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Our Sick System Still Needs Triage

Posted on Aug 2, 2010
AP / Charles Dharapak

Still pitching: President Barack Obama speaks about the new patient bill of rights and the health care reform act on June 22 in the East Room of the White House.

By Bill Boyarsky

Attending a meeting on the new health care law, I had to fight the urge to stand up and beg the experts to stop. They were making the issue too complicated. At this rate, nobody will be able to understand what the law will do. And this may be the fatal flaw of the ambitious program. The law is too complex for the public to understand unless President Barack Obama somehow finds a better way to explain it.

This gathering of detail-loving policy wonks in downtown Los Angeles last month provided an excellent example of the obstacles facing the president and the rest of the Democrats as they campaign in the tough midterm elections.

They are confounded by the difficulty of explaining health and the other new laws and programs enacted in the past productive two years. And this is something they must do before the Republicans win enough seats in November to dismantle what the Democrats have accomplished.

Obama made his own attempt at explanation this week in a video meant to show how to navigate the administration’s health care site, It was a good try, but he reminded me of someone from IT explaining a new corporate communications system or, worse yet, a chilly guy from HR walking employees through the next buyout.

When the health care law is fully implemented in 2014, it will cure many of the ills that plague those needing medical care. That, however, may be too long a wait for a troubled country, especially one faced with intractable unemployment and a fruitless, unpopular Afghanistan war.


Square, Site wide

I attended the health reform meeting, sponsored by the New America Foundation, to find out what’s happening with the program now that it’s the law. Some portions are beginning to take effect, and I wanted to know if it was helping anybody.

Castulo de la Rocha, who heads a community health organization in Los Angeles, said institutions such as his—which provide health care for the poor—are immediately benefiting from an additional $12 billion in funding over five years. This will permit the clinics to reach an additional 20 million patients, making a big improvement in the care of urban and rural poor.

But most of the other speakers were preoccupied with problems the new law will bring.

Hospitals will be measured on performance. Payments will be reduced to those with too many patients making return visits. Doctors will be pushed to abandon charging separate fees for each visit and treatment, which is the way medicine has been practiced for years. Expect the docs to fight back. Already they are spreading negative stories on how the health plan will play out.

Yet, positive things are happening now. High-risk insurance pools with policies for those with pre-existing medical conditions are beginning operation. Children 26 and under are now included in parental health insurance policies. Co-pays for many preventative services are banned in new policies. The law sets up a government program to provide funds for employers to continue insurance for those forced to retire at 55. It gives a $250 rebate to Medicare recipients reaching the “doughnut hole” in drug coverage. Small businesses will be given tax credits for offering employees health insurance. A report from Families USA and Small Business Majority said 4,015,300 small businesses, 83.7 percent of all small businesses in the country, will be eligible this year. 

Unfortunately for Obama, the major portion of the law does not take effect until halfway through his second term—if he wins re-election. That phase will involve the opening of insurance exchanges in which individual consumers or small businesses can shop for health insurance policies without most of the restrictions that now confront consumers. Americans would be required to buy health insurance, but the government would subsidize policies for those with low incomes.

Obama knew health reform would be a tough sell. Jonathan Alter in his book “The Promise” quoted the president as saying, “I remember telling Nancy Pelosi that this could end up being so costly for me politically that it would affect my chances if I were to run for reelection.” He went on to say that if it didn’t pass now, “it wasn’t going to be done.”

The Democratic dilemma is this: The administration has accomplished much—health care, a limited toughening of financial regulation and a huge bailout that probably prevented a depression—all of it hard to explain.

A July poll by the Kaiser Family Foundation shows that doubters can be converted. Fifty percent of those surveyed now support health reform, while those looking at it unfavorably have dropped from 41 percent to 35 percent in the past month. But support from the high-voting group of those 65 and older remains weak, with 46 percent viewing the plan unfavorably and 38 percent favorably.

The economy rather than health care will probably decide the election. Health care will be a factor in close races, however, which is why Obama and the other Democrats have to sell it in a strong and simple manner.

