Friday, October 26, 2012

The political class isn't smart enough to run health care


v  The political class isn’t smart enough even if they were good enough. Let us make the na├»ve assumption that everyone in the political class is altruistic. Assume they don’t romance about euthanasia, nor dream about population control. Let us assume that politicians are neither self-serving nor duplicitous, but instead they are noble. If the political class consisted of only those with the purest intentions, would they be able to manage the health care system? The answer is emphatically no! This critique was pioneered by the “Austrian School of Economics”.  Austrian economists dispute the government’s capability of controlling an economy because of the exponentially explosive amount of possibilities that bureaucratic wizards-of-smart have to consider. The free-market, meanwhile, discovers these answers automatically.v   

v  Proof of the wizard-of-smart failing:
Example: The Soviet Union relied on “cybernetics” applied computer science to provide information. The USSR’s pioneering computer scientist were heavily involved, include genius Nobel Prize winner Leonid Kantorovich. Kevin D. Williamson “The Politically Incorrect Guide to Socialism” p38
Example: The USSR was the largest producer of shoes in the world. “The USSR had three pairs of shoes for each citizen, but people had to wait to buy shoes. The problem was the available shoe did not reflect consumer’s taste: the shoes were made to fulfill a government plan.” James Dorn Cato scholar
Example: “The tale of Soviet-era production misalignment would be comical if they had not exacted such a high price in human blood. There would be huge surpluses of, say pesticides … but acute shortages of sugar, flour, shoes and other common items. Toilet paper was used as filler in sausage until toilet paper itself went into short supply.” Kevin D. Williamson “The Politically Incorrect Guide to Socialism”  p267
Example: America’s political class did everything it could to circumvent the free-market to increase home ownership. They gave home owners favorable tax status. They lowered interest rates. President Clinton’s Attorney General threatened to sue banks if they didn’t loan to those with bad credit. Community organizer Barack Obama and ACORN browbeat banks with protests that labeled them racists if they didn’t submit to giving loans out to risky recipients. Government-sponsored enterprises Fannie Mae and Freddie Mac gave banks an escape by buying up risky loans. Banks came up with their own solution by bundling mortgages and selling them to Wall Street. Wall Street bought the loans because they trusted that the loans were backed by the taxpayers because most of the loans were backed by the GSEs Freddie Mac and Fannie Mae. Wall Street was right. Thus the Wizards-of-Smart set in motion the house-building collapse, the current recession, the stock market collapse, and the Wall St./Fannie and Freddie bailouts which by some estimates cost more than we spent for World War II (adjusted for inflation!). http://www.americanthinker.com/2008/10/what_really_happened_in_the_mo.html , Mark Levin Liberty and Tryanny
v   they wanted demand to rise with rising prices rather than fall as prices went higher – which is to say they wanted magical pixies to plant unicorn trees and fertilize them with pixie dust.” .” Kevin D. Williamson “The Politically Incorrect Guide to Socialism”  p267 Using the same arrogant hubris, the wizards-of-smart command insurance companies use “community rating” for prices and force them to serve those with pre-existing conditions. This time they want prices to fall as demand increases.
 

v  Strangely, The federal government controls the amount of operating rooms there are.  Sec. 6001 PPACA (Consolidated) 62212y 100 PERCENT INCREASE LIMITATION   The Affordable Care Act has other similar limitations that include “procedure” rooms, giving power to the Secretary of Health and Human Services to grant exemptions. (and many other powers)

