The first major conference on health policy I ever attended, organized by The National Journal in Washington sometime in the late 1970s, focused on the rising cost of health care, which then absorbed close to 8 percent of gross domestic product and was threatening the unimaginable: to claim 10 percent or more of G.D.P.

Governors, senators, members of Congress, business executives, the heads of trade associations and leaders of unions representing health care workers made presentations, and all of them agreed that the growth of health care spending had to be curbed -”“ by what now is called “bending the cost curve….”

Over the decades, the mission has been a failure, naturally….

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“Well I’d love to take you back,” …[my Mom] said. “I’m really trying to figure out what this whole overhaul is going to mean. There have been so many rules, at least with my insurance.”

I told my mom I’d take care of sorting out the rules. I called the benefits office of the University of Southern Maine where my mom works and found out that I can re-enroll in her plan in November and be covered by January. Yeah, it’s not Sept. 23 ”” the date the provision “officially” takes effect. I’m just glad my parents have a plan that qualifies.

Right now, I am completely financially independent of them, something I’ve been working for since graduating from college. It is a strange and kind of demeaning concept to revisit a dependent type of relationship with them. I asked my mom recently if she thought this was awkward, too.

“It is what it is,” she told me. “It’s a stopgap measure. And you will be only covered for a couple of years until you turn 26. My hope would be that you would get a job that pays benefits. As far as it costing extra money for us, it didn’t make a huge difference. It wasn’t a whole lot more because I think in general people your age are healthy. And so it would be peace of mind to me to know that you have health care coverage.”

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Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats’ efforts to trumpet their signature achievement before the midterm elections.

Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.

These and other insurers say Congress’s landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.

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Every day, an average of 112 people — most of them the newly poor — sign up for free government health care in South Carolina.

Since the recession officially hit in December 2007, some 3,300 people a month, on average, have signed up for Medicaid in a state that outpaces the nation for poverty, obesity and diseases such as diabetes. Yet, South Carolina’s political leaders have been among the most vocal in the country in opposition of the new health care law….

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To make matters worse, leaders in Congress also slipped in a new reporting requirement to help pay for this health care law that will require all businesses to now file tax Form 1099 on every business-to-business transition of $600 or more, including buying normal supplies.

This has nothing to do with health care and everything to do with taxing small businesses and increasing their paperwork burden.

I hardly call this a reform that any small-business advocate should support.

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UnitedHealth Group Inc. and insurers in Florida and Oklahoma stopped offering children-only health coverage because of the potential added costs of sick youngsters under the new U.S. health-care law, state officials said.

UnitedHealth won’t sell new policies that cover only children, foreclosing an option used by parents seeing cheaper care, Kevin McCarty, Florida’s insurance commissioner, said today at a meeting of the National Association of Insurance Commissioners in Washington, D.C. Tyler Mason, a UnitedHealth spokesman, disputed McCarty’s statement in a telephone interview, saying the company is still issuing such coverage.

The law championed by President Barack Obama bans insurers from denying coverage to children based on their health. That makes it more difficult for health plans to predict costs because families can wait until a child is sick to buy coverage, according to Kim Holland, Oklahoma’s commissioner. She and Sandy Praeger, Kansas’ commissioner, said insurers in their states have dropped child-only plans as well, or discussed the idea.

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The lowest bracket for the personal income tax, for instance, moves up 50% ”” to 15% from 10%. The next lowest bracket ”” 25% ”” will rise to 28%, and the old 28% bracket will be 31%. At the higher end, the 33% bracket is pushed to 36% and the 35% bracket becomes 39.6%.

But the damage doesn’t stop there.

The marriage penalty also makes a comeback, and the capital gains tax will jump 33% ”” to 20% from 15%. The tax on dividends will go all the way from 15% to 39.6% ”” a 164% increase….
The HSA Withdrawal Tax Hike. “This provision of ObamaCare,” according to ATR, “increases the additional tax on nonmedical early withdrawals from an HSA from 10% to 20%, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10%.”

