Obamacare dominated the 2010 midterms, driving its Democratic authors to a historic electoral shellacking. But since then, the issue has slipped quietly underground.
Now it’s back, summoned to the national stage by the confluence of three disparate events: the release of new Congressional Budget Office cost estimates, the approach of Supreme Court hearings on the law’s constitutionality and the issuance of a compulsory contraception mandate.
Cost:
Obamacare was carefully constructed to manipulate the standard 10-year cost projections of the CBO. Because benefits would not fully kick in for four years, President Obama could trumpet 10-year gross costs of less than $1 trillion — $938 billion to be exact.
But now that the near-costless years 2010 and 2011 have elapsed, the true 10-year price tag comes into focus. From 2013 through 2022, the CBO reports, the costs of Obamacare come to $1.76 trillion — almost twice the phony original number.
It gets worse. Annual gross costs after 2021 are more than a quarter of $1 trillion every year — until the end of time. That, for a new entitlement in a country already drowning in $16 trillion of debt.
Constitutionality:
Beginning March 26, the Supreme Court will hear challenges to the law. The American people, by an astonishing two-thirds majority, want the law and-or the individual mandate tossed out by the court. In practice, however, questions this momentous are generally decided 5 to 4, i.e., they depend on whatever side of the bed Justice Anthony Kennedy gets out of that morning.
Ultimately, the question will hinge on whether the Commerce Clause has any limits. If the federal government can compel a private citizen, under threat of a federally imposed penalty, to engage in a private contract with a private entity (to buy health insurance), is there anything the federal government cannot compel the citizen to do?
If Obamacare is upheld, it fundamentally changes the nature of the American social contract. It means the effective end of a government of enumerated powers — i.e., finite, delineated powers beyond which the government may not go, beyond which lies the free realm of the people and their voluntary institutions. The new post-Obamacare dispensation is a central government of unlimited power from which citizen and civil society struggle to carve out and maintain spheres of autonomy.
Figure becomes ground; ground becomes figure. The stakes could not be higher.
Coerciveness.
Serendipitously, the recently issued regulation on contraceptive coverage has allowed us to see exactly how this new power works. All institutions — excepting only churches, but not excepting church-run charities, hospitals, etc. — will be required to offer health care that must include free contraception, sterilization and drugs that cause abortion.
Consider the cascade of arbitrary bureaucratic decisions that resulted in this edict:
(1) Contraception, sterilization and abortion pills are classified as medical prevention. On whose authority? The secretary of health and human services, invoking the Institute of Medicine. But surely categorizing pregnancy as a disease equivalent is a value decision, disguised as scientific. If contraception is prevention, what are fertility clinics? Disease inducers? And if contraception is prevention because it lessens morbidity and saves money, by that logic, mass sterilization would be the greatest boon to public health since the pasteurization of milk.
(2) This type of prevention is free — no co-pay. Why? Is contraception morally superior to or more socially vital than — and thus more of a “right” than — penicillin for a child with pneumonia?
(3) “Religious” exemptions to this edict extend only to churches, places where the faithful worship God, and not to church-run hospitals and charities, places where the faithful do God’s work. Who promulgated this definition, so subversive of the whole notion of godliness, so stunningly ignorant of the very idea of religious vocation? The almighty HHS secretary.
Today, it’s the Catholic Church whose free-exercise powers are under assault from this cascade of diktats sanctioned by — indeed required by — Obamacare. Tomorrow it will be the turn of other institutions of civil society that dare stand between unfettered state and atomized citizen.
Rarely has one law so exemplified the worst of the Leviathan state — grotesque cost, questionable constitutionality and arbitrary bureaucratic coerciveness. Little wonder the president barely mentioned it in his latest State of the Union address. He wants to be re-elected. He’d rather talk about other things.
But there’s no escaping it now. Oral arguments begin Monday at 10 a.m.
Charles Krauthammer’s email address is letters@ charleskrauthammer.com.
Brilliant summation, as usual.
