RUTHFULLY YOURS

The debate over the repeal and replacement of Obamacare has been hard for many on the right to parse because the concept of “repeal” — a term with a straightforward meaning that is isolated from “replace” — can lose its clear meaning when the two are joined at the hip.

Obamacare touched on so many aspects of health policy — aspects any reform effort would inevitably need to address, albeit in a different manner — that evaluating any one element of the law in isolation from the others is enormously difficult. Which aspects are central, and which are peripheral, is no easy question to answer for such a massive law. That difficulty is compounded by the lack of consensus among Republicans on an ideal replacement. Sound Obamacare replacement ideas in the minds of some may double down on Obamacare’s worst features in the minds of others. A further complication is introduced by the sequencing of reform. Some replace concepts, though in isolation of potential merit, may take on a different character in a policy context where metastatic remnants of Obamacare remain on the books pending repeal at a later date.

“Repeal and replace” has become a mantra in many corners on the right but it has long been a source of unease for some conservatives who have feared that “replace” might in practice not represent true “repeal.” The reaction to American Health Care Act represents the eruption of such concerns, which have brewed under the surface of our Obamacare debates for years, into the spotlight.

Sensing that things might play out precisely this way, many conservatives, Heritage Action included, urged Congress to lay the groundwork last Congress for an immediate repeal of Obamacare shortly after the inauguration of Barack Obama’s successor. That process culminated in the passage of the 2015 reconciliation bill that the same conservatives have urged Congress to pass for the last several weeks. But that bill was imperfect, as many noted at the time. Its authors, reluctant to test the limits of the Senate’s Byrd Rule, which limits what can be included in a reconciliation package, prematurely omitted from the bill the repeal of Obamacare’s various insurance regulations. Though it repealed Obamacare’s taxes and spending, it was understood at the time to be a floor, not a ceiling, for repeal. More work, we all knew, would be needed.

“American politics is dominated by an enduring myth,” writes author Peter Collier—the myth “that Democrats are the party of the common man, the voiceless, the powerless, the poor. That if you care about what happens to the least among us, you will cast your vote in the Democratic column.”

But as Collier also points out, the vast majority of America’s voiceless, powerless, and impoverished people are concentrated in cities that have been run exclusively by Democrats for decades—even generations—without interruption. These are cities where stratospheric rates of crime, poverty, unemployment, out-of-wedlock births, homes without fathers and failed school systems have become a way of life—along with oppressive and confiscatory taxes whose only discernible achievement is to keep the leaky ship of city government afloat for as long as possible before it is inevitably capsized by economic and social calamity.



Minneapolis, Minnesota is perhaps the least likely case in point. Camouflaged by the state as a whole, a synonym for plainspoken stability, it is just one of the many American cities that were once thriving centers of industry, prosperity and optimism—until Democrats took them over. Since 1978, Minneapolis has been governed exclusively by mayors from the Democratic Farmer Labor Party (DFLP)—the state affiliate of the Democratic Party.

Prior to this long era of Democratic dominance, Minneapolis’ poverty rate was consistently lower than the national average. Throughout the 1980s, when the trickle down of the Reagan economic boom had a positive effect on cities nationwide, Minneapolis shared in these good times, adding some 3,000 new jobs to its downtown area each year from 1981-87. As of 1983, only 8% of the city’s metropolitan-area population lived below the poverty level, as compared to approximately 15% of the national population.



But by 1988, then-mayor Donald Fraser—a member of the DFLP—had grown troubled by the stark contrast he saw between the majority of his city and who were thriving economically, and a number of African-American neighborhoods where crime, teenage pregnancy, and welfare dependency were experiencing a growth spurt. Taking a page out of the same playbook other big city Democrat mayors were using, Fraser believed that the cure was redistribution of income. He decided to revamp the way in which social-welfare expenditures were allocated and believed, specifically, that federal and local agencies needed to focus more of their resources on the economic problems confronting unwed mothers (who were disproportionately black) and their children.



The furor over the Congressional Budget Office’s report on the House GOP health bill is concentrated on predictions about insurance coverage, which suits Democrats fine. Lost amid the panic is that CBO shows the bill is a far-reaching advance for the market principles and limited government that conservatives usually favor.

The CBO is not omniscient, but if its projections are even close to accurate then ObamaCare repeal and replacement is the most significant government reform in perhaps three decades. Under conventional (static-revenue) scoring, the bill cuts spending on net by $1.22 trillion and eliminates a raft of new taxes worth $883 billion through 2026.

Despite this tax reform and new refundable tax credits for individual insurance purchases, the bill still reduces the deficit by $337 billion. Reducing spending, the tax burden and further debt generation is an enormous pro-growth fiscal bonus.

President Obama sought to permanently increase the government’s share of the economy to redistribute income to reduce inequality. ObamaCare was his spending wedge to force tax increases long after he had left office. The House health-care bill is the first crucial step to limit that wedge and restore the federal fisc to a more sustainable long-term path.

