The Homa Files

Punchline: Most voters believe the current plan will harm the economy, cost more than projected, raise the cost of care, and lead to higher middle-class taxes.

 
http://www.pollster.com/polls/us/jobapproval-presobama-health.php?xml=http://www.pollster.com/flashcharts/content/xml/USObamaJobPresHealth.xml&choices=Disapprove,Approve&phone=&ivr=&internet=&mail=&smoothing=&from_date=&to_date=&min_pct=&max_pct=&grid=&points=1&lines=1&colors=Disapprove-BF0014,Approve-000000,Undecided-68228B

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Here’s Why …

Excerpted from WSJ: Why Obama Can’t Move the Health-Care Numbers, March 9, 2010

One of the more amazing aspects of the health-care debate is how steady public opinion has remained. Despite repeated and intense sales efforts by the president and his allies in Congress, most Americans consistently oppose the plan that has become the centerpiece of this legislative season.

In 15 consecutive Rasmussen Reports polls conducted over the past four months, for every person who strongly favors it, two are strongly opposed.

The reason President Obama can’t move the numbers and build public support is because the fundamentals are stacked against him. Most voters believe the current plan will harm the economy, cost more than projected, raise the cost of care, and lead to higher middle-class taxes.

• 57% of voters believe that passage of the legislation would hurt the economy, while only 25% believe it would help.
• Voters think reducing spending is more important than reducing the deficit.
• People simply don’t trust the official projections: 81% of voters say it’s likely the plan will end up costing more than projected.
• 66% of voters believe passage of the president’s plan will lead to higher deficits
• 78% say it’s at least somewhat likely to mean higher middle-class taxes.
• Fifty-nine percent of voters say that the biggest problem with the health-care system is the cost: They want reform that will bring down the cost of care.
• Only 17% now believe it will reduce the cost of care.
• For most voters, the notion that you need to spend an additional trillion dollars doesn’t make sense. If the program is supposed to save money, why does it cost anything at all?
• The overwhelming majority of voters have insurance coverage, and 76% rate their own coverage as good or excellent.
• Half of these voters say it’s likely that if the congressional health bill becomes law, they would be forced to switch insurance coverage—a prospect hardly anyone ever relishes.

Full article:
http://online.wsj.com/article/SB10001424052748704784904575111993559174212.html

Note that the article is from the Washington Post, not WSJ or IBD.

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Excerpted from Wash Post: Obama is Choosing Liberal Divisiveness, March 10, 2010

Whatever the legislative fate of health reform, the Democratic health reformers have

• Divided Democrats while uniting Republicans,
• Returned American politics to well-worn ideological ruts,
• Employed legislative tactics that smack of corruption,
• Squandered the president’s public standing,
• Lowered public regard for Congress,
• Sucked the oxygen from other agenda items,
• Re-engaged the abortion battle,
• Produced freaks and prodigies of nature such as a Republican senator from Massachusetts,
• Raised questions about the continued governability of America,
• Caused the White House chief of staff to distance himself from the president’s ambitions.

Quite a list of accomplishments.

* * * * *
Early on Obama rejected the one, genuinely bipartisan health reform proposal — made by Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah — that would have ended employer-based insurance and given individuals a deduction to buy their own coverage from a menu of private insurance options.

Wyden has turned out to be the ignored prophet of the health debate:

“If you … just pound it through on a partisan vote, you will have people practically as soon as the ink is dry looking to have it repealed.”

Full article:
http://www.realclearpolitics.com/articles/2010/03/10/obama_is_choosing_liberal_divisiveness.html

During the ObamaCare “Summit Meeting”, Senator Dick Durbin (IL), himself a former medical malpractice lawyer, gave a spirited rebuttal to folks arguing that any cost-cutting health reform must address junk lawsuits.
http://www.youtube.com/watch?v=OKKPgVkfzw4&feature=youtube_gdata

Durbin’s argument revolved around 3 points:

1. Even without new laws capping damages, medical malpractice lawsuits are dropping off dramatically.

He cited a study by the non-profit Kaiser Foundation saying that the number of paid medical malpractice claims has declined by 50 percent over the last two decades.

And between 2003 and 2008, the total amount paid out for medical malpractice claims – across the entire United States – was cut in half, from $8 billion to $4 billion. 

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2. The Journal of the American Medical Association says that 100,000 deaths are caused by medical malpractice annually.

