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Yeah. As always, I give the Obama administration the benefit of the doubt with regards to intent, but I've increasingly come to feel that the Administration stepped wrong with this provision, and has created quite the mess, on moral, policy and political grounds. I'll say again--it's not just bad politics, it's morally troubling.
ADDED: I've been thinking this over a great deal, and I really should clarify a few things. I do not feel that the Obama administration has some deep desire to crush religious liberty, or dismantle Catholic hospitals and charities. I understand that it is a tough call in dealing with providing access to contraception-keep in mind that this measure does not force people to buy contraceptives. I agree with others that this probably was a genuine policy judgment, and the Administration misjudged the politics. The thing is, I still find the prospect of forcing religious organizations to pay for things that violate their consciences morally problematic, and I hope the year grace period will be used to straighten this out, as I don't see how this stands as is.
The Physician's Oath says:
I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practise my profession with conscience and dignity; the health of my patient will be my first consideration;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession; my colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honour.
Now, there are many variations of this oath, and I'm not sure this is the one that doctors have to take, but there is supposed to be a code of medical ethics. I guess Jack Cassell has no problem following through on that code, unlesss you happened to have voted for President Obama, that is.
ADDED: Based on the link Jim provided, this looks like a non-story at this point, as long as there's no actual denial of care.
When I first read that President Obama had appointed Utah law professor Scott Matheson to a position on the 10th Circuit court of appeal, I was as suspicious of the timing as most Republicans, given that Matheson's brother (Jim Matheson) is one of the Democratic Congressmen who has previously voted "no" on the healthcare reform bill pushed by the President and Speaker Pelosi. Coming in the midst of a major arm-twisting movement by the House leadership to pass the Senate version of the healthcare bill, it certainly had a certain aroma of pay-off to it, particularly when considered in conjunction with Admiral Sestak's apparent admission that the Obama Administration offered him a high-level job in return for withdrawing from a primary election challenge, allegations surrounding former Gov. Blagojevich, and similar incipient scandals.
But having read Prof. (former Judge) Paul Cassell's Volkh Conspiracy post on Scott Matheson's appointment, I am convinced that there's nothing to see here. Cassell confirms, from personal knowledge, that the vetting process for Matheson has been underway for several months now. Since he is a colleague of Matheson's, Cassell was contacted by the ABA as part of their evaluation process in mid-January. As Cassell notes: "Given that the ABA was evaluating Scott in roughly January, one would expect an announcement roughly six weeks later – exactly as happened here." Cassell also notes that he considers Matheson exceedingly qualified and as moderate of a judicial temperament as one could ever expect to be nominated by a Democratic president.
Cassell is not the only person in the world who would be familiar with the normal delay between ABA evaluation (which happens after the FBI background check) and public announcement of the appointment. The mere fact that the vetting process had begun so long ago is a solid indication that the nomination is no attempt at bribing Rep. Matheson.
Moreover, failing to make the public announcement would look even worse. Imagine that the healthcare vote were to happen in 2 weeks, and THEN Matheson's brother was formally nominated. If Matheson had switched his vote to "yes" just days BEFORE his brother's appointment, then the cries of payoff would be outrageously loud. Somebody, probably the GOP staffers for the Senate committee on judicial appointments, would be aware that the nomination was held up longer than the normal process, and that would be used as evidence that the President was keeping it in his back pocket to ensure compliance by Rep. Matheson.
So, having started the vetting process in January, or perhaps before, Pres. Obama was then in a damned-if-you-do, damned-if-you-don't situation. If he waited to release the nomination until after the healthcare vote, that would have looked like a pay-off (if Rep. Matheson switched his vote to yes), and if he released it now, it would still have looked like a pay-off (the only difference in the two cases being which party to the bribe bears the risk of the other party not fulfilling his end).
Prof. Cassell's insight and analysis has convinced me there's nothing to see here, and those opposed to Obamacare passing should keep their powder dry for other, more important issues.
It's over. Coakley has conceded.
There are a great deal of outrageous criticisms against the current health care reform plan, and there are a number of really good ones. This, by Bob Herbert (no foolin') is one of the good ones:
The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.