v  For sake of this exercise, we need to leave aside the likelihood that exemptions will be granted to the most lucrative campaign donors…to turf invaders like Walgreens and CVS’s clinics or turf defenders like the current hospitals. How does the Health and Human Service Secretary know the correct amount of procedure rooms? Will she use some new form of Cybernetics combining the Deep Blue Chess program and Jeopardy!’s Watson computer? Take Deep Blue for instance. Some have argued there are as many possible chess moves as there are atoms in the universe. Humans, who created chess, ipso facto, must be more complicated than chess. Even if that assertion is disputed, the human brain, its behavior, the human body and its health care is still extraordinarily complex. The complexity of human behavior is compounded exponentially by the fact that there are millions of us acting and reacting in real time simultaneously. Human health care is complicated, and predicting the appropriate amount of procedural rooms isn’t possible for a central brain in Health and Human Services. Get a bunch of brainiacs and brainiac wannabes, give them a super computer and they will still be at disadvantage over the market. For instance, will the young healthy formerly uninsured now start frequenting healthcare providers more often now that they must buy insurance? Will the fear of rationing cause elderly to schedule as many appointments as possible to get to the head of line should there be a problem? There will be pandemics, drug use spikes, health fads, population shifts that some mythical central brain must grasp. The market provides and army of thinking rational Kasparovs and Holts (tied Deep Blue, beat Watson) at every perspective.  Few are as smart as them, but they are likely as smart as the Health and Human Service Secretary. When a hospital or clinic decides how many rooms to have, for instance, they are blessed with on-hand perspective and possess honed skills for a specialized task. They are also blessed with institutional knowledge of past mistakes and triumphs.  And, they have money as instant feedback whether they made the right decision. 

 This is the calculus of consent: in the free-market a business gets 100% consent of 100% of its customers. Any other remuneration is because of fraud or politics or both, but that isn’t the “free-market.” With Democratic Socialism politicians receive consent of at least 51% of people who vote, which is always less than 51% of the people. Decisions to buy happen every second, but elections occur every two, four, or six years. The feed-back loop for business is direct and constant. The feed-back loop for politics is tenuous, diluted, and infrequent. Consent nearly vanishes with the purposeful quarantine of the Independent Payment Advisory Board, which under the Affordable Care Act decides reimbursement rates that can only be thwarted by a congressional super-majority. (Ironically installed with just a simple majority)
The ungraspable complexity of healthcare is proven by the ungraspable complexity ovf the bill. Key proponents of the Affordable Care Act admitted they didn’t read the bill, such as John Conyers and Max Baucus. I don’t think you want me to waste my time to read every page of the health care bill. You know why? It’s statutory language,” Baucus said. http://americaswatchtower.com/2010/08/25/max-baucus-wrote-the-healthcare-bill-but-did-not-read-it/

Sunday, October 14, 2012

Part one: Obama Care will give us rationing and nanny-tyranny

Part one of:
The political class is neither good enough nor smart enough to run Health Care. The tyranny of rationing and behavior control will be the consequence of the Affordable Care Act.

v  If politicians, lobbyists, generic bureaucrats, Presidents, Presidential Czars and Presidential Cabinet members proportionally reflected the population’s temperament, there would be the same proportion of magnanimous altruist, of well-intentioned busybodies, of corrupted souls, of two face liars, of decent people, and of malicious psychopaths. Since the aforementioned “political class” exerts more control over us than the general population, it is right to fear them. It is necessary to constrain, dam, and decentralize their power with a Constitution because they are not angels. It is a stretch, however, to expect a proportional representation of temperaments among them. Tyranny is humanity’s historical norm. Power corrupts.  

v  The left-wing chortles with snarky disdain at “slippery slope” arguments like the tyranny argument above. They say that their command to purchase insurance will not lead to state enforced vegetarianism or state forced abortions.  It’s ridiculous to assert, they say, that the affordable care act will lead to death panels where Jack-Kavorkian-Democrats pull the plug on Grandma. “Trust us” they say.  

 Supreme Court Justice Ginsberg mocks conservatives by quoting Robert Bork. “Judges and lawyers live on the slippery slope of analogies; they are not supposed to ski it to the bottom.”:http://www.politico.com/news/stories/0612/77958.html#ixzz21xMirlV9  By focusing on what might happen, but probably will not, the “slippery slope” distracts us from discussing the matter at hand; that the Affordable Care is desirable. Or so they say. 

v  The problem with their brush-off of the likely tyranny argument is two-fold: 1) Much of what we fear is already happening. 2) We don’t trust them because we know what major power players in left-wing intelligentsia have said.  

v  Rationing occurs today under Medicaid and Medicare because the government needs to save money, so it short pays for medical care. (The Affordable Care Act expands Medicaid and it grants greater authority to the Independent Payment Advisory Board which authorizes the short paying.)