Absent reform, the brutal budget math is that the U.S. is headed for a debt crisis; major tax increases that subtract from GDP and living standards; or deep and immediate cuts to entitlements that Americans have planned their lives around—or maybe all three. The longer Washington waits, the more painful and politically convulsive the corrections will be.

We keep reading that President Trump and Speaker Paul Ryan are on a collision course over entitlements, though when was Medicaid demoted from entitlement status? The bill transitions the program’s funding formula to block grants starting in 2020—for the first time, limiting the automatic and open-ended commitment that defines an entitlement.

WASHINGTON—Republican senators, alarmed by a nonpartisan report showing millions would lose insurance under the GOP health-care plan, warned Tuesday that the bill wouldn’t become law without fundamental changes.

At least a dozen Republican senators, including some who had previously kept a low profile in the health debate, made clear they had concerns over the bill’s policy proposals, complicating House leaders’ hopes that the bill’s momentum would overpower internal GOP infighting over legislative details.

Flashpoints included the potential loss of insurance coverage, changes to Medicaid, the trajectory of premium prices and the bill’s impact on costs paid by older, low-income and rural Americans.

Concerns mounted on Capitol Hill after the Congressional Budget Office, the independent legislative analyst, released a report on Monday that estimated the GOP health plan would reduce deficits by $337 billion over the coming decade and increase the number of uninsured by 24 million in 2026, compared with current law.

While many Republicans lauded the plan’s impact on the deficit and the high cost of premiums, the rising chorus of concerns means congressional GOP leaders and the White House will have to delicately balance modifying the bill in ways that appease one faction of Republicans without alienating another.

On Tuesday, the White House sought to discredit the report’s projections as unreliable, while Republican senators said they would push for an array of changes, including more assistance for older and low-income people to buy health insurance.

“This is difficult—it’s 18% of the economy,” said Sen. John Boozman (R., Ark.). “My concern is not with the timeline; my concern is doing it right.” CONTINUE AT SITE

The Republicans have started fixing the Obamacare disaster. For Trump, doing something about this failed program is critical, since it was a central issue he campaigned on. As his consigliere Kellyanne Conway says, there is a “binary choice … you’re either making good on the promise to repeal and replace Obamacare or you’re not.” Failing to deliver on this promise will have serious repercussions for the 2018 midterm elections and Trump’s own reelection

But right now, the Congressional bomb-squad trying to defuse this political IED are squabbling among themselves. Some claim that the changes proposed so far are a good start, for a complex and flawed entitlement like Obamacare will take time to fix. Others say what Paul Ryan et al. have proposed is merely “Obamacare lite,” Republican lipstick on that budget-busting entitlement pig. Dems on the sidelines are piling on, desperate to preserve Obama’s “legacy,” which also happens to be a big step toward the Holy Grail of progressives–– government-run, single-payer health care on the European model.

But the real problem continues to be ignored––the success of the progressive movement in addicting Americans to getting something for nothing because that “something” is defined as a “right.” And voters don’t like their rights messed with.

That’s the political conundrum facing the Republicans. Those in the Paul Ryan camp defend their adjustments to Obamacare by pointing out the greater participation of the market in their reforms. Here’s Ryan making the case:

It’s something that we as conservatives have always said if you really want to get free market principles injected into the health care system, you need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health care services, be they insurers, doctors, or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome. You don’t get that if you don’t have a viable individual free market.

All true, except the one thing Ryan doesn’t mention, and that’s the individual’s responsibility for his free choice. Whenever we talk about freedom of choice in the free market, we have to be clear that making the wrong choice, or a bad choice, will have consequences. Freedom without responsibility and accountability for how we use our freedom is a recipe for disaster. We all know, for example, that a lot of health-care money is spent on ailments related to lifestyle choices. About 28 million Americans have type-two diabetes. Obesity, poor diet, and lack of exercise are mostly responsible for this rising epidemic. In 2013 we spent $250 billion treating this disease, including the cost of lost productivity. The government paid 62 percent of this tab, and one in three Medicaid dollars was spent on diabetes. These costs will increase significantly as an aging, longer-living population becomes more vulnerable to the disease. And everyone expects the government to foot the bill.

Alfred Hitchcock’s black comedy The Trouble with Harry bombed at the box office when it was first released in 1955; it has now achieved the status of a classic. Today, a bizarre melodrama playing in all the major political theaters, which might be called The Trouble with Barry, has become an overnight smash hit. Starring Barack Obama, a prodigy of the art of surveillance and Teflon-like resilience, it will eventually run its course. However the plot may develop, one thing is certain: it will not be regarded as a classic.

The trouble with Barry, like Hitchcock’s moribund Harry, is that he never seems to go away, constantly emerging at the most inopportune moments. Unlike every other president in American history, Obama has dedicated himself to the practice of what the Washington Examiner has described as “post-presidential meddling.”