Some information that runs counter to Krauthammer’s predictable pro-corporate spin:
http://www.winningprogressive.org/health-care-reform-turned-2-years-old-yesterday
Some highlights of Obamacare that help all of us, but Republicans are eager to jettison in order to please the for-profit insurance corporations that line their pockets:
Prohibiting Denial of Coverage for Pre-Existing Conditions. health insurance companies have denied coverage to people with pre-existing conditions, which have ranged from cancer and epilepsy to acne, intent to adopt a child, being a firefighter, or even being a victim of domestic abuse. Such policies are not only fundamentally unfair to people who need coverage the most, but they limit people who have insurance through their employer from changing jobs or starting their own businesses out of fear of losing their insurance,
Prohibiting Retroactive Cancellation of Insurance: A second problematic industry practice ended by health insurance reform is known as rescissions – where your health insurance company happily accepts your premiums every month, but then finds an excuse to cancel your coverage as soon as you get sick. The vast majority of these cases involve minor unintentional errors or minor pre-existing conditions that the customer did not know about. Approximately 10,700 people find themselves in this position every year,
Ending Annual and Lifetime Coverage Limits: Another problematic health insurance industry practice is to place limits on the amount of coverage they will provide in a year or in your lifetime. This can have a significant impact if you are stricken with a serious or chronic illness as you may have to find a way to pay expensive health care bills in the midst of undergoing intensive treatment. As many as 20,400 people exceed their lifetime coverage limits, and 3,500 people exceed their annual coverage limits every year. Thanks to President Obama and Congressional Democrats, however, such limits will soon be a thing of the past.
Requiring Health Insurance Companies to Spend Your Premiums on Providing Benefits: Health insurance companies describe the amount of your premiums that they spend on providing health care to you as their “medical loss ratio.” In other words, if your insurer spends 70 cents on every dollar on health care, and the remaining 30 cents goes towards advertising, marketing, and profits, the medical loss ratio is 70%. While medical loss ratios for health insurance used to average 90%, it has slipped in recent years, with some companies in the individual market having ratios as low as 60%. The health insurance reform legislation halts this trend by requiring 80-85% of premiums to go toward providing health care, rather than marketing and profits
and your answer to the astronomical costs? Crickets. Hopefully the Supremes will stick a fork in the pork.
The cost of NOT insuring people is astronomical.
As PNHP explains, “The U.S. spends twice as much as other industrialized nations on health care, $8,160 per capita. Yet our system performs poorly in comparison and still leaves 50 million without health coverage and millions more inadequately covered. This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.” [http://www.pnhp.org/]
If your own policy is with a for-profit health insurance company, you yourself are very likely at risk of medical bankruptcy. If you develop a severe illness, they can drop you flat. Then the rest of us taxpayers pick up your bill.
The for-profits do this to their policyholders despite the fact that inflation-adjusted premiums on private health insurance rose more than 700 percent from 1969 to 2009. [http://www.nytimes.com/2011/06/13/opinion/13krugman.html]
The cost to all of us of an America in which millions of people lack adequate health care (or purchase expensive plans they can use only for catastrophic care) is astronimical.
Get a handle on healthcare costs. That is the untouched elephant in the room.
Yup and somehow the “free market” isn’t getting it done.
You don’t think it might be government policies do you?
Nope.
figures.
Would you dare or care to put a cost on Obamacare? Do you think government control will somehow make it less expensive and continue the quality? You must believe in the Easter bunny. Name one government program that does more and costs less. You can’t. Obamacare was sold to us as a cost savings program. Do you believe that? As the facts dribble out it gets more expensive each time the story is told. The so called savings are ten years down the road and they will never ever come. In the meantime the quality of care we enjoy and expect as Americans will be gone. The constitutional argument that Charles talks about in this article will be taken up this week by the Supremes. Our only hope is that the Constitution will be followed and this boondoggle reversed.
Thanks for this info, and the links. I saved it all. Very useful in many forums.
You’re welcome!
Go to the UK and buy something at a store then look at the receipt. Then tell me the costs are going to be less. That is just plain wrong. As far as insurance companies you can CHOOSE what to buy if you buy the low end insurance then you get what you pay for the same goes the other way.
It boils down to one thing CHOICE. Everybody wants freedom of choice for there lives. Except many who think this is a great idea. Surprisingly the majority of those who support are the ones that will not be paying for it.
Mandating I have to buy something I do not want or need is wrong.