Example: “Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.  How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather  than the quarterly checkups he considers ideal for the elderly. Still, at least he'll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.  "It's not easy. But you realize you either do this or you don't stay in business," she said. http://www.washingtonpost.com/wp-dyn/content/article/2010/11/25/AR2010112503638.html

Example: Barbara Wagner and Randy Stroup of Oregon were both initially denied life pro-longing cancer treatments because of the expense. Oregon already has a government saturated Health Care system. A bureaucrat offered public funding for assisted suicide instead. (Legal in Oregon) http://special.registerguard.com/turin/2008/jun/03/gift-treatment/

So the message from Oregon, so aptly stated by Barbara Wagner, is: “We’ll pay for you to die, but not pay for you to live.” http://www.pccef.org/articles/art67.htm

Example: Only 16% of Maryland dentist accept Medicaid patients. In one extreme case of note, Deamonte Driver died of a tooth infection that spread to his brain. Deamonte’s tragedy was used as evidence in support of ObamaCare. It turns out that Deamonte was insured by Medicaid.

The Cause and Effect: According Richard Foster, Medicare’s chief actuary, Obama Care will bring Medicare’s reimbursement rates lower than Medicaid*1. .So private healthcare insurance is squeezed by a pincer movement; Medicaid is expanded by adding 18 million people and reimburses an average of 56%*2, Medicare will add 2.5 million or more per year as people age*3, the reimbursement rate for Medicare is lowered, Healthcare providers will have to foist the unreimbursed expense upon those who have private insurance, and private insurance is forced to provide for those with pre-exiting conditions which will necessarily force up insurance prices. Eventually the burgeoning vine strangles the tree that sustains it.

Rationing is the necessary consequence of the government’s paltry reimbursement rates. As private insurance becomes unaffordable, Americans will gravitate to Medicaid or State run subsidized exchanges. Because more Americans will be sucked into some form of government health care, more will experience rationed healthcare. 1How ObamaCare Harms The Poor, by Avik Roy, National Review July 30 2012, 2. http://thf_media.s3.amazonaws.com/2011/pdf/TheImpactOfObamacare.pdf  3. http://www.medicalnewstoday.com/articles/212585.php 
 

v  Busybody nanny-state control is already occurring or threatening at various levels of government and with the Affordable Care Act specifically.

Example: Several major US Cities, including New York and Philadelphia, and the State of California have banned trans-fats. http://en.wikipedia.org/wiki/Trans_fat   117-136
Example: When life issues and “preventative services” conflict, the Feds via the Health and Human Service Secretary determines the moral decision for insurance companies. K. Sebelius requires “free” coverage for early-abortion pills, and sterilizations. (Women’s Preventive Services Guidelines and HHS Mandate Pg. 2) www.alliancedefensefund.org/obamacare   
Example: As of July 2010, indoor tanning services are subject to a 10 percent excise tax, under the Affordable Care Act. http://www.irs.gov/businesses/small/article/0,,id=224600,00.html This tax, like an alcohol sin tax, is designed to decrease a behavior the political class dislikes. (And is unambiguously aimed at pale people)
Example: Medicare will pick up the tab for obesity screening and intensive behavioral counseling…The Centers for Medicare and Medicaid. http://www.medpagetoday.com/PublicHealthPolicy/Medicare/29940
Example: For more proof that Government taking care of you can lead to it taking control of you, check out the WIC government food program’s authorized food list. Not allowed; foods with added sugar, whole milk, brown eggs, white bread, canned beans, potatoes, nuts, sardines pack in hot sauce, and more. http://www.cdph.ca.gov/programs/wicworks/WIC%20Foods/WICAuthorizedFoodListShoppingGuide-7-5-2011.pdf.pdf
Example: California’s Energy Commission proposed installing remote controls in home thermostats that could not be overridden by homeowners during an emergency. (Some think Global Warming is an emergency) http://www.ucan.org/energy/electricity/advanced_metering/big_brother_control_thermostats_homes
Example: Many states have or are considering mandatory drug testing for food stamp recipients. http://www.usatoday.com/news/nation/story/2012-02-17/welfare-food-stamps-drug-testing-laws/53306804/1 This is obviously an unconstitutional warrantless search, protected against by the 4th and then the 14th amendments. But if the Constitution is ignored to allow the Feds to surpass their boundaries to help you at your neighbor’s expense, it cannot be expected to protect you after it’s been ignored to begin with. 