Brand Name Drug Tax. Makers and importers of brand-name drugs will be liable for a tax of $2.5 billion in 2011. The tax goes to $3 billion a year from 2012 to 2016, then $3.5 billion in 2017 and $4.2 billion in 2018. Beginning in 2019 it falls to $2.8 billion and stays there. And who pays the new drug tax? Patients, in the form of higher prices.

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With so much water already under the bridge, it seems a risky move to wade into the debate between Commonweal (and its apparent legal advisor, Professor Timothy Jost) and the U.S. Conference of Catholic Bishops (USCCB) at this stage of the debate over the contents of the health care reform law (the Patient Protection and Affordable Care Act or PPACA). On the other hand, it might be the perfect time to step back and survey the prolific exchange. Commonweal’s editors just don’t seem to trust the USCCB’s legal or policy analyses of the PPACA insofar as freedom of conscience or abortion are concerned.

Conversely, Commonweal has extended every benefit of the doubt to the opinions of one professor, Timothy Jost, who not only has no record of cooperation with Catholic moral and policy interests along the consistent ethic of life, but seems to regard Catholic contributions to moral reasoning about law with animosity, comparing Catholic influence to the establishment of an Iranian theocracy. Furthermore, Jost seems to be a strident partisan across the board, a condition best (and hilariously) exemplified in his May 17 editorial for Politico, wherein Jost wrote how “unimaginable” it would be for American voters to want Republicans back in government when, under the Democrats, the “economy has come roaring back.”

Meanwhile, The USCCB’s uniquely nonpartisan voice””even in the midst of some of the nastiest inter-party exchanges in recent history””successfully held together advocacy against killing the unborn with advocacy for expanding health care insurance to all Americans. Yet Commonweal, it seems, would not be satisfied with anything less than a full-throated blessing of whatever the House majority decided to offer pro-life Americans while in the throes of desperate, last-minute negotiations.

Read it all (and follow the links if you haven’t followed the debate).

As some provisions of this year’s federal health care overhaul go into effect, Fairfax County is planning for how it will handle the changes.

Industry experts have said the cost of health insurance plans such as the one Fairfax County offers to its employees could increase by 4 percent or more in 2011, said Susan Woodruff, the county’s Human Resources director.

“That’s a cost that we, the employer, and the employees will have to find a way to share,” Woodruff said.

Given the county now budgets more than $68 million per year for its employee insurance needs, even a slight increase could add millions to the total.

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Membership in two of the largest Christian “health-sharing” ministries has grown since President Obama signed the massive health care reform bill into law earlier this spring.

Christian Healthcare Ministries and Samaritan Ministries, with a combined membership of more than 70,000 people, have both grown in enrollment, officials said.

“The health care reform bill removes the option of having (no insurance),” said the Rev. Howard Russell, executive director of Christian Healthcare. “The second thing is that the pricing to be part of out ministry is much lower than traditional insurance,” Russell said.

Read the whole article.

As cash runs low in government coffers around the country, politicians are ratcheting up the intensity of their search for revenue and new areas to regulate. Small businesses are in their cross-hairs in a mammoth, nationwide shakedown. They are the nation’s critical engine for growth, innovation and job creation, yet they are being starved for credit and slammed with more taxes, government directives and litigation exposure. This spells weaker profits and fewer jobs, risking a fundamental deterioration in America’s private sector.

The federal government’s response to the crisis is to build up Washington’s small-business dependency apparatus. Of the $3.6 trillion in federal spending planned in 2010 (overruns likely), many crumbs will find their way to small businesses through government loan programs and complicated tax credits. Politicians are addicted to spending and can trumpet their ability to bring home the pork while ignoring the devastating net outflow from small businesses to Washington.

