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Archive for the ‘Health Reform’ Category

I’m a huge fan of Switzerland, largely because its voters approved a spending cap that should be a role model for other nations.

It’s called the “debt brake” and it has helped reduce the burden of government spending in Switzerland at a time when most nations in Europe have been moving in the wrong direction.

But that’s not the only reason I like Switzerland.

I also appreciate the fact that Swiss voters seem to be much more sensible than voters in other nations.

Every so often I see polls, for instance, suggesting that French voters overwhelmingly want less government spending. But then they go out and elect statist presidents such as Sarkozy and Hollande.

In Switzerland, by contrast, voters are sensible where it counts most – in the voting booth.

Earlier this year, 76 percent of voters rejected a minimum wage hike.

Back in 2010, nearly 60 percent of voters shot down a class-warfare proposal for higher taxes on the rich.

And they’ve done it again. In a recent referendum, they defeated a government-run healthcare system by a landslide.

Here are some excerpts from an AFP report.

Swiss voters on Sunday rejected a plan for a seismic shift from the country’s all-private health insurance system to a state-run scheme. Referendum results showed that almost 62 percent of voters had shot down a reform pushed by left-leaning parties. …”The Swiss population does not want a single national scheme,” said the Swiss Insurance Association. “Our health system is among the top performers in the world. Competition between health insurers and freedom of choice for clients play a major role in this,” it added. …The rejection of the plan by nearly two-thirds of voters is a major blow for pro-reform campaigners, given that opinion polls had shown the ‘No’ vote was likely to be around 54 percent. In a 2007 referendum, 71 percent of voters rejected similar reforms. …for Switzerland’s cross-party government and its right- and centre-dominated parliament, the current system has proven its mettle and is debt-free, unlike the health services of France, Italy or Britain.

Though it seems that speaking French is somehow linked to economic illiteracy.

German-speaking regions voted against the plan, while their French-speaking counterparts were in favour.

Back in 2011, I wrote that there were five reasons why Switzerland was better than the United States.

But perhaps I wasn’t being sufficiently enthusiastic. Over at Being Classically Liberal, there’s an article entitled “9 Reasons Libertarians Should Love Switzerland.” Here’s the bottom line.

The Swiss are rich, happy, gun-owning, peace-loving people. The country has one of the freest market economies in the world and a relatively small and very decentralized government which hasn’t waged war since the early 19th century. In this libertarian’s eyes, Switzerland might just be the most awesome country in existence.

I’m agnostic on whether Switzerland is the “most awesome.” Hong Kong and Singapore, for instance, have smaller government.

That being said, Switzerland is much better on both guns and federalism.

And if you believe in grading on a curve, the burden of government spending in Switzerland is far smaller than it is in neighboring nations.

So it is a very admirable place.

Though I haven’t given up on America quite yet. And if I ever do, I’ll still choose Australia over Switzerland.

P.S. While it is encouraging that Swiss voters overwhelmingly rejected a single-payer healthcare scheme, I should acknowledge that their current system is not exactly libertarian Nirvana since it mandates that households purchase a health insurance policy.

P.P.S. But I don’t want to close on a bad point, so I’ll simply call your attention to the fact that Switzerland has one of the lowest levels of welfare spending among industrialized nations.

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America’s health care system is a mess, and we can assign almost all the blame on government. Simply stated, we don’t have functioning and efficient markets because Medicaid, Medicare, tax-code distortions, and other forms of regulation and intervention have created a system that is crippled by a third-party payer crisis.

There’s no logical reason to expect consumers to be smart shoppers, after all, when they’re only responsible for directly paying just 11 cents for every $1 of health care they consume. And providers have little reason to be efficient when they know that consumers are largely insensitive to price.

Let’s now apply these insights to the political controversy over birth control. Except, as I explained in July, there is no fight over birth control. As far as I’m aware, nobody is trying to ban birth control.

The real fight is whether the government should mandate that health insurance plans include coverage for birth control (and certain abortifacients).

Writing for Bloomberg, Megan McArdle explains that Obamacare’s birth control mandate is silly because a modest and routine expense shouldn’t be covered by insurance at all.