Medical malpractice reform will make doctors feel a little bit more insulated from legal liability for their actions and, therefore, will make them a little bit more careless.

The Congressional Budget Office estimates that the extra careless by doctors will result in additional 4,800 medical malpractice deaths a year. 

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3. According to the Congressional Budget Office, the Republican plan for medical malpractice reform will save $5.4 billion dollars a year … which is inconsequential in the context of a health care budget that is $2.5 trillion.

http://www.bostonpersonalinjurylawyerblog.com/2010/02/sen-durbin-demolishes-republic.html 

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What Durbin didn’t say …

A Massachusetts Medical Society study showed that “the plague of defensive medicine” leads to about 25 percent of doctor referrals, tests and procedures being done for no medical reason. [Ken’s calc: 25% times $2.5 trillion = $625 billion]
http://www.realclearpolitics.com/articles/2010/03/05/the_health_care_bill_is_a_failure.html

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A study published in the November 2009 issue of the Journal of Law & Economics showed that a rise in the cost of medical liability insurance led to more reductions of hours of medical service supplied by older doctors than among younger doctors.
http://www.realclearpolitics.com/articles/2010/03/06/alice_in_medical_care_part_iv_104664.html

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In other words, experienced doctors are leaving the profession, rather than putting up with the hassles and risks, and letting debt-burdened younger docs take over
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Ken’s Take: No health care reform can be taken seriously as a cost-cutting initiative unless junk lawsuits are controlled … probably by setting up medical tribunals that protect patient rights while adding sanity to the payouts.

Anthem BC /BS has provided ObamaCare supporters with a talking point: profit-mongering health insurance companies are arbitrarily jacking up premiums to unprecedented and unconscionable levels.  ObamaCare will put a stop to that pronto.

Further the President said that insurance execs can’t come up with any reasonable explanation for the rate changes.

Well, Anthem has penned a letter to Sec. Sebelius explaining the rate changes (link to letter is below)

While the letter is a bit long-winded, here are the key points … which, incidentally, make sense to me.

• In 2009, Anthem’s average premium increase was 2%.
• But the average claims per member — the underlying cost of serving subscribers — increased by 8% in 2009.
• So, Anthem’s individual health insurance business in California lost money in 2009.
• An independent actuarial firm concluded that Anthem’s proposed 2010 rates were actuarially sound, reflecting the expected medical costs associated with the membership in these plans.
• Anthem’s proposed 2010 rates satisfy or exceed the medical loss ratio required by California law i.e. the underlying medical costs are driving the rates
• The 39% increase reported in the media is an isolated case; some premiums went down by as much as 20%.
• After these premium changes are enacted, the average individual market premium in California  will still be about 1/2 the average individual market premium in New York.

Full letter:
http://www.wellpoint.com/pdf/SebeliusLetter02112010.pdf

Thanks to DNF  for feeding the lead.

Liberal pundits tout President Obama’s intellect and grasp of “the details”. 

May be true, but a couple of recent trillion dollar “gaps” gotta make objective observers scratch their heads.

Either he doesn’t know, he’s sloppy, or he’s fibbing.  Pick one.

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First, the CBO says that the national debt will rise by at least $1.2 trillion more than Obama’s White House projects.  Oops.

Excerpted from 247WallSt.com: Mr. Obama’s Missing $1 Trillion,  March 8, 2010 at 5:22 am

The Congressional Budget Office said the national debt will be rise by $9.8 trillion by 2020. The figure is $1.2 trillion higher than White House estimates.

The CBO estimates are lower than the President’s on both the receipt and expense sides of the ledger.

The differences between the White House estimates and those of the CBO are profound when the ten years are added up.

US debt held by the public is 67% of GDP under the President’s forecast, but 90% when the CBO estimates are used as the basis of calculations.

The President’s projections are obviously optimistic. If he is wrong, the price will be high enough that America may not be able to meet its debt obligations with any ease by the end of the decade. That could mean default on US sovereign debt, or austerity  greater than the American public has seen in decades.

http://247wallst.com/2010/03/08/mr-obamas-missing-1-trillion/

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Then yesterday, the President pitched his health care plan to nodding supporters as “reducing most people’s premiums and bringing down our deficit by up to $1 trillion dollars over the next decade”.  Oops, again.  Off by about $1 trillion … 

Excerpted from White House Blog: Obama Overstates Health Care Savings by $868 Billion, March 8, 2010

In what the White House calls the final push for health care reform, President Obama said: “Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people’s premiums and brings down our deficit by up to $1 trillion dollars over the next decade because we’re spending our health care dollars more wisely,”

The President was so proud of these cost-saving numbers in the latest version of health care reform, he delved into a bit of Washington-speak to back them up.

