Homosexuality and the Conservative Bible Project

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According to the conservative bible project homosexuality is punisable by death

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Kendoll and the Conservative Bible Project

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He loves it

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Bible Retranslation Project

(Difference between revisions)|Hebrew ???? ????? transliteration:"YHWH Tsvaot"|"Whereas Edom saith, We are impoverished, but we will return and build the desolate places; thus saith the LORD of hosts, They shall build, but I will throw down; and they shall call them, The border of wickedness, and, The people against whom the LORD hath indignation for ever." Malachi 1:4 (KJV)|The word "Tsvaot" means "armies" in Hebrew. While the words "hosts" was used as "armies" in the seventeenth century, many people do not perceive that word in such a manner today.[http://gptsrabbi.blogspot.co.il/2011/10/lord-of-hosts-lord-of-heavens-armies.html]|Hebrew ??? ????? transliteration:"Bnei Israel"|Hebrew ??? ????? transliteration:"Bnei Israel"

The Bible Retranslation Project recognizes two fundamental aspects of a modern language that causes it to be a constant state of flux or change:

familiar terms change their meanings, so text using them becomes misinterpretable new, more precise terms appear at a rate of about 1000 per year.[1]

Terms that were clear and meaningful to one generation are often unclear and less meaningful to the next; meanwhile, entirely new terms are constantly emerging, some of which may facilitate more precise translation from the Biblical Greek and Hebrew (and Aramaic in the case of parts of the books of Ezra/Nehemya and Daniel).

Both effects above -- due to culture and the emergence of new terms -- may be increasing as communications increase. If a word inevitably alters its meaning after an approximate number of uses, then the time period for the change in meaning will shorten due to improved technology, just as the length of a sound bite likewise shortens. Likewise, the rate of emergence of new terms may be directly correlated to the frequency of communication. In the internet era, combating the effect of language degradation and creation on the understanding of the Bible becomes more important.

But there is an economic obstacle to developing a translation of the Bible that remains current with changes in language. Book sales have been declining sharply due to the internet, and it is probably not easy to recoup the substantial costs ($10 million for the Holman Christian Standard Bible) that are required to develop a new translation. With the need to recoup and enormous investment, publishers of a new Bible are probably overly cautious in changing familiar terminology despite erosion in their meaning, in fear of criticism and a poor reception. A lower-cost and more dynamic approach is needed to combat the effects of persistent degradations in language.

As a first step to the Bible Retranslation Project, it is useful to identify modern terms having changing, unclear or altered meaning, which appear in important passages in translations of the Bible into the corresponding modern language. This will help avoid cliché and the repetition of culturally-familiar but suboptimal passages while producing a superior rendition from the original Hebrew and Greek into idiomatic modern English.

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Powerful new terms develop that were unknown or underutilized at the time of prior translations of the Bible into English. The English language, relatively weak at its beginning, continues to develop by adding insightful new terminology. These more precise and meaningful concepts should be utilized by English translations of the Bible. The King James Version was written in the early 1600s, and powerful terminology has been added to the English language since then, some in the past decade.

Examples include:

