An ironic unintended consequence of Obamacare

I've posted before about Obamacare and the Law of Unintended Consequences, pointing out the great potential for government aggression in the health care sector of our economy to produce exactly the opposite of its intended purpose—but I have to admit, this one surprised me anyway:

Faced with mounting debt and looming costs from the new federal health-care law, many local governments are leaving the hospital business, shedding public facilities that can be the caregiver of last resort. . . .

More than a fifth of the nation's 5,000 hospitals are owned by governments and many are drowning in debt caused by rising health-care costs, a spike in uninsured patients, cuts in Medicare and Medicaid and payments on construction bonds sold in fatter times. Because most public hospitals tend to be solo operations, they don't enjoy the economies of scale, or more generous insurance contracts, which bolster revenue at many larger nonprofit and for-profit systems.

Local officials also predict an expensive future as new requirements—for technology, quality accounting and care coordination—start under the overhaul, which became law in March.

Moody's Investors Service said in April that many standalone hospitals won't have the resources to invest in information technology or manage bundled payments well. Many nonprofits have bad credit ratings and in a tight credit market cannot borrow money, either. Meantime, the federal government is expected to cut aid to hospitals.

Yes, you're reading that right: the expansion of government-run health care looks to be resulting in . . . less government-run health care, and more for-profit hospitals.

All about the science? Don’t be so sure

We may have gotten a lot of pious talk from this administration about setting science free from political agendas, but don’t believe it. William Saletan connects the dots on one illustrative example:

Fourteen years ago, to protect President Clinton’s position on partial-birth abortions, Elena Kagan doctored a statement by the American College of Obstetricians and Gynecologists. Conservatives think this should disqualify her from the Supreme Court. They understate the scandal. It isn’t Kagan we should worry about. It’s the whole judiciary. . . .

Umm . . . about those “death panels” . . .

The media may have assured us that Gov. Palin didn’t know what she was talking about when she coined that phrase, and the Democrats may have insisted there was no such thing lurking in ObamaPelosiCare's shadows—but try telling that to the man President Obama nominated to take over government health care, Dr. Donald Berwick,

an outspoken admirer of the British National Health Service and its rationing arm, the National Institute for Clinical Effectiveness (NICE).

“I am romantic about the National Health Service. I love it,” Berwick said during a 2008 speech to British physicians, going on to call it “generous, hopeful, confident, joyous, and just.” He compared the wonders of British health care to a U.S. system that he described as trapped in “the darkness of private enterprise.”

Berwick was referring to a British health care system where 750,000 patients are awaiting admission to NHS hospitals. The government’s official target for diagnostic testing was a wait of no more than 18 weeks by 2008. The reality doesn’t come close. The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent.

Overall, more than half of British patients wait more than 18 weeks for care. Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed. . . .

With the creation of NICE, the U.K. government has effectively put a dollar amount to how much a citizen’s life is worth. To be exact, each year of added life is worth approximately $44,305 (£30,000). Of course, this is a general rule and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life.

To Dr. Berwick , this is exactly how it should be. “NICE is not just a national treasure,” he says, “it is a global treasure.”

And, Dr. Berwick wants to bring NICE-style rationing to this country. “It’s not a question of whether we will ration care,” he said in a magazine interview for Biotechnology Healthcare, “It is whether we will ration with our eyes open.”

My one complaint with Michael Tanner’s article is its title, “‘Death panels’ were an overblown claim—until now” . . . are you really so sure about that? If the claim isn’t overblown now, maybe it never was. Isn’t it just possible, Mr. Tanner, that Gov. Palin understood from the beginning what it took you a while to figure out? So the Democrats said there were no death panels in the bill. So they also said, “If you like your present health insurance, you can keep it”—but they didn’t write the bill that way. (Rather to the contrary, actually.) Who’s really worth believing here?