“Those aren’t my numbers,” President Obama said to the rising applause of the estimated 1,300 in attendance. “They are the savings determined by the Congressional Budget Office, which is the nonpartisan, independent referee of Congress for what things cost.”

That part is true. The budget office does keep score of what things cost. More precisely, the budget office projects what things cost or save over a given period of time.

But the budget office did not say the Senate health care bill would save $1 trillion over the next decade. Not even close.

It estimated the bill’s tax hikes and MediCare cuts would exceed new spending by $132 billion from 2010 to 2019, leaving President Obama’s “next decade” estimate $868 billion short. [Or, more than $1 trillion if you add back the so-called MediCare “doctor’s fix”.]

That’s some rounding error.

When contacted, a White House official said the President  meant to say the Senate bill would save $1 trillion in its second decade.

But, the CBO has said “Projections for years beyond 2019…would not be meaningful because the uncertainties involved are simply too great.”

http://whitehouse.blogs.foxnews.com/2010/03/08/obama-overstates-health-care-savings-by-868-billion/

On the Sunday talk shows, e of Team Obama’s mantras is that under government-run healthcare, payments to doctors will be made based on quality (outcomes) rather than the quantity of procedures being done.

Nice philosophically, but how to make it happen ?

Couple of observations:

• Quality over quantity should be easier in education than healthcare since students can be tested for progress.  But, virtually all merit pay programs for teachers (i.e. outcome-based) have been rejected out of hand or fail.  But, they’ll work in healthcare … hmmm.
• A common method for controlling output quality is to control input quality.  In healthcare, that means rejecting the toughest cases and treating only the sure winners.  For example, when I first investigated corrective eye surgery, the docs rejected me.  My eyes were too bad, and they wanted to tout the percentage of patients that they got to 20/20.
• It’s argued that a key to controlling quality is to make primary care physicians the coordinators of all medical services. That’s silly because:

  (1) there is a shortage of primary care docs (evidence: how quickly can you get an appointment when you’re sick? how about an appointment outside the 9 to 5 work day window?);

  (2) been there, tried that – in the past, most plans required that a patient see a primary care doc to get a referral to a specialist – the referral was almost always given – net impact: a step was added to the process

• The Mayo Clinic  — always cited as the model of outcome based systems — has stopped accepting Medicare in its Arizona facilities.  Hmmm. Guess it didn’t drive costs down low enough …

I guess it’s better to bum’s rush through legislation than to give it serious thought.  Disappointing.

Punch line: ObamaCare’s essential mistake is to choose health-care expansion over health-care reform.

Another insightful column from Peggy Noonan.

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Excerpted from WSJ: What a Disaster Looks Like , Mar 5, 2010

ObamaCare will have been a colossal waste of time—if we’re lucky.

It is now exactly a year since President Obama unveiled his health care push and his decision to devote his inaugural year to it—his branding year, his first, vivid year.

What a disaster it has been.

At best it was a waste of history’s time, a struggle that will not in the end yield something big and helpful but will in fact make future progress more difficult. At worst it may prove to have fatally undermined a new presidency at a time when America desperately needs a successful one.

In terms of policy, his essential mistake was to choose health-care expansion over health-care reform. This at the exact moment voters were growing more anxious about the cost and reach of government.

The practical mistake was handing the bill’s creation over to a Democratic Congress that was becoming a runaway train. This at the exact moment Americans were coming to be concerned that Washington was broken, incapable of progress, frozen in partisanship.

New presidents should never, ever, court any problem that isn’t already banging at the door. They should never summon trouble.

Mr. Obama did, boldly, perhaps even madly. And this is perhaps the oddest thing about No Drama Obama: In his first year as president he created unneeded political drama, and wound up seen by many Americans not as the hero but the villain.

And now here are two growing problems for Mr. Obama.

The first hasn’t become apparent yet, but I suspect will be presenting itself, and soon. In order to sharpen the air of crisis he seems to think he needed to get his health-care legislation passed, in order to continue the air of crisis that might justify expanding government and sustaining its costs, and in order, always, to remind voters of George W. Bush, Mr. Obama has harped on what a horror the economy is. How great our challenges, how wicked our businessmen, how dim our future.

