Anyone who thinks that Obamacare was about heath care, let alone health insurance, reform, is either, at best, naive, or, at worst, completely ignorant of the law – and how it was passed, and the consequences of its various statutes, regulations, rulings, and case law.

Obamacare was about social engineering – much the same way that Common Core is about federal control of school curriculum, to advance certain, shall we say, dogmas that most of us would find puzzling, if not outright outrageous.

But I digress. I’ve often told those that will listen that I could have written a health insurance reform proposal that would have numbered a few hundred pages and would have been much, much more successful than the Affordable Care Act, assuming that its goal was the elimination of the chronically un-insured in these United States, probably around twenty million or so (it wasn’t, re-read paragraph two). And, it certainly would not have cost upwards of $2T plus that we see now (and that figure will continue to rise, even as deductibles rise, and out-of-pocket expenses rise, and so on). And I would agree that reform was needed, just not what we got.

James C. Capretta is one of a handful of experts who I respect wholeheartedly with regards health care reform policy. In this article he lays out the compelling reason why we need, not just to repeal, but replace Obamacare: because reform is just as needed now, as it was in 2009.

Here is the most interesting conclusion that Mr. Capretta advances: “The hard work of developing a credible alternative plan has already been mostly completed. What is needed now is a spirit of practical compromise among key Republican policymakers. It will not be possible to beat an incumbent program — the ACA — with abstractions, good intentions, and idealistic concepts. What’s needed is a workable, politically viable plan, one that voters can see for themselves would work better than the ACA.” 

As the article points out, the hard work for a viable replacement for the ACA has already been done. It will take Republicans to advocate for it in a forceful way. And, if SCOTUS disallows the payment of premium credits in the federal exchanges, as detailed in King v. Burwell, then Republicans won’t need to wait for control of the White House to replace Obamacare.

OK, there – I said it. It will be an unmitigated disaster. The relationship between The State and The Citizen has now been forever altered. I’m of course speaking of Obamacare, a.k.a. The Affordable Care Act. But, from now on, we’ll just call it Obamacare for short. Has such a great ring – after all, hasn’t The Prez himself now embraced it?

It will not be our place, going forward, to rail against the excesses of the great unwashed masses who really did vote for “stuff”, including “free” health care, such that it is. Rather, it will be our  pleasure to point out all of the unintended (really – unintended? but I jest) consequences of the greatest piece of social engineering that has ever hit a nation, short of the Russian Revolution. Stay tuned, as this is going to get really entertaining – or, perhaps not, depending on your viewpoint (you small business owners, who have just been reclassified as a “large business” – you know what I’m talking about).

Obviously, I’m no fan of this legislation (thankfully, having an opinion isn’t a hangin’ offense – yet). Obamacare is, of course, the opening gambit in the final throes of a complete government takeover of the health care sector – whether five years or twenty years from now. In spite of the near-complete abdication by the media of their responsibility to report what is factual and accurate about Obamacare, some truths have filtered out. So, one of our responsibilities will be to elaborate on these “truths”, in spite of the near-total blackout you’ll get from most in the media, so that you, my dear readers, can begin to understand the enormity of what one-party rule and flagrant “gifting” to minority coalitions can create. Havoc, in other words.

(My sympathies in advance of those who will look back fondly on these pre-Obamacare days of full-time employment – meaning, forty hours a week, that is. Working two part-time jobs is really going to be stimulating!)

Beyond that, there will be numerous changes (hell, I might as well say it – changes in the thousands!) to health insurance, health insurance regulation, health insurance markets, health insurance policies, health insurance coverage, health insurance taxes – you get the idea – over the coming five years, as we rush headlong into the full implementation of Obamacare, which doesn’t fully  land on everyones doorstep until 2018. We will be here, barring some unforeseen event, giving you all of the gruesome details, so that you can watch the unfolding train-wreck with us. Get the popcorn. Lock the door.