I am not very patient with the political fights over the Affordable Care Act’s contraception mandate. …Generic birth-control pills are a cheap, regular expense used by many millions of people, exactly the sort of thing that insurance is not designed for. All this does is spread the cost around a bit while adding administrative overhead for your policy.

Moreover, the better policy is to allow birth control to be purchased without a prescription.

In other words, address the issue by reducing government regulation rather than imposing a mandate!

…make birth-control pills available over-the-counter rather than a prescription item. This is an excellent idea. It was an excellent idea before Obamacare passed, and it will remain a fine policy even if Obamacare somehow vanishes into dust. Physicians assess the danger of giving you birth control by asking simple questions you can ask yourself: Are you over 35, a smoker or troubled by a family history of early stroke?

Seems like a good idea, right? Particularly since it should appeal to Republicans that want less regulation and also appeal to Democrats that want easier access to birth control.

The Republicans are on board, as Byron York reports.

…the GOP has a new policy response… The idea is to make the birth control pill available over the counter, to all, 24/7, without a prescription. It’s becoming a trend among Republican candidates in Senate races around the country. In North Carolina, GOP candidate Thom Tillis recently embraced it. So has Ed Gillespie in Virginia. Mike McFadden in Minnesota. Gardner in Colorado. And one of the leading proponents of the move is a potential 2016 GOP presidential candidate, Louisiana Gov. Bobby Jindal. …Gardner first rolled out the proposal in a Denver Post op-ed in June. The birth control pill has safely been in use since it was first approved 44 years ago, Gardner argued. “When other drugs have that kind of track record, we approve them for purchase without a prescription,” he wrote. “Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale once they’d been proven safe and unlikely to be abused.”

But some Democrats are hostile.

Indeed, a columnist for the Denver Post is very upset that some GOPers are supporting over-the-counter access to birth-control pills.

Following the lead of Colorado U.S. Senate candidate Cory Gardner, a handful of Republicans in midterm races across the country are now embracing over-the-counter sales of birth control pills without a prescription. Don’t be fooled. It’s a disingenuous move that could actually make the pill more expensive for women… But women already pay for those pills as part of the health care coverage they purchase through employers. Why would we want to pay for them twice? …What happens, however, if birth control pills are sold over the counter? Insurance companies will likely stop covering them. That means women will keep paying health insurance premiums, plus an additional out-of-pocket fee for pills. …And free doctor visits to discuss birth-control risks could also be replaced with fee-based pharmacy consults to determine whether women have risk factors like smoking, hypertension or migraines that prevent safe use of the pill, reports the American College of Obstetricians and Gynecologists. That’s hardly a “cheaper and easier” alternative — which is why Politifact rates Gardner’s claim as “mostly false.”

I strongly suspect that the author simply wanted to make a partisan attack on the Republican Senate candidate in Colorado. After all, more substantive and serious people on the left, including those at both Vox and Think Progress, favor over-the-counter access to birth control.

But let’s assume she really believes what she wrote. In which case she would get an F from any economics professors because health insurance companies obviously include predicted costs when pricing their policies. So if the mandate disappears and birth control is available without a prescription, then insurance companies will be able to lower the cost of the policies they sell.

In other words, women wouldn’t be paying twice. Indeed, they’ll pay less, though that will only be obvious to those who understand that employer-provided health plans are part of overall employee compensation.

There is another reason, other than partisanship, for some on the left to oppose Republican proposals to allow birth control to be sold over the counter. And you won’t be surprised to learn that self interest is playing a role.

Writing for The Federalist, Ben Domenech notes that Planned Parenthood wants to retain the current prescription-only approach.

You may think Ben made a big mistake, or that I misinterpreted. After all, isn’t that contrary to the organization’s ostensible mission of reducing unwanted pregnancies?

Well, Ben points out that Planned Parenthood may be more interested in maximizing handouts than it is in reducing pregnancies.

