Impenetrable Care: Parsing the 2446 Pages of “Obamacare.”

Speaker Pelosi signing bill she hasn't read. She wasn't the only one, and not the first, or the last, to do so.

As have many ,I’ve railed against Congress for passing the Patient Protection and Affordable Care act without reading it. The bill famously had to be passed to find out what was in it, as Speaker Pelosi explained.

Since, like many, perhaps millions of Americans, I’m convinced I’m as smart as at least half the folks in Washington, It occurred to me that the time had come to walk the walk.  I’m going to read the whole damn thing – 2464 ages with the reconciliation – with the aim of finishing before the Supremes rule.

What do I bring to the job?  First, time. I’m retired.   This sucker is long!  A

The Emperor Justinian's Corpus Iuris is quite succinct by modern standards.

cursory search indicates that, so far, the Act runs to about 1.1 million words.  The Revised Standard Version(King James ) Bible is something  in excess of 700,000 words.  Justinian’s 7th Century code of Roman law is estimated at between two and three bibles.

I have no legal training, but rigorous high school English, four years of Latin and five of French – for that latinate legal vocabulary – and a master’s in English should help. And I spent many years in a job requiring me to read complex commercial contract language.  I am, I think, better equipped than many citizens for this task. Let’s  see if I’m up to it

 So we begin

“In the Senate of the United States,

December 24, 2009.

Resolved, That the bill from the House of Representatives (H.R. 3590) entitled ‘‘An Act to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain

other Federal employees, and for other purposes.’’, do pass with the following…”

 Huh? Homebuyer’s credit?


Strike out all after the enacting clause and insert:


2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Patient Protection and Affordable Care Act’’.

Oh,here we are. Congress does work in mysterious ways.

A fifteen page table of contents follows. Then after striking this, that, and the other thing we get to this:


 Subtitle A—Immediate Improvements in Health Care Coverage  for All Americans”

Section 2711 states that there shall be no benefit limit, either per annum or lifetime. Coverage, which may not be revoked except for fraud.   However, those benefits not considered essential under section 1302 b can be limited. Maybe. I guess we’ll see when we get to 1302(b) . Also referenced are some IRS codes. I’ll never finish this if I go and look them up as I go along.

Providers must cover

evidence-based items or services that have in

effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force.”(page 21)

Huh? Who are they?

…an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists who work under the auspices of the Agency for Healthcare Quality and Research.”

Never heard of them either? Me too. They hang out at HHS. Another to add to the collection of alphabet agencies such as BATF, ICE, and so on. I wonder if they have a SWAT tram.

‘‘(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;”

 So again, a reference to standards to beset by a government agency. At least I’ve heard of these guys, as we all have.

Here is also a philosophical question: what is the meaning of insurance, if we insure ourselves for foreseeable needs, such as childhood immunizations, or Ms. Fluke’s birth control pills? I really don’t remember, but I thin I got my shots at the doctor’s office, and my parent’s paid. In the 50s there was the polio epidemic and I remember getting the vaccine at school.

20 ‘‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guide lines supported by the Health Resources and Services evidence -informed preventive care.”


I understand every word and semiotic unit in this phrase, yet have no idea what they are talking about.

The process of distilling and disseminating the best available evidence from research, practice and experience and using that evidence to inform and improve public health policy and practice. “

Now I get it. Somebody, or, rather, a whole lot of somebodies, will decide what’s best for younger people, and that’s what they will get. Interesting that the first reference I found was in Canada.

‘‘(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.”(page 21)

Wait a minute. Health Resources and Services Administration? Another bunch?  I scrolled back and checked; Yup, first reference. So who are these folks?

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. ‘ And..”Comprising six bureaus and ten offices .


‘‘(c) VALUE-BASED INSURANCE DESIGN.—The Secretary may develop guidelines to permit a group health 7 plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs.”(page 22)

Value based?

“…the idea that consumers’ out-of-pocket medical costs should be based on the value of a service to their health rather than its price.”( From the Washington Post.)

So is that clear? I thought so.

“REGULATIONS.—The Secretary shall promulgate regulations to define the dependents to which coverage shall be made available under subsection (a).”(page 22)

The Slackercare clause

Well, well, well, no wonder insurance companies wanted in on this. This next section smacks of the industrial codes of the New Deals National Reconstruction Act.

‘‘(a) IN GENERAL.—Not later than 12 months after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to enrollees a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. In developing such standards, the Secretary shall consult with the National Association of Insurance Commissioners (referred to in this section as the ‘NAIC’), a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.”