Which is exactly what the tax is designed to do.
Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.
Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.
Read the whole thing. As much as I want health care passed, this is not a good thing, and it's not the only problem.
David Frum did this nation a great service in lighting the fire under the Miers nomination. But this is just sad. Most of Frum's misbegotten arguments and outright errors (that, for example, the Constitution doesn't authorize Congress to create—one might even say ordain or establish—inferior federal courts) are taken apart by Ace of Spades, but just a couple more notes to add.
1. Is Obamacare unconstitutional? It may be, in part or whole. Or it may not be in any regard. The one claim that would be truly ridiculous is the one Frum makes: that it is "unquestionably constitutional." Quite aside from the fact that it's being debated, and regardless of which way you or I might lean on the question, how could any bill that has not yet assumed its final dimensions be "unquestionably constitutional"? Until the House and the Senate agree on a bill, we can only speculate on what will be in it.
2. Frum cites Helvering v. Davis, 301 U.S. 619 (1937), for the proposition that Constitutional objections won't "impress the courts" because they "have consistently held that the general welfare clause of the Constitution empowers Congress to create social welfare plans based on compulsory contribution." But Helvering neither tackles the specific objections raised by DeMint et al nor covers the gamut of possible Constitutional attacks on Obamacare.
The objection raised by DeMint et al is that a federal mandate to buy a product from a private company is novel and unconstitutional; Helvering said nothing about such a mandate, merely that the general welfare clause authorized the Social Security Act. As Ace of Spades points out in the link given above, there is a vast difference between creating a government program in which all citizens participate and requiring all individuals to purchase something from a private provider. (Someone might object that the government mandates that you purchase car insurance from a private provider. But that is imprecise: state governments condition the individual's choice to drive a car—not everyone drives! Crawford v. Marion Co. Election Bd., 472 F.3d 949, 955 (7th Cir. 2007) (Evans, J., dissenting) aff'd, 128 S. Ct. 1610—on the purchase of such insurance. No one is required to carry car insurance.) So if Helvering is truly "the most relevant case," as Frum maintains, then Frum has no on-point case.
What's more, while Helvering's holding is too limited to support Frum's claims, the opinion itself acknowledged limits to its dicta. While Congress has the power to spend for the general welfare, "[t]he line must still be drawn … between particular and general. Where this shall be placed cannot be known through a formula in advance of the event. There is a middle ground or certainly a penumbra in which discretion is at large … [and] belongs to Congress, unless the choice is clearly wrong, a display of arbitrary power, not an exercise of judgment." 301 U.S., at 640 (emphasis added). The text passed by the Senate runs to some two thousand pages and was introduced six days before its adoption on a caucus-line vote. It would be hard to imagine a recent act of Congress that was more obviously an act of arbitrary power rather than judgment. And even if you don't accept that reasoning, it is clear that Helvering—Frum's best case—stops far short of slamming the door on any challenge to Obamacare.
3. Frum castigates DeMint's argument as "rest[ing] upon the ancient theory of enumerated powers. Under this theory, Congress may do only what the Constitution specifically authorizes Congress to do." That word "specifically" is the giveaway that Frum is burning a straw man. This sounds more like strict construction than enumerated powers to me. What was settled in cases like M'Culloch v. Maryland, 17 U.S. 316 (1819), was not that Congress is omnipotent, as Frum seems to believe, but rather, that the Constitution's grant of powers to Congress includes both explicit ends and the implied means to accomplish them. The sweeping clause says so in as many words. If Frum is having difficulty conceptualizing this, he might want to consider reading Justice Scalia's concurrence in Gonzales v. Raich, 545 U.S. 1 (2005), which explains it pretty clearly.