Those of you that think this is a good idea please go to the UK and see it in action. Canada even. See the wait times for the simple things. See the lack of people going into the medical fields. See the lack of quality we have here. You get what you pay for. Unless the government handles it then it costs far more and the red tape gets longer and longer.
Many Americans cannot afford to purchase any kind of health insurance. Many can afford only catastrophic coverage (no preventive care). Many who think they have full coverage find themselves dropped by their for-profit insurer when they become ill. Others discover that the cost of their cancer treatment hits a “cap” on their coverage–when they’re still terribly ill. People whose insurance is through their employer can discover they are un-insurable once they get laid off, because over the years they’ve developed a “pre-existing condition.”
These are not pitfalls that Americans “choose,” except by default, if they vote against health insurance reform.
As for Canada, here’s what the Canadian Medical Journal has to say (I hope you will read the entire article):
“We cannot condemn strongly enough the intellectual dishonesty of the lobbyists and politicians whose distortions of Canada’s health system camouflage their appalling rejection of reform for uninsured and underinsured Americans. All 32 million Canadians are insured. To be sure, some are unhappy to wait and some are denied treatments it would be better they had; no system is perfect or pleases everyone. But even the least fortunate Canadian is better off than the 47 million uninsured Americans, for whom no treatments are covered and for whom the wait is forever, unless they can afford to pay the health care bills…”
http://www.cmaj.ca/content/181/8/E128.full?etoc
My Canadian friends don’t understand what the fuss is all about down here. Everyone of them that I’ve spoken to thinks that their health care is just fine.
Your canadian friend might not understand but my aunt who retired after a career as a nurse in a New Brunswick hospital has told me many times that if I ever get the chance to vote AGAINST government run healthcare DO IT. My uncle (her husband) waited YEARS for a knee replacement suffering just to get around every day. He could hardly walk. He also had a stroke and cancer which he barely survived because of the delays in care. And their so called “free care” is built into every liter of gas they buy.
Ok so there are people who for whatever reason CHOOSE not to gain employment that would pay there bills. Lots of them We have whole communities of them. Insurance is a product if you choose the wrong one it is not my fault. All those who fall for internet scams because they failed to pay attention should we also take money from taxpayers to make up for there mistakes?
As for canada. If there system is so good and seeing as they people have already been forced to pay for it why do so many come here to the USA and pay out of pocket??
Last and this again is the most IMPORTANT point. This is the first time from the founding of the country that the federal government has made a law saying the people must WITHOUT A CHOICE buy something! If they want it or not. If they choose not to buy any they are criminals. This while accedptable in other countries goes against what this country is in terms of our freedoms. If for no other reason this should make even the most ardent supporter of government health care say wait that’s just wrong.
If this law is allowed to stand then federal government has just in one swoop has removed states rights and OUR rights. As if this is ok to do whats next? Federally mandated food? No more stores everybody just gets a box from the fed once a week or month with your food allotment for that time? That way everybody would get the same food and nobody no matter how much they make could have more food then the poorest of the poor? That would be fair right?
Another article for you to peruse–“Why I love Britain’s socialized healthcare system.”
The author’s newborn was desperately ill. “Because I am American, and those endless days and nights were spent in a maternity hospital in London, the week that followed has been very much on my mind as I listen to the recent attacks on the British National Health Service. It is a system that I found to be very different from the one currently being described as “evil” and “Orwellian” by politicians and commentators eager to use it as an example of the dark side of public medicine…
Instead, he learned “what the NHS is about — common decency. It is about the shared belief that all the people who live in the United Kingdom constitute a society, and a decent society provides certain necessities for its members. Freedom from hunger is one. Police protection is another. Free healthcare from the cradle to the grave is simply one more item on this list.
I saw this decency at work countless times over the following decade, until my return to the United States…”
His baby had excellent treatment, and recovered. His family was not bankrupted, nor did they have to place little jars in convenience stores hoping people might chip in a dollar or two, as desperate Americans wind up doing.
http://www.salon.com/2009/08/22/nhs/
I’ve lived in the UK and can share horror stories of residents paying themselves to avoid waiting. Thank God they had $$$.