The same is true with the administration’s other accomplishments. If the Democrats fail to make that sale, the Republicans will win the Senate and the House and begin their assault on everything Obama and his party have accomplished. That will be the prelude to what has been the Republican goal from the beginning: driving Obama from the White House and reversing what he and Senate and House Democrats have accomplished, including health care reform. And that would return us to where we were—or worse. Remember Sarah Palin?

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By Old Man Turtle, August 6, 2010 at 6:23 pm Link to this comment
(Unregistered commenter)

“Tobysgirl” testifies wholeheartedly to the natural fact that despite all efforts to
prevent it our essential Humanity just keeps intruding into the meant-to-be-
completely-sterile institutional environment like grass through the cracks in
cement.  It’s a damn good thing it does some real good in the process, too.

Report this

By Tobysgirl, August 6, 2010 at 3:46 pm Link to this comment

I agree with you, Old Man Turtle, about genuine health. I find it sort of sickening that many people think they can somehow be healthy while living in a violent society bent on destroying the Earth.

But I don’t deny the genuine caring one can experience when one is helpless and very ill. I never thought much of doctors, but the surgeon who saved my life in 1995 seems to me a truly caring person. And many, many nurses are excellent caregivers and advocates, including my own husband. I, too, believe in a totally different sort of society, but I have to live in this one, and I don’t want anyone to have to live for six weeks with a broken leg and no care. At least the hospital I went to cared for me in spite of my having no insurance and accepts my $20/month payment toward my huge bill.

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By Old Man Turtle, August 6, 2010 at 10:31 am Link to this comment
(Unregistered commenter)

If our health is a function of our Community (“Tobysgirl” seems to agree that it
is.) and sickness a disfunction of the domesticated peoples’ “individual”-ity
(She appears not to be there, yet.),  then repairing the rough break of a
community member falling off a roof or picking up the pieces after pickup
wrecks (to borrow her own examples) will be taken-care-of freely by actual
Living Human Community Members.  It is only isolated (from the Natural Living
Arrangement) “individual” IDentities who will be in-the-market for the cold
comfort and crippling in(?)-convenience of “medical insurance” anyhow.  Us
free wild Human Beings have neither need nor use for such false profit-
centered ponzi schemes. 

Besides, the minute “money” is involved, any genuine care delivered and
received will itself be purely accidental and quite despite the intentions and
purposes of the “system”  processing the “claim.”  The cheap imitation plastic
substitute for genuine CARE the current charade pretends to provide is all it
ever has been or is or will be “good”-for.  Which is to say, in the language of
organic functional integrity, “absolutely nothing,” just like WAR.

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By Tobysgirl, August 5, 2010 at 7:46 am Link to this comment

Thank you, gerard. I read the comments on the billionaires article and felt hopeless. I didn’t read Nader’s book, but in my opinion only the ORDINARY NOBODIES can “save” us.

I agree with you, Old Man Turtle, about health, but if you slip off your roof while repairing it, you need some sort of care! If some idiot (and New England is full of them) drives his truck into your vehicle, you might need care! It isn’t genuine health, but it sure is nice to be able to have someone care for your injuries, unlike a woman who was turned away by the local hospital and waited six weeks to find another hospital to set her broken leg.

I’m still paying for lifesaving surgeries done in 1995 and 1996, so welcome to the club of the uninsured!

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By gerard, August 4, 2010 at 5:51 pm Link to this comment

I’m very curious about a very “current event.”  Headlinss in Fortune Mag and Yahoo news announce that 40 billionairs have pledged to give “the majority of their wealth” to “charity.”
  If you go to the AP News,or Fortune Mag, site, you can find the names of the 40 so far and the fact that Warren Buffett is heading up a campaign to enlist billionaires worldwide. Letters from pledgers are online.  I read a couple that expound on the duty and benefit of charity etc. etc.  No doubt a ton of money will be siphoned into this and that private and public charity according to the decisions (whims?) of the givers.  A sarcastic article on this movement appears currently on Counterpunch.
  The general idea was posed last year by Ralph Nader in a book he wrote called “Only the Rich Can Save Us.”  The difference between his proposals and the current campaign is that he formulated a dream-plan for how to organize the giving rather than just solicit rich people for money.  But the idea comes from him, though online he seems to get no credit for it.
  I’m curious.  Do these wealthy individuals see anything wrong with the system under which they accumulate billions?  Do they recognize how their profuse profits on investments and their sharp management of funds, interest rates etc., actually contribute to the poverty they later try to alleviate with donations?  Do they understand at all how the general level of opportunity needs to be opened up and the rich getting richer (via exploitation of materials and labor) and then giving their money away does not solve the enormous problems of poverty and exploitation at the root?  Do they even care?

