You Break it, You fix it. Ownership

The rhetoric is stuck. If you are a Democrat you are pleased that Obamacare is now law. If  you are a Republican you are devoted to major amendments and even complete repeal.

There does not seem to be any middle ground. No DMZ.

The Democrats must own up to the failures of the ACA. It is not a total  failure however the intricacies and secondary effects are huge, some which  providers hospitals and insurers predicted. And then some that were a surprise.

Health providers not only want it corrected, it must be corrected and soon. It is time to tweak the law. Some changes are not tweaks. The past two years have exposed the weaknesses.  When you build a program and it does not work well it is time to study the negative aspects and make corrections.

Over the next three years more cracks will appear in the ACA. Expect it and also fix it. The cement has not yet hardened and there is still time to mold the ACA.

Health reform is such a huge undertaking that no one should expect immediately gratifying effect, except those who measure sucess by how many millions of people now carry an insurance ID.  In some cases the ticket is not worth very much due to high  deductibles, limited provider access, and prremium still beyond affordability except in the government's table of allowable expenses for medicaid. The figures based upon the FPL are obsolete and do not account for geographic location.  It costs much more to live in Los Angeles  than Topeka Kansas.

The amplitude of the argument is increasing without any serious introspection on the part of the democratic party.

DFLers say they're ready to get loud about federal health law,

Democrats in Minnesota are ramping  up their arguments, on the defensive and with little positive conter-argument, other than the number count.

Republicans have been criticizing the federal health care law for years, and Democrats have been on the defensive. But as the 2014 election approaches, Democrats are starting to push back.

They now say the Affordable Care Act is making a positive difference in people's lives and that Republican efforts to repeal it will take health insurance away from thousands of Minnesotans.

Views on the law are likely to get lots of airtime up to Election Day. On Thursday, the Minnesota Jobs Coalition, a group working to help Republicans defeat DFL Gov. Mark Dayton, announced it will air a TV ad linking Dayton to MNsure, Minnesota's online health care exchange.

But after taking some early lumps on MNsure — the rollout of the state website led to botched applications and the resignation of MNsure's executive director in December — Democrats are becoming more aggressive about promoting what they say are the program's benefits. What are they ?

Knowing how controversial the law has been, most democrats have kept their head down not responding to the many criticisms, and not just from Republicans. Now the pendulum has swung and democrats are ready to swing. Republicans have been criticizing the federal health care law for years, and Democrats have been on the defensive. But as the 2014 election approaches, Democrats are starting to push back.

They now say the Affordable Care Act is making a positive difference in people's lives and that Republican efforts to repeal it will take health insurance away from thousands of Minnesotans.

Views on the law are likely to get lots of airtime up to Election Day. On Thursday, the Minnesota Jobs Coalition, a group working to help Republicans defeat DFL Gov. Mark Dayton, announced it will air a TV ad linking Dayton to MNsure, Minnesota's online health care exchange.

But after taking some early lumps on MNsure — the rollout of the state website led to botched applications and the resignation of MNsure's executive director in December — Democrats are becoming more aggressive about promoting what they say are the program's benefits.
What is apparent is that the ACA is a misfire, creating so much chaos that many are now crying for a 'single payer' solution, as stated succinctly on Care2's web site:

"Then what should be done?

The solution has been staring us in the face for a long time now: A single-payer healthcare option for all Americans. Why? Because before the Affordable Care Act, it was clear that it is not acceptable to leave the basic human right to healthcare access to profit-driven corporations.

The Affordable Care Act should be seen as an attempt at something of a compromise between the public and private health sectors; unfortunately, this is showing itself to be wishful thinking, at best.

At least one state, Colorado, will be voting on the creation of single-payer healthcare this fall; however, for such a program to truly work, it would need to be instituted on a national level. Regardless, if Colorado does pass the ballot measure, it would certainly be a major step in the right direction."

Is it Time to Occupy Health Care ?

The occupy movement has become embedded in many protests. It culminated with Occupy Wall Street, followed by many others.

