indian Health Service.
    Fix the Veterans Health Administration.
    Fix Medicare and Medicaid.

    Then they might have a clue as to what’s needed.

    htom (412a17)

  53. DSCSA – Have you seen any Dem politicians giving back parts of their salary or perks, despite the protestations about same in the private sector?

    JD (0ecdbf)

  54. SPQR and Larry D – thanks for answering about who the uninsured are – I’ve always wondered where the figures came from. Considering I see people with Iphones, expensive sneakers etc, and yet have a food stamps card while I struggle to budget my food bill – yet they dont have insurance or need govt to pay (meaning taxpayers). In NY now they have ads asking people to call if they are low income and they can get free cell phones! It’s outrageous.

    Krystal (321f7e)

  55. There are a couple of other factors that affect our health care affordability. The retail prices that we see, like $50 aspirin tablets, are NOT what is paid by insurance. They all have contracts that heavily discount those prices. The discounts are from 75% to 90% so what you see is only paid by people who are uninsured. That is perverse to say the least but a doctor who offers a cash discount risks getting caught by Medicare which will reset his/her fee profile to that cash price and then discount that 75%. That’s why the surgeons who are doing surgery for cash fees have dropped Medicare. Otherwise, they could be prosecuted.

    This is an achilles heel for medical IRAs. You have to submit the claim through the insurance company to get the contract price so there is no administrative saving. We are evolving a cash market for health care in this country because the Medicare fees have gotten so low, it is not worth the hassle. Of course, this benefits the affluent and screws the poor but what else is new ?

    Mike K (90939b)

  56. DCSCA writes:

    Funny how conservative Republicans in Congress have yet to denounce their own life long publicly funded government healthcare coverage while insisting the public option in no good for the rest of Americans.

    It’s only funny to hacks who don’t know the difference between the two:

    The FEHBP. There is much confusion about the FEHBP, its unique character, its structure, and how it actually works. Misinterpretations are common and sometimes deliberate. For one thing, the FEHBP simply does not have “a benefit package” or any type of standardized health benefits package. Further­more, no single FEHBP plan covers all Members of Congress, federal workers, and federal retirees.

    Within the FEHBP, competing health insurers offer a variety of premiums, cost-sharing options, and benefit packages across various types of health plans, ranging from fee-for-service options and pre­ferred provider organizations (PPOs) to health maintenance organizations (HMOs) and health savings accounts. This year, 283 plans are available through the FEHBP at the national and local levels. The benefit packages change from year to year— sometimes dramatically—depending on prevailing market conditions, consumer demand, and insur­ers’ willingness to compete and offer different pack­ages through the FEHBP.

    This wide range of personal choices and the intense competition among the various health plans are precisely what make the FEBHP both popular and successful. It is the closest thing that Americans—at least those Americans who work for the federal government—have to a functioning, consumer-driven national health insurance market.

    Obama’s New Government Plan Compared to the FEHBP. The principles and practice of the con­sumer-driven FEBHP contrast sharply with Obama’s new national health plan.

    First, in the regulatory spirit of the Clinton health plan of 1993,[9] the Kerry plan of 2004,[10] and the Commonwealth Fund proposals, the Obama plan would impose a standardized benefits struc­ture on both the new government plan and every private health plan that participates in the pro­posed National Health Insurance Exchange. There is no comprehensive, standard benefit package in the FEHBP.

    Second, the Obama proposal would have a gov­ernment-run health plan in the National Health Insurance Exchange. No federal agency offers a government health plan through the FEHBP. Only private health insurance plans compete in that pro­gram, and even more important, they compete on a level playing field.

    Third, Obama’s proposal clearly envisions—but does not spell out—some type of price regulation. Although the language of his proposal is vague, enrollees are to be charged “fair” premiums and “minimal co-pays.” Presumably, Congress or an authorized agent, such as the proposed National Health Insurance Exchange, would define these terms. This would put the federal government in the business of deciding what constitutes a fair price and a proper co-payment for benefits and ser­vices, leading to some type of centralized rate set­ting or standardization of payments for providers. In the FEHBP, prices are market-based. No price regulation is imposed on plans or services.

    The challenge in creating a new government-run health plan is to balance promised benefits with costs. The subsidy envisioned in the Obama plan would probably need to be substantial, which would impose significant costs on taxpayers.[11] Concurrently, the plan would need to adopt tough regulatory mechanisms to control costs. For exam­ple, government officials could employ British-style “comparative effectiveness” standards to restrict use of medical services and procedures, or they could enforce strict pay-for-performance mea­sures to discourage doctors from providing what government officials deem “wasteful” treatments. In either case, the plan would need mechanisms that ration care and medical services to contain potentially explosive health care costs.