Washington’s expansion does nothing to create a robust small-business environment. Businesses with fewer than 250 employees provided most of the net job growth in the 2002–07 expansion yet are still in the starting blocks in the current recovery. The 2,300-page health care bill will take months and years to decode and will weigh heavily on small-business decisions. New regulations are mushrooming from the constant string of thick “stimulus” bills, the coming law on new financial regulations and the sure-to-be-bad tax bill toward year’s end.

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(Please note that the title above is from the print edition–KSH)

But while the research compiled in the Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care, the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula.

For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones, and Dartmouth’s maps would not pick up that difference. As any shopper knows, cheaper does not always mean better.

Even Dartmouth’s claims about which hospitals and regions are cheapest may be suspect. The principal argument behind Dartmouth’s research is that doctors in the Upper Midwest offer consistently better and cheaper care than their counterparts in the South and in big cities, and if Southern and urban doctors would be less greedy and act more like ones in Minnesota, the country would be both healthier and wealthier.

Read it all from Thursday’s New York Times.

On May 20, 2010, the Secretariat of Pro-Life Activities of the United States Conference of Catholic Bishops issued a statement supporting H.R. 5111, sponsored by Congressmen Joseph R. Pitts (R-Pa.) and Dan Lipinski (D-Ill.). H.R. 5111 is prolife legislation intended to protect the unborn and the consciences of health-care providers, and it is not surprising that the USCCB should support this bill. Unfortunately, the USCCB used this occasion to attack once again the major health-care legislation that was signed into law in March, the Patient Protection and Affordable Care Act (PPACA). The USCCB continues to misunderstand the provisions of PPACA and contributes to confusion about its content. This analysis is intended to correct the USCCB’s erroneous characterizations of PPACA, and to clarify what the legislation actually says and does….

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The new healthcare law will pack 32 million newly insured people into emergency rooms already crammed beyond capacity, according to experts on healthcare facilities.

A chief aim of the new healthcare law was to take the pressure off emergency rooms by mandating that people either have insurance coverage. The idea was that if people have insurance, they will go to a doctor rather than putting off care until they faced an emergency.

People who build hospitals, however, say newly insured people will still go to emergency rooms for primary care because they don’t have a doctor.

“Everybody expected that one of the initial impacts of reform would be less pressure on emergency departments; it’s going to be exactly the opposite over the next four to eight years,” said Rich Dallam, a healthcare partner at the architectural firm NBBJ, which designs healthcare facilities.

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Deep within the massive health-care overhaul legislation, a few little-noticed provisions have quietly reignited one of the bitterest debates in medicine: how to balance the right of doctors, nurses and other workers to refuse to provide services on moral or religious grounds with the right of patients to get care.

Advocates for protecting health workers argue the new law leaves vulnerable those with qualms about abortion, morning-after pills, stem cell research and therapies, assisted suicide and a host of other services. Proponents of patients’ rights, meanwhile, contend that, if anything, the legislation favors those who oppose some end-of-life therapies and the termination of pregnancies and creates new obstacles for dying patients and women seeking abortions.

Both sides acknowledge that the scope of any new conflicts that might arise under the legislation will become clear only as the implications of the overhaul unfold. But both agree that clashes are probably inevitable.

“It’s sort of the son of the ‘death panels,’ ” said Loren Lomasky, a University of Virginia professor of philosophy who studies conflicts of conscience in health care, referring to last summer’s controversy about end-of-life counseling. “This is a major transformation of the health-care system. And when this sort of thing happens, fissures can open up and you can fall into them if you’re not careful.”

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An all-but-overlooked provision of the health reform law is threatening to swamp U.S. businesses with a flood of new tax paperwork.

Section 9006 of the health care bill — just a few lines buried in the 2,409-page document — mandates that beginning in 2012 all companies will have to issue 1099 tax forms not just to contract workers but to any individual or corporation from which they buy more than $600 in goods or services in a tax year.

The stealth change radically alters the nature of 1099s and means businesses will have to issue millions of new tax documents each year.