4. Whether it's strict construction or enumerated powers, Frum seems to think that "[t]he heart went out of the theory in 1805, when then President Jefferson purchased Louisiana from the French in 1805 [sic.]," because "[t]he Constitution had said nothing about THAT either." Really? Only by feigning a construction so strict that you want to put a habit on it and call it Sister Mary Stigmata. The Constitution vests the executive power, a power that had always included the power to negotiate and conclude agreements with foreign nations, in the President. As OLC put it in 2001:
the purpose of the enumeration of executive powers in Article II was not to define and cabin the grant in the Vesting Clause. Rather, the Framers unbundled some plenary powers that had traditionally been regarded as "executive," assigning elements of those powers to Congress in Article I, while expressly reserving other elements as enumerated executive powers in Article II. So, for example, the King's traditional power to declare war was given to Congress under Article I, while the Commander-in-Chief authority was expressly reserved to the President in Article II. Further, the Framers altered other plenary powers of the King, such as treaties and appointments, assigning the Senate a share in them in Article II itself. (10) Thus, the enumeration in Article II marks the points at which several traditional executive powers were diluted or reallocated. Any other, unenumerated executive powers, however, were conveyed to the President by the Vesting Clause.
See also Am. Insurance Co. v. Canter, 26 U.S. 511, 542 (1828). Sure, Jefferson had worries about the Constitutionality of the deal, but his attorney general said otherwise, see Samuel Miller, Lectures on the Constitution of the United States 128 (1893), and I don't think I'm breaking new ground in suggesting that Thomas Jefferson's grasp of what the Constitution did and didn't authorize was never particularly impressive. (Jefferson, the Yogi Berra of the founding generation, is truly the most overrated of the early Presidents.)
* * *
Frum is certainly correct that "laws can be unwise without being unconstitutional." Sometimes they are both. Where Obamacare falls on that scale is not a question that can be answered ex ante, still less in vacuo as Frum would answer it (DeMint et al were at least objecting to a specific text). Nor can it be answered by overreading cases like Helvering or misconceiving (or misrepresenting) "200 years of constitutional history…."
Nelson cut a deal so far short of the Stupak language in the House that the National Right to Life Committee is going to score the cloture vote on the bill as a vote to subsidize abortion on demand. That won’t matter to anyone in the Senate, but it could have a major effect in the House. After her initial 220–215 victory, Pelosi can afford to lose only two net votes. Bart Stupak has declared the Nelson language unacceptable and vows to oppose the final bill if it doesn’t include the restrictions contained in his amendment. As John McCormack points out, earlier in the year Stupak was part of a bloc of Democrats who wrote a letter to Pelosi saying they’d stand against “any health-care-reform proposal unless it explicitly excludes abortion from the scope of any government-defined or -subsidized health-insurance plan.” Eleven of those signatories voted for the House bill.
Then there’s Joseph Cao, the Louisiana Republican who voted for the bill at the last moment during the first House vote but has said he would vote against the bill — even if doing so might cost him his seat — if it funds abortion. Surely, not all of the Stupak Dozen have that level of commitment. The full weight of the Democratic establishment will come crashing down on them if they threaten the bill. Still, it would take only two or three of them to upset the entire effort. One option would be simply to give them what they want. But will Barbara Boxer stand for the Stupak language in the Senate? This has been a devilish dilemma for the Democrats from the beginning, and it hasn’t gotten any easier as the stakes have gotten higher.
I remain skeptical that the Stupak backers will display any more backbone than Senator Nelson; whether they will be bought or buckle of their own accord remains to be seen. Nevertheless, Lowry & Costa's point about Pelosi's limited maneuvering room is well-taken, a fortiori given that "[n]o fewer than 60 liberals in the House imprudently made a pledge to oppose a bill without a public option." Suppose that Stupak himself and Cao are the only two to change their votes over the abortion issue: any single Democrat in the House can then step forward to claim the bounty offered by Howard Dean, Hamsher, et al. for this bill's head. Is there not one Democrat in the House as stupid as that shower? Really? Not a single House Democrat who might read this and think to themselves "I could really parlay a no vote today into a lot of netroots cred and thus money/name recognition in 2012"?
Just in case it hasn't been sufficiently clear to which mast my colors are nailed, I'm for scuttling the entire effort and starting from scratch. Even if one were to agree with the premises that animate the Democrats' efforts, the astonishing manner in which the bill now under consideration has reached the Senate floor over the last week is reason by itself to abandon ship. Whatever product emerges cannot possibly have received the level of scrutiny that ordinary legislation should receive as a matter of course, let alone the level demanded by so extraordinary and far-reaching legislation as this. Massive and intricate reforms are incompatible with the sort of brute-force legislative haste we have seen in recent days.