The culture of death and the death of culture

In an excellent short essay in the latest issue of The City, Baylor's Francis J. Beckwith responds to a Washington Post column by one T. R. Reid claiming that ObamaPelosiCare would reduce the number of abortions. His evidence? There are more abortions per thousand women in the U.S. than in countries like Denmark, Japan, Germany, and the UK. Of course, the birth rate's also quite a bit higher in the U.S. than in those countries, so his choice of statistic is more than a little disingenuous. But then, as Dr. Beckwith points out, there's also a much deeper and more profound problem with Reid's argument:

The prolife position is not merely about "reducing the number of abortions," though that is certainly a consequence that all prolifers should welcome. Rather, the prolife position is the moral and political belief that all members of the human community are intrinsically valuable and thus are entitled to the protection of the laws. "Reducing the number of abortions" may happen in a regime in which this belief is denied, and that is the regime that the liberal supporters of universal health coverage want to preserve and want prolifers to help subsidize. It is a regime in which the continued existence of the unborn is always at the absolute discretion of the postnatal. Reducing the number of these discretionary acts by trying to pacify and accommodate the needs of those who want to procure abortions—physicians, mothers, and fathers—only reinforces the idea that the unborn are objects whose value depends exclusively on our wanting them.

A culture that has fewer abortions because its citizens have, in the words of John Lennon, "nothing to kill or die for, and no religion too," is a sad, dying, empty culture. Mr. Reid seems to think being prolife is just about instituting policies that result in fewer abortions. But it's not. It's about loving children, life, and the importance of passing on one's heritage to one's legacy.

As Dr. Beckwith points out, that cultural emptiness—we might say, the absence of a strong pro-life impulse—has profound negative consequences:

What is going on in these nations is a shared understanding among its citizenry about the nature of its culture and its progeny: our civilization's future and the generations required to people it are not worth perpetuating. It is practical nihilism, for each nation believes that its traditions, customs, and what remains of its faith are not worthy of being preserved, developed, and shared outside of the populace that currently occupies its borders. In practical terms, this means, for one thing, that the present generation of Europeans older than 55 will not have enough future workers to sustain their own health care needs when they are elderly.

So, as we have seen in the Netherlands, involuntary, non-voluntary, and voluntary euthanasia will certainly become the great cost containers (or as they say more candidly in Alaska, "death panels").

That's about it. At its heart, the pro-abortion position is a bet on power; the abortion regime is a classic example of the tyranny of the majority, the powerful abusing the powerless because they can and it suits them. Even the weakest and most powerless women are still infinitely powerful by comparison to their unborn children; and of course, many children are aborted not because women desire the abortion but because they are coerced into it by someone else, usually by the father of the child. Though there are exceptions, almost all abortions are essentially matters of convenience for somebody, driven by the unwillingness to sacrifice pleasures in the present for the sake of the future, and the refusal to allow the self to diminish so that someone else may grow.

This is malignant individualism, a cancer of the ego; and it is not only destructive of human life insofar as it drives the abortion mills, it is also destructive of human flourishing on a broader scale, because it is absolutely inimical to any sort of healthy culture. True growth depends on the willingness to sacrifice, or at least invest, the present for the sake of the future; true culture, healthy culture, arises out of love of life and openness to life, even when that love and that openness carry with them a real cost. To choose abortion is to choose the opposite: rather than choosing life at the cost of one's convenience, comfort and pleasures, it is to choose death for the sake of protecting one's pleasures, convenience and comfort. That may be pleasing in the short term, but in the long term, no good can come of it.

Was this what you had in mind, Madam Speaker?

Nancy Pelosi famously declared that they'd have to pass the health care bill to find out what's in the bill. Well, now we're finding out:

"Turns out ObamaCare means if you like your health plan you can lose it. The president didn't have to actually strong-arm companies into dumping their employee health insurance because his bill carried financial incentives to virtually guarantee that result," [Rep. Joe] Barton said. "But something's very wrong when, like AT&T found out, paying $600 million in penalties will allow you to stop paying $2.4 billion for insurance, leaving both workers and taxpayers stuck. I suppose we can't know for some years how many thousands, hundreds of thousands or even millions of workers will lose their company insurance because of health care reform, but I know that it will be a breach of faith for most of them and a tragedy for some."

Why Mitt Romney is not the GOP frontrunner

Never mind the polls, he's nothing of the sort. This sums up why:

Put bluntly, President Obama has hitched his wagon to ObamaPelosiCare. Barring a major foreign-policy catastrophe (which is certainly possible; I'm still somewhat surprised we got no major attacks last year), and maybe not even then, it's hard to imagine a scenario for 2012 in which his health care bill is popular and he himself is not—and at this point, that's the only scenario under which a Romney victory is at all plausible. The fact of the matter is, however hard Gov. Romney tries to argue that his plan in Massachusetts was fundamentally different than the Democrats' national plan, he just has no case; they both come straight from the Teddy Kennedy playbook.