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Ideally, of course, Congress would have never passed the Medicare prescription drug benefit to begin with, and thus never handed out the initial subsidy. That way this whole kerfuffle could have been avoided entirely. And the broader point I’d draw from all of this isn’t so much that the Affordable Care Act is going to cost big corporations billions””though it certainly is””but that the health care sector is so thoroughly dominated by government regulations and subsidies that exercise far, far too much influence over how decisions about health care and its associated costs get made. So rather than argue over the tax treatment of drug subsidies, we ought to be pushing to get rid of the subsidies entirely.

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Bishop Thomas Tobin of Providence, R.I., demanded that CHA remove St. Joseph Health Services of Rhode Island from its membership rolls, calling its affiliation with CHA “embarrassing.”

In a March 29 letter to CHA President and Chief Executive Officer Sister Carol Keehan, Tobin said CHA had “misled the public and caused serious scandal for many members of the church.”

The CHA supported the health care bill, saying it would not increase public funding of abortion. The U.S. Catholic bishops disagreed, and urged the bill’s defeat. The bill passed on March 21, after President Obama promised to sign an executive order upholding a longstanding ban on federal funding of abortions except in cases of rape, incest, and the poor health of the mother.

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“It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

I must admit I often feel like my colleagues who grouse about spending all day treating patients who do not seem to care about their health and then demand a quick fix. I do not relish paying more taxes to treat patients who engage in unhealthy habits. But then I remind myself that we all engage in socially irresponsible behavior that others pay for. I try to eat right and get enough exercise. But then I also sometimes send text messages when I drive.

The whole point of insurance is to reduce risk. When people inveigh against the lack of personal responsibility in health care, they are really demanding a different model, one based on actual risk, not just on spreading costs evenly through society. Sick people, they are really saying, should pay more. Which model we eventually adopt in this country will say a lot about the kind of society we want to live in.

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It’s been a banner week for Democrats: ObamaCare passed Congress in its final form on Thursday night, and the returns are already rolling in. Yesterday AT&T announced that it will be forced to make a $1 billion writedown due solely to the health bill, in what has become a wave of such corporate losses.

This wholesale destruction of wealth and capital came with more than ample warning. Turning over every couch cushion to make their new entitlement look affordable under Beltway accounting rules, Democrats decided to raise taxes on companies that do the public service of offering prescription drug benefits to their retirees instead of dumping them into Medicare. We and others warned this would lead to AT&T-like results, but like so many other ObamaCare objections Democrats waved them off as self-serving or “political.”

Perhaps that explains why the Administration is now so touchy. Commerce Secretary Gary Locke took to the White House blog to write that while ObamaCare is great for business, “In the last few days, though, we have seen a couple of companies imply that reform will raise costs for them.” In a Thursday interview on CNBC, Mr. Locke said “for them to come out, I think is premature and irresponsible….”

On top of AT&T’s $1 billion, the writedown wave so far includes Deere & Co., $150 million; Caterpillar, $100 million; AK Steel, $31 million; 3M, $90 million; and Valero Energy, up to $20 million. Verizon has also warned its employees about its new higher health-care costs, and there will be many more in the coming days and weeks….

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If you ask doctors what they think the new health law means for them, the responses aren’t too cheery.

An online community for docs called Sermo and Athenahealth, a company that helps doctors’ offices electronically manage payments and records, ran a few questions by docs visiting Sermo’s site starting Wednesday night.

While the survey isn’t a scientific poll, the results are pretty clear. Docs aren’t wild about overhaul.

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When the common good takes a back seat to political and corporate interests, all, especially the vulnerable, are at risk. As the largest provider of non-governmental, non-profit health care in this country, the Catholic Church, and those who work as Catholic agencies and organizations, have a special obligation to vulnerable populations, such as the unborn, those with disabilities, and those at life’s end. These populations cannot be compromised in an effort to secure “the greater good.” This is utilitarianism, seeking the greatest good for the greatest number, and never equates to the common good.