During the past four years we have witnessed an internal breakdown of the health care financing system. In spite of the affordable care act and perhaps because of it, many insurers are withdrawing from the Obamacare Exchanges. The  Walmart model for health care is failing. The reason it has not worked is the health system is on the verge of a meltdown.  Walmart meets the demand with adequate inventory. Health Care has no inventory. In spite of this some large insurance companies are recording large profit margins. This despite the ACA's rule regarding the percentage of the health care premium which must go to patient care.

At each step of increasing regulation designed to improve quality decrease cost the effects have been paradoxical. This is true for many reasons. Our market system adjusts rapidly to barriers for care and the results are often counter productive and counterintuitive.  As Nancy Pelosi said 'We won't know what the ACA is until it is passed.  That is like throwing the dice, or spinning a roulette wheel.  Chances are very good you will lose. That is what has happened.

While the roster of patients who carry an insurance card has grown by millions since 2012 many cannot access care due to high deductibles for outpatient services, high premiums, a lack of providers and overcrowded emergency rooms.  The ACA which was supposed to make health care affordable and accessible has caused many patients to go to emergency rooms where they cannot be refused examination.  The quality of care has decreased due to overcrowding, exhausted health care personell and has increase professional burnout and exits from the health system.

The insurance card patients carry may not be worth the ink and paper upon which it is printed. l The addition of EHR created enormous expense for providers. The incentives came out of  your pockets.

Occupy Health is a nationwide movement scheduled the last week of October 2016 just prior to the Election.  The goals are to bring attention about the sad state of health care in the U.S. The situation was made much worse by the Affordable Care Act.  Well intentioned or not, it has evolved into a disaster. The outcome has resulted in millions of Americans who now have a mostly meaningless card...doctors are not accessble, deductibles are very high, as well as premiums for many people. The people were promised  health care. This was a vacuous statement.  The bottom effect was to decrease losses for hospitals to ensure they were paid. The result is more crowded emergency rooms, dangerously overworked health personell  and a lowering of quality for the insured.  Please comment on the Occupy Health facebook page. Share widely in your social network. And most important plan or join a movement in  your city. This will be a national demonstration including Alaska, Hawaii, and the U.S. territories.

Occupy groups are no longer splinter groups.  It has become mainstream, because our system has not worked and our leaders are lame. Every increase in federal regulation has not decreased costs. The bureaucracy, inefficiency and mandates have the opposite effects.

Our goal is to have several million demonstrators across the country. Having a march on the national mall is meaningless. It is a useless protest for television and the media.

Occupy your city, town, village, or intersection. Take it to city hall, town center, hospital, pharmacies, and medical clinics.

Participants will include patients, providers, health insurance companies, hospitals, and congressional representatives as well as administrators of CMS, and HHS.

We are recruitng leaders in all 50 states, and many cities throughout our nation. The ACA has brought attention to the plight of our system. It is not yet completed and must be amended or repealed. It won't happen unless the people demand it with overwhelming demonstrations.

This effects every American and our Health Care Matters.

FDA Orders Antibacterials Removed From Consumer Soaps - NBC News

A well overdue move by the FDA. The industry rolled over pretty quicklly...Another marketing hype !

The FDA and the Centers for Disease Control and Prevention agree that soap doesn't need added antiseptics to make it work any better.

"Washing with plain soap and running water remains one of the most important steps consumers can take to avoid getting sick and to prevent spreading germs to others," the FDA said.

"If soap and water are not available and a consumer uses hand sanitizer instead, the U.S. Centers for Disease Control and Prevention (CDC) recommends that it be an alcohol-based hand sanitizer that contains at least 60 percent alcohol."

Triclosan breaks open the cell walls of bacteria, killing them. But it takes several hours to do this, so it does little good in the time it takes to wash and dry hands.

The FDA is also reviewing hand sanitizers and products used by hospitals. 