The president can’t be a hope purveyor while he’s a doom merchant, and he appears to believe he has to be a doom merchant to justify ramming through his legislation. This particular legislation is not worth that particular price.

All this contributes to a second problem, which is a growing credibility gap. In his speech Wednesday, demanding an “up or down” vote, the president seemed convinced and committed — but nothing he said sounded true. His bill will “bring down the cost of health care for millions,” it is “fully paid for,” it will lower the long term deficit by a trillion dollars.

Does anyone believe this?

Does anyone who knows the ways of government, the compulsions of Congress, and how history has played out in the past, believe this? Even a little?

It would be a relief to have a president who could weigh in believably and make clear what his own bill says. But he seems to devote more words to obscuring than clarifying.

The only thing that might make his assertions sound believable now is if a group of congressional Republicans were standing next to him on the podium and putting forward a bill right along with him. 

GOP support won’t happen, for three reasons. First, they enjoy Obama’s discomfort. Second, they believe the bill is not worth saving, that at this point no matter what it contains —a nd at this point most people can no longer retain in their heads what it contains — it has been fatally tainted by the past year of mistakes and inadequacies.

And the third reason is that the past decade has taught them what a disaster looks like, and they’ve lost their taste for standing next to one.

Full article:
http://online.wsj.com/article/SB10001424052748704187204575101742162779612.html?mod=djemEditorialPage_h

Well, haven’t seen Buffett at the WH as much as the SEIU president.  In fact, don’t recollect seeing there at all in the past year.  Hmmm.

My bet: Warren probably won’t make the President’s invitation list any time soon, now that he advocates scrappoing the ObamaCare bill and starting over with a sharp focus on reducing healthcare costs.

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Excerpted from Politico: Warren Buffett would scrap health care bill, 3/1/10 

In a CNBC interview,  CEO Warren Buffett said that President Barack Obama should start over on health care …  scrapping the current health care bills and starting over.

Buffett said the current bill does not focus on controlling costs, which he sees as the central problem that must be addressed to reform the system.

“What we have now is untenable over time …  like a tapeworm eating, you know, at our economic body.”

“We have a health system that, in terms of costs, is really out of control.”

While Buffett applauded Obama for taking up the reform effort, he said that “unfortunately, we came up with a bill that really doesn’t attack the cost situation that much.”

Asked if he would be in favor of scrapping the Senate health care bill, Buffett responded: “I would be.”

If the president were to start over, Buffett would advise him to “just  say that one way or another, we’re going to attack costs, costs, costs.”

Buffett urged Obama to say that “we’re going to cut off all the kinds of things like the 800,000 special people in Florida or the Cornhusker kickback, as they called it, or the Louisiana Purchase, and we’re going to — we’re going to get rid of the nonsense. We’re just going to focus on costs and we’re not going to dream up 2,000 pages of other things.”

Buffett would like to expand access to health insurance, but he said he does not “believe in insuring more people till you attack the cost aspect of this.”

Full article:
http://www.politico.com/news/stories/0310/33693.html

Ken’s Take: Rep. Paul Ryan (or simply “Paul” in Obama protocol) was the star of the ObamaCare infomercial on Thursday.  His pointed, fact-based questions about the “reduced deficit” accounting” went conspicuously unanswered by the President. 

Obama didn’t score them as “legitimate points” and they weren’t summarily dismissed as mere “talking points” … but Obama did say he didn’t want the discussion to get “bogged down in the numbers”. 

Why waste valuable time on facts when you can be hearing “legitimate points” about wingnuts wearing their sister’s dentures?

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Excerpted from IBD: Rebuttals To Ryan? We’re Still Waiting, 02/26/2010 

It was the Wisconsin congressman who made the most pointed remarks about Obama’s reform proposal. For example:

• “This bill does not control costs (or) reduce deficits. Instead, (it) adds a new health care entitlement when we have no idea how to pay for the entitlements we already have.”

• “The bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending. The true 10-year cost (is) $2.3 trillion.”

• “The $247 billion Medicare “doctor fix” was outboarded from the plan as an unfunded item.”

• “The bill takes $52 billion in higher Social Security tax revenues and counts them as offsets. But that’s really reserved for Social Security. So either we’re double-counting them or we don’t intend on paying those Social Security benefits.”