    Karl (f07e38)

  57. No kidding. Consider the theory that it’s because when he — or the Dems in Congress — are forced to actually come up with one, it will offend enough constiuencies that it won’t pass.

    I’m looking for a transcript of Obama’s speech to the Business Council in Feb 2009. In the Q&A portion, he said Congress may find how many conflicts there are in their ideals as they work on drafting a bill.
    I always assumed that’s why he didn’t want to propose a specific plan.

    MayBee (cca412)

  58. #56- Hacks? Speak for yourself. The bottom line is they’re covered by a PUBLICLY FUNDED GOVERNMENT HEALTHCARE SYSTEM. If it’s good enough for them, it’s good enough for the rest of Americans. Like the Letterman joke, if you gotta explain it in an 18 inch deep response, it doesnt work.

    DCSCA (9d1bb3)

  59. That is going to leave a mark, Karl.

    JD (0ecdbf)

  60. The bottom line is they’re covered by a PUBLICLY FUNDED GOVERNMENT HEALTHCARE SYSTEM. If it’s good enough for them, it’s good enough for the rest of Americans.

    Their salary is also paid via public funds.
    If that’s good enough for them, it should be good enough for all of us. We should all get or paycheck from the government.

    MayBee (cca412)

  61. I see that DCSCA went with the “it is true because I puÞ it in ALL CAPS” argument. Nice.

    JD (0ecdbf)

  62. MayBee, that is a pretty devastating riposte. Nicely put.

    carlitos (84409d)

  63. I might add that, in 1986, Medicare tried to do a national fee schedule using the RBRVS, or “resource based relative value schedule.” Two problems with that:

    1, it was tweaked to devalue surgery, especially difficult and time consuming surgery. It was sold to the internists as a way to cut surgeon’s incomes and pad internists and primary care docs incomes. Guess what; it accomplished the one and not the other. There are a lot of stories about how screwed up the cardiac surgery fees were because the AMA had used a non-operating “heart surgeon” as a tame member of the committee that designed that particular camel.

    2. The trouble was that the fee schedule is mandatory and there is no balance billing. As a result, instead of market forces, it had thousands of pages of regulations to try to adjust for cost of living etc.

    Had they set a basic fee schedule that Medicare paid and then allowed balance billing, it wouldn’t have been so bad. I’ve actually had patients give me cash, sometimes substantial amounts (I’m not telling if I took it), because they saw their EOB and how low the reimbursement was for a big operation.

    You cannot duplicate a market and health insurance has screwed up the market for health care. Doctors are to blame for a lot of it.

    Mike K (90939b)

  64. YOU ALWAYS MAKE YOUR POINTS MORE CLEARLY BY USING ALL BOLD CAPS! I ONCE WORKED FOR THE CIA, AND MET VON BRAUN IN MY UNDIES! I ALSO WORKED FOR ENRON AND NASA, AND IN MY SPARE TIME TRAINED IN ASSASSINATION SQUADS FOR THE CIA! I ALSO LIKE WALKS ON THE BEACH AND CLEANING MY MOTHER’S LITTER BOX IN THE BASEMENT, WHERE I CURRENTLY RESIDE!

    Dmac (f7884d)

  65. Aubrey, I think Dmac was trying to say that ABC will begin a pogrom on those that “oppose” the healthcare plan Obomination.

    Thanks for clearing that up for Aubrey, GM Roper – she doesn’t appear to be too quick on the uptake.

    Dmac (f7884d)

  66. #58- Ah yes, if only everyone saw the world through the eyes of the Heritage Foundation. Fortunately, we don’t.

    DCSCA (9d1bb3)

  67. Mike K, I am curious as to whether you think the passing of this healthcare plan will discourage young people from going into medicine? I am currently reading about the doctor shortages in Canada, and wonder if you see the complicated boondoggle and increasing debt incurred as something that will have a negative impact on students thinking about medicine. If so, what incentives do you see the government putting in place to increase the numbers?

    Dana (aedf1d)

  68. I wonder if ASPCa realizes that comment #66 is apparently arguing with its own comment #58. Rocket science.

    Even if it was referring to MayBee @ #57, it fails to actually refute anything, other than to take a swipe at the Heritage Foundation.