v  Distrust the political class because of what they have actually said.

Example: From Ecoscience, co-authored by John Holdren in 1977. John Holdren is President Obama’s Science Czar.

“Adding a sterilant to drinking water or staple foods is a suggestion that seems to horrify people more than most proposals for involuntary fertility control. … To be acceptable, such a substance would have to meet some rather stiff requirements: it must be uniformly effective, despite widely varying doses received by individuals, and despite varying degrees of fertility and sensitivity among individuals; it must be free of dangerous or unpleasant side effects; and it must have no effect on members of the opposite sex, children, old people, pets, or livestock.

A program of sterilizing women after their second or third child, despite the relatively greater difficulty of the operation than vasectomy, might be easier to implement than trying to sterilize men. 

The development of a long-term sterilizing capsule that could be implanted under the skin and removed when pregnancy is desired opens additional possibilities for coercive fertility control. The capsule could be implanted at puberty and might be removable, with official permission, for a limited number of births.”  http://zombietime.com/john_holdren/  
 

Politicfact defends John Holdren because his recommendations attach the proviso "if the population crisis became sufficiently severe to endanger the society." Oh in that case it’s perfectly tolerable for influential policy wonks to suggest China like oppression because they really don’t mean it, until of course they mean it. Regardless, the rebuttal includes the same quotes and therefore helps prove the veracity of Holdren’s statements. http://www.politifact.com/truth-o-meter/statements/2009/jul/29/glenn-beck/glenn-beck-claims-science-czar-john-holdren-propos/
 

Example: Cass Sunstein , Obama’s Administrator of the Office of Information and Regulatory Affairs  "Many analysts, however, have suggested that the government should rely instead on the 'value of a statistical life year' (VSLY), in a way that would likely result in significantly lower benefits calculations for elderly people, and significantly higher benefits calculations for children," the 2003 paper said.
"I urge that the government should indeed focus on statistical life-years rather than statistical lives. A program that saves young people produces more welfare than one that saves old people," it added.
"Older people are treated worse for one reason, they are older. This is not an injustice.”
Read more:
http://www.americanthinker.com/blog/2011/06/is_it_time_to_push_cass_sunstein_over_the_cliff.html#ixzz21hATBMHF  

Example: Donald Berwick M.D. Obama’s head of HHS's Center for Medicare & Medicaid Services "The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out there. There is going to have to be a very difficult democratic conversation that takes place. The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open." Why Donald Berwick is Dangerous to Your Health By Hal Scherz Dr. Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.  http://www.realclearpolitics.com/articles/2010/05/26/why_donald_berwick_is_dangerous_to_your_health_105730.html

Example: "I am romantic about the NHS. I love it." Dr Berwick says about probably the best-known case of socialized medicine -- Britain's National Health Service (NHS). http://www.realclearpolitics.com/articles/2010/05/26/why_donald_berwick_is_dangerous_to_your_health_105730.html  

Reporting from a system that Obama’s head of Medicare, Dr. Berwick, is romantic about:

According to a report from a researcher at Barts and the London School of Medicine and Dentistry, one out of six people who died in the United Kingdom in 2007-08, died of continuous deep sedation, a mode of euthanasia.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four  others. “Forecasting death is an inexact science,” they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong… Dr Hargreaves …added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die…

