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Show Me ObamaCare - Despite a voter rebuke, how an obscure mandate will reshape health care.
The political revolt against ObamaCare came to Missouri Tuesday, with
voters casting ballots three to one against the plan in its first direct
referendum. This is another resounding health-care rebuke to the White
House and Democrats, not that overwhelming public opposition to this
expansion of government power ever deterred them before.
Senior Editorial Writer Joseph Rago reports on the Missouri results.
Missouri's Proposition C annulled the "individual mandate" within state
lines, or the requirement that everyone buy insurance or else pay a tax.
Liberals are trying to wave off this embarrassment, but that is hard to
do when the split was 71.1% in favor in a state John McCain won by a
mere 0.1% margin. The anti-ObamaCare measure carried every county save
St. Louis and Kansas City with 668,000 votes, yet just 578,000
Republicans cast a ballot in the concurrent primaries.
If the practical effects of this conflict between state and federal law
are likely to be limited, more importantly, Missouri's vote revealed
once again that the country is still aghast over President Obama's
health-care presumption. Earlier this week, the Congressional Research
Service reported that the new bureaucracy the bill created is so complex
and indiscriminate that its size is "currently unknowable." Capitol
Hill's independent policy arm added that among "the dozens of new
governmental organizations or advisory bodies," it is "impossible to
know how much influence they will ultimately have."
No wonder Missourians rebelled, as with voters in Massachusetts, New
Jersey and Virginia last year. There will be more such
what-have-they-done ObamaCare moments. Wait until the public discovers
the government is now literally determining what qualifies as "health
care" in America.
That isn't a typo. ObamaCare mandates that insurers spend a certain
percentage of premium dollars on benefits, but Democrats never got
around to writing the fine print of what counts as a benefit. So a
handful of regulators are now choosing among the tens of thousands of
services that doctors, hospitals and insurers offer. Few other
government decisions will do more to shape tomorrow's health market, or
what's left of it.
This command-and-control mechanism is the bill's mandate for insurance
"medical loss ratios" (MLR) of 85% for large employers and 80% for small
businesses and individuals. The MLR is an accounting statistic that
measures the share of premiums paid out in patient claims ("losses"). In
the individual market, MLRs typically run between 65% and 75%, and
Democrats like Jay Rockefeller and Al Franken think this is evidence of
excessive profits, executive pay, marketing and other supposedly
The same mentality prevails in the Administration, so it may well adopt
a narrow definition of medical expenses when it issues final regulations
by early fall. The insurance industry is lobbying for a less rigid
standard: It will be easier to run a business and turn a profit if more
of the costs are considered truly medical in nature.
More notable is that people partial to ObamaCare but largely outside of
politics are coming to understand the mess Congress has created. To wit,
much of health care's intellectual energy is moving toward a concept
called the "accountable care organization," which would replace today's
fragmented delivery system of mostly solo practitioners with teams of
doctors and hospitals working together. These integrated groups would
manage and coordinate care, use more information technology and try to
improve treatment quality for chronic disease and complex conditions.
Yet "it isn't easy to draw a bright line, or even a fuzzy line, between
traditional health services and some of the more innovative coordinated
models," says Mark McClellan of the Brookings Institution and a leading
accountable care proponent. The new model would rely on many tools that
aren't strictly medical, like, say, a checkup or a CT scan.
For example, how to classify a program to double-check doctors orders to
avoid one of the unnecessary surgeries that kill some 12,000 people
every year? Or counseling, calls, emails and other types of case
management to make sure patients comply with their diabetes regimen? Or
investments in electronic medical records? Obviously these programs
aren't the same as an O.R. visit, but they still cost money, often a lot
of it, and many insurance programs pay or are starting to pay for them.
The possibility that these will be written out of the MLR definition is
feeding a growing unease about politics shaping medicine more than it
already does. The California Association of Physician Groups, the
largest U.S. accountable care trade group, recently protested that a
narrow MLR ruling "would create a disincentive for plans to contract
with our members and undercut the coordinated care model."
Health Integrated, a respected medical consulting firm, urged regulators
"to avoid discouraging or inadvertently extinguishing the successful
innovation that (so frequently) arises only from a plan's ability to try
new ideas." Even North Dakota's Democratic Rep. Earl Pomeroy, who voted
for the bill, argues that tight MLR regulation "could have a chilling
effect on future innovative programs."
"The real question is the overall philosophical thrust, which will
determine the long-term direction of health care," Mr. McClellan says of
the coming definition. The regulatory debate is dominated by Senator
Rockefeller and others on the left who are still angry they never got a
public option and are trying to use MLR as a proxy for controlling the
insurance industry. The irony is that the new health models they claim
to favor may be collateral damage, even as insurers take the fall for
the problems Congress created.
Another danger concerns the individual market, where a wave of
destruction could be imminent. If the MLR definition is so arbitrary
that health plans can't cover their claims and expenses, they'll simply
withdraw that book of business. Mila Kofman, Maine's insurance
superintendent and an ObamaCare supporter, warned that "the federal
standard may disrupt our individual health insurance market" and is
seeking an exemption. Her protest is all the more notable given that
Maine's health regulations closely resemble those that are about to be
Ms. Kofman and others are right to worry. In the 1990s, an MLR crackdown
in Washington state caused the individual market to collapse in 36 of 39
counties. Too bad for the people with coverage today who were promised
they could keep it if they liked it.
This fight over medical loss ratios is an early taste of how a
"government takeover" operates in practice. The state insurance
commissioners advising the federal government—and who know something
about the business—have already missed several deadlines because writing
a uniform definition of medicine is "time consuming," while a wrong move
would "destabilize the marketplace and significantly limit consumer
We predicted that under ObamaCare politicians and technocrats would
dominate medicine, and here they come. Without more Missouri-style
revolts—or perhaps in spite of them—the rest of us will soon learn how
competent they really are.
Obama's black racist USAG appointee.
Eric Holder, racist black United States Attorney General drops voter
intimidation charges against the Black Panthers, "You are about to be
ruled by the black man, cracker!"
Eric Holder, prejudiced black United States Attorney General settles the
hate crime debate, "Whites Not Protected by Hate Crime Laws."
Felony President. 18 USC, Sec. 600. Promise of employment or other
benefit for political activity
Obama violated the law by trying to buy Joe Sestak off with a political
appointment in exchange for not pursuing an election bid to replace
Arlen Specter. Obama violated the law by trying to buy former Colorado
House Speaker Andrew Romanoff off last fall to see if he'd be interested
in an administration job -- instead of running against Sen. Michael
Nancy Pelosi, Democrat criminal, accessory before and after the fact, to
House Ways and Means Committee Chairman Charles B. Rangel of New York's
million dollar tax evasion. On February 25, 2010, the House ethics
committee has concluded that Ways and Means Committee Chairman Charles
B. Rangel knowingly accepted Caribbean trips in violation of House rules
that forbid hidden financing by corporations. Democrat criminal Nancy
Pelosi is deliberately ignoring the million dollar tax evasion of
Democrat Charles Rangel.
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Last edited by stevenricherd : April 13th 11 at 08:28 AM.
We can sport Obama, Obama has good action to take it. May be some department’s effected from it. But I thing, that's good for all...
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Last edited by nila11 : April 22nd 13 at 09:07 AM.
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