• “The bill takes $72 billion from the CLASS Act (long-term care insurance) benefit premiums and claims them as offsets.”

• “The bill treats Medicare like a piggy bank, (raiding) half a trillion dollars not to shore up Medicare solvency, but to spend on this new government program.”

• “The chief actuary of Medicare (says) as much as 20% of Medicare providers will either go out of business or have to stop seeing Medicare beneficiaries.”

• “Millions of seniors who have chosen Medicare Advantage (Medicare through a private insurer) will lose the coverage that they now enjoy.”

Full article:
http://www.investors.com/NewsAndAnalysis/Article.aspx?id=522446

I had it on as background music yesterday.  It was a complete waste of time (for them and me), but there were some notables.

(1) Lamar Alexander did a solid job in the GOPs opening statement — he was a great choice

(2) Paul Ryan did a great job laying out the economics in terms simple enough that even Dem reps could understand — which they don’t.

(3) Dick Durbin did a nice job defending trial lawyers: “malpractice suits and settlement amounts are going down not up — so what’s the problem”

(4) Good points by McCain re: the special deals … especially protecting seniors in FL but not in AZ

(5) The GOP doctors disappointed me … I thought they would be the secret weapon … but, they didn’t say anything that was particularly compelling

(6) One more sob story and I would have screamed … it’s legislation via anecdote

(7) I wish they had allotted Biden more time … his shallow comments at least have entertainment value

(8)  Probably reflects my biases, but I thought Obama was generally unpresidential and often downright rude : (a) “… because I’m the President” (b) “Call me Mr. President, but I’ll just call you Bob, and Mary, Harry … not Senator or Congressman” (c) “The campaign’s over John” (d) “Get off your talking points (I have some talking points that I want to share)” (e) “Pssst” … whispering to aides when GOP was talking.

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Biggest TakeAway: When the Dems go the reconciliation route, the country will erupt …

I’ve been concerned for awhile that there’s a strange political dynamic that might come into play re: the healthcare votes.

Conventional wisdom says that Dem reps from conservative states (think Lincoln in Arkansas) would bend over backwards to vote their constituents’ opposition to ObamaCare as a means of preserving their jobs.

My concern: if they aren’t in close races — i.e. probably going to lose in a landslide —  what keeps them from voting against their constituents’ preferences?

Answer: nothing …

Not every Democrat’s top priority is to minimize his party’s electoral losses.

Some would sacrifice the majority in Congress (or their own seats) to achieve the ideological goal of revolutionizing private health care in America.

If Democrats can be persuaded that they’re going to lose anyway, a major political argument against ObamaCare is off the table, and they can vote their ideology.

Source article:
http://online.wsj.com/article/SB10001424052748704188104575083601589992816.html?mod=djemEditorialPage_h

Bottom line: The critical problem is rising costs. The solution is more competition, greater individual control over health spending and structural changes that enhance the healthcare delivery system. e.g. more community clinics.

These guys hit the mail on the head !

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Excerpted from WSJ: A Better Way to Reform Health Care, Feb. 24, 2010

None of key ObamaCare elements — mandates, heavy-handed insurance regulation, and entitlement-based, middle-income subsidies – address health care’s fundamental problem: high and rising costs. They simply expand health-insurance coverage. The inevitable consequence will be to exacerbate the cost problem. 

To bring down costs, we need to change the incentives that govern spending. Right now, $5 out of every $6 of health-care spending is paid for by someone other than the person receiving care —insurance companies, employers, or the government. Individuals are insulated from the reality of what their decisions cost. This breeds overutilization of low-value health care and runaway spending.

To reduce the growth of costs, individuals must take greater responsibility for their health care, and health insurers and health-care providers must face the competitive forces of the market.

Three policy changes will go a long way to achieving these objectives: (1) eliminate the tax code’s bias that favors health insurance over out-of-pocket spending; (2) remove state-government barriers to purchasing and providing health services; and (3) reform medical malpractice laws.

The tax code’s favorable treatment of employer-sponsored health insurance over out-of-pocket health-care payments means that, for most families, buying health care through an employer is 30%-40% cheaper than buying it directly.

The best way to address this clear bias is by making all health spending — including out-of-pocket payments, purchases of individual insurance, and purchases of COBRA coverage — tax-deductible. It could also be achieved by expanding Health Savings Accounts and Flexible Spending Accounts, which also level the tax playing field between insured and out-of-pocket spending. That is, they make the tax treatment of insured and out-of-pocket spending more similar.