Now, in all fairness to Gov. Romney, the field has shifted somewhat on health care in the last few years; as Stephen Spruiell points out, it wasn't all that long ago that even the Heritage Foundation supported individual mandates for health insurance, something which is now universally opposed on the Right; Orrin Hatch even submitted a health care bill in the Senate which took that approach:

The problem for Gov. Romney is, he took his cue from that and signed a health care bill into law—and now that his bill hasn't reduced costs in Massachusetts (or helped much of anything else, really), and now that the political center has shifted to leave his accomplishment firmly on the political Left, he's stuck with it. It's possible he may be able to find a way to deal with that and put himself back within the conservative mainstream; but until he does that, he cannot with any intelligence be called the GOP frontrunner or anything close to it. As of now, the only thing one can reasonably call his presidential hopes is a mirage.

Good for Nebraska

This is good news:

The Nebraska legislature has signed off on a bill that Governor Dave Heineman will sign today that could head to the courts and ultimately weaken further the Roe v.Wade Supreme Court decision that has resulted in 52 million abortions. The bill bans abortions after 20 weeks of pregnancy based on the well-established concept of fetal pain.

By a vote of 44-5, the Nebraska unicameral legislature this morning gave final passage to the Pain Capable Unborn Child Protection Act introduced by Speaker Mike Flood.

One small step toward a more just and compassionate society.

The proof of the pudding

There are many on both sides of the political divide who believe that the passage of ObamaPelosiCare is basically final, pointing to other great entitlement programs of the past such as Social Security and Medicare. They could very well be right; it's very hard to get rid of government bureaucracies once founded, as they have a way of creating their own constituencies. I remember Republicans campaigning on abolishing the Departments of Energy and Education; once they had the chance, they never even tried to follow through.

And yet . . . the proof of the pudding is in the eating, and the health care "reform" package was sold on the promise that it would improve health care and reduce health care costs. Our president went around declaring that once the bill was passed, Americans would find out that we actually like it after all. Therefore, it seems to me that if it fails to deliver on those promises, there will be a sufficient political constituency to repeal this law (if one can refer to anything so bloated by a term which suggests organization and coherence).

As such, I'm guessing that if Robert Samuelson is right to declare that "Obama's proposal is the illusion of 'reform,' not the real thing," it won't last long. If I'm wrong and it improves our health care system, then the public will accept the significant new government intrusion into our privacy and autonomy, and it will stick around. This situation has at least this potential merit: ideas will be judged by their consequences. That, if nothing else, is as it should be.

Uncharted waters

I think Greg Sargent captured the significance of yesterday's big vote better than anyone I've yet read:

Last night’s big health reform victory made history in many ways, but in hard political terms perhaps the key one is this: This is the first landmark piece of reform that passed over the unanimous opposition of one major party.

Both Social Security and Medicare had bipartisan support. While they were both the achievements of Democratic presidents, there isn’t a clear sense in the public mind that it was entirely the work of one party over the implacable opposition of the other one.

Now an achievement of equal magnitude—health care reform, which will dramatically reshape a vital aspect of American life—is about to pass into law as the work of one party and one party alone. The other party emerges from this battle defined entirely by its unanimous opposition to it.

This could have more dramatic repercussions than any of us know right now, perhaps helping define the differences between the two parties for years, in a way that no other major political battle has.

Republicans say—publicly—that this will play in their favor, and claim the public will reward them for showing the fortitude to stand firm against a far-reaching expansion of government into a deeply personal aspect of our lives. Democrats counter that Americans will realize that the dreaded government takeover warned against by reform foes is a caricature—and that once they do, it will reinvigorate the pact between government and the American people.

All this is to say that the real argument underlying this fight—this chapter in the larger ideological showdown over the proper role of government in our lives, an argument that has taken mutiple forms throughout our history—is only beginning. There will now be an actual law that frames and defines this debate. And the fact that each party placed all its chips on competing visions dramatically ups the stakes, with untold consequences to come—not just for the parties, but for the prospects of future far-reaching legislative initiatives.

The one wrinkle he doesn't catch is the one Jay Cost highlights:

Harold Lasswell defined politics as who gets what, when, and how. By this metric, ObamaCare is bad politics for the foreseeable future. Like any major piece of legislation, this bill assigns winners and losers. The winners will be those who today are uninsured, but who will (eventually) acquire insurance. But there will not be a major reduction in the uninsured until 2014. So, the actual winners are going to be pretty few in number for some time.