FDA Orders Antibacterials Removed From Consumer Soaps - NBC News

Most View the CDC Favorably; VA’s Image Slips | Pew Research Center

High Favorable Ratings for CDC, NASA, DOD; Mixed Ratings for IRS

Unlike most government agencies the CDC (Communicable Diseases Center) enjoy some trust by the nation. The department of health and human services and CMS have shot themselves in the foot so many times, that few trust the overlying political exigencies affecting their day to day operation. Ultimately congress is responsible, however the messenger is always HHS.  HHS does not make the rules....it carries out the congressional mandate and the people's will.

The public continues to express positive views of many agencies of the federal government, even though overall trust in government is near historic lows. In fact, favorable opinions surpass unfavorable views for seven of eight government agencies tested – the IRS is the lone exception. In a survey last February, however, just 24% said they could trust the government in Washington always or most of time. (See this interactive for more on trust in government.)

The latest national survey by the Pew Research Center, conducted Jan. 7-11 among 1,504 adults, finds that 70% have a favorable view of the CDC, which came under criticism last fall for its handling of the outbreak of the Ebola virus. Nearly as many (68%) have a favorable view of NASA, and 65% hold a favorable view of the Department of Defense.

While overall favorable ratings for most of the agencies tested have changed little over time, there has been a sharp decline in positive views of the Department of Veterans Affairs (VA). Currently, 52% have a favorable view of the VA, down 16 points since October 2013. The agency has been widely faulted for delays in health care for veterans; the scandal led to the ouster last year of VA Secretary Eric Shinseki.

More Partisan Opinions of the EPA, CIA

Read the details from the link above







Most View the CDC Favorably; VA’s Image Slips | Pew Research Center

A Question found on Quora

Do some doctors regret becoming doctors? Why? How common is this?

I once went out for a lunch buffet with an Indian doctor in Tennessee. I went to discuss some business related to practice management software. As we began to have our lunch, an young intern of his joined us. It was a big buffet. So, we had time to talk.

We discussed his practice, about ICD-9 to ICD-10 transition and his general state of affairs. He had been in business for more than a decade. So, he was quite well set. Coming from India, he talked about how he came to pursue this line of occupation rather than the Engineering line. It was not surprising considering that most of the Indians growing in the 80s and 90s mostly had the doctor (MBBS) or engineer (BTech) educations to choose from.

However, as we began to talk about the money part of his business, I sensed that things were not going that well as he would have wanted or as much as he had expected when he chose this profession. It was not because he was losing customers or that there was competition. He talked about how the government was making it hard for him to get paid. You see in the US, the health care insurance companies get into the act once a patient visits a doctor. They go through the due diligence procedures (Coding, billing, claims and whole9 yards) before the doctors and hospitals would get paid. The doctor talked about how delayed payments were upsetting his small practice. He grumbled about how it was no longer lucrative to be in this line of occupation. What’s more, he wouldn’t encourage his own children to purse it. I was surprised that he was that frank about it in front of his intern.

I think the hard times were speaking, but what really amazed me was what the doctor did next at the lunch table. As the waiter placed one more plate of the Indian Naan on the table, the doctor quickly covered it in the paper napkin and swiftly / secretly pushed it in his suitcase.

It is not about being lucrative, it is about sustainability and stability. The business model is changing from FFS to QUALY, using unproven metrics to measure performance and outcomes. Population management does not always translate to the individual patient sitting in front of the provider. It is all about regulating doctors, decreasing utilization and taking the health care dollars for Defense, Education,

Profits In Health Insurance Under Obamacare

Furthermore, our societies, such the AMA have abandoned us.  I do not want those organizations speaking for me or you.

They 'negotiate' to maintain some bizarre mindset that patients and providers  are in control. Ask a patient if they are in control ?





(10/1) Home - Quora

A Question found on Quora

Do some doctors regret becoming doctors? Why? How common is this?

I once went out for a lunch buffet with an Indian doctor in Tennessee. I went to discuss some business related to practice management software. As we began to have our lunch, an young intern of his joined us. It was a big buffet. So, we had time to talk.