By the way, as of this writing, SCOTUS has decided that the Liberty University lawsuit, essentially about religious liberty and the new contraceptive mandates, should be heard, and apparently will be tracked to eventually wind up with the Justices. This may or may not be a side-show: it may give the Court a second bite of the apple when it comes to the constitutionality  of Obamacare. Yawn. I don’t think this is going to change much – I mean, what are we now 0 for 3? – not counting an election. I feel somewhat better about the Courts’ recent decision (9-0) regarding religious liberty, but beyond that, I don’t see this impacting the roll-out of Obamacare except in certain narrow ways – and this Administration will just do what it wants anyway. And besides – who ever said that Obama wants religious groups, such as the Catholic Church, delivering health care anyway? Better to turn it over to non-profit and completely controllable Accountable Care Organizations. They’re easier to unionize, anyway.

Next week I’ll talk about the new federal health plan option for states that have decided to back-hand the feds and refuse to start their own exchanges. Yes, we finally now have a “public option”. Stay tuned…

Well, I can’t pick horses, either.

With the stunning decision by the Supreme Court of the United States this morning, Chief Justice John Roberts reminded me of the history surrounding another Chief Justice, Earl Warren, appointed by President Dwight D. Eisenhower. Eisenhower, when asked, made the point that many may make about Roberts in the not-too-distant future – that it was, after all, a bad decision to elevate this juror to the Supreme Court, given his now-apparent political unreliability and left-leaning nature. Roberts has now proven, in at least two decisions this year, to be at least as politically unreliable as Justice Warren, and has firmly relabeled the Supreme Court as “the Roberts Court” rather than “the Kennedy Court”, since Justice Kennedy sided with the minority, all conservative, in the dissent to the bizarre and unsupported decision concerning the Affordable Care Act. Chief Justice Roberts, flatly, sided with the liberals on the Court in upholding the constitutionality of The Affordable Care Act.

It’s not as if the Court hasn’t previously made law out of whole cloth: but what’s interesting about this decision is that Mr. Roberts has essentially told the Obama Administration, and the country, that, while the individual mandate exceeds the Commerce Clause authority, the mandate can and will be considered a tax, something that the Administration itself argued wasn’t the case, until it had to be argued, and then promptly reversed itself, again, during oral arguments before the Justices. Chief Justice Roberts in essence said, yes, I think this is a tax, notwithstanding the Solicitor Generals’ previous denial, and as such you can proceed. He did what all Constitutionalists fear: he warped reality and invented law, conveniently, to advance an ideological position, from the bench.

The Affordable Care Act now becomes the biggest issue of this Presidential election, or perhaps any election since 1936. While Republicans have always espoused “repeal and replace” as the ultimate solution, in light of the devastation wrought by this decision, Republicans will be galvanized (or should be!) like never before to do just that, as, given the breathtaking depth and breadth of the societal changes wrought by Obamacare, they face the prospect of permanent isolation in the wilderness of politics, or, alternatively, complete disintegration as a political organization, if Mr. Obama is handed another four years to build a permanent majority of government-dependent voters who will fully embrace a government-dominated socialist society that promises them everything at the expense of the producers who, flatly, create the bounty we now enjoy. With this election, and this enormous landmark legislation now seemingly upheld, voters will be handed a stark contrast, one that favors liberty and individual freedom and one that favors “equality” and government intrusion. It is not inconceivable that, if Mr. Obama is re-elected, a permanent Democratic majority will come into power for decades, based only on the power of a newly created “dependency class” to continue voting to receive government largesse. And the bottom line is that, if you want to see the outcome of such a majority, take a good look at Europe today.

“That sound you hear is the marching of libertarians into Camp Romney, with noses held, knowing that the libertarian and conservative coalitions must unite to defeat Obama and Obamacare.” – Eric Erickson, Redstate.com

Media reports suggest that today (or, at, least, this week) the Supreme Court will hand down its decision on The Affordable Care Act. To briefly recap, dozens of states sued the federal government to overturn the act; the reasons for that suit are varied, such as the individual mandate, but include such issues as Medicaid funding requirements, which is a huge unfunded liability for states.

I’ve resisted the urge to handicap the forthcoming possibilities, but I do have an opinion. Right or wrong, I’m going to publish it today; one way or the other, the debates between Mr. Obama and Mr. Romney about health care in the upcoming general election will be fascinating to discuss in light of what the SCOTUS decides.

There are four possible outcomes: to do nothing and leave the entire Act standing; to narrowly strike down just the mandate provisions; to strike down the mandate and two other major provisions (which is the position that the Obama Administration said should happen if the Supremes conclude that the individual mandate is unconstitutional), and the fourth: declaring the entire Affordable Care Act unconstitutional.

