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The ongoing debate about the constitutionality of the health care legislation the President signed into law and its long-term ramifications continues to ramp up discussions on the Internet and in print.

Here’s a glance at just a few of the issues impacting the health care industry that are going to monopolize the headlines for years to come.

From the Wall Street Journal

http://online.wsj.com/article/SB10001424052748704094304575029331665110908.html?KEYWORDS=Daniel+Henninger [1]

… Why would anyone think it possible in 2010—as politics, economics or mere practical feasibility—to reorder 16% of a $14 trillion economy of 300 million people living in 50 separate states whose geography is 16 times larger than France?

The Obama reformers are driven by the idea that their bill would fulfill a dream running back 70 years to 1939, when FDR failed to win passage of a universal health-care bill.

But this isn’t 1939. It’s not even 1994. American health care, whatever its defects, is today unimaginably complex. What the Democrats are trying to do isn’t just difficult. It’s impossible.

According to data compiled by Hoover’s business research from the U.S. Census, the health-care industry consists of 340,650 separate establishments employing 5,508,926 people. I leave it to a mathematician to calculate the number of possible economic relationships this would produce every day, much less annually.

We have 512,000 physicians and surgeons, 2.2 million registered nurses and a galaxy of different jobs orbiting around them. Some 36% of these are in individual physicians’ offices. …

There are 8,616 separate medical-device companies in the U.S., employing 359,065 people. Within the device industry, its two largest categories are electronic and precision equipment and surgical appliances. These are the wizards of American medicine.

The president says the special interests oppose his bill. But to pay for the bill, Congress would levy a $2 billion annual tax on the medical-device industry, which ardently opposes the legislation. …

The president and his health-care advisers are giving philosopher kings a bad name. Only people who have reduced American health care to rows and columns of data in academic studies would think it possible to remake this incredibly sophisticated organism as easily as rebooting a spreadsheet.

From the Washington Times

www.washingtontimes.com/news/2010/apr/01/robbing-peter-to-pay-pauls-health-care/ [2]

… One costly provision buried in the lengthy reconciliation bill at the last minute has taxpayers covering long-term at-home care for the elderly. Through the so-called Community Living Assistance Services and Support Act (CLASS Act), Americans will find between $150 and $250 taken out of their paychecks each month to cover this program nobody knew about. …

Even some Democrats warned about the financial impact of the home-care program. Before the idea was dropped last year because of stiff opposition, Sen. Kent Conrad, a North Dakota Democrat who is chairman of the Senate Budget Committee, called the program a Ponzi scheme that would produce massive deficits in the future. A letter released at that time by Mr. Conrad and Democratic Sens. Mary L. Landrieu of Louisiana, Evan Bayh of Indiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Mark Warner of Virginia warned: “While the goals of the CLASS Act are laudable − finding a way to provide long-term care insurance to individuals − the effects of including this legislation in the merged Senate bill would not be fiscally responsible for several reasons.”

The senators were particularly concerned that the Congressional Budget Office numbers missed the real costs of the program. The CBO is instructed only to consider the fiscal impact over the next 10 years, but the way the scheme is set up, people must pay the additional taxes for at least five years to become eligible. So for the first five years we only see revenue. After that, the taxpayers are eligible only gradually. They must then become old enough to require home health care, so expenditures will occur in the distant future. In other words, we see taxes with no expenditures upfront, but huge expenditures picking up after the CBO’s 10-year evaluation window passes.

The budget concerns of a handful of Democratic senators kept the program out of the earlier version of the health care bill, which passed the Senate before Christmas. If the provision hadn’t been removed, Democrats wouldn’t have obtained the 60 votes needed to break the filibuster. Only by jamming it into the Senate reconciliation bill in March were they able to get it passed with the bare minimum 51 votes.

Ironically, the reconciliation procedure, requiring only a simple majority, was originally designed to help reduce the deficit. It certainly was not meant for circumventing normal procedures and throwing in last-minute budgetary land mines.

Democrats might not consider $109 billion in taxes over the program’s first 10 years to be controversial. But taking $150 to $250 out of each monthly paycheck will cause problems for millions of Americans. This is yet another example of Mr. Obama breaking his promise not to raise taxes on those making less than $250,000 per year. …

From Politico www.politico.com/news/stories/0410/35335.html [3]

Attorneys General Richard Cordray (D-Ohio) and Tom Miller (D-Iowa) explain why they denied their governors’ requests to join other states in a lawsuit that claims that the individual insurance mandate in the Patient Protection and Affordable Care Act (HR 3590) is unconstitutional.

… As attorneys general for our respective heartland states, we take issue with the constitutional arguments being made against this new legislation. Under long-settled Supreme Court precedents, Congress has ample power under the commerce clause of the Constitution to legislate on health care.