But you and every other person needs health care. Thats why we need a mandate. Maybe one hundred years ago you could find someone who never used medical services but not anymore.
Also, if you want to comment on the costs of the government delivering services, get your facts straight. The government is only a health care provider through the VA. This is the most efficiently run delivery system available. The red tape you speak of is in your head. Private insurers are not nearly as efficient as the VA. You have been sold a bill of goods on that point. Private enterprise cannot come close to the efficiency of government run services. Still, that is not what we are talking about. Obamacare has nothing to do with government run healthcare. You are misinformed if you think it is.
Private enterprise cannot come close to the efficiency of government run services…..Please put the bong down and adjust the tinfoil
It is an objective truth. Look at the costs for delivering care through the VA. It is many times more efficient. Administrative costs under private insurance run 7 – 25% depending on the size of the employer. The VA does it with 2%.
Put down the tinfoil hat and pay attention to the facts.
Typical sardonicism from Krauthammer. Any consideration of the positive aspects of health-care reform is apparently beyond his slanted perspective.
Canada – run by Conservatives – Universal Health Care
Britain – run by Conservatives – Universal Health Care
France – run by Conservatives – Universal Health Care
Germany – run by Conservatives – Universal Health Care
Here’s a statement from the British Conservative Party website:
“We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay.”
http://www.conservatives.com/Policy/Where_we_stand/Health.aspx
And this from the Canadian Conservative Party Platform:
“Stephen Harper’s Government is committed to a universal public
health care system and the Canada Health Act,”
http://www.conservative.ca/media/ConservativePlatform2011_ENs.pdf
Universal Health Care isn’t Socialist or even Liberal, it’s just civilized.
There is only one major political party in the world that opposes universal healthcare, the far right wing G.O.P.
“There is only one major political party in the world that opposes universal healthcare, the far right wing G.O.P. ”
Really? You may want to do some fact checking as the MAJORITY of the world says otherwise. By size and by population both. When another country does something and fails at it we should not try to do the same thing.
You may want to hand your check over to the tax collector every month but not me. I earned it and want it. If people are not smart enough or have enough drive to make there own way then there are charities or family but stop stealing what those who work earn to support the ones who do not.
The uninsured are already costing the average family $1,000 per year.
A grand a year is far far cheaper then Omama care. The program is not even started yet and the projected costs have already doubled ( SURPRISE ). If this omama care plan goes into effect many many people will be begging for the grand a year plan. Look at the taxc rates in the countries that have this type of system already let me know what one come in cheaper then a grand a year. I have been all over Europe and have paid the ( health care tax) in various places it is massive.
You’re just parroting talking points. Care to explain that “doubled” number you’ve come up with or are you just repeating what you heard on Fox? The reason the numbers “doubled” is because the two numbers being compared aren’t for the same set of years.
That’s not true. My husband and I have been uninsured for 10 years and we have paid 100% of our health care expenses out of pocket, unlike private insurers who pay a 65% negotiated rate, or Medicaid / Medicare, which pays a 50% negotiated rate. So in reality, many of us uninsured folks pay ever higher rates because of all of you who get by on negotiated rates. Uninsured people who become seriously ill quickly become impoverished and thus eligible for Medicaid, so I don’t know how you arrived at your $1,000 figure.
Don’t confuse the issues with facts.
You hand the money over to the insurance company in higher rates. You pay more at the doctors office and hospital. You are okay with spending too much as long as the government is not involved?
Everybody gets sick and sees a doctor at some time. Why should they not put some skin in the game?
This system only protects the inefficiency of the marketplace. We need to bend the cost curve and that cannot happen without the government imposing rules. I am a free market guy. the health industry is not a free market. Hospitals are required to provide care but they pass the costs of the indigents onto the rest of us. This is not a free market as it exists.
More insured people will distribute the costs more fairly across the population. Double digit increases in premium costs every year for two decades now cannot continue. We are all getting poorer by the day, all except the insurers of course.
This law is intended to reduce the number of people who feed off the free system and make us pay more. That is why the Heritage Foundation wrote the plan in the first place. This was a good and very conservative approach.
If the Congress (the people’s governing body in a democracy) is prohibited from requiring individual to be responsible in their health coverage then Social Security and Medicare can not be required either.
