Here’s How to Save $2 Trillion on Health Care

"Start by setting a goal for health care spending for the country as a whole that spending on healthcare should go up no faster than the gross domestic product," the Obama health care advisor said. "The 18 percent of GDP that we spend now on healthcare is enough and we should let it grow with gross domestic product."

Then, according the Commonwealth Fund, a private foundation that aims to promote a high performing health care, the country needs to pay health care providers smarter, consumers need to be more involved in choosing healthcare and administrative waste needs to be slashed.

On the latter point, Blumenthal said about 14 percent of our health care dollar, or $360 billion, is spent on administration.

(Read More: Countries With Aging Populations)

"The administrative waste reduction is included in Obamacare," he said, "but the implementation is extended and it's not getting the attention or the push it deserves."

In terms of paying doctors for Medicare, the Commonwealth Fund proposes freezing rates at 2012 and 2013 levels, and "increase them if physicians participate in high performance health systems or if they perform better than average in terms of quality and efficiency of care."By making the system function better, Blumenthal said the country could save $2 trillion over a decade, with half of the savings going to the federal government.

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Here's What Else Is Gripping US Besides Flu Bug

Google tracks searches for flu-related terms, and overall flu searches are up 200 percent from the 3-year average, reports CNBC's Bertha Coombs.

And, Dr. Poland said, if many New Yorkers are catching laryngitis, as has been reported, it is probably a rhinovirus. ''It's typically a sore, really scratchy throat, and you sometimes lose your voice,'' he said.

Though flu cases in New York City are rising rapidly, the city health department has no plans to declare an emergency, largely because of concern that doing so would drive mildly sick people to emergency rooms, said Dr. Jay K. Varma, deputy director for disease control. The city would prefer people went to private doctors or, if still healthy, to pharmacies for flu shots. Nursing homes have had worrisome outbreaks, he said, and nine elderly patients have died. Homes need to be more alert, vaccinate patients, separate those who fall ill and treat them faster with antivirals, he said.

Dr. Susan I. Gerber of the C.D.C.'s respiratory diseases branch, said her agency has not seen any unusual spike of rhinovirus, parainfluenza, adenovirus, coronavirus or the dozens of other causes of the ''common cold,'' but the country is having its typical winter surge of some, like respiratory syncytial virus ''that can mimic flulike symptoms, especially in young children.''

The C.D.C. and the local health authorities continue to advocate getting flu shots. Although it takes up to two weeks to build immunity, ''we don't know if the season has peaked yet,'' said Dr. Joseph Bresee, chief of prevention in the agency's flu division.

Flu shots and nasal mists contain vaccines against three strains, the H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1 cases have been rare, and the H3N2 component has been a good match against almost all the confirmed H3N2 samples the agency has tested. . (Read More: GlaxoSmithKline Wins U.S. Approval for New Flu Vaccine)

About a fifth of all flus this year thus far are from B strains. That part of the vaccine is a good match only 70 percent of the time, because two B's are circulating.

For that reason, he said, flu shots are being reformulated. Within two years, they said, most will contain vaccines against both B strains.

Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West 56th Street in Manhattan, said she recently was so sick that she was off work and in bed for five days -- and silenced by laryngitis for four of them.

She did not have the classic flu symptoms -- a high fever, aches and chills -- so she knew it was probably something else.

Still, she said, it scared her enough that she will get a flu shot next year. She had not bothered to get one since her last pregnancy, she said. But she has a 7-year-old son and a 5-year-old daughter, ''and my little guys get theirs every year.''

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Here’s What The Court’s Going To Do On ObamaCare

It would be nice if the future of federalism did not rest on what Anthony Kennedy had for breakfast –- if Senate Republican Leader Mitch McConnell did not spend all of December, 2009, giving Harry Reid back-to-back votes on issues which allowed Reid to buy off swing senators.

But we are where we are. So…

THE OBAMA ADMINISTRATION HAS ONE ARGUMENT STANDING ON BEHALF OF THE CONSTITUTIONALITY OF OBAMACARE: 116 BILLION.

That is the amount of cost-shifting Obama now claims occurs as a result of treating uninsured individuals.

Four problems:

First, 116 billion is nothing but a politicized magnification of the amount (43 billion) which the insurance companies claimed in cost-shifting from the uninsured to policy-holders during their ObamaCare lobbying campaign. (The 43 billion figure is where the $1,000-per-policy cost-shifting figure comes from.) But both the 116 billion and the 43 billion figures are fraudulent numbers which interested parties simply pulled out of the air.

Second, the administration understands the inherent bias in insurance company numbers when it suits its purposes. When Price-Waterhouse, in the eve of the passage of ObamaCare, estimated that it would increase the price of family policies to almost $25,000 a year by 2019, the Obama administration mercilessly attacked the number. 116 billion -– or 43 billion -– or $1,000 per policy — is no different. In their hearts, the administration understands it is lying to the court.

Third, whatever cost-shifting problems there are, over 68% of them are due, not the “young invincibles,” who are nothing but, once again, hapless “cash cows” who are being bled to fund a system which transfers their assets to those who, in some cases because of their own choices, are less healthy than they are. Rather, current cost-shifting problems, to the extent they exist, are as a result of the poor. But here’s the problem: Under ObamaCare, the poor (anyone with an income under 133% of the poverty level) would be put on Medicaid — AND TURNED FROM DE FACTO “FREE RIDERS” INTO STATUTORILY MANDATED “FREE RIDERS.”