Meanwhile, the losers begin to feel the effects immediately. Between now and the next presidential election, ObamaCare is going to pay out virtually zero dollars in benefits, but it will take billions out of Medicare. This is bad for seniors. They have an incentive to oppose portions of this bill (while supporting others, like the closing of the "Doughnut Hole," which Republicans will never repeal). While the Democrats will claim that this reduction in benefits will have no effect on the quality of their care, CBO is much less certain . . .

After decades of developing a reputation for defending the interests of senior citizens, the Democrats have put it in serious jeopardy with this legislation. And they've done so right at the moment when demographic shifts are making the senior population more powerful than ever.

How will it all play out? Only time will tell.

Remember the Law of Unintended Consequences

We human beings have the tendency to forget that we exist within systems of relationships, which are themselves part of larger systems, and that anything we do causes ripple effects. The consequence of this is that we tend to assume that we can change this one thing over here without changing all the other parts of our lives, because everyone else’s behavior will remain the same. Life doesn’t work that way, but we never seem to remember that. This is, I think, the biggest single reason for the Law of Unintended Consequences (which states, in its simplest form, that whatever you do will always produce consequences which you neither intended nor foresaw; Murphy’s codicil to that is that those consequences will usually be negative): we fail to consider that other people will adjust to the changes we make, and thus don't stop to think about how they are likely to do so.

This is, of course, true on a national and global scale as well as on a personal and local one; and we’ve just gotten a pretty big red flag regarding the possible unintended consequences if ObamaPelosiCare passes. To wit, a survey taken by a leading medical search and consulting firm and reported in the New England Journal of Medicine found this:

The poll finds 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of a public option will either force them out of medicine or make them want to leave medicine.

Doctors also seem to understand the impact that will have as 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.”

Why would they feel this way? Consider:

62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.

The respected medical journal also found 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” and 30% feel income will “decline or worsen somewhat” with a public option.

Just 28.7 percent of doctors support the pro-abortion health care bill pending in the House

The assumption tends to be that if doctors and others in health care don’t like the changes the government wants to make, they can just lump it; but that fails to take into account that they do in fact have another option: they can stop seeing patients. Or, alternatively, they can stop seeing some patients (as many doctors and hospitals already restrict the number of Medicare patients they’ll take on), or see them on a different basis.

If this bill passes, will it really mean that nearly half of our primary-care physicians will leave practice? I’m sure it won’t; but will it mean that some leave, and some work fewer hours, and some retire early, and that in general, the availability of doctors drops? For my part, I saw enough “reduced activity days” (read: one-day strikes) by doctors while we were in Canada that I have no doubt it will. How is that going to improve health care?

Proponents of socializing our medical system need to take this very seriously. As the managing partner of the firm that conducted the survey wrote,

Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases. The overwhelming prediction from physicians is that health reform, if implemented inappropriately, could create a detrimental combination of circumstances, and result in an environment in which it is not possible for most physicians to continue practicing medicine.

Health-care reform and increasing government control of medicine may be the final straw that causes the physician workforce to break down.

The responsibility of our representatives

There was a remarkable article in The New Republic two weeks ago by William Galston with the revealing title, “The Public Isn’t Enthused About Health Care Reform. So What?” Galston opens with this:

“With the passage of time,” former Bush administration official Pete Wehner writes today, “President Bush’s decision to champion a new counterinsurgency strategy, including sending 30,000 additional troops to Iraq when most Americans were bone-weary of the war, will be seen as one of the most impressive and important acts of political courage in our lifetime.” Wehner may turn out to be right. And his argument has broader implications that deserve our attention.

Wehner tacitly defines political courage as the willingness to go against public opinion in pursuit of what a leader believes to be the public interest. Fair enough. And unless one believes—against all evidence—that democracies can do without courage, so defined, it follows that there’s nothing necessarily undemocratic about defying public opinion when the stakes are high. After all, the people will soon have the opportunity to pass judgment on the leader’s decision. And they will be able to judge that decision, not by the claims of its supporters or detractors, but by its results.