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By - bill, August 4, 2010 at 5:07 pm Link to this comment

Wow, Bill - your referral to “the past productive two years” tells us pretty much all we need to know about your delusions.

Two years with strong Democratic majorities in both houses of Congress plus a Democratic president with exceptional rhetorical gifts and all we got was this complete capitulation to the insurance, pharmaceutical, and hospital industries as the ‘health-care reform’ on which Obama campaigned?  Back in 2003 he told us that with such a government we would get a single-payer solution, but we didn’t even get the watered-down ‘public option’ (plus drug reimportation to curb prices and no mandates) which he used to help get himself elected (and them promptly abandoned after they had served that purpose).

Democratic Congressional majorities in 2006 didn’t slow down our enthusiasm for war one bit - nor did even greater majorities in 2008 with a Democratic president.  And now you claim we need MORE Democrats in office?

I think not:  I think we need far FEWER Democrats in office, to the point where the current national Democratic establishment has been completely destroyed and we can then start electing REAL Democrats to start turning the country around.

I’ll be voting Republican for national offices in November for the first time since reaching voting age in 1968, and continuing to do so until the above goal has been accomplished or I’m given REAL progressive new Democratic faces to vote for (I might make one exception if I lived in Dennis Kucinich’s district, I suppose).  If that means voting for Sarah in 2012, so be it:  establishment lapdogs have been holding up the specter of the Republican alternative to try to convince me that I have to vote for Democratic sellouts far too long for that threat to have any power over me now, and the prospect of some short-term Republican pain is well worth putting up with for the hope of longer-term improvement in the only party that MIGHT become worth supporting if we force it to.

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By Midnight, August 4, 2010 at 10:31 am Link to this comment
(Unregistered commenter)

There will be many problems with implementation.
For example, the Pre-Existing Condition Insurance Plan
(PCIP) for the most part will be administered by the states.  California states"currently, we do not have applications for the PCIP….we will place your name on the list for a PCIP application when they are available in THE NEXT MONTH OR SO.
CA advises that California’s Major Risk Medical Insurance Program is in existence—a program developed with the insurance industry—so try it!

As usual health insurance is available for the healthy—-  health insurance is not available
for the unhealthy.

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By ron hansing, August 4, 2010 at 8:10 am Link to this comment
(Unregistered commenter)

I gave our Senator McCaskil in Missouri, 25 reasons why the health care bill will be a colassal failure.

It doesn’t really do any good to mention them, because no one will listen anyway.

So, what’s the use… I will just sit back and watch.

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By Gloria Picchetti, August 4, 2010 at 7:50 am Link to this comment

There will never be real health care reform until the senators & the congressmen (frankly all elected officials) pay for their own health insurance.
What did they reform? They, those who get free insurance, made it possible for me to choose between eating or buying a mandatory health insurance policy.

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By MeHere, August 4, 2010 at 7:17 am Link to this comment

One doesn’t need to thoroughly know the details of this complex plan to make a
guess as to how it will work out. It’s enough to know that the big insurance and
pharmaceutical businesses will continue to operate basically as they’ve always
done, with phenomenal profits. More people will be insured but the already
deteriorated quality of care will probably continue or get worse.  It’s interesting to
notice that the emphasis is on being “insured” rather than on providing good
health care for all. Expect more trouble down the road.

