On Thursday, House Republicans once again voted to repeal President Obama’s health care law. I don’t think it’ll be a major spoiler to predict that the repeal bill won’t go any further. But I do think the vote is a good opportunity to reflect on the future of Obamacare, which I divide into four possible scenarios. 1. Obamacare is a success, and liberals build on it
Under this outcome, the law works as well as or better than its supporters predicted. After some initial hiccups, it expands insurance coverage to those in need without disrupting the health care experience for those who are already satisfied. The cost-control measures work, and providers are able to deliver better care at a lower price by taking advantage of government incentives to be more efficient. As a result, the government saves hundreds of billions of dollars on Medicare without seniors noticing any cuts to their benefits and access. Young and healthy Americans flood into the insurance market to offset the cost of providing insurance to older and sicker Americans, including those with pre-existing conditions. The new insurance exchanges are vibrant marketplaces offering beneficiaries a wide range of options, promoting competition that drives down the cost of premiums. Over time, more individuals and businesses demand access to the exchanges, and America evolves into an exchange-driven single-payer system. 2. Obamacare is an epic disaster and it gets fully repealed
Under this scenario, the law unravels. The cost controls do not work, proving especially troublesome for smaller regional hospitals. They either start closing, stop accepting Medicare or cut services. This effectively reduces the benefits seniors can get out of Medicare, and they, along with industry lobbyists, pressure Congress into undoing the cuts that are one of the primary offsets to the law’s trillions in new spending. On top of this, new taxes kick in – mandate penalties, the insurance premium tax, the medical device tax, pharmaceutical tax, etc. – and businesses struggle to adjust to a raft of new regulations. The exchanges are swamped with technical problems and poorly administered, making it difficult for individuals to sign up. Not many insurers participate in the exchanges, meaning they don’t offer sufficient choices to promote competition. New regulatory requirements drive up the price of premiums, so young and healthy Americans decide they’d rather pay a penalty than invest in costly insurance. Without the younger and healthier people in the risk pool to offset the cost of sicker Americans, insurers raise premiums even further, prompting yet more individuals to exit the insurance market. And so, the dreaded insurance “death spiral
” ensues. In the meantime, newly insured individuals start taking advantage of their free or heavily subsidized care, but the capacity of the health care sector does not grow quickly enough to meet demand, translating into long waits at doctors’ offices and difficulty getting appointments in the first place. The ensuing backlash from all fronts leads to a Republican takeover of the Senate in 2014 and helps elect a Republican president in 2016. At some point in 2017, a new Republican president signs a law wiping Obamacare off the books. 3. Obamacare is largely a disaster, but it survives, and possibly expands
Though I’ve written a lot over the past several years about the likely negative consequences of the law, no matter how chaotic the implementation, at some point at least some constituency of voters will be deriving some benefits from the law. It’s one thing to support repeal when it means voting against theoretical subsidies for theoretical beneficiaries. But once the law goes into place, repealing the law would mean stripping away benefits from people actively receiving government aid. Let’s say, in 2017, there’s an incoming Republican president with – at best – control of the House and a narrow Republican Senate majority. Would he or she be willing to use reconciliation to push through a repeal bill when confronted with Democratic attacks that it would take millions off the Medicaid rolls and make millions more lose their subsidized private insurance? Republicans have not traditionally shown themselves to have the political fortitude to roll back entitlements once they are in place. At the same time, if Republicans do not respond with an alternative to clean up the mess, then liberals will begin to blame problems in the health care sector on the idea that Obamacare left too much control in the hands of private industry. This will prepare the groundwork for a further move toward a socialized single-payer health care system, perhaps by, say, re-introducing a “public option.” There have been many times in American history when failures of government policy led to further expansions of government. Limited government advocates should be wary of this happening with Obamacare. 4. Obamacare is largely a disaster, and it gets reformed
Under this scenario, a combination of public backlash and adverse court decisions forces Congress to re-open Obamacare. It doesn’t get fully repealed, but it gets reformed. Perhaps, for instance, exchanges remain, but there are far fewer restrictions on what type of insurance can be offered, broadening the range of options and providing more affordable choices for those who don’t have as many medical needs. States may be given actual flexibility on the operation of the exchanges, and Medicaid funds become block granted. Insurance is made accessible to those with pre-existing conditions without the “guaranteed issue” and “community rating” policies that force insurers to cover everybody who applies at a price effectively set by government. This allows Congress to get rid of the federal individual mandate.