Which leads to: Fourth, everyone understands that the reason for the mandate was not to address the “free rider” problem (which could have much more easily been done by modifying the 1986 treatment mandate in minor ways), but rather to bribe the insurance companies into not running Harry & Louise ads.

NOW FOR A LITTLE LEGAL REALISM

The justices are only human.

And conservatives have fallen down in failing to make a bigger issue over liberal attempts to threaten and intimidate the court -– first, in the New York Times, then in the Washington Post [“Will Conservatives save Obamacare?” by Robert Barnes, the Washington Post, March 18, 2012, page B1] -– and repeatedly by Bob Beckel and others on Fox.

All of the threats are thinly veiled (“Roberts is protective of the court’s reputation, however, and sensitive to the perception that its decisions are politicized.”), but they are nothing more or less than disguised threats to attack the court if it doesn’t do as liberals want.

Interestingly, speaking of politicized justice, both the New York Times and the Washington Post, in their court “vote-counting,” start with the proposition that the four liberals on the court will “jump” when told to by the Obama administration. This is hardly a ringing endorsement of the independence or the judicial integrity of Ginsburg, Breyer, Sotomayor, and Kagan.

True, Kennedy has shown, in Massachusetts v. EPA, that he is not oblivious to a firestorm of public opinion swirling around him. But, with Gallup showing that between 72% and 76% of the public believes ObamaCare is unconstitutional, and with other polls showing that 67% of Americans believe that either ObamaCare or the mandate is unconstitutional, liberals are making a threat which they can’t enforce.

And, lest anyone believe that liberals believe their vote-counting bravado, Friday, two Columbia Law professors [Abbe Gluck and Michael Graetz] published an op-ed in the New York Times arguing that, should the mandate be overturned by the court, the statute should nevertheless be severed. (More on this later, but what does that tell you about their assessment of the likelihood of success?)

They understand, as do most court-watchers, that there are legal realities which are never vocalized, but are true nonetheless:

WICKARD V. FILBURN DOESN’T REALLY GIVE YOU ANY CLUE ABOUT WHAT THE COURT WILL DO: This is the 1942 case where a farmer was penalized for growing wheat for his own consumption because, were everyone to do the same, it would impact commerce.

This is taught in law schools as a “can-you-believe-that?” case. It was the high water mark of politicized New Deal jurisprudence, and is now generally viewed by conservatives as the epitome of what was wrong with the Roosevelt court. And it would have to be extended even further to apply to someone who didn’t even grow wheat -– and, in fact, did nothing.

GONZALES V. RAICH DOESN’T REALLY GIVE YOU ANY CLUE ABOUT WHAT THE COURT WILL DO: This was the case about whether the federal government could preempt state laws on medical marijuana.

If you look at the way the court deals with “law-and-order” cases, it differs from its approach to other appeals. There was no way the court was going to, effectively, legalize all drugs in order to overturn Wickard. And the fact that it considered doing that tells you something.

THE FACT THAT THE COURT, IN THREE POLITICALLY DIFFICULT CASES, FAILED TO FIND A COMMERCE CLAUSE JUSTIFICATION FOR GUN-FREE SCHOOL ZONES, PARTS OF THE VIOLENCE AGAINST WOMEN ACT, AND PARTS OF THE BRADY LAW DOES TELL YOU SOMETHING ABOUT THE COURT’S -– AND KENNEDY’S -– PREDISPOSITION ON ARTICLE I, SECTION 8, ISSUES.

THREE OBSERVATIONS ON SEVERABILITY

THE FACT THAT THE COURT SET ASIDE AN HOUR TO ARGUE SEVERABILITY, WHILE NOT DISPOSITIVE, IS MORE SIGNIFICANT THAN LIBERALS WOULD LIKE TO BELIEVE.

NOTWITHSTANDING EVERYTHING, I WOULD BET THE COURT WOULD REMAND THE CASE FOR AT LEAST SOME OF THE SEVERABILITY DELIBERATIONS.

WANT TO KNOW WHY THE SEVERABILITY CLAUSE IN EARLIER DRAFTS “MYSTERIOUSLY” DISAPPEARED? I have gone round-and-around with both House and Senate Legislative Counsel over this issue. And one or the other will regularly remove severability language from a draft because, while not irrelevant, it is not dispositive. It is a way that the Leg Counsel’s office asserts its authority against congressmen who “dare” to draft their own legislation.

Of course, as the mandate became more controversial at the end of the process, senators did begin to notice that the severability clause had disappeared.

Had Jim DeMint not objected to waiving the nine-day process necessary to send a bill to conference, the severability clause could have been easily reinserted in conference. But he did; and it wasn’t.

Finally, there was the opportunity to reopen the bill to further amendments, including an amendment on the severability clause, to assuage Democratic moderates like Ben Nelson, after the manager’s amendment had been presented. But, again, this would have required chopping apart the “tree” constructed to block DeMint, and that would have kept the Senate in session until well past Christmas. So that wasn’t done either.

But the point for the court to consider is that senators knew they had an opportunity to reinsert the severability clause, but with considerable pain, and chose not to.

by Michael E. Hammond, former General Counsel Senate Steering Committee 1978-89 and a Dunbarton, New Hampshire resident.

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