The Locker Room

December 28, 2010

The power of Sebelius

Posted by Mitch Kokai at 3:04 PM

Sticking with the theme of an unconstitutionally strong federal bureaucracy, National Review's Rich Lowry explores the power wielded by the federal Health and Human Services secretary:

The text of Obamacare is dry and legalistic, except when it summons the majesty of the King James Bible to intone imperiously, “the secretary shall . . .”

The secretary in question is the secretary of health and human services, Kathleen Sebelius, who “shall” and “may” do all manner of things to complete the great unfinished canvas that is Obamacare. As George W. Bush might say, Sebelius is “the decider.” Because of the discretion she’s granted to remake American health care, she rivals Nancy Pelosi, Hillary Clinton, and Oprah Winfrey as the most powerful woman in America.

The New York Times reported the other day that HHS has created a version of the “death panels,” in Sarah Palin’s famous coinage, that were stripped out of the law after an uproar in 2009. Why did we bother having that fight, with all its fiery accusations, if Kathleen Sebelius and her underlings could simply act at their discretion?

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Re: High-risk pools

Posted by Mitch Kokai at 2:08 PM


William Kristol also took note of the Washington Post article you referenced. Kristol was surprised that the Post did little to promote its lead front-page story. 

This is unusual—featured pieces in the print edition are most often featured online as well. It’s unfortunate that Goldstein's fine reporting has almost disappeared from the home page of the website, since it constitutes a devastating indictment of Obamacare.

The headline summarizes the piece well: "Health plans for high-risk patients attracting fewer, costing more than expected." These health plans are a major feature of Obamacare, as they are intended to make it easier for people with preexisting health conditions to purchase insurance. Instead, they seem to have managed to achieve the liberal big-government public policy trifecta: the plans aren't helping nearly as many people as they were supposed to; they're costing more than they were supposed to; and the big government solution to this will be ... to seek more clients through advertising, so as to expand the size of an inefficient program and break the bank even more quickly.

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They haven't done nothin' ... yet

Posted by Mitch Kokai at 1:22 PM

We learn from a new Public Policy Polling survey that just 41 percent of North Carolinians think the state will be better off because of a Republican-controlled legislature, while 37 percent predict that we'll be worse off.

Coverage of the new poll in "Under the Dome" suggests that the numbers offer some good news to Gov. Beverly Perdue. Voters might not like her, but they don't like the Republicans, either.

That assessment prompts two responses. First, unlike the Republican-led General Assembly, which is still one month away from taking office, Perdue has had two years (as governor, and more than a decade before that as a legislator and lieutenant governor) to try to build public support.

Second, PPP's Tom Jensen offers the following assessment:

When you combine the feelings North Carolinians have about both parties in the legislature with the persistent negative feelings toward Bev Perdue, the main thing you can take away is that North Carolina voters just don't like their state government and that cuts across party lines.

Given uncompetitive tax rates, burdensome regulations, and a poor bang for the buck, the distaste for North Carolina state government is understandable. That's why a GOP-led legislature might want to look at ideas that will lead to better government performance in the future.

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High risk pools cost more than advertised

Posted by Joseph Coletti at 11:27 AM

The Washington Post says people are surprised by the high costs of federal high risk pools "and it is an open question whether the $5 billion allotted by Congress to start up the plans will be sufficient." These concerns come even though just 8,000 people have enrolled in the plans so far while Medicare's chief actuary expected 375,000 would sign up.

North Carolina's existing Inclusive Health pool was barely off the ground when the federal pool got added with lower premiums and more generous enrollment rules, but no ability to shift from the state plan to the federal plan.

"Like the rest of the country, we thought we'd have pretty much a stampede. That obviously hasn't materialized," said Michael Keough, executive director of North Carolina's plan. With nearly 700 participants, it is among the nation's largest so far, but it has one-third of the people expected by now.

One problem, in what has become a common refrain the past two years, is that the risk pools were oversold. One man in the Post story, Will Wilson, 57, takes $3,000 worth of AIDS drugs each month, ended up in bankruptcy, is now signed up with the federal AIDS Drug Assistance Program but has no other insurance.

Wilson remembers tears streaming down his face in February 2009, the night that he watched Obama vow to Congress, "Health-care reform cannot wait, it must not wait, and it will not wait another year!"