It is undeniable that the enacted Patient Protection and Affordable Care Act includes public funding of programs that provide abortion on demand. No accounting practices, or requiring enrollees or employees to write separate checks for abortion coverage, changes that fact. The plan would mandate that in each regional Exchange only one of the qualifying plans not include abortion. Furthermore, there is no restriction on coverage of assisted suicide costs. President Obama’s executive order cannot override federal law. In fact, his Order merely requires adherence to the Act. Specifically, it states: “This Executive Order is not intended to, and does not, create any right or benefit, substantive or procedural , enforceable at law or in equity against the United States.” While he attempts to assure us that the seven billion new dollars for Community Health Centers will be applied consistent with the Hyde Amendment, the placement of that language within the Act does not make it subject to the cost-sharing provisions for abortion coverage. Most significantly, Beal v. Doe, 432 U.S. 438 (1977) dictates that, without statutory provisions for the Hyde amendment within each enacted law, “essential services” are to include abortion.

Both individuals and employers will be penalized for the absence of health care coverage. There is no evidence of conscience protections for individuals or employers, who may find themselves having to write separate checks for undesired abortion procedures that happen to be in the plan of choice. There is limited evidence of conscience protections for providers, and the legislation does not provide for protection against coercion of health care providers and employers related to contraceptives or abortifacients. Here we see, most significantly, that a house divided eventually will pay the price for taking compromising positions. Yet, unfortunately, in public opposition to the US Conference of Catholic Bishops’ call for rejection of this legislation as it was written, the Catholic Health Association and fifty-five women religious urged its passage.

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Many who call themselves conservatives propose to cast aside even government programs that have stood the test of time. They seem to imagine a world in which government withers away, a phrase that comes from Friedrich Engels, not Buckley. Or they tie themselves up in unruly contradictions, declaring simultaneously that they are dead-set against government-run health care and passionate defenders of Medicare.

And while modern conservatism has usually supported the market against the state, its oldest and most durable brand understood that the market was an imperfect instrument. True conservatives may give “two cheers for capitalism,” as Irving Kristol put it in the title of one of his books, but never three.

Perhaps I have just fallen into the very trap I warned against, seeking a conservatism that corrects, but doesn’t oppose, progressivism.

But to my mind, conservatism has always made its greatest contribution as a corrective force that seeks to preserve the best of what we have. As our long and bitter health care debate winds to a close, might proponents of such a conservatism find an opening? Are they still there?

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Poor Bart Stupak. The man tried to be a hero for the unborn, and then, when all the power of the moment was in his frail human hands, he dropped the baby. He genuflected when he should have dug in his heels and gave it up for a meaningless executive order.

Now, in the wake of his decision to vote for a health-care bill that expands public funding for abortion, he is vilified and will forever be remembered as the guy who Stupaked health-care reform and the pro-life movement….

Stupak, too, knew that the executive order was merely political cover for him and his pro-life colleagues. He knew it because several members of the U.S. Conference of Catholic Bishops explained it to him, according to sources. The only way to prevent public funding for abortion was for his amendment to be added to the Senate bill.

Clearly, House Speaker Nancy Pelosi and the president didn’t want that. What they did want was the abortion funding that the Senate bill allowed.

Thus, the health-care bill passed because of a mutually understood deception — a pretense masquerading as virtue. No wonder Stupak locked his doors and turned off his phones on Sunday, according to several pro-life lobbyists who camped outside his office.

Read it all.

Third, the combination of pressure and disinformation used to break the prolife witness on this bill among Democratic members of Congress ”“ despite the strong resistance to this legislation that continues among American voters ”“ should put an end to any talk by Washington leaders about serving the common good or seeking common ground. Words need actions to give them flesh. At many points over the past seven months, congressional leaders could have resolved the serious moral issues inherent in this legislation. They did not. No shower of reassuring words now can wash away that fact.