…interestingly enough, Planned Parenthood is pushing back on over-the-counter contraception. Why is this? Why would Planned Parenthood want to decrease the availability of contraception, and require women to see a doctor in order to get it? That seems awfully paternalistic of them. …birth control is a major lead generator for Planned Parenthood, to the degree that they can’t afford to lose their existing purpose as a source of prescribed contraception without it hurting their status as an institution. …Now you can understand why they wouldn’t want potential customers to be free to go to CVS or Walgreens or Rite Aid instead of heading to Planned Parenthood – providing those and other services is worth a lot of taxpayer money, $540 million in FY 2012 alone. And if you don’t provide those services, you can’t bill the taxpayers for them. …That’s why they want to keep the government’s ban on over-the-counter birth control intact.

Here’s a chart from Ben’s article that shows “what percentage of Planned Parenthood’s “services” are related to contraception.” As he notes, “it’s over a third of their activity.”

So I guess it makes sense – at least from an amoral perspective – that the organization wants to limit access to over-the-counter birth control.

By the way, the GOP plan for easier access to birth control is not a move to uncharted territory.

Here’s a map from a pro-reform left wing group that shows that over-the-counter birth control pills are easily available to most of the world’s women.

Let’s close by sharing one final – and very persuasive – piece of information from the experts at Reason.

Women already have over-the-counter access to Plan B, which involves larger doses of the hormones that are present in birth control pills.

…the Food and Drug Administration (FDA) has been considering making oral contraceptives available over-the-counter (OTC) for more than twenty years. “Plan B,” an emergency contraceptive, became available OTC last year. That one-step pill is simply a more potent dose of the same hormones that make up regular birth control pills. There’s no good medical justification for the differentiation. Yet in America, regular birth control pills remain stubbornly behind the pharmacy counter and behind the times.

In other words, the usual pro-regulation argument is that prescriptions are necessary because consumers can’t be trusted to make their own decisions with strong doses of medicine.

But the government already has made Plan B available over the counter while blocking similar access to birth control pills. Go figure.

P.S. Planned Parenthood is not the only interest group that has behaved in a disreputable and dishonorable fashion.

P.P.S. If you want to know what happens to healthcare in the absence of pervasive third-party payer, check out this remarkable chart.

P.P.P.S. Since today’s topic was birth control, let’s use this opportunity to revisit our collection of Sandra Fluke humor. Just in case you don’t remember, she was the 30-year old college student who got her 15 minuted of fame by demanding that other people pay for her expenses. Anyhow, if you want to laugh, check out this great Reason video, this funny cartoon, and four more jokes here.

P.P.P.P.S. On a separate topic, I added my two cents late last year to a debate inside libertarian circles over whether America’s plethora of welfare programs should be replaced by a single “basic income” grant that would be given to all Americans. Sort of a guaranteed minimum income.

I acknowledged that the current system is a mess, but I suggested that decentralization was a better approach.

…it seems that nothing could be worse than the current system. …But what about the idea of trashing what we have today and instead offering everyone some sort of basic income? …I agree, but only sort of. I like the idea of radical reform, but I think there’s a better road to Rome. It’s called federalism.

But what if someone held a gun to my head and said federalism wasn’t an option and demanded that I choose between the “basic income” and the status quo?

There’s not an obvious right answer, but I suspect I would prefer the devil I know because of fears that we might get more redistribution and even bigger government.

And I’m not the only one to have that opinion. Here’s what a proponent of more redistribution wrote about the concept.

Basic Income, unlike the programs we have now, will be politically easy to raise once it’s in place. …if you have one big, high-profile redistribution program, you can get enough popular support to overcome the concentrated opposition of the rich people footing the bill. …by endorsing Basic Income, libertarians are walking right into a trap. Anti-redistributionists’ great fear has always been that the masses will use the power of majority rule to simply vote themselves more money. As things stand, the fragmentation of our redistribution programs makes it easier for the anti-redistributionists to punch holes in the safety net. If the fragmented system were replaced with one universal, high-profile program, the result would be a huge political gift to redistributionists.

But maybe I’m just a pessimist. Tyler Cowen has a different perspective.