"Your plan for coordination of industry follows precisely our lines of cooperation." Benito Mussolini, speaking in open letter to FDR, 1933.

Pure corporatism, which is a polite way of saying classically fascist: industry, advocates and qualified individuals, all working together to tell us what w e need and what we’ll get. Given current practice, those “advocates” will likely be funded in part by the government, just as the EPA funds NGOs that then sue it.

At least, that’s the way I see it.  I suspect the people who out this together view it as a collaborative effort of the “healthcare community.”

And yet another group involved, without even a name yet, but they will no doubt get plenty of office space and a snazzy web page, funding and per diems.

Pages 25-27 describe benefits summary standards. This seems harmless though rather prescriptive, but it is noteworthy that the sections preempts any state regulation.Is it really harmless? A government controlled consortium of “interestd” parties will define the language in which we describe insurance terms and medical procedures. Will they think out of the box, or box us in?

Also, there is the philosophical question: would not insurance companies that gave out fraudulent or impenetrable benefit summaries suffer in the marketplace? In making such market based objections one is in the position of howling after a train that is disappearing down the track or more accurately left before the passenger arrived,or should this legislation stand, the metaphor would be that the station is closed, and grass has overgrown the rusting rails.

I have barely reached page 30, but have already learned that the Federal government is even  more vast than I knew and is set to be even more so, beyond  imagination as that is.  This act, with its multi-aency involvement, working groups and standard setting, is set to loose great torrents of administrative law that will in time seep into every aspect of our lives  It is classically fascist in that it aims  to shepherd disparate social and economic groups to an ostensibly mutually beneficial agreement under the eye and ultimately enforcement, of the state.

The emperor Diocletian used coercion, micromanagement and a debased currency in trying to halt economic decline. Sound familiar?

The urge to control economic activity is an old one, and the record of failure for such efforts is equally ancient.

  (More to come)




Death Spiral: Kathleen Sibelius and W.B. Yeats

On 29 February,  HHS Secretary Kathleen Sibelius was on the Hill testifying as to why the Affordable Care Act is not the cause of the decline in employer provided health insurance.  When asked about the decline in employer provided health insurance coverage, the Secretary replied:*

“Well again, Congressman, what you’re seeing…  It wouldn’t have mattered if we had passed the Affordable Care Act or not. The private market is in a death spiral.”

In health insurance parlance, a “death spiral” is:

“The health insurance death spiral occurs when individuals with higher health expenses are driven by market forces towards one particular plan. The higher costs associated with individuals who have pre-existing health conditions cause premiums and out-of-pocket costs to escalate, which drives healthier individuals out of the plan, because the cost becomes too high for the small amount of need they anticipate. This causes premiums and out-of-pocket costs escalate further because there aren’t as many healthy individuals left to absorb the risk, so even more healthy people leave the plan, and prices climb even higher. This cycle continues spiraling on and on until prices are so high that the coverage is unaffordable.”.(source)

This describes Obamacare.  Of course the private market is dying.  That’s the idea.  It always was.

It is something of a cliche to quote the most well known of Yeats, but when I read the word death spiral could not but hep think of the falcon’s gyre in “The Second Coming.”

                                     Turning and turning in the widening gyre
                                     The falcon cannot hear the falconer;
                                     Things fall apart; the centre cannot hold;
                                     Mere anarchy is loosed upon the world

This administration’s attack on the insurance market is only one instance of the anarchy they have loosed  Obama promised fundamental change.  This is one promise he has kept.

                                     The blood-dimmed tide is loosed, and everywhere
                                      he ceremony of innocence is drowned;

Marx and Engels condemned the bourgeoisie in that  ” It has pitilessly torn asunder the motley feudal ties that bound man to his “natural superiors.”   That of course was what led to the great advances in human prosperity and freedom.  The modern Left wishes to sunder the ties of law and civic responsibility that have made Western  Civilization so successful,  and reestablish those feudal ties to our natural superiors, the governing class. The sundering of of ancient ties to our freedoms has been accomplished without the blood once foretold by the likes of Bill Ayers and Bernardine Dohrn, but that “ceremony of innocence,” our confident sense of self, the optimism and energy that so entranced deTocqueville, are indeed drowning.. And thus we turn to government, even for something so basic as deciding who will care for our bodies, and how this should be done.