New Term First Developed Potential Uses in a Bible Retranslation After Jesus released His spirit at the Crucifixion, English translations should now state that the Roman soldiers "gambled" to win his clothing, rather than the less clear statement that they "cast lots." See Matt 27:35; Mark 15:24; Luke 23:34; John 19:24.[2] relevant to Jesus teaching the younger Apostles Relevant to the parable of the talents Original Term English Translation Usage Lack of Clarity Real meaning Suggested Improvement Hebrew ???? ????? transliteration:"YHWH Tsvaot" "Whereas Edom saith, We are impoverished, but we will return and build the desolate places; thus saith the LORD of hosts, They shall build, but I will throw down; and they shall call them, The border of wickedness, and, The people against whom the LORD hath indignation for ever." Malachi 1:4 (KJV) The word "Tsvaot" means "armies" in Hebrew. While the words "hosts" was used as "armies" in the seventeenth century, many people do not perceive that word in such a manner today.[2] Hebrew ??? ????? transliteration:"Bnei Israel" "And the LORD did that thing on the morrow, and all the cattle of Egypt died: but of the cattle of the children of Israel died not one." Exodus 9:6 (KJV) The word "Bnei" means "sons of" in Hebrew, not children. Sons of Israel, sometimes used to refer to the literal sons of Jacob, most of the times used as a title for the entire nation of Israel. Sons of Israel. When used as a title for the nation of Israel, always capitalize the word "Sons". In the rare instances in which is refers to the literal sons of Jacob, the word sons should not be capitalized so long as it does not appear in the beginning of a sentence. Greek ????? transliteration:"logos" "In the beginning was the Word, and the Word was with God, and the Word was God." John 1:1 (NIV) "Word" now means a short utterance of a single concept, which can include a vulgarity or a falsehood underlying logic or profound statement of the truth replace "Word" with "Truth"[5] ???????? (note the definite article!) It's often transliterated into Adam rather than just kept as the man/person/human being. The connotation needs to be that of humanity rather than maleness; anthropos rather than aner; homo rather than vir. I feel this loses the sense of ???????? as an Everyman, a universal figure prototypical of humanity. One might note also that ?????? "Eve", whilst it is undoubtedly a name, needs the connotaion of life (????) to adequately convey meaning to a reader. "From the fullness of his grace we have all received one blessing after another." John 1:16 (NIV) "grace" has become a female name and a sports term to refer primarily to smoothness in style spiritual and majestic gift-giving replace some instances of "grace" with "boundless generosity" Describing the skins used in the construction of the Tabernacle It's now thought that this is certainly not a badger (or not a Melis one) Possibly "Hirax", though I'm not up on the most recent theories on this. One for an expert, I think. "For to us a child is born, to us a son is given, and the government will be on his shoulders. ... Of the increase of his government and peace there will be no end." Isaiah 9:6-7 (NIV) "government" now means officials paid by mandatory taxes and accountable to a democratic vote replace "government" with "kingdom" - I dislike this - I don't think that monarchy metaphors are really as strong or as relevant as they used to be in the days of the ubiquity absolute rulers. Also "kingdom" is an area of land, I think we want something like "rulership"? Though that sounds a bit ugly. Dominion, perhaps? Greek e????? transliteration: "eirene" "peace" now means an absence of war an inner peace and lack of personal fear or anxiety replace "peace" with "tranquility" - but this then gives possible issues for verses like I Kings 20:18, which now reads And he said, Whether they be come out for tranquility, take them alive; or whether they be come out for war, take them alive. Perhaps we could keep "peace" for shalom, and "tranquility" for eirene? Except Jesus, saying "Peace be with you", is presumably using shalom alechem, or Aramaic cognate, which leads to some interesting issues of consistency. Response: The Hebrew "Shalom" and Greek "Eirene" mean the same thing, which can be either a political state of peace (not at war) or a personal state of peace. If someone says "I'm at peace now", that means more than just they're not at war. So I object to the premise. We do need a better word to distinguish the two, but that word doesn't exist in Hebrew, Greek, or English (at least not as one word). Greek p???s??? transliteration: "plousios": "abundantly supplied"[7][8] "It is easier for a camel to pass through the eye of a needle, than for a rich man to enter into the kingdom of heaven" (Matthew 19:24) nearly everyone is "abundantly supplied" today with food and entertainment, and "rich" has come to mean relative wealth without any absolute significance; continued use of "rich" is misleading in justifying laziness and socialism miserliness to the point of laziness and being unproductive "fully fed and entertained" or "idle miser," or something similar. [9] "Thou shalt not kill" Exodus 20.13 (KJV) In Biblical times, as today, the bearing of arms to defend ones family and society was the hallmark of Judeo-Christian civilization. The commandment referred to unjustifiable homicides - murder and manslaughter - rather than advocating blanket pacifism, as many Leftists today interpret it. to murder or take up arms without sufficient justification replace "kill" with "commit murder" depending on the original text and the context - it'd not be sensible to use murder in the context of an animal doing it, for instance! "Blessed are the meek: for they shall inherit the earth" Matthew 5:5 (KJV) / Ps 37 "meek" now means excessively mild, passive, pathetically submissive. replace "meek" with "God-fearing" The Hebrew forms mean nothing to a modern reader I think we could afford to be bold and translate these names. Footnotes are a cowardly choice. If we had the name of his two sons were Feeble and Poorly, it'd make much more of an impression. Response: A lot of Hebrew names in the Old Testament, particularly in the Book of Ruth, have translations. For instance, Esau means "hairy". We can't really translate all of them. The Book of Ruth is full of these more so than any other book. Naomi ("my delight") asks to be called Mara ("the bitter one"), Orpah means "gazelle" and comes from the root meaning "back of the neck", appropriate given how she turns her back on the people, Boaz means "fleetness", and Obed means "servant". We really can't translate all of these or it becomes nonsense. Where do we draw the line? I prefer footnotes, at least in the Old Testament which is so ripe with these names with literal meanings. "The liberal soul shall be made fat: and he that watereth shall be watered also himself" Proverbs 11:25 (KJV) "liberal" now means adhering to leftist or socialistic political or social doctrines replace "liberal" with "generous", in line with most modern English versions Greek ?d?? transliteration: haidou, "Hades" "No, you will go down to the depths. If the miracles that were performed in you had been performed in Sodom, it would have remained to this day." Matthew 11:23 (NIV) "depths" is now understood to mean the ocean. "Hades" was used by Matthew to help Greeks comprehend Christianity's Hell. The LXX use "haidon" in Psalm 115 to translate the hebrew "dumah", so it's applicable to other concepts as well. replace "depths" with "Hell" - "shall be brought down to hell." (KJV) How then do we distinguish between haides and geenna (sticking to the Gk. for the moment)? Perhaps keep haides for the general realm of the dead, and geenna for a place of punishment? That seems to me to be the difference in nuance. Greek pa?ad?d?µ? transliteration: paradidomi "... he bowed his head and gave up his spirit." John 19:30 (NIV)[10] "gave up" has a newer meaning, attested in the OED since the eighteenth century[11]: it now means to quit and stop trying, or surrender. It has acquired a negative connotation. "relinquish" is a term that avoids ambiguiity and possible negative connotation. replace "gave up" with "released" or "relinquished"

See the Book of Esther for a synopsis of its history.