    JD (0ecdbf)

  69. DCSCA, I have taken DRJ’s advice not to engage you in these comments. But, previously I had made a suggestion to you and I’ll just try one more time for posterity. On my screen, your last comment 66 refers to your previous comment 58. Which makes no sense, because you appear to be criticizing yourself. Comment numbers are fluid, for reasons I don’t understand.

    I ask you not to change, moderate your comments, answer questions, back up claims with links – none of that silly blog etiquette. But please do try to refer to comments with a little more detail. You might even deign yourself to use the ‘quote’ button and cut / paste them in your very post. It would make the comments more readable, and the blog a better place.

    carlitos (84409d)

  70. Dggcrpp has much trouble referring to the correct posts it mentions – must be a little cognitive problem, not that it prevented it’s amazing career in science fiction writing.

    Dmac (f7884d)

  71. #69- I’ve taken it as well. Lets agree not to engage.

    DCSCA (9d1bb3)

  72. Then they piled back into their clown car gas-guzzling SUVs and sped away.

    FTFY, Karl

    carlitos (84409d)

  73. Karl left a mushroom bruise on DCSCA’s forehead. He may be concussed.

    JD (0ecdbf)

  74. Actually DCSCA’s all caps are his usual attempts at misrepresentation. “PUBLICLY FUNDED GOVERNMENT HEALTHCARE SYSTEM” is simply an inherent misrepresentation – and not accidentally so. The deception is deliberate. The options available are simply not “government healthcare”. They are perhaps publicly funded insurance but the healthcare itself is often not itself provided via a government entity.

    SPQR (72771e)

  75. SPQR – it does not care. It wants its free healthcare, dammit.It also ignores or does not understand that in the above scenario, the government is in the same role as an employer, not a health care provider or insurance plan. Details …

    JD (0ecdbf)

  76. JD, the deception is not from ignorance – although DCSCA has plenty of that. Its intentional.

    SPQR (72771e)

  77. But, with the amount of taxes it will require to do this, the government could very well become our employer.

    JD (0ecdbf)

  78. So how many of the people rolling out this bill were doctors? How much input did they get from Doctors? Nurses? Anyone in what used to be called the Medical Profession?

    tyree (158c98)

  79. tyree, the Democrats used as many doctors for healthcare reform as they used Auto company executives to “reform” the domestic automobile manufacturing business.

    SPQR (72771e)

  80. Tyree – Let’s not get ahead of ourselves here. Teh One has not yet had the stones to do anything as audacious as actually roll out a plan. His plan, so far, consists of him saying the words “my healthcare plan”.

    JD (0ecdbf)

  81. Let ’em fix Medicare first

    Neo (46a1a2)

  82. How much input did they get from Doctors? Nurses? Anyone in what used to be called the Medical Profession?

    Well, actually, yes: Howard Dean, MD, yes, that Howard Dean, who strongly supports the bill.

    The linked report by Sally Pipes is certainly worth reading.

    Howard Dean and President Obama will have reached their dream of a government-run health care system for all. Only then will former presidential candidate Dean unleash his victory scream. But the American people will then no longer enjoy the best health-care system in the world. Canadians have an escape valve. When they are on a long waiting list for urgent care, they come to the United States and pay out of pocket for their care. Where will we as patients go when we are denied care?

    Dana (aedf1d)

  83. Where will we as patients go when we are denied care?

    That’s easy. Tijuana.

    SPQR (72771e)

  84. I really am interested in understanding how we already spend more per capita for medicare and medicaid than many of the Country’s with Universal Health…

    I wonder how it is that we rank #1 in the World in per capita medical spending, yet the only medical areas we rank #1 is Obesity, teen pregnancy and Plastic Surgery…

    I wonder why the GOP and Insurance Companies spend 10’s of millions of dollars to spread fear about Universal Health in places like Canada, yet Canada leads us in virtually every health measure and has had 12 straight years of Surplus budgets even with the expense of Universal Health…

    I wonder why just because someone changes jobs, they lose health coverage…And if they have an existing condition, they lose coverage for that condition completely…

    I wonder as European Countries take over US Automakers, why US automakers have had to apply $1500 in expense per car for medical coverage, while the EU and Japanese automakers add nothing because of Universal Health…

    But I guess instead of wondering I should just do like the Right and stick to rants and rhetoric…

    Reality not Rhetoric (4f41c2)

  85. Please post the URL where you copied that piece. It’s hilarious!

    steve miller (0fb51f)

  86. It is amusing how much of “Reality not Rhetoric”‘s comments are in fact not reality and are rhetoric. That does not include, of course, the outright falsehoods.