At this writing, I view the third and fourth scenarios as the most likely outcomes. All the signs point to a rocky implementation of the law, meaning there will likely be some window to revisit it. The big question is whether the next major health care reform legislation reins in Obamacare or moves the nation closer to single-payer. The outcome will largely depend on the party affiliation of the next several presidents as well as how serious Republicans get about rallying around a health care reform policy. http://tinyurl.com/bblnh93
The problems with the IRS extend beyond playing politics with conservative groups seeking a tax-exempt status. I have never made this public before, but given the heightened interest in the way the IRS has conducted itself, the time has come to disclose what happened.
Just weeks after Barack Obama was elected president in 2008, I was notified by the IRS that the Catholic League was under investigation for violating the IRS Code on political activities as it relates to 501(c)(3) organizations. What the IRS did not know was that I had proof who contacted them to launch the investigation: Catholics United, a George Soros-funded Catholic organization.
The IRS was contacted on June 5, 2008, to launch a probe of the Catholic League, and the letter sent to me was dated Nov. 24, 2008. The June 5 letter was sent to the IRS by lawyers from Catholics United; it was mailed to Director Marsha Ramirez, director of Exempt Organizations Examinations, and to Lois G. Lerner, director of EO Division.
The "evidence" against me was nothing more than news releases and articles I had written during the presidential campaign on various issues. The lawyers also asked the IRS to question the source of new funding we had received, implying that we received illegal contributions.
The timing is not coincidental. On Oct. 20, I issued a news release, "George Soros Funds Catholic Left," and on Oct. 23, I wrote another one, "Catholic Left Scandal Mounts"; both mentioned Catholics United. The same day, Oct. 23, I was asked to go on CNN, and when Catholics United found out, they contacted the station trying to spike the interview.
The person who did this was the head of Catholics United, Chris Korzen. He said I was not "an authentic Catholic commentator and representative of the Catholic Church," and that they should either drop me altogether or put me on with Alexia Kelley of Catholics in Alliance for the Common Good (Catholics United is listed on the 990 of Catholics in Alliance as a related organization; Soros greases this group, and by extension, Catholics United).
The bid to keep me off TV failed. But here's the key: Korzen was dumb enough to share with CNN the complaint issued by his group to the IRS. The document, which was leaked to me by someone at CNN, matches up extraordinarily well with the IRS complaint of Nov. 24.
In the end, the IRS concluded that although the Catholic League had "intervened in a political campaign," it was "unintentional, isolated, non-egregious and non-recurring"; our tax-exempt status remained intact. This is false: I intentionally addressed political issues, and did not intervene in the campaign, unless, of course, my freedom to speak about political issues is a violation of the IRS Code. If that is the case, then this IRS unit should fold.
So the problem extends beyond the IRS. It extends to left-wing activists, funded by left-wing tycoons, all for the purpose of silencing conservatives. It's time someone was held accountable for this obscene political game. http://tinyurl.com/bac4z62
A bill introduced Friday calls on the federal government to craft a national strategy for dealing with the public health effects of climate change.
Rep. Lois Capps (D-Calif.) is sponsoring the measure. She said climate change has factored into recent increases in allergies, asthma, tropical diseases, drought and high temperatures.
“Regardless of what one believes about its causes, climate change is very real,” Capps said in a statement, adding, “We have to provide our public health officials with the tools and resources they need to effectively track and prepare for these significant public health challenges.”
Democratic Reps. Edward Markey (Mass.), Doris Matsui (Calif.) and Jan Schakowsky (Ill.) are co-sponsoring the bill.
The legislation will likely face resistance in the Republican-controlled House, which has blocked other bills regarding climate change.
The bill directs the Health and Human Services secretary to create a national plan to assist medical professionals with health issues linked to climate change.
It would authorize the Centers for Disease Control and Prevention to research the nexus of climate change and health, including the health implications of reducing greenhouse gas emissions. It also would bolster tracking of diseases and environmental health indicators. http://tinyurl.com/aa5hpee
Internal cost estimates from 17 of the nation's largest insurance companies
indicate that health insurance premiums will grow an average of 100 percent under Obamacare, and that some will soar more than 400 percent, crushing the administration's goal of affordability.