And those who should be guarding our institutions, seem helpless, lost, or worse, indifferent, while the new vanguard advances heedless to all objection

                                   The best lack all conviction, while the worst
                                   Are full of passionate intensity.

There is no question as to the “passionate Intensity” of this administration in pursuing its goals. Indeed, the death spiral Ms Sibelius cites is an unintended metaphor for what may be yet to come, as she testified on March 2nd:

Sebelius told a House panel Thursday that a reduction in the number of human beings born in the United States will compensate employers and insurers for the cost of complying with the new HHS mandate that will require all health-care plans to cover sterilizations and all FDA-approved contraceptives, including those that cause abortions.

“The reduction in the number of pregnancies compensates for the cost of contraception,” Sebelius said. She went on to say the estimated cost is “down not up.”

On the less weighty side of things, Ms Sibleius’ comment is typical of the kind of flip accounting gimmicks that are thrown up by all sides in political discourse.  In the longer view, it is deeply troubling. The Secretary is then perhaps unaware unaware of the demographic death spiral in the old cultures of Europe, where the birthrates for native Europeans – and yes, that means whites – have long since fallen below  replacement.

Or perhaps she is, and subscribes to the notion that the shortfall in human beings can be replaced with industrious immigrants.  One need only look to Britain where population has increased due to immigration from countries with a much lower level of economic, and human development, resulting in vast welfare dependency, defiant and resistant enclaves committed to Islamic rule, and a government that submits to the demands  of the invaders for whom it threw open the gates. Such a society most certainly “lacks all confidence.”

In the U.S., births were at replacement rate as recently as 2007, after thirty- five years  below that rate, 2.2 live births per woman, necessary to maintain a population, but has since dropped again.

“The rule which we intend to promulgate in the near future around implementation will require insurance companies, not a religious employer, but the insurance company to provide coverage for contraceptives,” Sibelius told the subcommittee.

The key word is “promulgate”.  It smacks of the arrogance of imperium. The praetors of the left know best. What we have here is a whiff of the totalitarian population control fantasies of the 1970s, a leading exponent of which was  John Holden, Obama’s “Science Czar.” He has since tepidly disavowed these views( rather recently, in fact, when they came to view), but the lesson is that he was wrong then, yet this administration is once again looking to population control, and, one could say, the eugenics of Margaret Sanger, when one considers African -American abortion rates, to manage a perceived problem.

The lLft simply doesn’t like people, other than those who form their self anointed elects( and not always then, as the history of leftist purges demonstrates)  The communist regimes of Europe and Asia spoke of their love of the masses, then slaughtered them.  The soft totalitarianism of the modern left will keep them from being born.

Coda: Finally, in a story that has hardly blazed across the airwaves, The estimated ten year cost of affordable Care, according to the CBO has doubled and the impact on employer provided coverage far more severe than anticipated.  Isn’t it always so?

*On these posts, it is my habit to use only “mainstream media”  as sources.  I am often alerted to stories by “right wing blogs,” but as I hope, in my small way, to perhaps , one at a time, convince the unconvinced, I research the stories in the traditional media which, quite undeservedly, retain a reputation for accuracy and even handedness.Yet, I was unable to find any reference on to Ms Sibelius’ testimony in the alphabet services. It’s real – you can see the video here.

Obama to Congress: Buddy Can You Spare 1.2 Trillion?

WASHINGTON — The Obama administration says the federal government has nearly reached its borrowing limit – again.

Treasury officials said Tuesday that the White House plans to request another $1.2 trillion in borrowing authority Friday…(HUFFPO)

Congress to Obama:   Sure, pal.  Here ya go.  Get it back to me, well, whenever.

President walks away whistling, jauntily tossing a freshly minted  $1.2 trillion coin.

Update: I decided this really wasn’t fair, so…

President continues his walk, stops in a convenience store, buys some stuff, and then walks back to the congress and tosses out some change, 100 billion dollar coins, aiming handfuls of them at his buddies, but everybody gets some.


The original title of this piece was “Detain Lindsay Graham.”

I’m no fan of the South Carolina senator. Senators Graham(R), McCain(r), and Leven(D) are behind a piece of legislation that would designate America as part of a world wide battlefield, and allow the military to indefinitely detain Al Queda suspects wherever apprehended.  As he demonstrated during the uproar over the Florida Koran burning, Graham is no stickler on the niceties of constitutional protections.   I don’t know much about Leven, but the statute of limitations on exposing stupidity in war heroes ran out on McCain a long time ago.