Verse Translation Discussion and notes ??????? ??????? ????????????? ???? ?????????????? ????????? ???????? ?????-??????--?????? ??????????? ??????? ???????? And it was, in the days of Ahhashverosh - this being the Ahhashverosh reigning all the way from India to Ethiopia, a hundred and twenty-seven provinces, How do people want to transliterate ??????????????? We could do with someone up on Persian history, really. Anyone? I've used "provinces" for ????????, though I'm very open to suggestions! Also is "all the way from... to" too colloquial, and is it justified by the text? Does ?????? really signify India, historically? Answer: Since this is the only mention to my knowledge of India in that time period's Hebrew, I don't know about historically. But in modern Hebrew, it has always referred to India. I'm guessing that's from this verse. It's the best answer we have. ?????????? ?????--????????? ????????? ?????????????? ??? ??????? ?????????? ?????? ??????????? ????????? in those days, when the king Ahhashverosh sat on his throne, in the the city of Shushan, is "his throne" OK for kise malkhuto? I've gone with "capital" for ??????? which I think reads neatly. (Would it be alright to translate Shushan as Susa, or is that too much of a leap?)

Response: Kise malkhuto literally means "royal chair". I think we can understand that to mean a throne. Also, Shushan was not the captial, it was where the King lived in the summer when the captial got too hot. Updated response: That Hebrew word my computer is incapable of typing means "in the city", so I'll replace my palace edit with city. "Iyra", (Ayin - Yud - Resh - Hay) means a generic city, but "Be'er" or "Berah" refers to a specific city. See multiple Israel cities such as Beer Shevah.

????????? ???????? ????????? ?????? ????????? ?????-??????? ?????????? ???? ?????? ??????? ?????????????? ???????? ????????????--???????? in the third year of his reign, he made a drinking-party for all his ministers and his subjects. The warriors of Persia and Media, the aristocrats, and the ministers of the provinces were in his presence, (Media here refers to the region of that name, not to the plural form of medium) ????????????, ???-?????? ??????? ?????????? ?????-????? ?????????? ???????????? ?????? ??????? ?????????? ??????? ???? when he showed the wealth of the glory of his kingdom and his glorious splendor and magnificence for many days, 180 days. ("glorious splendor and magnificence" - HALOT s.v. ????? entry 1; ref. Est 1:4) ??????????? ????????? ???????? ?????? ????????? ?????-????? ????????????? ??????????? ????????? ??????????? ?????-????? ?????????--???????? ?????? ???????? ??????? ??????? ????????? And when these days were fulfilled (completed), the king gave, to all the people that were found in Shushan, from the greatest to the least, a drinking party seven days long in the court of the garden of the king's palace. Something along the lines of "when this period ended" should work, instead of "when these days were fulfilled (completed)". ("palace" - HALOT s.v. ???????; ref. Est 1:5, 7:7,8; three usages total, all "palace.") ???? ????????? ????????? ?????? ??????????-???? ????????????, ???-????????? ?????, ??????????? ?????; ??????? ????? ???????, ??? ??????? ??????-???????--????? ????????? There were white and violet linens held by purple linen ropes on silver rings and marble columns; couches of gold and silver on a flagstone pavement of (red stone), marble, (mother-of-pearl or a stone like pearl), and precious (black) stones. This is going to be hard to say, but alot of this stuff is certainly not modern. Although the white and violet linen and purple cords, the silver rings and the marble (possibly alabaster) columns, and the silver and gold couches (or beds) all work (I think...the silver and gold couches might present a problem.) The real problem arrives when you get to the stones. The ??????, ???, and ??????? are all used only once in Esther. The usage of ????? as "white marble" only occurs three times, all in Esther. All other times it is used as "linen" or "fine linen". If you want, you can go ahead and reduce the flagstone pavement to "multicolored", if it suits you. ??????????? ???????? ?????, ???????? ????????? ????????; ?????? ???????? ??? ?????? ????????? ?????????????? ??????, ???? ?????: ????-??? ?????? ?????????, ??? ????-??? ???????--????????? ????????? ?????-??????? ???? ????????? ???????????, ???????? ????????? ???????--?????, ???????????, ??????, ????????? ??????????????. ????????, ????????????, ??????? ???-?????????, ?????????--????? ?????????? ????????? ?????????? ???????? ???????????, ????? ??????????, ???????? ????????????, ????????????? ???-?????? ????????? ??????????????. ???????? ???-????????? ???????????, ??????? ?????????--???????? ????????: ?????????? ????????? ???????????? ???-????????, ????-?????? ??????? ????. ?????????? ??????????? ?????????, ?????? ???????? ?????????, ??????, ?????? ????????????; ?????????? ????????? ?????, ????????? ???????? ???. ????????? ?????????, ?????????? ??????? ?????????: ????-???, ?????? ?????????, ???????, ????-??????? ???? ??????. ?????????? ??????, ??????????? ?????? ????????? ??????????, ????? ?????????, ????????--???????? ?????? ?????? ???????, ????? ?????? ?????????, ???????????? ?????????, ????????????. ??????, ???-??????????, ????????????, ?????????--??? ?????? ???-????????, ???-??????? ????????? ??????????????, ??????, ????????????. ????????? ????? (????????), ??????? ????????? ????????????, ??? ???-????????? ????????, ??????? ????????? ???????????: ???? ???-????-??????????, ?????-????-?????????, ??????, ??????-????????? ????????? ??????????????. ????-????? ?????-??????????? ???-????-??????????, ?????????? ??????????? ????????????: ??????????, ????????? ?????????????? ????? ???????? ???-????????? ??????????? ????????--?????-?????. ????????? ?????? ??????????? ??????? ??????-???????, ?????? ???????? ???-?????? ???????????, ?????, ?????? ?????????; ???????, ?????????? ???????. ???-???-????????? ????, ????? ?????-???????? ???????????, ?????????? ???????? ?????-???????, ????? ????????: ?????? ???-?????? ?????????, ??????? ????????? ??????????????, ????????????? ?????? ?????????, ??????????? ????????? ?????????. ?????????? ???????? ????????? ??????-???????? ??????-??????????, ???? ?????? ????; ?????-??????????, ???????? ????? ????????????--???????????, ?????-?????. ?????????, ????????, ????????? ?????????, ????????????; ????????? ?????????, ???????? ????????. ??????????? ????????, ???-????-????????? ?????????--???-???????? ?????????? ???????????, ?????-??? ????? ????????????: ???????? ????-????? ?????? ?????????, ?????????? ?????????? ??????