I have no idea what the “Vegas line” is on this decision, so, I will take my shot-in-the-dark and lay odds:

Do nothing: 12 to 1. Not likely.

Strike down just the individual mandate: 6 to 1. Too narrow, and creates a bigger problem.

Strike down the mandate and the provisions relating to it (the position argued by the Administration if the mandate is unconstitutional): 4 to 1. The Administration wins, and the remaining Act becomes a rallying cry for progressives who always wanted the single-payor option (and this decision almost guarantees it).

Strike down the entire Act: 3 to 1. The most sensible solution of all.

My reasons for giving the best odds for striking the entire Act lay in the unprecedented suit brought by a coalition (frankly, a majority) of states against the federal government. I’m unaware of any action brought against the government by so many states, and this alone should prompt an unprecedented examination of the role of the federal governments’ power to pass legislation that intrudes on the right of the states to govern themselves. It also bears pointing out that the federal government is, technically,  a government of limited powers (the term “states rights” is not a pejorative for discrimination, despite what liberals have always said) with the remaining powers reserved exclusively to the states. With the individual mandate exceeding any rational understanding of the purpose and use, even in liberal hands, of the Commerce Clause, the demand by the states to be relieved of a burden they clearly feel is unconstitutional has to be carefully considered. The strange manner in which the Act was passed, the lack of ANY bipartisanship (or, of that matter, any input from anyone except the Progressive Caucus in the bills ultimate form) the distorted cost projections, not to mention the majority view of the Act across the nation by voters – all of these things must be taken into account by the Justices. Never mind that they are legal scholars who pass judgment on constitutional issues at the highest level; there is and always will be a political element to every controversial Supreme Court decision. Couple this with the lack of a severability clause, and my opinion is that the Supremes err, not on the side of caution, but on the side of good sense: telling Congress that this legislation is so flawed and so intrusive that it would be best to just start over.

And that is what I think the Supremes will do. If they don’t, they will be performing a major disservice to the country, by leaving in place a huge entitlement program that completely remakes the social contract between the government and its citizens (or should they now be called subjects?) without any rational means to pay for it (assuming that the Commerce Clause doesn’t allow the government to tell you what you must buy), while dooming a portion of the insurance industry to almost-certain extinction or, worse, outright nationalization or regulation as a monopolistic utility, with the government calling ALL the shots, while re-distributing massive tax increases to pay for it.

Whatever they decide – it’s going to be interesting. And don’t forget that, in the absence of any new federal legislation, states, including Colorado, will be in a position to craft their own solutions, which is how it should be in the first place. The fact is that Colorado state Republicans control the House by a slim one vote margin – and history shows that in the early 90’s, Colorado’s Governor Roy Romer (D) threatened to pass a single payor system unless “health reform” was enacted, which set us upon the very path we now walk.

Let the games begin! Quoting Rep. Michele Bachmann: ““The decision on Obamacare goes well beyond health care,” she wrote. It “will determine whether or not the court believes the government has a right to mandate that Americans buy a product or service, a direct impact on our freedom and liberty.”

Today, as the Supreme Court continues to hear arguments, and asks pointed questions about the legality of Obamacare, it is interesting to note a salient fact that the left conveniently ignores, and in fact pivots away from, and much of the right, unfortunately, doesn’t seem to want to address, probably for political reasons: federal government spending on health care is the prime reason we have a health care crisis in this country.

And on this point, heads will explode: Medicare is a program that is best left to the private market to deliver. And Medicaid is intended for the financially indigent, and should be strengthened, not by forcing billions in expanded “unfunded mandates” down the states’ throats, which is, in my opinion, one of the main driving forces behind the lawsuit brought by 26 states against the federal government over Obamacare. It should be strengthened via block grants from the federal government to the states, so that states may craft their own solutions for the truly poor and financially indigent, rather than the micro-managed and politically inflamed rules from Washington. Note the use of the term “truly poor”. And it should not be a vehicle for the feds to use to jam millions of otherwise insured folks into Medicaid, rather than stay with private insurance, precisely what Obamacare will do. Welcome to the new “dependency class”.