We discussed his practice, about ICD-9 to ICD-10 transition and his general state of affairs. He had been in business for more than a decade. So, he was quite well set. Coming from India, he talked about how he came to pursue this line of occupation rather than the Engineering line. It was not surprising considering that most of the Indians growing in the 80s and 90s mostly had the doctor (MBBS) or engineer (BTech) educations to choose from.

However, as we began to talk about the money part of his business, I sensed that things were not going that well as he would have wanted or as much as he had expected when he chose this profession. It was not because he was losing customers or that there was competition. He talked about how the government was making it hard for him to get paid. You see in the US, the health care insurance companies get into the act once a patient visits a doctor. They go through the due diligence procedures (Coding, billing, claims and whole9 yards) before the doctors and hospitals would get paid. The doctor talked about how delayed payments were upsetting his small practice. He grumbled about how it was no longer lucrative to be in this line of occupation. What’s more, he wouldn’t encourage his own children to purse it. I was surprised that he was that frank about it in front of his intern.

I think the hard times were speaking, but what really amazed me was what the doctor did next at the lunch table. As the waiter placed one more plate of the Indian Naan on the table, the doctor quickly covered it in the paper napkin and swiftly / secretly pushed it in his suitcase.

It is not about being lucrative, it is about sustainability and stability. The business model is changing from FFS to QUALY, using unproven metrics to measure performance and outcomes. Population management does not always translate to the individual patient sitting in front of the provider. It is all about regulating doctors, decreasing utilization and taking the health care dollars for Defense, Education,

Profits In Health Insurance Under Obamacare

Furthermore, our societies, such the AMA have abandoned us.  I do not want those organizations speaking for me or you.

They 'negotiate' to maintain some bizarre mindset that patients and providers  are in control. Ask a patient if they are in control ?





(10/1) Home - Quora

Zika Virus is not the only serious disease carried by Mosquitos

Health Train Express has been away for part of the summer, and there is much news to report.

It is that time of the year for insect repellent. And not just for ridding the pesky evening bugs and annoying bites that ruin summer picnics, baseball games and outdoor sporting events

During the summer an airborne force in the sky (the mosquito) carries multiple threat weapons, guided by heat seeking, carbon dioxide homing missiles.   The onslaught is continuous and each season begins again as reported by the  World Health Organization. With modern prevention measures large epidemics are not prevalent. Our air defense system of mosquito control, repellents and treatment for  the diseases is vastly improved.

Mosquito-borne diseases

Mosquitoes cause millions of deaths every year

These tiny predators go after targets much larger than themselves. Many years ago scientists revealed the deadly tropical diseases spread by these vectors.  Controlling these diseases depended upon destroying the vector mosquitos.  

Here are some of the villains:

Chikungunya

The virus is transmitted from human to human by the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue. 

Dengue and severe dengue

 Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. This mosquito also transmits chikungunya, yellow fever and Zika infection. 

West Nile virus

Human infection is most often the result of bites from infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues.

A very small proportion of human infections have occurred through organ transplant, blood transfusions and breast milk. There is one reported case of trans placental (mother-to-child) WNV transmission.

To date, no human-to-human transmission of WNV through casual contact has been documented, 

Malaria

In most cases, malaria is transmitted through the bites of female Anophelesmosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. Unlike Yellow Fever, Dengue, Chikungunya and West Nile Virus the pathogen is not a virus, but a parasite, P. falciparum .

Red Blood Cell with falciparum

Yellow fever

The yellow fever virus is an arbovirus of the flavivirus genus and is transmitted by mosquitoes, belonging to the Aedes and Haemogogus species. The different mosquito species live in different habitats - some breed around houses (domestic), others in the jungle (wild), and some in both habitats (semi-domestic). There are 3 types of transmission cycles: 

Treatment

Good and early supportive treatment in hospitals improves survival rates. There is currently no specific anti-viral drug for yellow fever but specific care to treat dehydration, liver and kidney failure, and fever improves outcomes. Associated bacterial infections can be treated with antibiotics.