Now, it might surprise some folks that in large part, I agree with Galston here. He cites Alexander Hamilton in support of his position; I would go back further, to one of the inspirations of the modern conservative tradition, Edmund Burke (emphasis mine):

Certainly, gentlemen, it ought to be the happiness and glory of a representative to live in the strictest union, the closest correspondence, and the most unreserved communication with his constituents. Their wishes ought to have great weight with him; their opinion, high respect; their business, unremitted attention. It is his duty to sacrifice his repose, his pleasures, his satisfactions, to theirs; and above all, ever, and in all cases, to prefer their interest to his own. But his unbiassed opinion, his mature judgment, his enlightened conscience, he ought not to sacrifice to you, to any man, or to any set of men living. These he does not derive from your pleasure; no, nor from the law and the constitution. They are a trust from Providence, for the abuse of which he is deeply answerable. Your representative owes you, not his industry only, but his judgment; and he betrays, instead of serving you, if he sacrifices it to your opinion.

Properly understood, we elect officials to represent us, not to be our puppets. What they owe us is, first, an honest description of their character and beliefs, so that we can vote for them with an accurate understanding of how they would represent us; and second, to represent us with integrity in a manner consistent with that description. As such, there is no question that Barack Obama, for instance, ought to seek the passage of what he honestly believes to be the best laws possible, whether they are popular or not. Public unpopularity is not in and of itself an argument against any law, initiative, or executive action.

That said, I think Galston goes too far when he writes,

Note that to accept this argument, as I do, is to deny that President Obama and the Democrats are acting high-handedly—let alone anti-democratically—in moving forward with comprehensive health insurance reform. They genuinely believe that the public interest demands it—and that the people themselves will eventually agree. And they know that the people will have the last word.

This paragraph fails for two reasons. In the first place, Galston is comparing a legislative effort by President Obama and the Hill Democrats with an executive decision made by George W. Bush—which in this context is comparing apples and dragons. Had President Bush forced a declaration of war against Iraq through Congress in the face of rising majority opposition, that would be a direct parallel—and the Left would without question have called such action “high-handed,” “anti-democratic,” and a whole host of other things that would have been far less complementary. And they would have been right. What President Bush actually did was to make a decision which was unilaterally his sole responsibility to make as the ultimate commander of our nation’s military forces; which is a very different thing.

In the second place, the high-handed and anti-democratic nature of the actions of the Democratic Party leadership does not rest in the fact that they are proposing policies which are currently unpopular. If they believe those policies to be best, they are honor-bound to do so. Where it rests is in their unwillingness to allow the democratic process to work to their detriment. Were they to follow the rules, it seems clear that at this point, they would lose—but rather than accept that fact, and either compromise with more moderate folks in Congress (to produce a bill that could draw sufficient support) or lose honorably and move on, they have resorted to arm-twisting and attempts to subvert the process. True, they are far from the first to do either; but the fact that wrong has been done before doesn’t make it right.

To understand the key point here, we must I think return to Burke:

Your representative owes you, not his industry only, but his judgment; and he betrays, instead of serving you, if he sacrifices it to your opinion.

If this is true (and I believe it clearly is), then it is at least as true that our representatives betray us if they sacrifice their judgment to anyone else’s opinion either, and especially if they do so for personal or political gain; and this is exactly what President Obama and Speaker Nancy Pelosi are trying to push a number of House Democrats to do. Do they have the right to push an unpopular agenda? Yes, and the responsibility to do so, if they believe it best—but only within limits. They are exceeding those limits in a manner which is, yes, high-handed and anti-democratic, even if it is also courageous, and there’s nothing wrong with calling them on it.

The reconciliation farce

If you listen to the news, you probably know that both the House and the Senate have passed health care bills; that the two bills differ; that the Senate Democrats no longer have a filibuster-proof majority; and that rather than allowing even the slightest bit of Republican input to revise the bill—just enough to pick up one Republican vote—the administration and the Democratic leadership on the Hill have opted to use the budget reconciliation process to solve the problem. There's been a fair bit of handwringing over that, but it’s what they’re ostensibly going to do.

“Ostensibly” being, I think, the key word, because I don’t believe it’s ever going to happen, even if the House passes the Senate bill (which is far from assured at this point). Jeffrey Anderson laid out the reasons why two weeks ago, though most people don't seem to have caught on:

Senators want nothing to do with “reconciliation”—whether politically or for what it would do to their chamber—and they already like their own bill (which the House would then already have passed) just fine. The President would then already have gotten a bill through both chambers, and while House members would complain powerlessly, he would dip his pen in the ink and visualize himself in the history books. He might even try to score a few extra political points by saying, As you know, we intended to use the reconciliation process to make a few small changes to the Senate bill. While I know that there was some disagreement from some people, I think that that process would have been entirely appropriate to pursue. But some people are uncomfortable with it, and I think that’s a legitimate concern. It’s important to remember that our democratic institutions deserve the benefit of the doubt. Also, the American people understandably think that we’ve been focused on health care long enough. So that’s why I am making the decision not to pursue “reconciliation.” Instead, I am moving on to a jobs bill. . . .