…let’s say a historical accident swept Basic Income proponents into power for a term and they passed that legislation.  Over time those income transfers would prove larger, more visible, and they would at least appear superficially more anti-work than the public stomach for them.  I predict they would be restricted along a number of possible dimensions, starting with (partial) work requirements for the able-bodied. Under most plausible assumptions about the Basic Income level, most people would not be recipients, nor would they expect to be potential net gainers from the program. …So I think the “why send money to people who aren’t working?” intuition will crowd out the “I want to think of myself as someone who helps other people” feeling.

I guess it depends on how the “basic income” is designed. If the government sends checks to everybody (as some are proposing), then Tyler’s “plausible assumption” about recipients would be wrong.

Which reinforces in my mind that my original idea was right. Let’s go with federalism and get Washington out of the business of redistribution.

The decentralized approach has been very successful in Switzerland and its also the system that’s consistent with the Constitution.

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It’s time to add to our collection of horror stories from the U.K.’s government-run healthcare system (previous examples can be found here, herehereherehereherehereherehere, here, here, here, here, here, here, and here).

What makes today’s story different, though, is that the bureaucracy not only is denying care to a small child, but also seeking to prevent the family from seeking treatment elsewhere.

Check out these excerpts from a blood-chilling story in USA Today.

The parents of a child suffering from a severe brain tumor signaled Monday they would defy efforts to force them to return to Britain, days after their family fled.

So why did they feel the need to escape a presumably civilized nation?

It seems government-run healthcare isn’t exactly on the cutting edge when it comes to life-saving treatments.

The family had fled to Spain in hopes of selling a property to obtain enough cash for a new treatment in the Czech Republic or the United States they hope will help their child. Police pursued them and issued an arrest warrant on suspicion of neglect after Southampton General Hospital realized their patient — Ashya King, 5 — was gone, without their consent. British authorities have made no apology for the warrant.

I can’t resist interrupting the main focus of the story at this point because the story then includes this line.

The case has riveted Britain, which is proud of a health service that offers universal care.

Maybe Brits are proud of their NHS, which would be a poor reflection on the collective IQ of the nation, but it certainly doesn’t offer universal care.

Unless, of course, you include neglect and torture in your definition of care.

Now back to our main story.

…the saga has…raised volatile questions of how much power authorities should have in interfering in some of the most sensitive of questions — and whether it has the right to insist that treatment dictates be followed. …Television images have shown the Kings being loaded into a Spanish squad car in handcuffs. When asked by the BBC on their views, the couple told the reporter they are just trying to help their child. …The family has criticized Britain’s health care system, saying he has a serious tumor that needs an advanced treatment option called proton beam therapy and that it wasn’t being made available to him. …Unlike other types of cancer treatment, it doesn’t indiscriminately kill surrounding healthy tissue, so there could be fewer long term effects.

But fear not. If little Ashya can somehow hold on until 2018, maybe the bureaucrats will be able to help.

Britain’s health department announced in 2011 it will build two treatment centers to make proton beam therapy available in London and Manchester from 2018. Until those facilities open, Britain will pay for patients eligible for the therapy to go to the USA and Switzerland for treatment. It wasn’t immediately clear why health care officials didn’t make this option available to Aysha.

As a parent, I know I would break the law if faced with the same situation.

It’s outrageous and disgusting, though, that such laws even exist.

P.S. I don’t mean to pick on the United Kingdom. We also have horror stories about government-run healthcare in the United States.

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I like to think that very few people despise Obamacare more than me.

I don’t like Obamacare because it’s a fiscal boondoggle.

I don’t like Obamacare because it’s bad healthcare policy.

I don’t like Obamacare because it generated an embarrassingly bad decision by the Supreme Court.

I don’t like Obamacare because it is driving people out of the labor force and into government dependency.

I don’t like Obamacare because it has increased corruption in Washington.

And I don’t like Obamacare because it further enriches and empowers Washington’s political class.

But I also like being honest and that means I’m willing to acknowledge that there’s one small part of Obamacare that will have a positive impact.