Fourth, self-described “Catholic” groups have done a serious disservice to justice, to the Church, and to the ethical needs of the American people by undercutting the leadership and witness of their own bishops. For groups like Catholics United, this is unsurprising. In their effect, if not in formal intent, such groups exist to advance the interests of a particular political spectrum. Nor is it newsworthy from an organization like Network, which ”“ whatever the nature of its good work — has rarely shown much enthusiasm for a definition of “social justice” that includes the rights of the unborn child.

Read it carefully and read it all.

The White House says it isn’t worried that 13 state attorneys general, including South Carolina’s, are suing to overturn the massive health care overhaul, and many legal experts agree the effort is futile.

But the lawsuit, filed in federal court seven minutes after President Barack Obama signed the 10-year, $938 billion health care bill, underscores the divisiveness of the issue and the political rancor that has surrounded it.

Read it all from the front page of the local paper.

Diocese of Connecticut Bishop Suffragan James E. Curry, speaking to ENS from the House of Bishops meeting in Camp Allen, Texas, called the legislation “a wonderful step that continues our national walk toward accessibility.” The Episcopal Church’s longstanding commitment to health care reform is deeply rooted in the Baptismal Covenant, he said.

“For 2,000 years followers of Jesus have been at the forefront of efforts to provide for the health and well being of all people. We do this because the law of love compels us to care for everyone,” Diocese of Maryland Bishop Eugene T. Sutton said in an e-mail to ENS. “While people of good will disagree about some controversial provisions in the new health care legislation, in the main, Christians everywhere should rejoice that our society has taken a major step toward ensuring that all citizens have adequate and equitable access to health care without fear that sickness will result in their financial ruin. For that alone we say, ‘Praise God!'”

Curry and Sutton were among the seven Episcopal bishops who travelled to Washington, D.C. in September 2009 to advocate on Capitol Hill for health care reform.

Members and bishops of the Episcopal Church, the church’s Washington-D.C.-based Office of Government Relations, its Episcopal Public Policy Network and the ecumenical faith community continued to advocate for the health bill and press representatives to pass the bill up to March 21, when the bill passed the House by a vote of 219-212.

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This is helpful material in terms of provisions and dates when they are to become effective.

Nobody knows how this bill will work out. It is an undertaking exponentially more complex than the Iraq war, for example. But to me, it feels like the end of something, not the beginning of something. It feels like the noble completion of the great liberal project to build a comprehensive welfare system.

The task ahead is to save this country from stagnation and fiscal ruin. We know what it will take. We will have to raise a consumption tax. We will have to preserve benefits for the poor and cut them for the middle and upper classes. We will have to invest more in innovation and human capital.

The Democratic Party, as it revealed of itself over the past year, does not seem to be up to that coming challenge (neither is the Republican Party). This country is in the position of a free-spending family careening toward bankruptcy that at the last moment announced that it was giving a gigantic new gift to charity. You admire the act of generosity, but you wish they had sold a few of the Mercedes to pay for it.

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5. Four million people will lose their employer-based plans.

The new health care law will impose a list of benefits each health care plan will have to offer if they are to remain in business. The Congressional Budget Office also estimates that about 4 million people would lose their employer-based plan and be forced to buy plans on the new government exchanges.

6. Medicare will cut services along with costs.

The bill makes $528 billion in cuts to Medicare, including a $136 billion reduction for Medicare Advantage. The Medicare Advantage cuts will force 4.8 million seniors off the popular plan by 2019. An additional $23 billion in cuts to Medicare will come from a panel charged with slashing Medicare spending.

7. The bill will not pay for itself.

The CBO found that the bill would reduce the deficit by $138 billion over 10 years, but the savings was achieved by leaving out a $208 billion provision lawmakers will have to enact later to ensure doctors are adequately paid for treating Medicare patients. When the “doc fix” is included in the bill, it runs $59 billion in the red over the next decade. And former CBO Director Douglas Holtz-Eakin said that “if you strip out all the gimmicks and budgetary games” the 10-year deficit would exceed $560 billion.

Read it all.