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By E, August 3, 2010 at 4:19 pm Link to this comment
(Unregistered commenter)

I’m one of the lucky ones that doesn’t have health care. I started losing a whole ton of weight over a really short period of time, had to go to the ER twice in one week due to dehydration. Then to a gastroenterologist, an imaging center for a CT Scan, then back to a GP,and now am headed for a urologist.My bills are nearing about 10,000 dollars, I’m waiting on a program through the hospital that pays for all of my bills, but so are about 20,000 or so more, or so the lady says. I’ve also applied for our state health care, it’s a lottery system right now, and apparently there’s almost a million people lined up to get it.  Meanwhile, I’m still sick ,and we’re still blowing 20 billion a month on war. Screw Obama, and screw every other politician in office. Vote them all out, no wait, it’s time for a revolution.

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By RayLan, August 3, 2010 at 4:11 pm Link to this comment

too little too late- There is no Health Care reform without a public option - it’s nice that pre-existing conditions won’t disqualify - but the private insurance companies will find a way - since they are out for maximizing profits - that is the overriding reason for public health care - sickness should never be marketable commodity.

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By textynn, August 3, 2010 at 3:50 pm Link to this comment
(Unregistered commenter)

It’s complicated because they want to make sure that the Havemores can get their hands on every last asset or property those that can’t pay full price have.

All it is, is an extension of Welfare to a larger pool of people. Which you can’t get until you have nothing left to sell. To qualify with poverty includes everything you own, down to the last rusty car out back of your parent’s house in your name. 

If you need it explained to you, just find an impoverished person on Welfare. They can explain it to you down to the complete oversight of your entire life and all the paperwork and signatures of pretty much everyone you know including landlords, employers, and employers of everyone in your household for a start.

Enjoy Dem voters , you’ve just been served up to the system.

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By ocjim, August 3, 2010 at 1:25 pm Link to this comment

How do you explain that we sold out to big pharma and health care giants long ago and that the reform is just an extension of that sellout.

We now pay some 31% of health care costs in the form of administration, including fat salaries and payoffs to CEOs, profits and dividends—all on our backs. Our health care costs are heading toward 20% of GDP.

Explain that to a public that doesn’t want to think.

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By FRTothus, August 3, 2010 at 12:39 pm Link to this comment

If the administration wanted something that could be easily explained, Single-Payer, Universal Health Care (not insurance-industry care) would have provided it.  But explaining to the public why they have been thrown overboard at the behest of for-profit corporate interests will take some doing, and therefore requires a “tough sell”. 

What has never been a part of this “debate” is why the public does not deserve the same socialized care that members of Congress receive, or why we are expected to pay for this out of pocket, why it is still connected to employers, or why the taxes we already pay are not enough after filling the black hole of Pentagon spending and lavish corporate welfare.  A country that is rich enough to bail out every failed corporation, every banker and bond-holder’s loss from risky investments, and relentlessly protects the wealthy from the allegedly “free market” that closes plants at home and exports jobs overseas, that rewards the greed and avarice of the few at the expense of the many, destroys the environment, wrecks the livelihoods of millions of citizens, somehow never has any money left over to take care of anyone not in the business of death.  The thing is, government expenditures are from OUR money.  Where is it written that our government is supposed to make a profit?  It is OUR money, and how we spend it, or how much we are able to “borrow” against our own future earnings, is, or would be in a democratic republic, our decision.  Should we choose to “waste it” on providing our people with health care, decent housing, and a secure retirement, rather than really waste it on endless wars and massacres for elite profit and hegemony, well then that’s our right.  But then this is apparently not a democratic republic, because our rules don’t give a damn about us, or what we want.  What we have is the top-down rule of an elective dictatorship intent on pleasing their corporate patrons, not the ground-up decision-making that provides for the common good our fictitious textbooks and national myths insist we have. 
Had we a President with backbone, he would have put before Congress an ultimatum (as Kucinich suggested in the Primaries he would do if he was elected) to either extend Single-Payer to all US Citizens, or the US Congress, chock-full of hypocrites and corporate appeasers, would lose theirs. Period.
That’s what a real leader would do.

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By Old Man Turtle, August 3, 2010 at 11:06 am Link to this comment
(Unregistered commenter)

If “civilization” itself is a form of disease (It is.), and “individual”-ity is its primary manifestation among Humans (It is.), then anything at all to do with institutionalized “health care” is not simply divorced from reality, it is in mortal combat with it.  So it’s no wonder, really, that such a fundamentally false “premise” generates so much meaningless sound-and-fury.