New regulations, policies, taxes, fees and mandates are the reason for the unexpected "rate shock," according to the House Energy and Commerce Committee, which released a report Monday
based on internal documents provided by the insurance companies. The 17 companies include Aetna, Blue Cross Blue Shield and Kaiser Foundation.
The report found that individuals will face "premium increases of nearly 100 percent on average, with potential highs eclipsing 400 percent. Meanwhile, small businesses can expect average premium increases in the small group market of up to 50 percent, with potential highs over 100 percent."
One company said that new participants in the individual market could see a premium increase of 413 percent when new requirements on age rating and required benefits are taken into account, said the report. "The average yearly cost for a new customer in the individual market grows from $1,896 to $3,708 -- a $1,812 cost increase," it added.
The key reasons for the surge in premiums include providing wider services than people are now paying for and adding less healthy people to the rolls of insured, said the report.
It concluded: "Despite promises that the law will lower costs, [Obamacare] will in fact cause the premiums of many Americans to spike substantially. The broken promises are numerous, and the empirical data reveal that many Americans, from recent college graduates to older adults, will not be able to afford the law's higher costs." http://tinyurl.com/aobscy9
Human ears are a problem for plastic surgeons. But writing in Nano Letters, researchers at Princeton and Johns Hopkins universities described how they used a standard 3-D printer to create bionic ears with auditory powers far beyond the natural human endowment. The technique lets scientists mimic the structural complexity of the ear while achieving a wider range of audible frequencies through the embedded electronics. They used the printed ear to culture genuine cartilage in vitro from calf cells.
Once they had one ear, the scientists printed another that was the mirror image, and then had both listen to Beethoven's "Für Elise" while linked to loudspeakers. Researchers were able to assess the sound quality—which was good.
All human progress is in some sense an effort to transcend biology, so it's no surprise that the body itself has become a focus for innovation. Scientists and medical device firms are developing a range of inventive therapeutic devices, including artificial kidneys, retinal implants and sensors such as electronic tattoos that can monitor vital signs. Already several countries have approved a partly organic synthetic heart for human implantation.
Tissue engineering, used to grow new skin for burn patients, will allow even greater advances, such as custom heart valves. Eventually these creations will surpass the originals, and the Olympic controversy over sprinter Oscar Pistorius' artificial legs will seem quaint—to say nothing of what genetic engineering will offer.
Technology and social change are always entwined. In Western societies, people can already choose to a great extent who they are, including their own gender. It can't be long before a host of superhuman powers will be available and the meaning of the term "human" is contested.
Which superhuman powers would you want? Be careful: Just look at King Midas, granted his wish to be able to turn everything into gold.
In the future, we'll have the power to change our very natures. En route, for better or worse, we'll just have to play it by ear. http://tinyurl.com/cbw6w3v
Many Europeans see American farming and its reliance on genetically modified crops as more Frankenstein than Farmer in the Dell. Now, the opposition here to U.S. agricultural practices is threatening to become a major battle in discussions starting next month that could sweep away trade barriers between the United States and Europe.
Many here worry that a trade pact would ease regulations that have made it difficult for genetically modified crops and products to reach European shores. Genetically modified crops are broadly unpopular in Europe, and farmers and environmentalists fear that if trade restrictions are lowered, both genetically modified seeds and U.S.-grown genetically modified products would quickly take over European farmland and grocery stores.
Some farmers are hoping to stop the talks if rules that govern their work are thrown into the mix, and they are determined to keep U.S. industrial farming an ocean’s-length away.
U.S. crops inspire fear among everyone from French wine producers to German corn growers. Many European farmers say that plants that are carefully engineered to do everything from boosting production to repelling pests have uncertain environmental consequences and, once growing, spread uncontrollably via pollen that can float for miles on the wind.
But in the United States, many farmers wring extra profit out of each acre they plant with the new seeds, and the technology has quickly cornered the U.S. market despite lingering concerns from environmentalists and consumers. In the United States last year, genetically modified crops comprised 88 percent of all corn, 94 percent of cotton and 93 percent of soybeans, according to Agriculture Department figures. In the European Union, they covered less than 1 percent of farmland, mostly in Spain, according to the European Commission.
“We will fight this until we cannot fight any more” if it appears that restrictions on growing genetically modified crops are about to be loosened, said Reinhard Jung, the head of the Brandenburg Farmers’ Federation. Jung’s 25 spotted brown cows grazed calmly one recent afternoon on a field behind his squat, red-brick farmhouse. “We don’t want to make the same mistakes with our agriculture that the Americans made with theirs,” he said, adding that American farms have become industrial in scale, unlike the postage-stamp plots in Germany.