The explanation for this vast collective flip-flop is—have you guessed?—politics. Medicare recipients are much more likely to vote Republican than the uninsured who would benefit most from the Democratic bills. In 2003, Karl Rove was pushing the traditional liberal tactic of solidifying senior support with a big new federal benefit, don't worry about how to pay for it. Today, GOP incumbents are more worried about fending off primary challenges from the right, like the one Grassley may face in 2010, or being called traitors by Rush Limbaugh. But what happened the last time they were in charge gives the lie to their claim that they object to expanding government. They only object to expanding government in a way that doesn't help them get re-elected.
Consider this story. Whole Foods CEO John Mackey writes a reasonable op-ed in the WSJ, criticizing Obamacare. I don't agree with all his points, but his argument is reasonable and thoughtful. Apparently, certain hysterical lefties have declared him a traitor, and have launched a boycott of Whole Foods. Hysterical.
This story gets more interesting, because Althouse wrote a blog post on this, and the not-so-moderate way the Moderate Voice handled this. Then, there was this, where the TMV took issue with being accused of endorsing a post on their own blog.
The way I see it, the boycott is totally irrational, as Mackey said nothing that deserves such an overreaction. Also, if you allow it on your blog, you're responsible for it--guest post or not. One needs to be mindful of those voices, even those you may not agree with, that may appear to affect your moderate reputation. Not to mention one's choice of language (the voice has to be moderate).
In other words, boycotting a store chain because the CEO wrote a dissenting op-ed isn't moderate. It's hysterical.
In short, Whole Foods is everything leftists talk about when they talk about “corporate responsibility.”
And yet lefties want to boycott the company because CEO John Mackey wrote an op-ed that suggests alternatives to single payer health care? It wasn’t even a nasty or mean-spirited op-ed. Mackey didn’t spread misinformation about death panels, call anyone names, or use ad hominem attacks. He put forth actual ideas and policy proposals, many of them tested and proven during his own experience running a large company.
Is this really the state of debate on the left, now? “Agree with us, or we’ll crush you?”
As to that last point, for certain Lefties, I guess it is. Whole Foods seems to be the left-wing model of a good corporation, the anti-Wal-Mart, if you will. And then the CEO dissents from the party line, and the company is now evil, and must be destroyed?
This proves that irrational, ideological hysteria is a bipartisan disease.
Eugene Robinson, on how Obama may have laid a trap for himself in selling his plan:
But reform is being sold not just as a moral obligation but also as a way to control rising health-care costs. That should have been a separate discussion. It is not illogical for skeptics to suspect that if millions of people are going to be newly covered by health insurance, either costs are going to skyrocket or services are going to be curtailed.
The unvarnished truth is that services are ultimately going to have to be curtailed regardless of what happens with reform. We perform more expensive tests, questionable surgeries and high-tech diagnostic scans than we can afford. We spend unsustainable amounts of money on patients during the final year of life.
If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending. It's irresponsible for politicians, such as Sarah Palin, to claim -- outlandishly and falsely -- that there's going to be some kind of "death panel" to decide when to pull the plug on Aunt Sylvia. But it's understandable why people might associate the phrase "health-care reform" with limiting their choices during Aunt Sylvia's final days.
We should be having two debates. One should be about the obligation to ensure universal access to health care, which will directly benefit millions of struggling families and make this a better society. The other -- a more complicated, difficult and painful discussion -- should be about the long-term problem of out-of-control health-care costs, which would be a looming crisis even if President Obama had never uttered the word "reform."
Mickey Kaus has been arguing a variation of this point for a while, that Obama is making a mistake making this about cutting costs, rather than about full coverage. Long-term cost bending, is exactly that, long-term:
A debate on long-term cost control and end-of-life care--especially an emotional and acrimonious debate--is a highly useful debate to have. But it's not a useful debate to have right now. Right now it is killing Obama's universal care plans. ... And it wasn't a debate we had to have right now. It's a debate Obama has brought on himself by framing health care as an attempt to "bend the curve" of long term costs decades from now. He could have just said "Here's how I would guarantee health security for everyone. And here's how we're going to pay for it for the next ten years."