For Human Beings (the same as for every other Kind here) our health is a function of our natural organic form, with its own given function essential to the health of our Mother Earth and Her Living Arrangement.  Trying vainly to produce a “healthy individual” is conceptually oxymoronic, and absolutely guaranteed to be a more-and-more painfully terminal exercise in abject futility.

For our tame Sisters and Brothers it is only a question now of whether they can kill their aberrant “selfs” before those “selfs” kill them.  That so many, however, actually worship their sickness makes their prognosis pretty grim.

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By felicity, August 3, 2010 at 11:00 am Link to this comment

The Kaiser Family Foundation also predicted that
under so-called health care reform, in the near
future health insurance will cost a 60-year old woman
$10,000/year - needless to say we’re looking at
zillions of government dollars being needed to
subsidize most 60-year old women, not to mention a
lot of the rest of us.

Not a revelation or even a surprise given that the
health-insurance consortium wrote most of the reform

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By Justin Weleski, August 3, 2010 at 10:01 am Link to this comment

Obama is having a difficult time conveying the
beneficial aspects of the health care bill because
the bill does little more than tinker around the
edges of a monstrous, for-profit health care/health
insurance system.  The system itself is ravenous and
extractive.  No amount of minor fixes and amendments
will change the very basic fact that large
corporations make obscene amounts of money by
providing and denying health care services to
American citizens.  Health care/health insurance
corporations have a fiduciary duty to their
shareholders, not patients.

That is the elephant in the room.

Instead of challenging corporate America’s death grip
on the health of the American public, Barack Obama
chose to implement a number of “feel good” reforms
while further cementing the status (and customer
base) of our nation’s health care/health insurance

He sold out to his corporate donors.  That’s all
there is to it.  Anyone with a fully functioning
brain realizes this, and no amount of apologetics or
scare tactics (“Remember Sarah Palin?”) will change
this very basic fact.

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By gerard, August 3, 2010 at 9:33 am Link to this comment

Considering how far behind in national health care we have been for so long, and what a bloody battle it was to get what we now have, it would seem wise to accept the present situation and build on it. The politics of the country are rigged to demand compromise with conservatism, and that’s not likely to change much until the economic “system” is brought under the control of more just laws.
  As the Republicans are known to oppose every law that benefits the general public, we can assume that building on what health care we now have will not occur in another Republican administration, but instead we will regress to a lesser state of punishing the poor again.
  Theoretically I regret it, but practically, I’ll vote Democratic—again.

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By callahan, August 3, 2010 at 8:59 am Link to this comment
(Unregistered commenter)

We already have an excellent,cost-effective program for delivering medical
care—Medicare. Instead of building on this successful template, Obama chose to
reinvent the wheel with his HCR legislation written mostly by the insurance

Agreed, it didn’t help his credibility that after telling Medicare for All advocates all
year that he needed 60 votes to get anything through the Senate, lo and behold he
goes ahead and passes healthcare with the 51 vote reconciliation process—but
didn’t bother to improve the bill at that time.  As Sen. Feingold pointed out, the
bill that passed is the one the President wanted all the time.

Come on, they treat the public like rubes and they expect anyone to support them? 
Good luck with that.

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adc14's avatar

By adc14, August 3, 2010 at 8:24 am Link to this comment

The bill has no cost controls. Someone explain to me how you pay premiums without an income? Come 2014 I’m willing to bet even more people will be uninsured than we have presently. It’s been my experience that a policy’s complexity is inversely related to its effectiveness. What’s so galling about this is it was completely unnecessary. We already have an excellent,cost-effective program for delivering medical care—Medicare. Instead of building on this successful template, Obama chose to reinvent the wheel with his HCR legislation written mostly by the insurance companies. It’s a cynical piece of work that was designed to maintain the status quo while APPEARING to be helping the people. The Dems deserve to pay for this rubbish. I have no sympathy for Oboover.

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By balkas, August 3, 2010 at 6:13 am Link to this comment

Curioso appears that congress-WH-judiciary do not call US healthcare system the greatest ever. They do proclaim that US is the best country in the world with a perfect constitution, jurisprudence, etc., but dared not proclaim the greatness of US healthcare system.
It is merely called a reform!
So, we do have God Bless America! But not God Bless Sick America? tnx

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By diman, August 3, 2010 at 6:07 am Link to this comment

What your system needs is euthanasia!