See the Book of John for a synopsis of its history.

Verse[12] Translation Discussion and notes ?? ???? ?? ? ????? ?a? ? ????? ?? p??? t?? ?e?? ?a? ?e?? ?? ? ????? In the beginning was the Word, and the Word was with God, and the Word was God. It is curious, though not necessarily meaningful, how the Greek inverts the order of God and the "Word" at the end of this all-important sentence. ? http://minnesota.publicradio.org/display/web/2006/06/22/word/?rsssource=1? http://biblestudy.crosswalk.com/search/?type=bible&keyword=entropy&translation=niv? http://www.merriam-webster.com/dictionary/media? Harry Ritter, Dictionary of Concepts in History, 419.? The same Greek term of "logos" is used in other contexts disjointed, or even against, God, and translating the term as "the truth" in those very different contexts would not work. For example, And whoever speaks "logos" against the Son of man, it shall be forgiven him (Matt 12:32) and But he did not answer her "logos".(Matt 15:23) Current translations already draw a distinction between these very different contexts by capitalizing "Word" in John 1:1, but not in the contrasting uses.? http://www.blueletterbible.org/Bible.cfm?b=Jhn&c=20&v=19&t=NIV#conc/19? http://www.studylight.org/lex/grk/view.cgi?number=4145? James never used the term plousios to describe a believer.[1]? Often this term was used by Jesus (assuming he spoke Greek) to criticize unproductive, self-absorbed people who inherit wealth, as in the encounter with the rich young man who walked away, and also the Prodigal Son. - but N.B. When the evening came, there came an idle miser of Arimathaea, named Joseph, who also himself was Jesus' disciple. It could work, though.? http://www.blueletterbible.org/Bible.cfm?b=Jhn&c=19&v=30&t=NIV#conc/30? http://dictionary.oed.com/cgi/entry/50094974/50094974se136 sense 64c? Textus Receptus

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The Obamacare Evaluation Project: Cost

Medical Progress Report No. 14 March 2013 RHETORIC AND REALITY

The Obamacare Evaluation Project: Cost

Paul Howard, Senior Fellow, Manhattan Institute

Yevgeniy Feyman, Research Associate, Manhattan Institute

Project Description

President Barack Obama’s first term was defined by the battle over, and the passage of, the Patient Protection and Affordable Care Act, the landmark health-reform legislation known popularly as Obamacare. Along the way, Obama, the law’s supporters, and independent analysts such as the Congressional Budget Office (CBO) made specific claims or projections about how the law would affect consumers, patients, and businesses.

Now, three years after Obamacare’s passage, many key provisions of the legislation are beginning to be implemented. Whether implementation succeeds or fails will be strongly influenced by the reactions of states, providers, insurers, businesses, and consumers to the law’s provisions and to the thousands of pages of new health-care regulations.

Rhetoric and Reality is a project of the Manhattan Institute’s Center for Medical Progress designed to offer an ongoing, objective, and accessible perspective on the law’s performance in light of key claims or projections made about it. Our project will examine the law’s effect on Americans in five overarching areas: health-care costs, insurance coverage, employment, access to care, and consumer-driven health plans. Additional topics may be added.