    Its almost like you could predict …

    SPQR (72771e)

  87. I wonder how it is that we rank #1 in the World in per capita medical spending, yet the only medical areas we rank #1 is Obesity, teen pregnancy and Plastic Surgery

    I wonder how an ignoramus thinks that repeating long – discredited canards it actually will appear to have coherent thought processes. Sadly, NO!

    Dmac (f7884d)

  88. I think that one sits around and wonders about a lot of things.

    JD (2f1bff)

  89. Of course, teen pregnancy and obesity have an impact on those international health statistics. RnR probably applauds a plan that would promote abortion and tell people what they can and cannot eat. If not, there will need to be an explanation of how Obamacare is going to address the underlying causes of those bad (and misleading) statistics just cited.

    Karl (065e81)

  90. I’m with MayBee. They are cashing in GOVERNMENT PAYCHECKS!!!1!1

    If government paychecks are good enough for Congress, they are good enough for the rest of us.

    carlitos (84409d)

  91. One factor that is NEVER mentioned in the rants about our terrible healthcare system is the fact that the black underclass contributes a lot to bad outcomes and immigrant Mexicans contribute to obesity statistics and diabetes incidence.

    A friend of mine was the medical director for a big Colorado HMO. He was going over their data and found one community with a high incidence of obesity and type II diabetes. He went down there to give them a lecture on preventive medicine, then learned that it was a mining community and their HMO members were about 85% Mexican immigrants.

    UCI did a study about 15 years ago on why cervical cancer deaths are so high in Hispanic women. What they learned was that these women refused pap smears. Why ? They couldn’t prove it but there was a lot of anecdotal evidence that these women know that early cervical cancer is related to early sexual activity, especially with many partners. Having a pap smear is the same as admitting you’ve been a slut.

    Medicine is full of these details that you can tease out of you get into health outcomes research.

    Another example is a study, I think in the New England Journal, that black women in the military, either service members or dependents, have lower birthweight babies and higher neonatal mortality than whites or Hispanics. This is in a controlled circumstance where everybody gets good prenatal care, etc.

    Another factor is the issue of blacks having higher rates of hypertension, prostate cancer and colon cancer. Hypertension could be related to slavery and I’ve never seen a study in Africa to see if the incidence is as high. One theory is that salt retention was a factor in survival on slave ships so slaves had been selected by that factor for high blood pressure. I don know that colon cancer is very rare in African village culture. that was reported by Burkett before Africa got so urbanized by the socialist regimes.

    Nobody does research on the racial factor because it is not PC. They will research economics, alleging they get less care, but not the racial factor itself.

    Mike K (90939b)

  92. Mike K., I think Sally Satel did some interesting writing in the past about how political correctness has hindered healthcare.

    SPQR (72771e)

  93. That should read: “I do know that colon cancer is very rare in African village culture.”

    Mike K (90939b)

  94. Mike K, would you address #67, please?

    Dana (aedf1d)

  95. Then they piled back into their clown car and sped away.

    haha ha ha ha!

    MayBee (cca412)

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  97. ROTFLMFAO at the clown car line….

    redc1c4 (fb8750)

  98. how much of the colon cancer disparity is because of diet, and how much is because a generally shortened lifespan means most people die off before things like that can get started?

    redc1c4 (fb8750)

  99. #44 — Comment by JD — 6/19/2009 @ 11:08 am

    Pons – SHOCKA, huh?

    This is funnier than hell.

    And still he hasn’t answered!!

    I mean if a person cannot figure out if a President should put forth details on a major program, well, he is lost (good for amusement though).

    Pons Asinorum (9fb321)

  100. #61 — Comment by JD — 6/19/2009 @ 12:44 pm

    I see that DCSCA went with the “it is true because I puÞ it in ALL CAPS” argument. Nice.

    Well, now that it is in ALL CAPS, it must be true.

    #84 — Comment by Reality not Rhetoric — 6/19/2009 @ 1:50 pm

    you forgot to put it in ALL CAPS, so I know it’s not true.

    Pons Asinorum (9fb321)

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  102. That’s easy. Tijuana.

    Comment by SPQR — 6/19/2009 @ 1:50 pm

    There’s been so many murders in Tijuana lately, you may not need a doctor if you go there; just a funeral director. I hope this isn’t racist.

    PatAZ (9d1bb3)

  103. Mike K, would you address #67, please?

    Comment by Dana

    I teach medical students and there are still plenty of kids who apply. The student loan situation may soon make it impossible for anyone but the wealthy or the beneficiary of a family project (like some of the Asian kids) to make it.