With talks expected to begin within weeks, Europeans and Americans are still finalizing the topics where they will try to find an agreement
, but officials on both sides say that genetically modified crops are almost certain to be part of a broader discussion about easing restrictions on the flow of agricultural products in both directions.
Few involved in the discussions expect European concerns over genetically modified products to endanger the entire trade pact, but analysts say the brouhaha could limit the extent to which agriculture is part of the final agreement.
Just two genetically modified crop types are approved for planting in the European Union, out of a far wider range of species used elsewhere. But one of the two, a BASF potato, is no longer marketed; the other, a Monsanto corn breed, is banned for growing in France, Germany and elsewhere, despite findings from both U.S. and E.U. food regulators that the produce is safe. http://tinyurl.com/bk4rfg2
Child-care centers that get U.S. government subsidies will for the first time have to meet a uniform set of federal standards for employee background checks, first-aid training and other protective measures.
The proposal by the Department of Health
and Human Services would force state governments to require child-care providers to comply with fire, health and building codes, set up safety training, fingerprint employees and agree to surprise inspections. More than 500,000 facilities that accept federal funding will be affected, the agency said today in a statement
This rule updates regulations last published in 1998 that left oversight of child-care businesses largely up to states. The decision to expand federal oversight is being proposed because “too many children remain in settings that do not meet minimum standards of health and safety,” the agency said.
“What’s troubling is that child-care safety standards vary state-by-state, even city-by-city,” Kathleen Sebelius
, the U.S. health and human services secretary, said today on a conference call. “The rule would require child-care information to be available in user-friendly websites.”
The rule would apply to providers who accept federal Child Care and Development funds, which serve about 1.6 million low-income children, according to the statement. The proposal is subject to a 75-day comment period before taking effect and wouldn’t impose on a state’s ability to license child-care providers. http://tinyurl.com/a95pk5l
In young people, blood vessels appear to be able to compensate for the effects of obesity. But after middle age, this adaptability is lost, and arteries become progressively stiffer as body fat rises - potentially increasing the risk of dying from cardiovascular disease.
The researchers suggest that the harmful effects of body fat may be related to the total number of years that a person is overweight in adulthood. Further research is needed to find out when the effects of obesity lead to irreversible damage to the heart and arteries, they said.
Obesity is known to be a major risk factor for heart disease, but the reasons for this are not fully understood.
Researchers at the Medical Research Council (MRC) Clinical Sciences Centre at Imperial College London scanned 200 volunteers to measure the speed of blood flow in the aorta, the biggest artery in the body. Blood travels more quickly in stiff vessels than in healthy elastic vessels, so this allowed them to work out how stiff the walls of the aorta were using an MRI scanner.
In young adults, those with more body fat had less stiff arteries. However, after the age of 50 increasing body fat was associated with stiffer arteries in both men and women.
Body fat percentage, which can be estimated by passing a small electric current through the body, was more closely linked with artery stiffness than body mass index, which is based just on weight and height. Men are on average about 21 per cent fat and women 31 per cent fat.
The research was funded by the MRC, the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, and the British Heart Foundation, and published in the journal Hypertension.
Dr Declan O'Regan, who led the study, said: "The effects of having more fat seem to be different depending on your age. It looks like young people may be able to adapt to excess body fat, but by middle age the cumulative exposure to years of obesity may start to cause permanent damage to the arteries. One implication is that the potential beneficial effects of weight loss may depend on your age and how long you have been overweight. This is something we plan to study further.
"We don't know for sure how body fat makes arteries stiffer, but we do know that certain metabolic products in the blood may progressively damage the elastic fibres in our blood vessels. Understanding these processes might help us to prevent the harmful effects of obesity." http://tinyurl.com/bxrq7bd
Senator Elizabeth Warren wants
to set the interest rate on federal loans made to low-income college students at 0.75 percent. Why? Because the Federal Reserve lends to banks at that rate, while the government charges 6.8 percent on most student loans; because the government “profits” by lending to low-income students; and because students are being crushed by debt.