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By chris, August 3, 2010 at 5:27 am Link to this comment
(Unregistered commenter)

FYI regarding CNS news from the “about us” link

“...Study after study by the Media Research Center, the parent organization of, clearly demonstrate a liberal bias in many news outlets – bias by commission and bias by omission – that results in a frequent double-standard in editorial decisions on what constitutes “news.”...”

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By FiftyGigs, August 3, 2010 at 4:49 am Link to this comment

Here’s another opportunity for cynical liberals to undermine themselves—oh, woe is you—and help usher in another conservative era of everything liberals want… lots of victimization.

It is incredible that it comes as news to liberals that one bill, even a massive bill, isn’t enough to do the job. Have liberals just gotten lazy or stupid?

To achieve our goals, we need to keep conservatives out of power. It’s that simple, and guess what? We’re mostly there. Shrink Republican presence in Congress and push through more bills, like oh, i don’t know, single payer maybe?

How in the world do you plan to get that under conservatism?

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By ardee, August 3, 2010 at 2:39 am Link to this comment

Considering that, as a nation, we rank #37 in the world in the providing of health care to our citizens, one might surmise that this law will do nothing to raise our ranking.

The law is certainly not all bad, as the article ( barely) touches upon. But, what is needed is not a cosmetic fix far too concerned with maintaining Insurance Industry profits but a complete tear down and rebuild, one that puts the patient before the profit..

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BarbieQue's avatar

By BarbieQue, August 2, 2010 at 10:38 pm Link to this comment

>>“When the health care law is fully implemented in 2014, it will cure many of the ills that plague those needing medical care.<<”

Well hopefully it will help people that need medical care that are not now getting it. One of the biggest problems is that there is no real mechanism or incentive to keep or lower prices (Buy pills from Canada? Nope). This is why a public option was and is needed.

>>“Americans would be required to buy health insurance<<”

Once again, where does the Federal Government get the authority to mandate that Citizens purchase health insurance, or anything for that matter?

They say (sometimes, each “official” seems to have a different explanation depending on when they’re asked) the Commerce Clause!

The Commerce clause now is used to mandate the purchase of a good or service.

Never before in history.

And they don’t even have their stories straight.

For those of you that may mock concerns about this unprecedented intrusion, let me ask you—

You won’t have a problem when a (R)epublican uses the Commerce Clause to mandate the purchase whatever they think is worthy, from a For Profit company, with no public non profit option. Maybe Ammo and a 12 gage shotgun since some studies show it’s useful for self defense?


Here’s Nancy Pelosi trying not to answer the authority question:
Pelosi Says: ‘Are You Serious?’

Feinstein said: “Well, I would assume it would be in the Commerce clause of the Constitution…”

Here’s a good one:
House Judiciary Chairman Says Constitution’s Non-Existent ‘Good and Welfare Clause’ Authorizes Congress to Force Americans to Buy Health Insurance

Apparently CNS news was and is one of the only news organizations in the country that are bringing this up. Why is that?

Is it just that the Mainstreamers are just good little lapdoggies? Or maybe it is impossible for them to begin to understand that this country has a law of the land. Or, did.

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By ofersince72, August 2, 2010 at 10:00 pm Link to this comment

You can’t spin this law good no matter how hard it
is tried..

  The so called 20billion sure hasn’t hit anywhere around
here and there has been no added medicade.

2014,  ho hum,  we don’t know , except manditory
pay money to legalized thievery.

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By Andy J., August 2, 2010 at 9:38 pm Link to this comment
(Unregistered commenter)

The reason they’re making it sound too complicated is because it is too complicated. The Democrats had to put us all through incredible contortions, and waste billions of dollars we need for other purposes (infrastructure, green energy, jobs) so they could preserve the inefficient, immoral for-profit ‘health’ industry.

Preserving the profits of corporate parasites is more important than our actual health, middle class prosperity, and national solvency? Give me a break. Epic fail.

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