Prevention

1. Vaccination

Vaccination is the most important means of preventing yellow fever. In high-risk areas where vaccination coverage is low, prompt recognition and control of outbreaks using mass immunization is critical for preventing epidemics. It is important to vaccinate most (80 % or more) of the population at risk to prevent transmission in a region with a yellow fever outbreak.

Finally, the latest viral threat

Zika virus

Zika virus is primarily transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. Aedes mosquitoes usually bite during the day, peaking during early morning and late afternoon/evening. This is the same mosquito that transmits dengue, chikungunya and yellow fever. Sexual transmission of Zika virus is also possible. Other modes of transmission such as blood transfusion are being investigated.

WHO | World Health Organization

The Human Brain Library — The Institute for Brain and Society

Part of the Brain Initiative:

Dr. Annese, Institute for Brain and Society/The Brain Observatory and Dr. Allan Jones, CEO Allen Institute for Brain Science at the Washington IDEAS Forum.

Brain Mapping

Three major initiatives:

      1. Allan Institute for the Brain

      2. Federal Iitiative

      3. The Brain Initiatives  (Euro China, French)

Optogenetics, high magnification microscopy, Real-time analysis of electrophysiology.

Can human emotion, and/or cognitive thinking be distilled into a science?  The past three decades have advanced our understanding of what emotions and thoughts are biochemically.

Our knowledge of how we think and how we feel is being distilled into basic science. New imaging techniques now allow scientists to see what is happening when and where in our brain in real-time. We have discovered the brain has certain regenerative capability by it's redundancy, much like a backup of your computer's hard drive. The brain's inherent 'intelligence' allows it to 'rewire' it's neuronal network, allowing for different regions of the brain to alter function. Neural plasticity allows for these amazing changes. In the near future a combinaton of behavioral training and neuropharmacology will be the future of treatment for neurolgic treatment. The 'black hole of the brain may be coming to an end.

When and where do sentience reside ?  Is it a place in our brain?  ( the capacity to feel, perceive, or experience subjectively.^[1] Eighteenth-century philosophers used the concept to distinguish the ability to think (reason) from the ability to feel (sentience). In modern Western philosophy, sentience is the ability to experience sensations (known in philosophy of mind as "qualia") Does self awareness require sentience, or do they go hand-in-had?


The answers to these questions and others may come soon with tools such as fMRI new advances in high power microscopy, optogenetics and public involvement.

The Human Brain Library — The Institute for Brain and Society

Senior citizens rarely consult Dr. Google for medical advice, study says - LA Times

Senior citizens need more medical care than anyone else in the United States. And the Internet is chock full of health information. Yet seniors are far less likely than other adults to tap into it, new research shows.

 A report published Tuesday in the Journal of the American Medical Assn. found that only about 18% of participants in the National Health and Aging Trends Study got health information online in 2014.

 That pales in comparison with the approximately 60% of adults of all ages who have told the Pew Research Center that they consult Dr. Google at least once a year -- including the 35% who said they rely on the Web to diagnose their own ailments or the maladies of people they know. 

Since 2011, thousands of Medicare beneficiaries in the aging trends study have been completing annual surveys that gauge their use of technology. In the survey’s first year, 64% of the survey takers had computers and 43% were hooked up to the Internet. Their average age was 75.

Among all 7,609 initial study participants, only 16% said they went online to learn something about health. In addition, 8% said they filled prescriptions online, 7% used the Internet to get in touch with their doctors and 5% dealt with their insurance claims on the Web.

Altogether, 21% of seniors who were surveyed in 2011 used the Internet for at least one of these four health-related tasks, according to the JAMA report. By 2014, that figure rose to 25% — a small yet statistically significant increase, the study authors wrote.