I think SS/Med are the next target
These are not private commercial enterprises that I’m being forced to purchase
so your argument is essentially that the government can force you to pay for their product but not a commercial one?
Krauthammer: The Rabble Rouser
I would suggest an impartial review of anything this guy writes. He makes his living promoting extreme conservative agendas that are designed to favor large corporations and the very wealthy.
Thanks Charles.
@Harry–
I wonder why you’re quick to support the for-profit insurance corporation model. It’s been endangering, even destroying, American health for decades. What is the cost of the for-profit model? I suspect you don’t know.
Many factors are involved in both Obamacare and the for-profit model–from the cost-per-pill of prescription medication to the cost to America as a nation of having families go bankrupt due to overwhelming medical bills that the for-profit companies decline to pay.
I suspect the core of your argument is that only “other” people will benefit from Obamacare.
The health reform law has eliminated lifetime limits on coverage for more than 105 million Americans. Before health reform, many Americans with serious illnesses such as cancer risked hitting the lifetime limit on the dollar amount their insurance companies would cover for their health care benefits. Were you one of them? Anybody in your family?
Does anyone in your family have a pre-existing condition? Are you exempt from having a baby or grandchild born with what an insurance company will call a pre-existing condition?
Do you know that for-profit insurers have been able to deny coverage or limited benefits for them? Up to half of Americans under 65 and as many as 17 million children suffer from a pre-existing condition. You and your family with pre-existing conditions can now get coverage under the newly-created Pre-Existing Condition Insurance Plan, which provides comprehensive health coverage to Americans who have been without health coverage for a least six months, who have a pre-existing condition, or who have been denied coverage because of a health condition.
Do you know how much of your insurance premium goes to pay the CEO’s inflated salary? Before the fCA, insurance companies can spend “a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing” instead of medical care and services. Twenty% of Americans who buy insurance coverage are in plans that spend more than 30 cents for every dollar on administrative costs. Another 25 percent of Americans have plans that spend 25 to 30 cents of every dollar on administrative costs. There are even extreme cases where companies spend more than 50 percent of each dollar on their own operating costs. Under health reform, insurance companies must spend at least 80 percent of their premium dollars on medical care and improving health care quality.
Are you now, or will you ever be, elderly? Before the health care law, elders faced the Medicare “doughnut hole”—a gap in prescription drug coverage that forced us to pay out of pocket, sometimes thousands of dollars, for medication. With the health care law, those who faced the “doughnut hole” coverage gap can now get 50 percent discounts on brand name prescriptions and 14 percent discounts on generic drugs. This reform saved seniors and people with disabilities to an average of $600 in 2011. In 2020, the “doughnut hole” gap will be closed for good.
Thank you for your very informative posts. It’s obvious that you’ve done a lot of research, if only people could have open minds and do the same I think the cat fights would disappear.
You’re welcome!
Hey Liz. You didn’t address the cost. And when the cost of this goes off the charts do you think that there will be no limits? Everything for everybody? Sustainable? No. Preexisting conditions and no limits come at a tremendous cost. Who will bear the cost? How will that be absorbed and not affect me? It won’t. The American taxpayer will pick up the cost of this and there are fewer and fewer of us supporting more and more every day. Entitlement spending and this Obamacare boondoggle are going to bankrupt us as a nation. That is more and more of a possibility each day as the debt grows out of control. The cost saving aspect of this law is not real. It does not exist. The majority of Americans want this repealed. If it was so good for us why is that so?
You ask “If this is so good why is that so?” Because the vested interests in keeping the industry inefficient and frought with waste have money to spend to keep it this way. They spend it on misinformation. They pay to confuse the people. This is just another investment to them. This particular investment pays off when people are too stupid and misinformed to make the decision that serves them best.
Do you want to see how much money the industry is spending on misinformation?
http://adage.com/article/campaign-trail/262m-spent-ads-debating-health-care-reform/233630/
Notice that spending against reform is four times the level. Who would spend their money to prevent change? Ask yourself who is profiting from the current system. It isn’t the average worker who has seen real wages in decline as health care premiums rise year on year.
How many of you have received information from 60 Plus Association and or Pat Boone’s ad on TV beating on Obama’s health care law? Now everybody take a wild guess who is funding this whole distortion of the facts.