Each evaluation will be based on the best available data and will be revised as new or more authoritative data become available. Each evaluation will come with a letter “grade” on the law’s performance, using the following scale:

A = Very strong likelihood that the reforms will achieve their intended goals

B = Moderate evidence that the reforms will achieve their intended goals but a need for future analysis

C = Weak evidence that reforms will achieve their intended goals or growing evidence of unintended
consequences

D = Little or no evidence that the reforms will achieve their intended goals and significant evidence of unintended consequences

F = Undeniable evidence that the reforms will produce effects contrary to their intended goals

I (Incomplete) = Insufficient evidence to support a final judgment on the effects of the reforms

About the Authors

Paul Howard is a Manhattan Institute senior fellow and director of the Institute’s Center for Medical Progress. He is also the managing editor of Medical Progress Today, a web magazine devoted to chronicling the relationship between private sector investment, biomedical innovation, market-friendly public policies, and improved health. Howard writes on a wide variety of health policy issues, including medical malpractice, reform of the Food and Drug Administration, and Medicare initiatives. He is often quoted on health-care issues, and his columns have appeared in national publications, including the New York Post, Dallas Morning News, Investor’s Business Daily, and WashingtonPost.com. He is also a member of the Manhattan Institute’s Project FDA, a committee of physician-scientists, economists, medical ethicists, and policy experts whose purpose is to show how twenty-first century technologies can help improve FDA regulations and accelerate the drug-development and drug-approval process without sacrificing safety. Howard received a Ph.D. in political science from Fordham University in New York City in 2003, and holds a bachelor’s degree from the College of the Holy Cross in Worcester, Massachusetts.

Yevgeniy Feyman is a Manhattan Institute research associate providing research and analysis on health care and energy policy. He blogs on health care and entitlement reform at MedicalProgressToday.com, and has written for National Review Online, The Washington Times, and FOXNews.com. Feyman holds a degree in economics and political science from Hunter College.

Introduction

The Patient Protection and Affordable Care Act (aka Obamacare) was described to the American public not only as a means of expanding coverage but as a way of holding down spending on health care. As President Obama told the Washington Post in 2009, “I think it’s important for us to make sure that 46 million people who don’t have health insurance get it. And I think it’s important for us to bend the cost curve, separate and apart from coverage issues, just because the system we have right now is unsustainable and hugely inefficient and uncompetitive.”[1]

As of this writing, important parts of the law have not gone into effect (in particular, the coverage provision). The administration has nonetheless remained adamant (based on CBO estimates dating back to 2009) that the law will create substantial savings in the health-care system. Examining some preliminary data that include projections by independent, nonpartisan experts allows us to test the president’s claims that Obamacare will lower U.S. health-care costs. Based on analysis of the available data, we project that Obamacare will increase U.S. health-care spending and will not lower health-care costs.

Health-Care Premiums

Monthly health-insurance premiums are calculated based on actuarial predictions of an individual’s risk of requiring medical care. For instance, all other things being equal, premiums—the amounts charged for insurance coverage—will be higher for the elderly than for the young, as the elderly tend to have more health problems than do the young. Premiums are effectively the canary in the health-care coal mine because they take into account not just the actual cost of care but also state and federal taxes, politically mandated coverage requirements, and how many sick or healthy people purchase insurance. As these underlying costs change, insurance premiums change with them.

The American health-care system is dominated by so-called third-party payers (i.e., an organization other than the patient or a health-care provider that actually pays for health-care services when they are rendered). Usually, the third party is an insurance company or the government. As a result, individuals often conflate the cost of their insurance premiums with the cost of their health care—that is, as a person’s premiums rise, so will his perception that his health care is becoming more expensive and vice versa (regardless of whether that is true). Because of this, we focus first on premiums paid directly by households, not on premiums paid by either an employer or by the government.

As it turns out, since the passage of Obamacare, household premiums have increased by a full 11.3 percent. Moreover, this increase even outpaced the rate of the medical services consumer price index (CPI), which netted a mere 6.8 percent increase over the three years that we measure.[3] The CPI is the commonly used measure of inflation; the medical services CPI measures the growth in prices of medical services.

Independent analysis also suggests that this trend will not slow down anytime soon. In 2012, the CBO and Joint Committee on Taxation estimated that by 2016, employer-based family coverage will cost $20,000, with varying amounts of minimum required contribution based on family size and income.[4] This will be an increase of $4,255 from 2012’s total family premium of roughly $15,745—a 27 percent jump.[5]

Looking further down the road, per-enrollee household private health-insurance premiums are projected to rise steadily through the rest of Obamacare’s implementation (2013–21), with the exception of a brief dip in 2014. (The dip is related to a one-time shift in costs from individuals to the government because people purchasing insurance on insurance exchanges will, on average, pay less of the cost because of federal premium subsidies. This drags down the average premium increase for households, but the costs will be borne by the federal government, i.e., taxpayers.)

A recent survey of insurance companies by the American Action Forum, a think tank, found that key Obamacare reforms will likely cause significant premium increases, particularly for young and healthy policyholders, and that much of these increases will be unrelated to the expansion of benefits under the law. Other elements in the law, including smaller rating bands (limits to how much more insurance companies can charge older enrollees than younger ones) and prohibitions on gender and health-status rating (sicker enrollees also cannot be charged more) contribute significantly to future projected premium increases.[7] The projected increase in private health-insurance premiums is likely even to outstrip increases in medical inflation over ten years, further indicating that Obamacare is driving up insurance premiums beyond the price of individual health-care services. For instance, because Obamacare requires a richer benefit package in the individual and small-group markets and adds new taxes on drugs, insurance companies, and medical devices, along with new subsidies for buying health insurance, Obamacare will, on average, place upward pressures on premium prices.[8]

Health-Care Spending

It is often remarked that health-care spending in the United States is out of line with countries that have similar, advanced economies. This, coupled with reports of hundreds of billions of dollars in estimated annual waste, means that careful attention should be given to reforming the U.S.’s level of health-care spending and “bending the curve” of its growth rate.