He has thrown himself fully into Alinsky-style “community organizing,” stirring up resistance to the Trump administration in every way conceivable: installing, according to the New York Post, a “shadow government,” dubbed Organizing for Action, comprising more than 30,000 agitators and 250 chapters across the U.S., in order “to sabotage the incoming administration”; renting a dwelling and setting up command headquarters around the corner from the White House; cooking up the Russian hacking fable; and most recently, allegedly wiretapping Trump Tower, which seems disturbingly probable following the salient remarks of Ret. Army Intelligence Officer Tony Shaffer on Fox and the revelations from Breitbart News. Mark Levin’s accusation that Obama is orchestrating a “silent coup” against Trump rings true. As Daniel Greenfield points out:

There is now a President and an Anti-President. A government and a shadow government. The anti-President controls more of the government through his shadow government than the real President.

Obama and his Deep State have engaged in “a criminal conspiracy of unprecedented scope.”

And yet, even today, few media outlets are willing to investigate the innumerable instances of lying, lawbreaking, corruption, broken promises and cronyism for which Obama is clearly answerable. That he is likely involved in a wiretapping operation against a political opponent should not come as a surprise to anyone who has observed or researched the man. As Matthew Vadum comments in FrontPage Magazine, “It might be said that every day of his presidency he committed at least one impeachable offense” — whether abusing executive powers, bypassing Congress, leaking classified information, misrepresenting Obamacare, being ultimately responsible for the Fast and Furious and Benghazi infamies, and more.
Hugh Hewitt Presses Trump to Fire Obama Holdovers

The wiretapping affair is only the latest in a vast and ongoing sequence of misdemeanors, scandals and illegalities — a list compiled by Doug Ross runs into hundreds of such instances of impropriety and malpractice. No matter. The list will only grow. The editor of a prestigious conservative site wrote me calling this latest outrage a “game changer.” That remains to be seen. I would have thought, for example, that Obama’s first Executive Order (13489) on January 21, 2009, sealing his vital records would have been the game changer we were waiting for, but Barry sailed on unscathed.

There have been weak presidents, deluded presidents, and harmful presidents before him, but never has there been anyone as sinister or questionable as Obama, not excluding even the malefic Jimmy Carter or the sleazy Bill Clinton. What J. R. Dunn writing in American Thinker has said of Hillary, “the most repellent and corrupt American presidential candidate since Aaron Burr,” is equally true, in my estimation, of Barack Obama. Meanwhile, it is Trump who faces a barrage of threats, calls for impeachment and acts of disobedience that would have been more explicable if levied against Obama for his historic deceptions and malfeasances. Under the pestilential reign of Obama, and indeed years of Democratic incumbency, the shining city on the hill has become a murky city in the swamp.

Again, unless there is real tort reform the FDA will have a permanent problem, and so will the pharmaceutical companies…..rsk
The Food and Drug Administration is the nation’s most ubiquitous regulatory agency, overseeing everything from syringes and CT scanners to drugs, vaccines and most foods. These products account for more than $1 trillion annually, or about a quarter of U.S. consumer spending. This slow, dysfunctional agency needs drastic reform of its requirements, procedures and attitudes.

One reform Scott Gottlieb, President Trump’s nominee to lead the agency, will likely embrace is “right to try”—that is, giving terminally ill patients access to unapproved medicines. He could remove the FDA from judgments about “compassionate use” of unapproved drugs. There is already a trend in this direction: Thirty-three states have passed laws aimed at providing easier access to experimental treatments that are still in the earliest stages of human testing.

The right to try unapproved drugs has the potential to be compassionate and sound public policy—but there are dangers. The concept must be implemented in a way that takes into consideration the realities of drug testing.

According to the libertarian Goldwater Institute, right-to-try legislation would allow “terminally ill Americans to try medicines that have passed Phase I of the FDA approval process and remain in clinical trials but are not yet on pharmacy shelves.” It would also expand usage of “potentially life-saving treatments years before patients would normally be able to access them.”

But here’s the rub: About three-quarters of drugs that pass Phase I will never be accessible. They ultimately won’t be approved, because of either safety concerns or lack of efficacy. Most legislative proposals, including the one recently introduced by Sen. Ron Johnson (R., Wis.), would enable patients to request the drugs after only the most meager safety testing.

Phase I testing, often the first time a new drug has been administered to humans, provides extremely limited information. These trials are performed on between 20 and 100 patients and last only a short time. They’re usually administered to paid, healthy volunteers, who may not provide a good representation of how the drug will affect terminal patients. Such trials essentially exist to determine what doses of the drug are tolerated without causing gross safety problems such as seizures, organ failure or death.

The determination of efficacy starts in Phase II, when the drug is administered to volunteers who suffer from the disease or symptom for which the drug is intended. If the results of Phase II are promising, the drug moves into still larger Phase III trials—the most extensive and expensive part of drug development.

A physician at a large health insurer, who spoke to me on the condition of anonymity, recently raised concerns about right to try. He wonders “where liability will ultimately lie when and if something goes wrong.” Even trickier: “Who is the deep pocket if and when the treatment fails and the patient’s family is looking for someone to blame?” He warns that the right to try could become an “unfunded mandate” and raises questions about who will pay for the drugs and how their prices will be determined. Medical insurance as we know it was never designed or intended to cover unproven treatments of last resort. CONTINUE AT SITE