I’ve always been struck by the Democrat’s premise that Medicare is cast in stone and real change is inconceivable. It’s a testament to their allies in the media just how brilliantly they’ve managed to frame the debate strictly within the narrow confines of the status quo, secretly knowing that the status quo is a) in large part responsible for the undoing of the health insurance market (what little of it truly exists, anyway) and b) absolutely essential to restrain, restrict and ultimately collapse any solid attempt at true Medicare reform, which must include the federal government’s dissolution of Medicare as it now stands.

Now, the Obamacare premise goes like this: “that 40 million Americans are distorting the health-care market by shifting costs of free emergency-room care to taxpayers and insurance rate-payers”, as stated in todays’ Wall Street Journal, “Health Law Faces Constitutional Test”.

(An aside: the real fallacy of this idea is this: it doesn’t cost anywhere near $1T, assuming you accept the original CBO-scoring of the costs of Obamacare [which I don’t, and no thinking person not under the influence of a lobbyist should] to provide health care, even at the inflated costs one typically finds in a hospital ER, to the uninsured in America, even if you want to accept the 40 million figure, which any number of studies have pointedly derided as wrong, and artificially inflated.)

Let me chart the path of the reasoning: the federal government is blaming people without health insurance for the catastrophic rise in the cost of health insurance premiums, and advances the notion that the “market” is ‘broken” and they must ride to the rescue.

Except that the market is “broken” because of a lack of market-friendly ideas and execution, including costly mandates, lack of tort reform, and – wait for it, here comes the gorilla – cost-shifting and price fixing by the federal government in Medicare reimbursement and, to a lesser extent, the unfunded mandates driven by Medicaid onto state budgets. The people-in-charge, the one’s riding to the rescue, and in fact the reason we have a problem in the first place.

The arguments in the Supreme Court over Obamacare are admittedly not on this little-known fact, and they shouldn’t be – the constitutional challenge to the law will suffice, for now, and Medicare’s role in our health care system isn’t a legal issue, per se, but rather a political one. But the premise behind Obamacare should be open to vigorous, even rancorous, debate, even if that debate is revolutionary: Medicare is ill-served in the federal government’s hands, and should be abolished and returned to the private market, albeit with adequate safeguards and regulatory framework to allow it to work as a free-market vehicle which delivers health care to the elderly without rationing or capitation. Assuming, as I do, that the nation’s seniors need, even require, a strong health care delivery system, Obamacare, with it’s IPAB function serving as a rationing board over a capitated health care delivery system, is not the answer, even if it’s deemed constitutional. It’s intent, really, is  to accelerate the drive to a single, Medicare-style system for all – the dreaded government option – only it won’t be an option, it will be all you have.

Obamacare is a dismal failure, not only because of its inherent unconstitutionality, as anyone who understands the limited power of  the federal government must see, but because it’s a canard to believe that the feds are acting in good faith to “fix” what they have broken: a free-market derived health care delivery system that rewards efficiency, is innovative, and more importantly doesn’t come between a doctor and his patient. Broadly, Medicare pays only about 85% of the cost of delivery of health care and, given that the feds buy almost half of all health care delivered in the U.S. yearly, this is a huge cost-shift to the private sector, a form of taxation which goes unanswered and ignored by those on the left, and makes the health care costs associated with the uninsured pale in comparison.

Of course, as everyone knows, whenever Medicare is discussed in the public realm, Democrats portray Republicans as “pushing Granny off the cliff”, while secretly watching their own minions do exactly that – while Republicans, powerless to stop them, get the blame. After all, it was Democrats who crafted the $500 million Medicare cut that brought the costs of Obamacare “below” $1T. Only it didn’t.

No discussion of how to fix the health care system in this country can exclude the federal government’s price-fixing in health care pricing, or the effect of this cost-shift, labeled as the “hydraulics of health care”, on the private sector. To do otherwise is equivalent to re-arranging the deck chairs on the Titanic. And Obamacare certainly isn’t the vehicle to do that, as it completes the disaster Democrats have been secretly hoping for. The Supreme Court challenge to Obamacare, while absolutely necessary, is a sideshow to what the real problem is. And continued chaos favors the Democrats anyway: all the more reason why Republicans need control of the House, the Senate AND the White House.

Lastly, Paul Ryans’ proposals on Medicare are interesting and informative, but I d0n’t think they go far enough – either in terms of building a true market-based health care system, or in terms of the impact on our looming Greek-style default over unfunded liabilities. More on this later.