Many health-policy analysts have argued that counting employer-sponsored insurance premiums as taxable income would be a more effective way to undo the current tax code’s bias toward employer-sponsored health insurance. In theory, we agree.

But the fate of the so-called tax on Cadillac insurance plans only serves to underscore the wisdom of leveling the playing field by making all health-care spending tax deductible. The beneficiaries of these high-priced plans, such as labor unions and public-sector employees, lobbied intensely and largely against the tax, and the president’s plan defers the tax until 2018. The end result is the essential elimination of the plan’s only tangible improvement to incentives.

There are two additional steps to reforming private insurance markets.

First, individuals must be allowed to buy health insurance offered in states other than those in which they live.

The current approach of state-by-state regulation has raised costs by reducing competition among insurance companies. It has also allowed state legislatures to impose insurance mandates that raise prices, while preventing residents from getting policies more suitable for their needs.

Second, reasonable caps on damages for pain and suffering need to be established in medical malpractice cases. Caps on these kind of damages reduce costs and decrease unnecessary, defensive medicine.

These three policies fundamentally change incentives among individuals, insurers, and providers to gradually slow the growth in costs by reducing inefficient demand without sacrificing quality and innovation.

Taken together, the policy changes outlined here will produce a substantial decline in health-insurance premiums. Premiums will fall as workers opt for health plans with higher copayments. Insurance companies will lower premiums in the face of stiffer competition. And doctors will practice less defensive medicine.

It is also important to increase access to health care — but this should not be confused with increasing access to health insurance, and it cannot be achieved without getting costs under control. There are several ideas for improving access worth considering: removing artificial barriers to entry for physicians and within specialty groups, allowing states greater flexibility with Medicaid, providing tax credits for health spending, and expanding programs that provide services directly, such as Community Health Centers.

The president’s plan is failing because it does not speak to the concerns of the majority of Americans. Instead of addressing the high and rising costs of care, it proposes mandates, invasive regulation, and unaffordable new entitlements. This will not bring health-care costs down—it will only make this problem worse.

Full article:
http://online.wsj.com/article/SB10001424052748704804204575069133264585068.html?mod=WSJ_newsreel_opinion

I cringe when I hear an Obamatron say that that the majority of Americans support the proposed changes to the healthcare system. 

Some stuff is nuanced, but that’s just a flat out, boldface lie !

Below are Pollster.com’s poll-of-polls — with it’s increasing wide margin of disapproval — and a recap of all recent major polls. 

I guess our elected representatives don’t care — we just need to be protected from ourselves.

Last week I noted that Virginia was about to enact a law outlawing the ObamaCare individual mandate which force a person to buy health whether the wanted it or needed it, or not. 

The states rights legislation is spreading like wildfire.

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Excerpted from WSJ: Health Backlash in the States, Feb.  20, 2010

The backlash against ObamaCare is moving beyond the Tea Parties and has now arrived in state capitals.

In more than 30 states, legislators are proceeding to pass statutes or ballot initiatives that would guarantee the right to choose medical services and insurance.

These laws are generally called Health-Care Freedom Acts. If enacted, they will set off a Constitutional 10th Amendment fight over whether there are limitations on the powers of the federal government to regulate health care and override the protections in these state laws.

Almost all these measures would make it illegal for the government at any level to require a citizen of the state to purchase health insurance. This would let Americans opt out of any federal “individual mandate,” which makes people buy insurance or pay a tax, a la Massachusetts and both the House and Senate bills in Congress.

Second, the bills would guarantee the right of residents to pay directly for health services without incurring penalties or fines. This means citizens could go outside any government-run system to purchase private treatments from the doctor or hospital of their choice. Often, the federal Medicare program doesn’t let doesn’t let doctors charge extra for specialized care.

Virginia’s legislature has already passed such a law.

If Congress passes some version of health legislation, the federal law may pre-empt these state laws. But states do have the right to provide extra protections beyond what federal law guarantees. Many states, for example, have freedom of speech protections that go beyond federal law.

The major constitutional issue is whether Uncle Sam has the right to supercede state laws, based on the Commerce Clause of the Constitution, and compel Americans to join a federal health system, as they must with Social Security and Medicare.

Full article:
http://online.wsj.com/article/SB10001424052748704804204575069821900574214.html?mod=WSJ_Opinion_AboveLEFTTop