Yeah, his point makes sense to me. The idea is about coverage, right? A lot of thse cost-cutting measures seem so long-term, that it's hard for people to see the immediate benefit, and the confusion allows for irresponsible people to spread hysteria, with stuff like "death panels."
HT: The Daily Dish
You know what, I've come to a realization. I think it's clear that the town hall protests by the right are backed by lobbyists and party activists*. It's also true that many of these protests have gotten kinda ugly. Oh, and I also believe that a number of the attacks on the health care plan are boundless, hysterical, and also false.
That being said, the Democratic strategy of complaining about all this does nothing to actually get the bill passed. Right or wrong (and I guess I outed where I stand), the GOP strategy is working in some respects. Obama's numbers are going down. To be fair, there are many legitimate concerns about the health plan, and while I think certain people are stoking those fears to the point of hysteria, those fears need to be assuaged. Spending your energy complaining about bogus GOP arguments wastes energy that ought be spent countering those arguments.
Put simply, to complain about being punched in the nose looks like whining, and nobody wants to be the one who looks like they're trying to stop protests. The idea is to fight back, and win, by winning the argument.
*UPDATE: After being properly corrected by Dennis, and Theo, I felt the need to update this post a bit to admit my error, and painting those behind the protests as lobbyists. The fact is, while certain high profile people may be supporting these protests, it's not fair to paint the real people showing up as all being lobbyists. I screwed up on that score. Just wanted to add that.
The Health Care bill has been delayed:
Senate Majority Leader Harry Reid, D-Nev., delivered the official pronouncement on what had been expected for weeks, saying, "It's better to have a product based on quality and thoughtfulness rather than try to jam something through."
His words were a near-echo of Republicans who have criticized the rush to act on complex legislation that affects every American.
Reid told reporters the Senate Finance Committee will act on its portion of the bill before lawmakers' monthlong break. Reid then will merge that bill with separate legislation passed by the Senate Health, Education, Labor and Pensions Committee earlier this month.
Yesterday VP Biden announced an "agreement" between the administration and major hospital groups to trim payments by $155 billion as part of over all health care reform. Details were scant and it wasn't clear if that over one year of ten years.
This is one of a serious of public "agreements" between the Obama Administration and major healthcare "players" In March we learned of an agreement in principle between the Administration and major health care organizations representing physicians, insurers and others to save $634 billion. Its not clear how much of this $634 b includes the later specific "agreement" with hospitals and drug makers and others.
We've also heard of an agreement between the administration and Big Pharma to reduce costs by $80 billion over ten years.
Now to be clear we have heard of additional costs in this Herculean effort. The President has already stated it will take at least $630 billion over 10 years to get universal coverage accomplished.
He's also promised to fix the payment adjustment methodology, Sustainable Growth Rate (SGR),that Medicare has in place. This formula has anually triggered lowered payments to physicians. Each year after much lobbying from physicians, this adjustment has been "adjusted" to ease or eliminate the pain.
OK, so lets do some back of the envelope math. First we'll make some big assumptions. 1) The announcement of $634 billion from doctors, hospitals etc announced in March doesn't include the later announced reductions AND that it will be an ANNUAL reduction 2)any announcement of savings over ten years will be assumed to save one tenth of that amount annually.
And the final BIG assumption/statement is that we AT A MINIMUM spend 50% more per capita than the next highest spending country with no additional health benefits BUT WITH universal coverage (I'm referring to Switzerland). So our target is an over 33% reduction in health care expenditures.
In 2006 the US spent a little over $2.1 TRILLION dollars on healthcare. So we'd need to save about $700 billion annually. The Obama administration has announced savings of $155 b from hospitals, $8 billion annually from Big Pharma and $634 b from doctors, hospitals etc. That all totals $797 billion. Hey We're there!.... but wait a minute. We're going to spend $63 b annually to expand coverage and some other undefined amount to "fix' physician payments.