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients." http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html
Or is he romantic about this story? “When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.” Warden family did not give up. They paid out of pocket for private consultations to reduce pain and suffering. The treatments suggested by the private consultation, not only eased his pain, they cured his cancer. Read more: http://www.dailymail.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-mans-chilling-story-reveals.html#ixzz2213MAbOR

Or is he romantic about this statement made by a Brit in the web comment section of the Kenneth Warden story? “My dad paid into the system for over 40years and was diagnosed with cancer in February 2012 and left to die 6 wks later at 67- too young- as the NHS couldn't be bothered with sending him for testing any earlier despite continuous doctor appointments, glaring symptoms and even 2 A&e visits. We will be pursuing a complaint. It does make you wonder, doesn't it? The NHS is a shambles. All my family now have (sic) private cover but we shouldn't have to as we have all worked and paid our way. - Anoni, London, 08/4/2012 09:09”
Next blog, Part two: The political class isn't smart enough to run healthcare, even if their intentions are pure

Wednesday, October 10, 2012

The free-rider lie


v  The lie:  Free-riders, people who don’t pay their health care bills, are the main driver pushing Health Care insurance costs higher. Obama Care proponents, including Justice Ginsberg in her Supreme Court opinion, cite a statistic claiming free-riders extracted from health care providers $43 billion worth of uncompensated care in 2008. 
1.       The truth is that “$43 billion” is a lie.
v  Three-fourths of skipped bills are compensated.
“We traced its estimates of the magnitude of… $43 billion per year, … to two sources: the aforementioned Health Affairs study, and a non-peer-reviewed study commissioned by FamiliesUSA, a Washington, D.C., group long known for its advocacy of greater government involvement in health care. Yet Congress simply ignored the evidence in the Health Affairs study and failed to recognize the serious flaws in the FamiliesUSA analysis.

Specifically, Congress ignored the $40 billion to $50 billion that is spent annually by charitable organizations and federal, state, and local governments to reimburse doctors and hospitals for the cost of caring for the uninsured. These payments, which amount to approximately three-fourths of the cost of such care, mitigate the extent of cost shifting and reduce the magnitude of the hidden tax on private insurance.” http://www.hoover.org/publications/hoover-digest/article/84061
v  “Analysts at the Urban Institute concluded that uncompensated care accounts for 2.8% of all health care spending, and that cost shifting due to the uninsured raised private insurance premiums is 1.7% “at most.” The non-partisan Congressional Budget Office agrees: “Overall, the impact of cost shifting on payment rates and premiums for private insurance seems likely to be relatively small.” http://www.cato.org/publications/commentary/cost-shifting-does-not-justify-obamacare
2.      The truth is that the Federal Government is the biggest free-rider and therefore the biggest driver of higher insurance prices.
v  If you accept the lie that Justice Ginsberg cites, “43 billion of uncompensated care in 2008,” then the federal government is still six and a half times the free-loader as the scapegoated free–riders.

Medicare spending … reached $466 billion in 2008. Spending on Medicaid was $352 billion in 2008. http://www.healthaffairs.org/press/janfeb0907.htm pulled from the Center for Medicare and Medicade Services.  Kaiser Foundation estimates a national reimbursement rate of 0.72 in 2008 for Medicare and Medicaid. (The Government uses monopoly-like purchasing status and the force of law to short-pay bills) $352billion + $466billion= $818 billion. $818 billion is under 3/4th payment on actual invoices. Extrapolating from $818 billion, the total invoices for Medicare and Medicaid were $1,136 billion ($1.1 trillion). This leaves $318 billion that politicians refused to pay hospitals and doctors. That is over 6.5 times what the scapegoated “free-riding” uninsured left to the HealthCare system, and is $318 billion that providers must offset by raising prices to private insurance. The real free-rider is the Federal government.
v  If you don’t accept the “43 billion dollar” lie, and only count the quarter of skipped bills that providers are stuck with, then Federal Government was 29 times the free-loader than the free-riders were in 2008.
v  Furthermore, the Heritage Foundation cites the fact that Medicare/aid compensation is now closer to 56%. 
3.      The truth is that the Patient Protection Act betrays the lie.
v  They justify tyranny with duplicity by attempting to have it both ways: The uninsured are free riders who burden us by using health care they don't pay, but that hospitals are forced by state good-Samaritan laws to provide and then must make up the cost by increasing prices on those who have insurance. And, the uninsured are primarily healthy young adults who are an actuarial gold-mine for insurance companies because they "incur relatively low healthcare costs." In other words the mandate betrays their lie, if the uninsured burdened the system significantly then they couldn’t be used buoy the new system.