House members would be left holding the bag. Target squarely on their chests, they would now get to face their fuming constituents after having passed a $2.5 trillion bill that would allow public funding of abortion, would send $100 million to Nebraska, $300 million to Louisiana, $100 million to Connecticut, would exempt South Florida’s Medicare Advantage enrollees from annual $2,100 cuts in Medicare Advantage benefits, would raise taxes, raise deficits, raise health costs, empower Washington, reduce liberty, politicize medicine, and jeopardize the quality of health care. Most of all, they would feel the citizenry’s wrath for having voted to pass a bill that only 25 percent of Americans support.

Anderson’s argument was only strengthened when the Senate parliamentarian ruled that not only must the House pass the Senate bill as is before reconciliation could be used to amend it, the President must sign it into law. That sounds more than a little fishy to me, but there it is: if the House passes the Senate bill, it will have to become law before anything can be done to change it. Figure the odds, at that point, that either the President or the Senate lifts a finger to do so. Why should they? The Senate Democrats, as noted, are content with their bill, the President will be content to have signed sweeping health care legislation, and both will want to put the whole long, bruising slog behind them; why reopen the battle unnecessarily to consider making changes Senate Democrats won’t vote for anyway?

For all the talk about trust, there’s no doubt in my mind: if the House passes the Senate bill, that’s the end of it. If House Democrats get hung out to dry for it, as far as the Senate and the White House are concerned, that’s just the price of victory.

The most critical health care reform

even ahead of tort reform, I think, is the simplest: cost transparency. As Barbara Kiviat writes,

A big part of the reason consumer goods are so cheap in the U.S. is because people always know what they're paying. As a consequence, consumers can push prices lower by voting with their feet. If CVS tries to sell me a toothbrush for $4 when the one at Rite Aid goes for $3, I will shop at Rite Aid and CVS will learn its lesson. This dynamic almost entirely accounts for the success of Wal-Mart. Yes, Wal-Mart has more efficient (and therefore cheaper) distribution than almost any other company on Earth, but the whole reason Wal-Mart is going for cheap in the first place is because there are hundreds of millions of Americans who demand it—a demand that is listened to because people are able to make well-informed decisions about when to walk away.

Lately I've been wondering if we might not be wise to unleash such price-crazed consumerism on the field of health care. The great health care debate has two prongs. I don't know the best way to expand coverage to the uninsured. But I do have an idea about how to drive down the eye-popping cost of medical treatment: price tags. . . .

I have long been fairly quiet about health-care policy because I feel I don't know enough about the intricacies of the debate. But one thing I do know about is the price-setting power of the enlightened consumer. I know about the effects of price transparency, and I know about what happens when you give Americans the tools to hunt for deals and value. Think about Wal-Mart. Think about going on Expedia to comparison shop airline tickets. Think about the first question you ask when you are considering buying a particular house.

Now think about health care.

Read the whole thing—it's great.

Can the ObamaPelosiCare push succeed?

In the most recent posts on his HorseRaceBlog, Jay Cost analyzes the legislative process that the Democratic leadership will have to use to bring the Senate health care bill to final passage of both houses of Congress, and then the political context in which they will be trying to do so, and concludes that it's possible but will be a very long row to hoe. If you want to understand the fight that's ahead, read his posts; they are, as usual from Cost, meticulous, well-informed, and insightful pieces of analysis.

Howard Dean invokes the Babel fish

Watching Howard Dean try to spin Scott Brown's victory to mean that Democrats need to keep pushing for socialized medicine is quite entertaining, given that Chris Matthews isn't about to buy it. I can only conclude that Matthews doesn't want to get run over on the next zebra crossing.

Not a good bargain

The notion that the IRS should be able to seize your assets if you don’t arrange your health care to the approval of the federal government represents the de facto nationalization of your body, which is about as primal an assault on individual liberty as one could devise.

—Mark Steyn

That captures the core issue here—and my most basic philosophical reason for opposing ObamaPelosiCare—about as well as can be done. Though Benjamin Franklin comes close:

Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.