When I heard abut this, I wondered why this story wasn’t bigger news  I ran across it in a comment posted to an article on more general constitutional issues on Pajamasmedia which linked me to the ACLU and the Hill.

The ACLU Had this to say:

In support of this harmful bill, Sen. Lindsey Graham (R-S.C.) explained that the bill will “basically say in law for the first time that the homeland is part of the battlefield” and people can be imprisoned without charge or trial “American citizen or not.” Another supporter, Sen. Kelly Ayotte (R-N.H.) also declared that the bill is needed because “America is part of the battlefield.”

I couldn’t find exaclty were the quote came from,and there is no citation, as there is not for the following:

In response to proponents of the indefinite detention legislation who contend that the bill “applies to American citizens and designates the world as the battlefield,” and that the “heart of the issue is whether or not the United States is part of the battlefield,” Sen. Udall disagrees, and says that we can win this fight without worldwide war and worldwide indefinite detention.

Who these “proponents” are who make these contentions is again, not stated.

And it got me pretty worried, and I wasn’t buying McCain and Leven’s clarifications in the Washington Post, as quoted in the Hill.  There was quite an uproar across the blogsphere, but when I had read a number of online takes it hit me that I was getting hits mostlyon the left, and among the Ron Paul crowd, with many claiming that this provision could be extended to any body for any reason.

So I decided to read the bill.  Here’s the money shot:


    (a) Custody Pending Disposition Under Law of War-
      (1) IN GENERAL- Except as provided in paragraph (4), the Armed Forces of the United States shall hold a person described in paragraph (2) who is captured in the course of hostilities authorized by the Authorization for Use of Military Force (Public Law 107-40) in military custody pending disposition under the law of war.
      (2) COVERED PERSONS- The requirement in paragraph (1) shall apply to any person whose detention is authorized under section 1031 who is determined–
        (A) to be a member of, or part of, al-Qaeda or an associated force that acts in coordination with or pursuant to the direction of al-Qaeda; and
        (B) to have participated in the course of planning or carrying out an attack or attempted attack against the United States or its coalition partners.
      (3) DISPOSITION UNDER LAW OF WAR- For purposes of this subsection, the disposition of a person under the law of war has the meaning given in section 1031(c), except that no transfer otherwise described in paragraph (4) of that section shall be made unless consistent with the requirements of section 1033.
      (4) WAIVER FOR NATIONAL SECURITY- The Secretary of Defense may, in consultation with the Secretary of State and the Director of National Intelligence, waive the requirement of paragraph (1) if the Secretary submits to Congress a certification in writing that such a waiver is in the national security interests of the United States.
    (b) Applicability to United States Citizens and Lawful Resident Aliens-
      (1) UNITED STATES CITIZENS- The requirement to detain a person in military custody under this section does not extend to citizens of the United States.
      (2) LAWFUL RESIDENT ALIENS- The requirement to detain a person in military custody under this section does not extend to a lawful resident alien of the United States on the basis of conduct taking place within the United States, except to the extent permitted by the Constitution of the United States.

Not only does the provision not extend to American citizens, but it also excludes legally resident aliens, and it is limited to Al Queda or Al Queda related activities.

Much of the hysteria is therefore unwonted. Now, I have never liked that term “Homeland Security.”  It sounds translated from German. And it’s funny, during World War Two  we seemed to just fine with the FBI chasing spies in the U.S., so there are issues here.

The most troubling aspect of this furor for me is that once again we see the obsession with, or diversion to Al Queda, as Islamist regimes take power throughout the Middle East, and Muslim Brotherhood sympathizers and enablers  lobby on Capital Hill.  The “moderate Islamist”   leader of Tunisia’s Islamist party Ennadha holds forth there today, hosted by MPAC(Muslim American Political Action).   Not long ago we had a young Dominican  home grown jihadi picked up by NYPD.  Whether this focus on the tatters of the force that brought down the Twin Towers is ignornace, willful blindness, a calculated and cynical ploy to make us beleive that these guys in congress are “doing something”, or a combination of all of these, I don’t know.

What I do know Is that the Obama administration’s appeasement of Islam,  the failure of the opposition party on the whole to call him on it,  and the refusal of the political establishment of both parties, the media and academia’ to address the violence at the core of Islamic scripture are far greater dangers to American security than the remnants of Al Qeda could ever hope to be.

And you can’t trust the ACLU.   I knew that.