Today, Americans spend well over $2 trillion—close to 18 percent of GDP—on health care, and U.S. health-care costs have grown much faster than either income or GDP growth over the last several decades. However, despite the best intentions of its supporters, Obamacare will not make much of a dent in these trends. The Centers for Medicare and Medicaid Services (CMS) projects that between 2012 and 2021, America will spend $36.8 trillion on health care. Absent Obamacare, CMS estimates that spending would be $36.3 trillion—a difference of just $500 billion over ten years. In other words, without Obamacare, Americans would spend less on health care.

Obamacare does little to actually stem spending growth, aside from some relatively small pilot projects on reimbursement reform that have had disappointing results thus far, either producing some savings but also some cost increases, or increasing outright health-care spending. For instance, the implementation of electronic health records has, thus far, not only failed to decrease health-care spending but seems to have increased it by making it easier for providers to bill for additional services.

In fact, the largest components of estimated deficit savings in CBO projections related to Obamacare come from revenue increases rather than actual decreases in U.S. health-care spending. As noted earlier, the law shifts health-care costs from individuals to government, with the overarching goal of reducing the share of health-care spending borne by low- and middle-income uninsured consumers. The problem is that evidence strongly suggests that when out-of-pocket spending is lower, health-care spending actually rises.[9] In fact, American consumers spend less on out-of-pocket costs than most of their advanced Organisation for Economic Co-operation and Development (OECD) competitors.

If we examine per-capita health-care spending across a number of OECD countries, we see a significant correlation between out-of-pocket spending as a share of total health-care spending and the level of per-capita health-care spending. This explains about 30 percent of cross-country variation in 2010, suggesting that in order to “bend the cost curve” of health-care spending, more out-of-pocket spending may be needed in the form of deductibles, co-pays, and cost-sharing for routine expenses. In other words, consumers must become more cost-conscious.

Critics may rightfully point out that Figure 4 is incomplete: if we compare actual out-of-pocket spending per capita (rather than the share of total) with total spending per capita (including the share covered by government and insurance companies), it appears as if more out-of-pocket spending is associated with higher, not lower, health-care costs. The issue with this approach is that the causal direction is not clear—that is, we already know that the U.S. spends more both overall and on a per-capita basis. Therefore, it is likely that an increase in actual per-capita spending will also increase actual out-of-pocket per-capita spending. The reverse is certainly possible—that increasing per-capita out-of-pocket spending will increase total per-capita spending—but intuitively, it seems unlikely. Many other studies, for instance, have found that increasing out-of-pocket costs reduces the use of health-care goods and services, serving as a check on spending.[10]

What we do know—again, from cross-country comparison (and this casts some doubt on the potential criticism earlier)—is that the out-of-pocket spending share of total health-care spending is strongly, and negatively, correlated with health-care spending as a share of GDP, a measure that is, in essence, the burden of health-care spending on the economy.

One may, however, criticize this approach on moral grounds by claiming that the poor and indigent should be protected from rising health-care costs. Of course, some means-tested subsidies, such as Obamacare’s premium subsidies, are desirable (and indeed, are used in countries such as Switzerland), but Obamacare provides these subsidies far above the poverty line—for families who make up to 400 percent of the Federal Poverty Level, or about $94,000 for a family of four in 2014.[11] This means that the subsidies will be going to people who may not actually need them because they could easily afford to buy their own coverage.

When consumers are less cost-conscious (in this case, because they pay fewer direct medical costs), producers have greater freedom to raise prices while consumers have an incentive to utilize additional health-care services.

Consequently, increases in the costs of medical services have consistently been greater than cost increases in the rest of the economy. To combat this trend, policymakers should focus on finding ways of making most nonpoor consumers more cost-conscious rather than less cost-conscious. By focusing on cutting out-of-pocket spending—which is projected to fall from around 11 percent of total health-care spending today, to 9.3 percent by 2021[12]—Obamacare does little to stem the growth in medical prices and may, in fact, accelerate some price increases by reducing price sensitivity and increasing demand for health services by bringing the newly insured population into the market.

Obamacare will also push about 12 million Americans into Medicaid. This joint federal-state health-insurance program for the poor is a huge and growing budget concern: it will spend some $638 billion in federal dollars over 11 years to expand coverage to the 12 million new beneficiaries. By 2023, the federal government will be spending $572 billion annually on the program; state spending will bring the spending to about $1 trillion. Because access to care in the program is spotty, it is questionable whether expanding it is worth the massive investment, given the growing share of the budget that the program makes up.[13]

Ultimately, all the existing evidence suggests that Obamacare will not reduce health-care costs, although it will certainly shift the cost burden to the government (which is ultimately the responsibility of taxpayers) as well as other, non-health-related industries. And while we don’t address the costs of Medicaid spending in this report, the cost of expanding Medicaid—for state and federal budgets—is another important concern that policymakers should bear in mind.