SO If all these come to pass and there are no other additional costs we might be getting somewhere. I know you all may be a bit skeptical that the Obama administration can actually get this done. And your skepticism might be reinforced by this statement from Rep. Waxman,chairman of the House Energy and Commerce Committee regarding the agreement with hospitals
We're certainly not bound by that agreement. The White House was involved, and we were not
And also if we'd like to examine a recent state example of such a large effort, lessons from Massachusetts might give one pause. These include incomplete success at "universal coverage", runaway costs,and coverage and benefits cuts to reduce the deficit.
I thought I saw you lurking in those details!
Pretty good overall, although I have a few issues. When he was asked about whether he'd sign the budget without the middle-class tax cut attached, his answer was too vague for me. I was looking for a definitive "no" on that one, that is that he would insist on the tax cut he promised. I know there's already one in the stimulus, but he was a bit too vague on that.
His answer on the deficit bothered me too, as he didn't really convince me how he's going to keep the deficit down in the out-years. Not saying it won't happen, and more than willing to give him room on this, but there's a lot of numbers being tossed around.
All in all, not too bad, but a few concerns.
With last Tuesday's Health Care Summit, President Obama begin the search for the Holy Grail of new Democratic programs, comprehensive Health Care Reform. As a “down payment” in that effort the President committed over $600 billion toward health care reform. That number only begged a greater question, “How much will it cost?”
So that we’re all on the same page lets be clear about what it costs right now. Here’s an excellent group of charts demonstrating what we spend on health care in America.
1) We spend 50% more per capita on health care than the next highest country (Norway)
2) Dollars for health come about equally from government, business and private households
3) Those dollars funnel through payers with 40% paid out by governmental programs (Medicare, Medicaid and others), 34% by private payers/insurers and 12+ % out of pocket
4) Those dollars are spent on: 31% hospital care, 21% physician services, 10% on pharmaceuticals and a variety of other costs. NOTE: 7% goes to administrative costs including insurance profit. That's ALL administrative costs.
Two other key basic realities of American Healthcare:
1) About 43 million Americans or nearly 15% American are insured
2) In spite of our extraordinary spending we Americans have not improved our health to a coincident degree as compared to other western nations
So we already spend far more than any other country and yet we can’t provide basic coverage for 1 in 7 of our citizens and though our health has improved over the years it hasn’t improved as much as other countries who have spent much less.
So how will spending at least $600 billion more (25% of what we already spend on an annual basis) lead to better coverage and/or better health?
You know, all things considered, Obama's recent confirmation troubles aren't that monumental in the grand scheme, but with Daschle now out as HHS Secretary nominee, for yet another tax issue, one starts to wonder if the Obama Administration has figured out that the appearance of a pattern matters, and this sort of thing leaves you open to piling on by your enemies. Not to mention, it's embarrasing. These things do start to matter after a while. No need to to panic. Callin' 'em as I see 'em, that's all.
The long and short of it: Partners Healthcare (the state's largest health care provider including Boston's two great giants: Mass General and Bringham) made a "handshake" agreement with Blue Cross (the state's largest insurer) to:
give Partners doctors and hospitals the biggest insurance payment increase since Massachusetts General and Brigham and Women's hospitals agreed to join forces in 1993.
In return, (Partner's) would protect Blue Cross from (their) biggest fear: that Partners would allow other insurers to pay less. Those who helped broker the deal say CEO Thier promised he would push for the same or bigger payment increases for everything from X-rays to brain surgery from Van Faasen's (Blue's CEO)competition, ensuring that all major insurers would face tens of millions in cost increases. Blue Cross called it a "market covenant."
There's just so many good quotes in here. The "duh" quote addresses concerns for the merger of Mass General and Brigham, thus creating Partners:
Though many analysts saw the merger as a smart way to reduce costs, three Boston University School of Public Health researchers warned at the time that it "actually may increase the cost of care," adding a layer of bureaucracy while boosting the market power of the combined institution.
And that it did. And all in the name of "higher quality" of care (which of course was not delivered)
This is REQUIRED READING