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)




Legislative Inflation: The Weimar Solution

Patient Protection and Affordable Care Act in physical form

As the Supreme court considers the constitutionality of the Patient Protection and Affordable Care Act (Obamacare) it is meet to consider this statute in another light: length.

The bill which famously had to be read to determine its contents is often referenced as being around 1500 pages – estimates vary.  How many pages of regulations and administrative law cases this will spawn is anybody’s guess, but the exponent will be very large.

Lengthy laws and codes are nothing new, as is s alack of consensus on the exact length The Code of Justinian was two to three times the length of the bible( I.m not sure which one) according to a cursory internet search.

The Anglo Saxon tradition seems to be a bit more pithy, and to have survived the Norman invasion as  as the Magna Carta fit on a single length of parchment, and the quite succinct United Sates  Declaration of Independence and Constitution.

Tend: Holding steady. See for more fun stuff.

But that was then.  Now there is  for example,  the monstrous United States Tax code, which metastasizes daily.  16,000 plus pages, by some counts.  That’s a lot of dead trees, but the pulp based holocaust is at least tempered by digital formatting..

If ignorance of the law is no excuse, then, at this point we are all guilty of something,

When the inflation on Germany’s Weimar republic reached a height where the denominations were simply beyond human comprehension, they did find a solution.

I would suggest the same for many of our statutes.




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.

The Commerce Clause: Herding Economic Animals into the Statist Corral

Article I, Section 8, Clause 3

(Congress shall have Power) To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes;


This same question—what are the limits of Congress’s authority under the Commerce Clause—is at the heart of the dispute over the health-care law’s individual mandate.Adam Winkler, “Daily Beast, November 11, 20011


Man is an economic animal as well as a political animal andis, therefore, born into an industrial system as inevitably as he isborn into a political state. -Henry J. Thurston, “The  Teaching of Economics in secondary Schools Schools, The School Review, Vol.4,no.8, 1896



This administration is rather big on logos.

There are plenty of amateur constitutional scholars out there; I’m not one, yet it seems to me that a little common sense and average reasoning skills would lead one to be deeply troubled by Obamacare, not just in itself, but also as proof that our governed really knows no limits, and only observes those that suit its purposes of the moment.

If the government can tell you to buy a product you may not want or need, and can tell the seller how to configure the product, what can’t the government do in any field of economic activity?

If Obamacare can tell you to buy insurance, and tell the insurance company that it must keep your children on your policy until they are 26, why can’ t the government tell you to buy an electric car, and the manufacturer that it must include GPS and a high end stereo whether you want these features or not?

No doubt it can, and may well do so one day.

If the government can tell Insurance companies what their profit margin should be, as Obama care does with the “medical loss ratio” proviso,  why can’t the government dictate what is an acceptable profit in any industry, even to the point of none at all?

Under the line of argument presented by Obamacare’s defenders, and if indeed man is an economic animal, then there is little of our behavior that  government cannot regulate.  The devil can quote scripture, and this administration can and will cite the Constitution of a government clearly conceived to be limited, in order to further its limitless ambition.