Obamacare’s Grade on Controlling

Health-Care Costs: C

Since the mid-1980s, medical inflation has outpaced all other inflation by an ever-increasing margin. While many factors play into this phenomenon, Obamacare fails to address the drivers of excessive and continuous price increases for medical goods and services. By shifting costs to government and taxpayers and by increasing overall U.S. health-care spending, Obamacare will, by its own standards, fail to control health-care costs.

Proponents of the law have pointed to the CBO’s February 2013 budget outlook as evidence that the law is already reducing costs, particularly for Medicare. In the updated outlook, the CBO did revise downward its estimated spending for Medicare from 2013 to 2022 by $137 billion. However, 75 percent of that revision comes from Medicare’s prescription drug benefit, Part D.[14] There is no reason to think that the Part D savings stem from Obamacare. For one thing, actual Part D spending has been about 30 percent below CBO’s original projections. More important, Obamacare actually expands the Part D benefit (and increases spending relative to what it would be otherwise) by requiring manufacturers to issue rebates to cover branded drugs through the infamous “doughnut hole.”

Obamacare does attempt several payment reforms and initiates a number of pilot programs.[15] For instance, to deal with the disproportionately large share of Medicaid spending by dual-eligibles (those who qualify for both Medicaid and Medicare), CMS has started the Financial Alignment Initiative, which places dual-eligibles into a private managed-care program to improve care coordination and outcomes.

Other attempts at cost control include the implementation of payment reform projects designed to get doctors and hospitals focused on delivering health care more efficiently and improving health outcomes for patients, rather than simply maximizing payments for the services they provide. Specifically, Obamacare seeks to increase outcome-based care in Medicare through the use of Accountable Care Organizations (ACOs). ACOs allow providers who can offer better outcomes at lower costs to “share in the savings” with the federal government. The evidence on ACOs, however, is mixed—a CMS pilot project from 2005 to 2010 failed to consistently show significant savings.[16] ACOs also present antitrust concerns as well; if they encourage greater hospital consolidation, which seems to be the case, then reduced competition may stymie any downward pressures on costs from bundled payments. Because we do not yet know how these programs and other initiatives will ultimately play out, there is a possibility that the ACA’s efforts may yet result in modest savings; but at this juncture, that appears unlikely.

As such, we give Obamacare’s cost-cutting efforts a grade:

C = Weak evidence that reforms will achieve their intended goals or growing evidence of unintended consequence

As these programs and other evidence develop on Obamacare’s effect on health-care costs, we will update our findings appropriately.

Endnotes

Washington Post, July 22, 2009.

A minor data issue concerns the combined use of MEPS and EHBS data. In recent years, EHBS data have shown higher absolute numbers for employee contributions but slower rates of increase. MEPS data have shown the reverse. We consider MEPS to be a more robust data source and one that is more nationally representative, given the state-by-state breakdowns; thus, where possible, we defer to MEPS data. Year 2012 data were projected for MEPS by using the ten-year average ratio (MEPS/EHBS) to project MEPS data for 2012 based on existing 2012 EHBS data.

U.S. Department of Labor: Bureau of Labor Statistics, and author’s calculations, based on the urban CPI for medical care.

Congressional Budget Office, “CBO and JCT’s Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance,” March 2012, http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-15-ACA_and_Insurance_2.pdf.

Kaiser Family Foundation and Health Research & Educational Trust, “Employer Health Benefits, 2012 Annual Survey,” http://ehbs.kff.org/pdf/2012/8345.pdf. Using Kaiser’s numbers gives a smaller potential increase than the results we would have seen using the estimating methodology from n. 2 above.

These numbers are not completely comparable with the numbers for average employee contributions, but they still represent an important element of rising health-care costs. They are calculated as household private health-insurance premiums divided by enrollment in employer-sponsored insurance, other private health insurance, and exchanges. These numbers include Medicare supplemental coverage (which is less expensive than full insurance coverage) and thus may understate increases. Additionally, these numbers do not include out-of-pocket spending, such as deductibles. The drop in 2014 likely indicates a shift to premium subsidies for the exchanges.

Douglas Holtz-Eakin, “Insurance Premiums in 2014 and the Affordable Care Act: Survey Evidence,” American Action Forum, January 2013,
http://americanactionforum.org/sites/default/files/AAF_Premiums_and_ACA_Survey.pdf.

The ten-year (2003–12) historical difference between overall inflation (CPI) and medical inflation (Medical Care CPI) is 1.4 percentage points. The 2012 Medicare Trustees report assumes an average 2.8 percent CPI increase over ten years. CMS’s projection for ten-year per-enrollee private health-insurance premiums is an average increase of 4.7 percent. If the historical difference holds, this means that medical inflation should increase at an annual average of 4.2 percent (over ten years). Thus, private insurance premiums should increase at an average of 0.5 percentage points greater than medical inflation (4.7 – 4.2 = 0.5). Note that this assumes that medical inflation will be greater than its ten-year historical average (2003–12) of 3.9 percent. Last, the CBO’s latest projections estimate an annual CPI increase significantly less than 2.8 percent. By using a greater number for CPI (from Medicare’s Trustees), we may understate the difference between medical inflation and insurance-premium-cost growth.