According to Sourcewatch an independant investigative group it is Big Phama and the Koch brothers recently.
I wonder why they would fund such distortion? Could it be they want better health care at less money to the insurance companies, somehow I doubt it.
Thanks for illustrating my exact point. The anti-ACA rhetoric is funded by powerful interests. They are not the ones trying to raise families, they are trying to raise their profits at the expense of the rest of us.
My son lives in South Korea and had a 3-day hospital stay. The cost: $40.
I lived in Ireland for several years. I had to get a tonsil drained and spent two nights in the hospital because of the infection. My bill: 60 pounds (no euros back in the 90s). I have citizenship in both countries and would move their in a second if I ever got sick.
See ya!
Sorry to disappoint you, i’m not sick. i just have the option of not going broke if i get cancer or something. not a bad option.
The law and the myth of the law are two different things. The supreme court will not decide the issues that Krauthammer supposes are under consideration. They will deal with the actual law and real precedent. Krauthammer operates in the realm of hyperbole. Consider the sentence: “The new post-Obamacare dispensation is a central government of unlimited power…” Really, unlimited power Charles? I think the supreme court will understand this is not about giving the government unlimited power. It is about one particular kind of power, one that it already exercises and has for years: the ability to tax and incentivize behavior. There are innumerable examples of incentives built into the tax code. This is not new or reaching.
By making this argument about that which it is not about, opens up the discussion to non-issues and hyperbole. Death panels do not exist under this law. The reverse actually is closer to the reality. Now an insurance company executive can decide if you are going to be approved for life saving treatment or not. this law takes some of that away from the executive, insisting on certain established standards to protect consumers.
Perhaps Mr. Krauthammer has been fortunate enough to have never had an insurance company refuse payment or terminate a policy at their own discretion. Millions of Americans have not been so fortunate. Everybody is a consumer of health care. Currently, some pay and some do not. This law makes sure that everybody pays. Does it not make sense since everybody uses it? This is not even really a mandate. You are free to spend $700 to speak your mind and not enroll with any policy.
It used to be the centerpiece of conservative philosophy that individual responsibility is what makes for good policy. This law creates an incentive to be responsible for yourself and to obtain coverage. It also makes it easier to do that. Krauthammer is not speaking as a conservative here. He is speaking as a paid mouthpiece for the vested interests that are content to see America fiscally destroyed by inaction on heath care spending.
If you want to see deficits under control, ever, you have to support heath care reform. There are no other leverage points that can make or break our economy like this one. We are drowning in inefficiency and that is being protected by the likes of this writer and this article.
We are America, people. We can create a health care system that is better than the rest. Instead we settle for one of the worst systems. Stop letting the money the insurers spend on PR talk you out of improvement. We pay the most for the 37th best outcomes. That is no bargain. It is that bad and getting worse though.
If you can get a housecall in France for $50 or you can get treated for an infection in Germany for $50 why can’t we get efficient here? We can! We need to forget everything the health insurance industry is telling us and learn from our neighbors. Germany operates through strictly private companies without any public option.
We are the most efficient in the world in nearly everything we make and do. That should be and can be true of health care as well. Don’t let politicians talk you into settling for less than that. This law is only a first step to breaking the control away from the inefficient model perpetuated by the insurance industry and their powerful lobby. We want free market solutions, not expensive PR campaigns. We want to stay well and get better quickly. The current system incentivizes just the reverse.
Face it folks, its broken. Until we can break the partisan logjam, this will at least shift things a bit in favor of the consumer. Let this be the beginning of reform, not the end. There are great systems out there that we can learn from and tailor something that fits who we are as a people and provides essential care at reasonable cost. We are being weakened by the corporate sponsored voice that does not have the same needs and concerns the rest of us have. We can do better. Learn the facts, demand the policies.
Charles Hammerhead should at least try to get his facts somewhat correct. But I guess all you can expect is the same old bull most of the conservatives speal. For the real facts go to
http://factcheck.org/2012/03/health-care-costs-didnt-double/
99% of the problem with the Health Act is that Obama did it. The R’s don’t want to admit or allow anything the Pres. has done.