Fisking the DNC

Last week the DNC released a rather oddly-timed attack ad against Sarah Palin, going after statements she made some time ago about the Democrats' plans to take over our national health care system. Not being ones to let such things go unnecessarily unchallenged, Conservatives4Palin decided to fact-check the DNC. Here's what Sheya and the rest of my honored colleagues who took up that task discovered:

On partial-birth abortion

No, it isn't all Doug Hagler all the time around here (though I should probably declare this "Doug Hagler Week," and send him a thank-you card for giving me so much to post about), but he did say something in his post on George W. Bush that I think requires a response. To wit, here was the first point he adduced in President Bush's favor:

Bush banned what is often erroneously called partial-birth abortion, or more accurately late-term abortion. I'm not sure what the moral argument in favor of late-term abortion would be.

Now, there are several things that need to be said here. First, I do agree completely with the second sentence. Second, Aric Clark tried to counter that sentence by misrepresenting late-term abortion (the abortion industry is actually woefully under-regulated, and notorious for fighting any regulation on proclaimed ideological grounds). And third, none of that is actually germain to the point, because Doug's first sentence here is almost completely wrong. On a technical level, President Bush didn't ban partial-birth abortion, Congress did, though under his leadership. On a semantic level, the term "partial-birth abortion" is not in fact erroneous. And on the level of content, "partial-birth abortion" does not mean "late-term abortion," it means something very particular.

For those who are pro-life and squeamish, you might not want to read further, especially if you already know the score on partial-birth abortion. If you're pro-choice and squeamish, I would suggest that you do read on, so that you understand what it is you're defending. And if you're pro-choice and not bothered by the details, then may God soften your heart.

To the jump . . .

*********

Partial-birth abortion is a particular procedure, technically known as intact dilation and extraction (as well as by other, similar terms) and often referred to as D&X. The Free Dictionary describes the procedure this way:

According to the American Medical Association, this procedure has four main elements.^[8] First, the cervix is dilated. Second, the fetus is positioned for a footling breech. Third, the fetus is extracted except for the head. Fourth, the brain of the fetus is evacuated so that a dead but otherwise intact fetus is delivered via the vagina.

Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using laminaria tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such as synthetic pitocin are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus' leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the birth canal, causing what is referred to by some people as the 'partial birth' of the fetus. The doctor subsequently extracts the rest of the fetus, usually without the aid of forceps, leaving only the head still inside the birth canal. An incision is made at the base of the skull, scissors are inserted into the incision and opened to widen the opening^[9], and then a suction catheter is inserted into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass more easily through the birth canal. The placenta is removed and the uterine wall is vacuum aspirated using a suction curette.

The AMA doesn't acknowledge the term "partial-birth abortion," but that's not because it's factually inaccurate; to the contrary, it's descriptive and evocative, which is precisely why the AMA resists it. Nor is it true to say that the procedure is only used in "rare and terrifyingly ugly situations," as Aric Clark claimed; rather,

Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers (a trade association of abortion providers), told the New York Times (Feb. 26, 1997): "In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along."^[35] Some prominent self-described pro-choice advocates quickly defended the accuracy of Fitzsimmons' statements.^[36]

This is nothing less than the torture-murder of innocent human beings for no more crime, in most cases, than being inconvenient to the mother—or to people whom the mother is unwilling to challenge. You may well argue that opposition to abortion requires pacifism, opposition to anything one might call torture, and the like, and you might well be right (though at this point, I'm not convinced; I intend to argue through some of these things in the near future)—but it seems to me far stronger in the other direction: the arguments for pacifism and for the condemnation of such things as waterboarding apply with even greater force to abortion. To call oneself a pro-choice pacifist is to be logically and morally incoherent.

The key to victory: don't lose your nerve

If Obamacare doesn't pass, it will in the end be because the Democrats forgot that rule. Granted, they have some reason—right now, 2010 isn't looking like a great year for them. Support for the President's health care "plan" (one has to put it in quotes because there is not in fact one coherent plan) is down to 41%, with 56% opposed, and the numbers are even worse among senior citizens; perhaps more importantly, the sense of inevitability is gone, with a slight plurality of voters saying no health care bill will pass this year (and a majority of independents—58%). The President's approval rating continues to sag as well. Still, his Approval Index is somewhat better than it was earlier this year, and the Democrats have pulled to within two points of the GOP on the generic congressional ballot; and perhaps most importantly, the Democratic caucus on the Hill has the votes to pass any bill it pleases with no help whatsoever from the Republican minority. In short, if the Democratic Party actually believes in its declared principles, all its leaders have to do is stick to their guns and they can do what they believe to be best.