“It is precisely because these indi­viduals, as an actuarial class, incur relatively low healthcare costs that the mandate helps counter the effect of forcing insurance companies to cover others who impose greater costs than their premiums are allowed to reflect.” Chief Justice John Roberts

v  Claiming that the Affordable Care prevents free riders from passing their cost on to you is a lie. Those who cannot pay hospitals back now, are precisely the ones exempted from the individual mandate penalty.

The lawyers defending the bill before the Supreme Court admitted that “[t]he amount of the penalty will be calculated as a percentage of household income for federal income tax purposes, subject to a floor and [a] ca[p],” and that individuals who earn so little money that they “are not required to file income tax returns for the taxable year are not subject to the penalty” §5000A(e)(1); who earn too little income to require filing a tax return   

Conclusion:

Justifying the Affordable Care Act as a solution to prevent free riders from passing cost on to you is a lie. Those who cannot pay hospitals back now, are precisely the ones exempted from the penalty. The real free-rider grabs an ever growing market share and wields the force of law to impose its will. The real-free rider is the Federal Government.

Saturday, October 6, 2012

The Patient Protection and Affordable Care Act is a take-over of the healthcare system by the federal government.


v  Citizens are told by the federal government to buy approved insurance plans, instead of arranging to pay for health care the way free citizens see fit. 

v  The federal government approves the insurance plans that you must buy.

v  The federal government requires that, beginning in 2014, large employers provide their employees with Obamacare-compliant insurance plans or pay a heavy fine and employers of any size who provide their employees with insurance must offer only Obamacare-compliant plans or face similarly burdensome fines and lawsuits. (26 U.S.C. § 4980H Pg. 1; ObamaCare Sec. 1562(f), Pg. 152), (26 USC § 4980D Pg. 1; ObamaCare Sec. 1562(e)-(f), Pg. 152; 29 U.S.C. § 1132 Pg. 1; ObamaCare Sec. 1562(e)-(f), Pg. 152) ww.alliancedefensefund.org/obamacare 

v  The new law contains 700 references that the (Health and Human Services) Secretary “shall” determine and “may” determine 139 times. For instance, The Secretary shall develop oral health components that shall include tooth-level surveillance.” Section 4102

v  The federal government controls the amount of operating rooms there are in hospitals.  Sec. 6001 PPACA (Consolidated) 62212y 100 PERCENT INCREASE LIMITATION 

v  “As part of new labeling requirements, she'll also have the power to regulate a wide variety of foods -- even Happy Meals. A clause of the law titled "MENU VARIABILITY AND COMBINATION MEALS" reads: "The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children's combination meals, through means determined by the Secretary, including ranges, averages, or other methods." http://spectator.org/archives/2010/06/04/the-empress-of-obamacare/1  At first this reads like the Secretary prescribes the nutrient chart, but read it again; “determining …the nutrient content…” Which definition of “determine” is used here? To ascertain after observation? Or, to control and decide?  