More specifically, the so-called Cadillac tax on expensive employer-provided health plans will slightly reduce the distortion in the tax code that encourages over-insurance and exacerbates the healthcare system’s pervasive third-party payer problem.

Indeed, we’re seeing some signs of this already, even though the tax preference isn’t capped until 2018. Here are some excerpts from a story published by Fox News, starting with a description of the law.

…companies desperate to avoid a 40 percent ObamaCare “Cadillac tax” are finding ways to shift the costs to workers. The so-called “Cadillac tax,” now four years away, will affect health plans that spend more than $10,200 per worker. “The excise tax, when it hits in 2018, will affect both employers and employees,”said Brian Marcotte, president of the National Business Group on Health.

Allow me to make an important correction before sharing other parts of the story.

Companies aren’t shifting costs to workers. The money currently spent on health insurance policies is part of total employee compensation.

Think of it this way. If a company hires you for a salary of $50,000 and also includes a $10,000 health insurance policy, what’s your total compensation?

If you give an answer other than $60,000, you’re either very bad at math or you have the logic skills of a politician.

So the story should have stated that the Cadillac tax is merely making workers more aware of costs that already exist.

Thanks for letting me vent. Now back to our main point, which is that the Cadillac tax discourages overinsurance, and this is already leading to some positive changes in the marketplace.

Employees will get incentives to reduce costs through such arrangements as wellness programs, including losing weight or stopping smoking. Meanwhile, employers are shifting workers into plans with higher deductibles, just as ObamaCare does in the health care exchanges, and using health savings accounts to help defray the costs.

I’m particularly happy that employers and employees are shifting to plans with higher deductibles. As I’ve explained before, health insurance should cover large, unanticipated costs, such as the onset of cancer or getting injured in a car wreck.

But it shouldn’t cover annual checkups, elective surgery, and other routine and/or predictable expenses.

And we have one other bit of good news. The tax isn’t going to raise nearly as much money as the politicians wanted!

The “Cadillac tax” was originally intended to take effect sooner, but unions and other groups convinced officials to delay it until 2018, reducing the anticipated income from $137 billion to $80 billion over ten years. But many analysts predict it will be far less than that. Henry Aaron of the Brookings Institution said, before then, it’s expected that most of the businesses that offer that form of insurance will back off and make the insurance less generous, so the tax won’t bite.” …if employers are able to avoid it and less than expected is collected, ObamaCare could fall tens of billions short in paying for itself as promised.

I should hasten to add, by the way, that I’m glad that Obamacare isn’t paying for itself since that simply means lots of taxes to accompany all the additional spending.

I’d be even happier, of course, if we could figure out how to get rid of all the spending as well.

Just in case folks are thinking I’ve gone soft, let’s close today’s post with some humor directed at the rest of Obamacare.

Since the IRS is a big part of Obamacare, here’s a particularly good bumper sticker that shares a line with the above poster.

Here’s a poster mocking the delightful fiscal impact of the law.

Though whoever put this together should have been careful of using The Joker.

I like this next poster since it highlights how politicians have exempted themselves from the law.

Last but not least, here’s Dr. Obama making a cameo appearance.

Ah, the IRS shows up again. Do you sense a theme?

And don’t forget the IRS bureaucrats want to be exempt from the law as well.

P.S. If you’re a glass-one-tenth-full person, here’s some other good news about Obamacare.

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When government suppresses the free market and takes over the healthcare sector, you get some really odd results.

Consider these stories from Sweden:

 A man sewing up his own leg after getting frustrated with a long wait.

The government denying a wheelchair to a double amputee because the bureaucrats decided his impairment might not be permanent.

Speaking of amputations, an unfortunate man was put on such a long waiting list that his only treatment, when he was finally seen, was to have his penis removed.

Today, we’re going to augment that list. But not with another story from Sweden, which is actually a much better country in terms of public policy than most folks realize.

Instead, we’re going to look at some great moments in government-run healthcare in both the United States and the United Kingdom.

Our first story is from the Chicago Tribune and it deals with Medicaid and Medicare spending.

But we’re not going to look at the aggregate data. Those numbers are very sobering, to be sure, and you can click here and here to learn more about that problem.