Congress has the authority to regulate anything that affects interstate commerce “among the several States.” This is bolstered by the supremacy clause, which explicitly makes the Constitution and the laws of the United States “the supreme Law of the Land” for all Americans.

For Congress to have the power to pass this legislation, therefore, the health care problem need only affect interstate commerce. It clearly does. …

From C-SPAN www.cspan.org/Watch/Media/2010/04/04/HP/A/31401/Jonathan+Strong+Daily+Caller+Reporter.aspx [4]

When a caller from Texas asked Jonathan Strong, a reporter for the Daily Caller, what the constitutional basis is for making everybody buy health care, Strong replied:

“Traditionally people say that under the Commerce Clause, which allows Congress to regulate interstate commerce, health care is tied enough into the economy that it would suffice constitutional muster under that.”

Strong added that some constitutional lawyers in Washington, D.C. believe that since the IRS is going to enforce some of the provisions [in the health care legislation] it may allow lawyers to justify the bill under the Taxing and Spending Clause of the Constitution, “which has much broader range of authorities than just the Commerce Clause.”

From Politico www.politico.com/news/stories/0410/35496.html [5]

… [Gov.] Pawlenty [R-Minn.] and other Republicans say the mandates [requiring citizens to buy health care insurance or pay a penalty] constitute an “unprecedented overreach by the federal government into the lives of individual citizens.”

The Republicans are employing different tactics to get around their states’ top lawyers.

In order to get her state in on the lawsuit, [Gov.] Brewer [R-Ariz.] got a law passed granting her the authority to go around Democratic Attorney General Terry Goddard, who is running against Brewer for governor. …

“I reached out to my attorney general, requesting him to look and see if he would look into the legalities of the bill that was being proposed in Congress, and he refused to look into it,” Brewer explained. “So we started moving forward. And then, certainly, after it was passed by Congress, I reached out to him again to ask him to represent the state of Arizona against this very overreaching mandate by Congress, and he refused to do so.” …

From the Washington Times

www.washingtontimes.com/news/2010/apr/05/eyes-closed-on-health-care/print/ [6]

Rep. Dan Burton (R-Ind.), senior Republican on the House Committee on Oversight and Government Reform, describes the impact the health care legislation will have on seniors who use Medicare Advantage.

… On Sept. 21, 2009, the Obama administration’s Centers for Medicare & Medicaid Services (CMS) imposed a gag order on all Medicare Advantage and prescription drug plans, prohibiting them from communicating with seniors about the proposed Medicare cuts in health care reform.

The order was in response to a mailer sent out by Medicare Advantage provider Humana Inc. It seems the company had the audacity to tell its customers that the $123 billion in proposed cuts to Medicare Advantage contained in the Senate Finance Committee’s version of health care reform would likely result in lower benefits and about 2.7 million people losing their Medicare Advantage coverage − for the record, the actual cuts made to Medicare Advantage by Obamacare came in closer to $205 billion. CMS deemed the information to be “misleading” and “inaccurate.” However, after an analysis by the nonpartisan Congressional Budget Office and the independent Medicare Payment Advisory Committee confirmed Humana’s facts, CMS was forced to rescind its inappropriate and unconstitutional gag order. Inexplicably, Rep. Waxman [D-Calif., chairman of the Energy and Commerce Committee] has never seen fit to haul anyone from the administration before his committee to answer for what happened.

From Politico www.politico.com/news/stories/0410/35421.html [7]
Former Sen. Norm Coleman (R-Minn.), the chief executive officer of the American Action Network, provides commentary about the increasing costs of health care reform and its effects on employment for the middle class and Medicare coverage for seniors.

… Beacon Hill Institute, the fiscally conservative economic research group of Boston’s Suffolk University, estimates 700,000 jobs will be lost, as small and medium-sized businesses try to provide health care for their employees.

The law does not allow seniors to keep the insurance they have. By 2019, 4.8 million seniors will be squeezed out of Medicare Advantage.

The law does not help states with the high cost of health care. It makes the states’ budget situations worse. By 2014, states will be required to pay 50 percent of the administrative costs that come with expanding Medicaid.

This law will not let the middle class keep its plans. The CBO projects that by 2016, the basic plan, covering only 70 percent of a family’s medical expenses, will cost $14,100 a year. Families making $88,000 or more won’t qualify for the government subsidies.

This means a family making $100,000 could spend as much as one-fifth of annual income to keep private insurance. …

Melissa Barnhart is an intern at the American Journalism Center, [8]Accuracy in Media [9] and Accuracy in Academia. [10]

*Blog entries by interns reflect their personal opinions only and not that of Accuracy and Academia.