Some senior citizens were more likely to go online for health-related reasons than others. For instance, the odds were twice as high for white seniors than for their black and Latino counterparts. College graduates were seven times more likely to handle health issues online than were seniors who didn’t finish high school. Seniors who rated their own medical condition as “excellent” were twice as likely to boot up their computers for the sake of their health than were seniors who rated their medical condition as “poor.”

Apparently, these seniors had better things to do than research ways to prevent heart disease, manage symptoms of diabetes or stave off dementia. Email was far more enticing. Electronic banking (but not online shopping) was also more popular.

Apparently, these seniors had better things to do than research ways to prevent heart disease, manage symptoms of diabetes or stave off dementia. Email was far more enticing. Electronic banking (but not online shopping) was also more popular.

“Digital health is not reaching most seniors,” wrote the authors, all from Brigham and Women’s Hospital in Boston. That means the Internet isn’t living up to its potential as a tool to “improve quality, cost, and safety of their health care.”

And perhaps that may not be a bad thing.

But perhaps seniors are right to eschew the health information available online. A 2014study in the Journal of the American Osteopathic Assn. found that Wikipedia entries for nine common health conditions -- coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, high blood pressure, diabetes, back pain and high cholesterol -- contained a significant amount of information that was at odds with the latest medical research.

Senior citizens rarely consult Dr. Google for medical advice, study says - LA Times

Google misfires as it aims to turn Star Trek fiction into reality

Tri-corders ?  Glucose measuring contact lenses  ? Truth or fiction ?

Hype plays a large role in media publications. Perhaps well intentioned,  but often written to attract more readership by an unsophisticated readership.  The front counters of grocery checkout stands share space with The Enquirer, The Hollywood Reporter, People Magazine, or Popular Science about what is 'gossip' in the health science space.

Large multi-billion dollar companies purchase smaller competitors to kidnap intellectual property,  hire scientific luminaries and inventors with what they consider to be petty cash from their vaults of gold and greenbacks. Money is seductive....even  to reputable scientists and especially to inventors and entrepenurs anxious to capitalize on the singularity of exponential growth in health technology. To lose out on a possible chance of success (even if the odds are 1 our of ten or even 1 out of 1000 would appear foolhardy when the stakes are so high and the rewards in virtual wealth are just that....virtual (not real).

A new term I shall coin is  'virtual estate'...the polar opposite of 'real estate'.  During the time when our economy and real estate values crashed, Virtual estate thrived.

Runaway (not to be considered a bad thing) fuels rapid advances and also has a high failure rate.

Google misfires as it aims to turn Star Trek fiction into reality









Beam me up, Scotty !  Kirk out.

5 rituals that will help your brain stay young | World Economic Forum

5 rituals that will help your brain stay young | World Economic Forum

Panic prompted ObamaCare lawlessness

Obama faced major reluctance on the part of  insurance companies to join and remain in the Health Insurance Exchange.  A last ditch agreement funded by what was yet to be approved congressional approval of a budgetary allotment.

Panic prompted ObamaCare lawlessness

By Doug Badger
The Hill, July 15, 2016

Senior Obama administration officials took a series of decisions beginning in late 2013 that ranged from the reckless to the illegal in an effort to keep insurers participating in health insurance exchanges.

A report issued last week jointly by the House Ways and Means and Energy and Commerce committees explores how the administration came to unlawfully funnel $7 billion in unappropriated money to insurers through a single ObamaCare program.

The program — known as cost-sharing reduction (CSR) — requires insurers to reduce deductibles and other out-of-pocket spending for certain low-income people who signed up for coverage through health insurance exchanges. In turn, the statute authorized the administration to seek an appropriation from Congress to reimburse insurers for the cost of providing these coverage enhancements.

The congressional report chronicles how the administration determined as early as 2010 that it needed an appropriation to make CSR payments to insurers. In April 2013, the president submitted a budget to Congress formally requesting the appropriation.

But in July, the Senate Appropriations Committee, then controlled by Democrats, expressly denied the president's request. Sometime after Congress refused to fund the program, the administration contrived the theory that it could spend money without an appropriation.