v  When life issues and “preventative services” conflict, the Feds via the Secretary determine the moral decision for insurance companies. K. Sebelius requires “free” coverage for early-abortion pills, and sterilizations. (Women’s Preventive Services Guidelines and HHS Mandate Pg. 2) www.alliancedefensefund.org/obamacare  

v  Religious exemptions to the HHS mandated coverage of abortion pills and sterilizations are determined by the Secretary. The exemptions are narrow. Any religious school or charity that serves people of other faiths is not exempt because it does not meet the requirements (a Christian soup kitchen, a Catholic school, etc.) Even some churches are not exempt if they are too focused on serving people besides themselves. (HHS Mandate Pg. 2) www.alliancedefensefund.org/obamacare  

v  The Secretary can fine doctors up to $10,000 if they have part ownership in their hospital and neglect filling out the correct paperwork informing the Secretary they are part owners. PPACA 

v  Employers can either pay $20,000 a year or so for the family coverage Kathleen Sebelius chooses for them, required by the PPACA not only for their workers but for all of their dependents as well, or they can start paying the tax penalties. That includes for those with 50 or more full-time employees a penalty of $2,000 per year per full time worker (minus 30 employees), if they offer no insurance. But even if the employer does provide employee health insurance, the employer is assessed a penalty of $3,000 per employee if the worker nevertheless qualifies to purchase his or her own health insurance on a state health insurance exchange and does so. http://heartland.org/editorial/2012/08/17/new-face-health-care-irs  

v  The Affordable care act creates the Independent Payment Advisory Board (IPAB). IPAB is a rationing board.

v  The government denies that it is a rationing board, but “with its authority to control prices, it will be able to drive Medicare payments so low, doctors will stop offering key services to patients.” Stanley Kurtz, National Review

v   Dr. Elaine C. Jones, government relations committee co-chair of the American Academy of Neurology stated, "We are also very concerned about the power of the IPAB to cut payments to physicians. The sole function of the IPAB is to cut spending…”Mary Ellen Schneider (March 1, 2011). "Physicians Offer Rx for Fixing Health Reform Law". Internal Medicine News.
 

v  Insurance companies are told who they must insure and how they must insure them. Acting in unison, there will be scant difference between them, thus creating a monopoly effect. This monopoly effect is hidden by the ruse of multiple companies, but really they take orders neither from you nor your employer, they take orders from the federal government. Their hope is to solicit favor with politicians to gain recognition on state-run exchanges, and also to protect the lucrative individual mandate. Instead of focusing on the consumer, sheer self-preservation will pin their hopes on campaign donations and lobbying.  
v  Doctors recognize this ruse and see it as the worst of both worlds; several big bullies and one Godzilla bully teaming up against them.  Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.” …co-founder of the DPMA Kathryn Serkes told TheDC.  “Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,” Read more: http://dailycaller.com/2012/07/09/report-83-percent-of-doctors-have-considered-quitting-over-obamacare/#ixzz20BUu3Vdw              These additional organizations have also registered their disapproval. “Previous surveys by Athena, Sermo, Deloitte, the Doctors Company Survey, the Physicians Foundation, and IBD/TIPP have clearly shown that most doctors are unhappy with the direction of things, and a clear majority are opposed to the health care law” http://www.forbes.com/sites/marcsiegel/2012/08/12/will-your-doctor-quit-obamacare-foretells-mass-exodus-from-patient-care/
 

v  Like insurance companies, healthcare providers motivated by self-preservation will pin their hopes on campaign donations and lobbying.  The patient will be reduced to a “Where is Waldo” guy in a sea of insurance agents, compliance staff, lobbyists, politicians, lawyers and bureaucrats.

v  The politicking of the healthcare industry will not save them. Godzilla has the Independent Payment Advisory Board whose meager reimbursement rates for Medicare/Medicaid can now only be vetoed by a congressional super-majority. The board is Independent by design, so that it is more difficult for Congress to rebuke paltry Medicare/Medicaid reimbursement rates. Healthcare providers will skimp on money-draining procedures or face closing their doors. Skimping on money-draining procedures is rationing.

v  Citizens are told by the federal government to buy approved insurance plans, instead of arranging to pay for healthcare the way free citizens see fit. (It is worth repeating)