    There actually is a new medical school started by Cleveland Clinic and Western Reserve that will forgive tuition if the student chooses to stay in research. The whole college tuition thing is a scandal.

    There will always be kids who want to be doctors. I was one. I started medical school without the money to pay for the second semester ($600 in 1961) but I just assumed something would turn up. It did. I got a scholarship that paid for the rest. Today, the school would not accept me without a plan to pay. The student loans that we deal with now were simply not available. If they had been, I would have gone to Cal Tech where I had my dorm room but no money.

    Canada has made a decision to limit medical school admissions and import foreign docs, many from third world schools where they have no clinical exposure at all.

    Mike K (90939b)

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  105. Let’s not rejoice too soon. “Both parties are meeting to discuss a compromise” means that our wallets and lives are in peril.

    Is it a good plan or is it the camel’s nose under the tent?

    Patricia (2183bb)

  106. Can I assume your payroll deduction is made, whether you think you can afford it or not?

    That’s one aspect of the French system I don’t care for. However, since Mike K speaks highly of it, and since he appears quite knowledgeable about the issue in general (ie, he is a doctor, after all, with decades of experience and observation), and is someone who strikes me as level-headed about most socio-political issues, when he speaks, I listen.

    It would be interesting to see him debate the healthcare issue with leading pundits and analysts who are strictly opposed to the idea of the government getting closer than a mile to managing the nation’s medical system. That would be a thousand times more informative and illuminating than the “clown car” show next week (with special guest “Bozo Obama”) scheduled by ABC News.

    BTW, since many on the left are generally most bothered by the notion of the disadvantaged not getting healthcare, or having to pay too much for it, they must be deliriously happy about the situation in Southern California. I’m referring to the huge numbers of low-income “undocumented” people in this part of the US who pay very little in taxes, even more so if they’re involved in under-the-table-payment jobs. And yet hundreds of thousands of such folks have been somehow managing to access medical care while in America. Better yet, they really haven’t had to pay for it!

    Of course, many emergency rooms in LA are packed with visitors and many of those facilities are running in the red, some of them eventually going out of business. But all that proves is taxpayers, who in effect already are subsidizing a very socialized form of healthcare, will need to dig down even further and deeper to keep the system running.

    And with that reality on one hand, and the dreamworld (or nightmare) of Obamacare on the other, the saying of the day is: There’s a sucker born every minute.

    Mark (411533)

  107. Since a majority of those who benefit from the Obama regime’s health care power grab are not legally in the country, the question to ask yourself is “do you want to pay an extra $1000 a year in taxes to provide health insurance for illegal aliens?” Republicans don’t seem to be able to ask, so I will. Do you really want to?

    Ken Hahn (53d2a9)

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  110. My point about the French system, at least the most important point, is that the insurance funds (or companies if you prefer) pay a national standard fee schedule that is a basic fee. Doctors can charge more if patients are willing to pay. What this would do is introduce a market mechanism. If the patient can’t afford more, they can find doctors who will accept the fee. This could be aided by a program to forgive student loans for each year that the new doctor accepts the fee schedule.

    The crucial feature is free choice and fee for service. That controls utilization because (at least in France) the patient pays the doctor then gets reimbursed by the health plan. Here is a private transaction that keeps the two parties in touch and allows negotiation. We have had a moral hazard problem for 50 years because neither party pays the bill.

    Mike K (90939b)

  111. Here’s giggles – the White House already walking back.

    Is there anything Obama has ever said on a policy matter that has not been revoked?

    The Empty Suit has a forked tongue.

    SPQR (26be8b)

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  113. SPQR – His words cease having any meaning the moment the words pass over his lips.

    JD (d2a915)

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  129. […] columnist to figure out what Americans think about healthcare reform and related issues. Indeed, public opinion on these issues has remained essentially unchanged since the last time Democrats tried healthcare reform in 1993-94. If Jerry Seib is looking for […]

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  130. […] to Obamacare? Did Michelle Obama start a patient-dumping program? Patterico’s Pontifications: Dialing 911 for Obamacare Riehl World View: Buh Bye Liberal Health Care Plan? Michael Tanner, National Review Online: The […]

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  131. […] to Obamacare? Did Michelle Obama start a patient-dumping program? Patterico’s Pontifications: Dialing 911 for Obamacare Riehl World View: Buh Bye Liberal Health Care Plan? The World According to Lawgirl: Michelle […]

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