Will they? Well, if Rich Lowry is to be believed, maybe not:

That's the prediction of a source in the Senate. He thinks Reid will certainly vote for cloture, but that the bill will be so unpopular—and his own standing in Nevada so precarious—that he'll vote against it on final passage, especially if—as seems likely—the sweetheart deal for Nevada on Medicaid is eventually stripped out.

If—and it seems implausible, but if—one of the two primary legislative leaders of the Democratic Party is in fact prepared to bail on the most important element of his party's political agenda in a bid to save his own skin, then combined with the Senate Finance Committee's decision to euthanize the "public option," one would have to conclude that we're seeing a major failure of nerve. Barack Obama may well need to pull a mighty big rabbit out of his hat if he wants to win this one—and given that he hasn't managed that yet, and seems to have no real idea how he might, I don't know where he's going to find one.

Reflections on Obamacare as potential law

The great misnomer in the health care “reform” debate comes in references to “the health care bill” or “the health care plan.” There is no one health care bill, and no one health care plan. There are various versions of legislation, and much yet to be decided, and probably whole sections that haven't been written. There is in no reasonable sense one coherent piece of legislation.

More importantly, though, even when there is, and even if it passes, we still won’t be that much clearer on what the law is. Randall Hoven explains:

Let's just say that you use HR 3200 as a surrogate for Obama’s plan. It definitely has words—1,017 pages worth. Here is what Congressman John Conyers said about it.

What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?

To appreciate this statement, you should know that Conyers has been in Congress since 1965; only John Dingell, the bill’s sponsor, has served longer in the House. You should also know that Conyers has a law degree. And now he is chairman of the House Judiciary Committee.

If a legislator of 44 years, himself a lawyer and in fact chair of the judiciary committee, along with two other lawyers cannot figure out what this bill means, what hope do you, or I, or any "neutral" fact checker have of figuring it out?

William Jacobson, a professor of law at Cornell Law School, chronicled his efforts to understand this “dense House bill” in the American Thinker. He used a “dartboard” method to randomly select pages to analyze, stopping after seven such pages. “I will try to explain what the section and provisions on the page mean. There is no guarantee that I will be able to do so, as some of these provisions may be incomprehensible.”

“Incomprehensible” to a law professor. Also incomprehensible to an experienced legislator and lawyer working with other lawyers. Yet we are supposed to believe, say, the Huffington Post, when it interprets Obama’s health care plan for us?

This is not just a health care issue; it is an issue with all modern legislation. That is, the legislation passed by Congress and signed by a President become ink blots for those left to interpret it in the future. The money to fund the legislation is quite real, but the meaning of the legislation is more like quantum mechanics: there is no “there”, just probability distributions.

In other words, whatever plan passes (if a plan passes at all) won’t be “law” in the sense that we usually think of; it will, rather, be only an approximation. The way things work these days, we might think we know what the law means, but we really don’t until the courts are done making up their collective mind how they want to rewrite—err, I mean interpret—it.

This isn’t the only issue that arises, either, when we stop to consider Obamacare not as a political issue but as a potential addition to the law code. There is in fact a more significant one: is it even constitutional? Retired attorney and constitutional law instructor Michael Connelly, having read all of HR 3200, doesn’t think so:

This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures. You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.

If you decide not to have healthcare insurance or if you have private insurance that is not deemed “acceptable” to the “Health Choices Administrator” appointed by Obama there will be a tax imposed on you. It is called a “tax” instead of a fine because of the intent to avoid application of the due process clause of the 5th Amendment. However, that doesn’t work because since there is nothing in the law that allows you to contest or appeal the imposition of the tax, it is definitely depriving someone of property without the “due process of law.”

So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though. The 9th Amendment provides: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” The 10th Amendment states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people.” Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to control.

Much has been made, and quite properly, of the fact that the President wants to transfer 1/7 of the American economy to government control; but if Hoven and Connelly are right, that’s only the lesser danger. The greater danger is the corrupting effect HR3200 (or more likely, its descendant) would have on our laws and our political process. It’s a funny thing, when a Republican was in the White House, the Democrats raged against the “imperial Presidency”; but when it’s one of their own, they’re happy to go along with an absolutely unprecedented power grab by the Executive Branch. They must not figure they’re ever going to lose another election.