Instead, we’re going to drill down into the details and get some up-close evidence of why the programs are so costly. Simply stated, providers learn how to bilk the government.

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions. Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.  And then there was this: The sessions were often being performed by obstetricians and gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled. So Medicaid began cracking down, and spending plummeted after new rules were implemented.Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows. Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total. Among the highest billers for group psychotherapy in Illinois were three OB-GYNs and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.

Some of the specific examples are beyond belief. Keep in mind as you read the next passage that there are only 365 days in a year, and only about 261 workdays.

Of the Illinois OB-GYNs billing for group psychotherapy, Dr. Josephine Kamper had the highest number of sessions. She was paid for 10,399 sessions in 2012, at a cost to Medicare of $207,980. …Another OB-GYN, Lofton Kennedy Jr., billed for 9,154 group psychotherapy services. He declined to comment. The third-highest-billing OB-GYN, Philip Okwuje, charged Medicare for 8,584 group therapy sessions.  

Illinois isn’t the only place where taxpayers are getting ripped off.

A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office. Another large biller was Makeba Gordon, a social worker in Detroit. She was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.

And I’m sure you won’t be surprised to learn that the bureaucracy in Washington doesn’t seem overly worried about this preposterous waste of money.

Aaron Albright, a spokesman for the U.S. Centers for Medicare & Medicaid Services, said in an email that Medicare has no policy regarding which physicians may perform group psychotherapy. During such sessions, “personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support,” according to rules set out by one of Medicare’s contractors.

The second story comes from the United Kingdom.

Regular readers know that the government-run healthcare system in the United Kingdom is an ongoing horror story of denied care, sub-standard care, and patient brutality (click here to see some sickening examples).

You would think the U.K.’s political class would respond by trying to use money more effectively.

You would be wrong. The bureaucrats somehow have decided that tax monies should be used to finance a sperm bank, even though private sperm banks already exist.

Here are some excerpts from a report in the Daily Mail.

Britain is to get its first NHS-funded national sperm bank to make it easier for lesbian couples and single women to have children.For as little as £300 – less than half the cost of the service at a private clinic –  they will be able to search an online database and choose an anonymous donor on the basis of his ethnicity, height, profession and even hobbies. …The National Sperm Bank will be based at Birmingham Women’s NHS Foundation Trust, which currently runs an existing NHS fertility clinic and recruits sperm donors from the local population. Funded by a £77,000 Government grant, the bank will be run by the National Gamete Donation Trust (NGDT) which this year received  an additional £120,000 of public money to organise egg and sperm donation.

Some have criticized the initiative because it will purposefully increase the number of fatherless children.

…the move – funded by the Department of Health – is largely designed to meet the increasing demand from thousands of women who want to start a family without having a relationship with a man. Critics last night called it a ‘dangerous social experiment’ that could result in hundreds of fatherless ‘designer families’. …Ms Witjens rejected suggestions that children suffer adverse consequences from lacking a father figure. …Ms Witjens pointed to the removal of the reference to a ‘need for a father’ in the Human Fertilisation and Embryology Act, when taking account of a child’s welfare when providing fertility treatment.

I’m sympathetic to the argument that children do best in conventional households with fathers, but my main reaction to this story is that government shouldn’t try to either penalize or subsidize unconventional households.

And a government-sponsored sperm bank definitely falls into the latter category.

But I’m not surprised. Governments love to squanders other people’s money, and the U.K. government has considerable expertise (if you can call it that) in this regard.

Heck, the U.K. healthcare system is even financing boob jobs. But we’re not talking about reconstructive surgery for women who had mastectomies. They pay for breast augmentation for women who claim “emotional distress.”

Though maybe the U.K. government deserves a special prize. It developed a giveaway program that was so convoluted that nobody signed up to take the money.

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Many of you probably heard about the “Halbig” decision, in which a federal court struck a blow against Obamacare by ruling that the IRS was wrong to arbitrarily grant subsidies for health insurance policies purchased through a federal exchange.