Wilson became an activist for health reform, circulating petitions, going to demonstrations. And the day after the president signed the bill into law, a Chicago Sun-Times column quoted him as saying, "I've had a grin on my face all day" at the prospect of the high-risk pool he could join.

Then Wilson discovered that insurance under the new risk pool would still cost $600 a month. It "was almost as much as my rent. It was like, no way! I was floored."

But that is what the policy would have cost Wilson if he was completely healthy. The federal high risk pool sets premiums no higher than the "standard rate for a standard population." Wilson's problem is that he lives in Chicago where regulations and other factors make basic insurance up to $150 more expensive per month than in other parts of the state.

To encourage enrollment, Inclusive Health is spending more on advertising, and plans across the country are cutting premiums by 10 percent or more (for those over 55 on Inclusive Health, premiums will fall 31 percent)despite higher premiums for everyone else, which could mean people who went without insurance and got sick could end up with lower premiums than people who stayed healthy and insured.

Expect even more perverse incentives in 2011 when people need prescriptions to get over the counter remedies with their Health Savings Accounts (HSAs) and other rules kick in.

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Sowell blasts 'political end runs' that violate the Constitution

Posted by Mitch Kokai at 11:11 AM

Thomas Sowell's latest column posted at Human Events slams the federal bureaucrats who revived a controversial health care measure specifically rejected by Congress:

Bills passed too fast for anyone to read them are blatant examples of these end runs. But last week, another of these end runs appeared in a different institution when the medical "end of life consultations" rejected by Congress were quietly enacted through bureaucratic fiat by administrators of Medicare.

Although Congressman Earl Blumenauer and Senator Jay Rockefeller had led an effort by a group of fellow Democrats in Congress to pass Section 1233 of pending Medicare legislation, which would have paid doctors to include "end of life" counselling in their patients' physical checkups, the Congress as a whole voted to delete that provision.


Whatever the merits or demerits of the proposed provision in Medicare legislation, the Constitution of the United States makes the elected representatives of "we the people" the ones authorized to make such decisions. But when proposals explicitly rejected by a vote in Congress are resurrected and stealthily made the law of the land by bureaucratic fiat, there has been an end run around both the people and the Constitution.

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Making the sausage

Posted by Mitch Kokai at 10:01 AM

The latest cover package in The History Channel Club's magazine highlights the upcoming 100th birthday of the late President Ronald Reagan.

While one article offers a brief version of the 40th president's biography, the other offers a lesson in political wheeling and dealing. Barbara McLennan was a congressional budget analyst in 1981 when Reagan was working on his first budget and tax plans. She explains how her boss, Sen. (and future Vice President) Dan Quayle worked to get a tax bill amendment originally proposed for a life insurance company in Fort Wayne, Indiana.

At 4 p.m. I walked to the Ways and Means offices in the Longworth House Office Building. The walk, across the Capitol grounds past the Supreme Court and the Library of Congress, took more than 15 minutes. When I arrived staff members were putting together large piles of paper and printouts for use during the tax bill conference.

I recognized a young blond woman I'd probably met at a Budget Committee hearing, though I didn't know her name. She worked for Rep. [Dan] Rostenkowski. [He chaired the House's powerful Ways and Means Committee.] When I told her I worked for Quayle, she smiled and said, "How is Danny? Does he like the Senate?" I replied, "Very busy. We have an amendment in the tax bill. Can I show you which one it is?"

She took out her side-by-side comparison of the House and Senate bills prepared by the Joint Committee on Taxation. I pointed to Quayle's amendment near the end of the document. She smiled and said, "Don't worry. I'll make sure Danny [Rostenkowski] knows it's Quayle's." She had so many papers I helped her carry some back to the Capitol.


The next morning I phoned Quayle's staff director at home. "What happened?" I asked. "Congratulations," he said. "We've got a piece of the tax bill. Of course, so did everyone else. Rostenkowski didn't object to any amendments. The revenue loss might be tremendous."

A passage like this one helps make the case for more open, transparent government operations, much like those proposed in the John Locke Foundation's recommendations for the new General Assembly's First 100 Days.


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New Carolina Journal Online features

Posted by Mitch Kokai at 07:01 AM

Karen McMahan's new Carolina Journal Online exclusive focuses on steps the new Republican-led General Assembly could take to reorganize legislative staff.

John Hood's Daily Journal explains that North Carolina needs serious leaders.

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