With that mix of populist rhetoric and subterfuge, Senator Warren stands to whip up a mob of angry students (and pundits) who will demand that the government drop the interest rate on student loans to 0.75 percent. Good luck reasoning with a mob. Nevertheless, here is what everyone should know about Senator Warren’s case for lower interest rates. The interest rate at which the “government” lends to banks is part of an emergency loan program that the Federal Reserve uses to prevent runs on banks. The 0.75 percent rate is actually a penalty rate, about three times higher than what banks charge each other in the market. Banks rarely use it, and lose money when they do. Lastly, the Federal Reserve is not part of the government, nor is it controlled by it; it is an independent entity. Therefore, the “government” does not lend to banks at 0.75 percent.
What about Senator Warren’s claim that the government makes money off loans to low-income students? Senator Warren is not telling the whole story here either. She points to figures that the non-partisan Congressional Budget Office says
“do not provide a comprehensive measure of what federal credit programs actually cost the government and, by extension, taxpayers.” In fact, when the budget office “accounts more fully… for the cost of the risk the government takes on when issuing loans,” it reports
that Subsidized Stafford loans – those made to low-income students – cost
taxpayers $12 for every $100 lent out, or $3.5 billion per year. If the loans cost $3.5 billion a year when the government charges a 6.8 percent interest rate, cutting the rate to 0.75 percent would more than triple that cost.
The claim that the government makes money on these loans is even more dubious given that the Department of Education estimates
that 23 percent of the Subsidized Stafford loans it makes this year will default. That puts it among the riskiest loan programs that the federal government runs. By comparison, about 7 percent of the loans under the Federal Housing Administration mortgage program are expected to default. That program provides loans to high-risk borrowers who do not qualify for a traditional mortgage because they lack the savings, income or credit history.
To be sure, the student loan program should serve high-risk borrowers. By their nature, students generally do not have collateral, earnings or credit histories. But when nearly a quarter of the loans are expected to default, charging a 6.8 percent interest rate is hardly the usury Senator Warren suggests. A non-profit credit union would charge at least double that rate.
Let’s say Senator Warren is right that students are being crushed by debt. Even so, lawmakers need not cut interest rates to alleviate that burden. The government has a solution in place.
A program available now, called Pay As You Earn, allows the same borrowers who would be eligible for Senator Warren’s proposal to have their annual loan payments set at between 0% and 10% of their incomes, depending on their earnings and family size. That is, a borrower’s income – not the interest rate – dictates the payment, and it is always an affordable share of his income, never exceeding 10 percent annually. The program also guarantees that no one has to pay beyond 20 years. No matter how much a student borrows, or the interest rate, the loans are forgiven at that point.
Too few borrowers are aware of the Pay As You Earn program, however, and others struggle to enroll due to administrative hurdles. If Senator Warren were serious about easing students’ debt burdens, her first legislative proposal would have addressed those issues. Instead, she gave students a crash course on the Federal Reserve’s discount window and false hope that they will be able to borrow from it. Those students would be much better off learning about Pay As You Earn. http://tinyurl.com/amwgmeb
Rep. Trent Franks (R-Ariz.) will offer a bill to ban late-term abortions in response to the gruesome case of Kermit Gosnell, an abortion provider recently convicted of killing three viable infants.
Franks announced Friday that he will revise his measure banning late-term procedures in the District of Columbia to apply to the nation as a whole.
The bill will criminalize abortion after 20 weeks of pregnancy based on the disputed premise that fetuses can feel pain at that stage. In a statement, Franks compared late-term abortions to Gosnell's killing of three infants born alive after failed abortion procedures. The conviction took place Monday.
"Had Kermit Gosnell dismembered these babies before they had traveled down the birth canal only moments earlier, he would have, in many places nationwide, been performing an entirely legal procedure," Franks said.
The case, notable for its grisly details, received attention from congressional Republicans starting in late April.
Greater media coverage followed after the GOP accused journalists of avoiding a difficult story about abortion.
Franks is a leading opponent of abortion rights in the GOP-led House, known for his bills to ban sex-selective abortions and late-term abortions in D.C.
His forthcoming legislation promises to create a major fight between House Republicans and supporters of abortion rights, who argue that prohibiting abortion before fetal viability is unconstitutional.
The bill could pass the House but has little chance in the Democrat-led Senate.
Franks will revise his measure next Thursday at a hearing of the House Judiciary subcommittee on the Constitution, which he leads.
A previous version of the D.C. ban exempted women whose lives are in danger but not victims of rape or incest. http://tinyurl.com/b2xz7m3