Senior officials at the Office of Management and Budget (OMB) drafted a legal memorandum during late 2013 declaring that the government could make billions in CSR payments to the insurance industry without congressional approval. The administration began making the unlawful payments in January 2014.

Although the administration continues to stonewall the congressional investigation into how it arrived at this decision, the committees have learned that several Treasury Department officials raised concerns about the OMB memo. Those officials were permitted to read the document, but were forbidden to make copies or take notes.

The administration has denied Congress even that courtesy, defying congressional subpoenas for copies of the OMB memorandum and other material relevant to the investigation. It has supplied them with a memorandum that Treasury Secretary Jack Lew signed in January 2014 directing his subordinates to begin making CSR payments. But that memorandum has been redacted to omit the department's legal justification.

The administration also has slapped a gag order on current and former employees, instructing them not to answer the committees' questions about the legality of the unappropriated spending.

The administration has good reason to stonewall. Its ostensive reason — that the legitimacy of the CSR payments is under review by the courts — is a smokescreen. The Supreme Court settled that matter in a 1929 case arising from the Teapot Dome Scandal, holding that congressional inquiries cannot be thwarted by ongoing litigation.

The administration's defiance has a much simpler explanation: Its actions have no legal basis. Even The New York Times has acknowledged that if the administration were permitted to continue spending unappropriated money, "it could have major — some might say huge — consequences for our constitutional democracy."

At least one federal judge agrees. In a lawsuit filed by the House of Representatives, Federal District Court Judge Rosemary Collyer in May ruled that the CSR payments were unlawful. The Justice Department has appealed Collyer's ruling.

My July 8 testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations showed how the government's unlawful spending on the CSR program fits into a broader pattern of malfeasance in ObamaCare implementation. That malfeasance includes decisions made during the first half of 2014 to unlawfully divert $3.5 billion to $4.5 billion from the Treasury to insurance companies through the "reinsurance" program. It also involves the attempt by the government to turn the law's "risk corridor" program into a new version of the Troubled Asset Relief Program (TARP), forcing taxpayers to cover losses resulting from bad business decisions made by insurance executives.

Those abrupt and unlawful policy reversals were occasioned by a serious miscalculation of demand for health insurance among relatively healthy people.

It turns out that millions don't want it, unless premiums are steeply discounted. ObamaCare does the opposite for people in relatively good health, requiring insurers to overcharge them for a product they may not want or need, while discounting premiums for those in poorer health.

The result is a dysfunctional "market" that attracts high-risk enrollees and repels low-risk ones, leaving insurers with a losing proposition: a pool of customers who are disproportionately older, less well and paying premiums that are too low to cover their medical bills.

When the consequences of this dysfunctionality dawned on the administration, panic set in, prompting a series of regulatory improvisations providing for the payment of billions in corporate subsidies to the insurance industry.

Although the administration is not especially fond of insurers (as the president demonstrated this week with his renewed embrace of the "public option"), the exchanges would collapse without them. To avoid the political embarrassment of insurers withdrawing en masse from the exchanges, it has chosen to supply them with unlawful payments and stonewall congressional inquiries into this misconduct.

The administration's actions raise concerns that transcend the fractious politics of ObamaCare: They are institutional and constitutional in nature. Institutional because Congress's core lawmaking and oversight functions are being effaced. Constitutional because its power of the purse is under legal assault.

In such circumstances, Congress cannot be passive. It must act to require the administration to follow the law.

Badger, a former White House and U.S. Senate policy adviser, is a senior fellow with the Galen Institute. This piece was adapted from his July 8 testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations.

Read the article in The Hill

Information provided to Health Train Express by Galen Institute

Laboratory Results: Do you receive them ?

https://www.dropbox.com/s/9598jagn1oso8w9/One%20of%20the%20problems%20with%20medical%20care%20is%20the%20lack%20of%20internal%20controls%20in%20a%20practice.doc?dl=0