And why did the judges rule against the IRS? Well, for the simple reason that the Obamacare legislation specifically says that subsidies are only available for policies purchased through exchanges set up by state governments. My Cato colleague Michael Cannon explains:

The PPACA authorizes the IRS to issue health-insurance tax credits only to taxpayers who purchase coverage “through an Exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act.” The tax-credit eligibility rules repeat this restriction, without deviation, nine times. The undisputed plain meaning of these rules is that when states decline to establish an Exchange and thereby opt for a federal Exchange — as 34 states accounting for two-thirds of the U.S. population have done — the IRS cannot issue tax credits in those states.

The legal fight isn’t over, of course, and it’s quite likely that the Supreme Court will make the ultimate ruling (which is worrisome since Chief Justice Roberts already has demonstrated that he’s sometimes guided by politics rather than the law).

But that’s an issue for another day.

Our topic today is humor. Or maybe it’s hypocrisy. Or perhaps it’s duplicity. Heck, it’s all of those things and more. Why? Because a leading supporter of Obamacare (who often conveniently forgets to disclose that he got $400,000 of our tax dollars to help draft and promote the law) has been caught with his pants down.

As you can see in this video, Professor Gruber is now pretending the Halbig decision was wrong even though he repeatedly acknowledged in the past that states would have to set up exchanges in order for their citizens to get subsidies.

Wow.

I’ve never seen a more brutal video. And it’s effective because Gruber is hoisted on his own petard.

Heck, this puts him in the same category as Paul Krugman, who also has been caught changing his views (he used to admit that unemployment benefits increase joblessness, but more recently made the opposite argument to boost Obama’s agenda).

Though I should admit that hypocrisy and duplicity aren’t limited to the left. I’ve criticized Republicans, after all, for occasionally justifying their anti-tax views by citing the Keynesian analysis of the Congressional Budget Office.

But let’s not digress. Instead, let’s simply enjoy the emasculation of a statist.

And because the video is so enjoyable, I guess I’ll put it in the humor category.

And if you like humorous Obamacare-related videos, here are some other examples from the archives.

*Creepy Uncle Sam wants to conduct an OB/GYN exam.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*Young people discover that they’re screwed by Obamacare.

*The wrong circus comes to town.

*Remy of Reason TV sings about the joy of part-time work.

*A cartoon video imagines a world where buying coffee is like buying government-run healthcare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

Let’s close with a pair of cartoons, both of which are related to the Halbig decision, at least in that we have an Administration that doesn’t seem to care about the rule of law.

We’ll start with Michael Ramirez.

Here’s Chip Bok’s contribution.

P.S. On a different topic, the battle over the Export-Import Bank is getting more heated. You probably won’t be surprised to learn that President Obama supports this corrupt example of corporate welfare (even though he said he was opposed back in 2008).

This is a rare issue where some honest leftists are on the correct side. That’s because, as illustrated by this Venn diagram (h/t: Charles Murray), some of them are willing to side with libertarians in the fight to makes sure big government and big business don’t get to conspire against taxpayers.

Sadly, too many DC leftists are hypocrites, happy to line the pockets of big companies if such policies also expand the power of government.

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Last September, I shared a disconcerting video showing an unfortunate young woman getting her OB/GYN exam from a very creepy version of Uncle Sam.

Well, you’ll be pleased to know that “Creepy Uncle Sam” does not discriminate. In this video, a young man faces the unpleasant experience of getting his prostate checked.

Kudos to Generation Opportunity for putting together such clever videos.

But I think their most recent video is a true masterpiece. It manages to showcase almost all the bad features of Obamacare in a short, amusing, pithy form.

And if you like videos that make fun of Obamacare, here are some other examples from the archives.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*Young people discover that they’re screwed by Obamacare.

*Remy of Reason TV sings about the joy of part-time work.

*A cartoon video imagines a world where buying coffee is like buying government-run healthcare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

Let’s close with a good cartoon from Ken Catalino.

And whatever the government says Obamacare costs, you can feel confident (albeit depressed) that the real cost will be higher. Especially if you’re also counting non-fiscal costs such as fewer jobs.

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