A recent study by the RAND Corporation looked at the impact of high-deductible health plans (HDHPs) on health-care spending. HDHPs increase the out-of-pocket share borne by consumers—the findings indicate that use of HDHPs results in lower health-care spending; see American Journal of Managed Care 17, no. 3 (March 2011): 222–30. Previous studies also confirmed that consumers are very price-sensitive when choosing health-insurance plans; see http://www.nber.org/reporter/summer06/buchmueller.html.

Gary Robbins, Aldona Robbins, and John Goodman, “Inefficiency in the U.S. Health-Care System: What Can We Do?,” April 1994, http://www.ncpa.org/pdfs/st182.pdf; and Rand Health Insurance Experiment, http://www.rand.org/pubs/research_briefs/RB9174/index1.html.

See http://aspe.hhs.gov/poverty/13poverty.cfm.

CMS’s National Health Expenditure Projections, Table 16, Household Out-of-Pocket Expenditures,
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf.

Future Medicaid spending is somewhat difficult to gauge; according to CMS, the program’s per-enrollee costs are greater than those of private insurance. However, this includes the elderly and disabled, who utilize health services at a greater rate. Comparing per-enrollee costs for Medicaid with private insurance may indicate that Medicaid is more “efficient”; however, this efficiency comes at the cost of access to care, due to reduced reimbursements to providers.

See CBO, “March 2012 Medicare Baseline,” http://www.cbo.gov/sites/default/files/cbofiles/attachments/43060_Medicare.pdf; “February 2013 Medicare Baseline,” http://www.cbo.gov/sites/default/files/cbofiles/attachments/43894_Medicare2.pdf; and “The Budget and Economic Outlook: Fiscal Years 2013–2023,” http://www.cbo.gov/sites/default/files/cbofiles/attachments/43907-BudgetOutlook.pdf.

Some pilot programs, such as the effort to increase efficiency by adopting electronic health records, have not been very successful.

Cola et al., “Spending Differences Associated with the Medicare Physician Group Practice Demonstration,” Journal of the American Medical Association (September 2012): 1015–23.

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Green groups rally on climate, urge Obama to reject Keystone project

Environmental groups gathered on the National Mall in Washington, D.C. Sunday and marched on the White House for a climate change rally largely aimed at pressuring President Obama to reject the Keystone XL oil sands pipeline.

Organizers said 35,000 activists attended the rally, where speakers portrayed the battle over the pipeline as a struggle between grassroots green groups and deep-pocketed special interests.

“They’ve got the lobbyists. They’ve got the super-PACs. They made the campaign contributions. They’ve got this town in their pockets — they have got the situation under control. And then you show up. And then we show up. And we change the game,” Sen. Sheldon Whitehouse (D-R.I.) told the crowd not long before it marched on the White House.

Obama will decide whether the project goes forward because it crosses national boundaries.

More from The Hill:
• States join battle over drone flights
• Privacy advocates: Cybersecurity bill faces tough odds
• Press corps: 'Frustration' over lack of access to Obama
• Graham: Hagel disavowed remark on Israel, State Dept.
• Defense industry focuses on minimizing sequester damage
• Dems hold fire on climate change votes

The pipeline would bring fossil fuels from Canadian tar sands fields to the Gulf Coast. Environmentalists are painting Obama’s upcoming decision as the litmus test for whether he plans to make good on recent comments about tackling climate change.

Activists at Sunday’s rally said approving the pipeline would taint Obama’s record on climate change. They said they hoped the demonstration would give the president the will to nix Keystone, even when a majority of both the House and the Senate want it built.

“His heart is there. The question is can we change the politics enough so he can do what he knows is right. And I believe that he will,” Van Jones, a former Obama adviser, told The Hill.

Courtesy of Shadia Fayne Wood | Project Survival Media | 350.org

The politics surrounding the project are formidable.

Blocking Keystone would play into Republican assertions that the president is scuttling a project that could enhance energy security and create thousands of jobs to appease environmental supporters. They have pressed the White House to green-light the pipeline.

Oil-and-gas groups, such as the American Petroleum Institute, have helped lead a lobbying effort to get Keystone built.

Canada also has tried to sway the administration into approving the pipeline, as it would benefit that nation's oil sands industry.

Obama also has his own base to consider, as several union groups are eager for the jobs Keystone would bring to their members. The AFL-CIO’s building and construction trades division has endorsed the pipeline, and that department’s leader expects the full labor federation to lend its support.

But there is no time to delay when it comes to climate change, Susan Casey-Lefkowitz, director of the Natural Resources Defense Council’s (NRDC) international program, told The Hill.

“There is no deal to be done,” she said. “We need to do everything we can on every front.”

That is why NRDC and other green groups also want Obama to pursue more stringent carbon emissions standards.

The environmental community is pushing the White House to set emissions standards for existing power plants to build on proposed rules in Obama's first term that effectively barred construction of new coal-fired power plants.

Courtesy of Joshua Lopez | Project Survival Media | 350.org

Greens also want Obama to forge ahead with clean-energy research and deployment on federal lands, measures to boost energy efficiency in homes, buildings and manufacturing and efforts to make coastal towns and cities more storm resilient.

The green groups are focusing their pressure on Obama because of gloomy prospects for passing climate bills this Congress. Republicans will not accept fees on carbon emissions — the same goes for some conservative Democrats.

In an interview with The Hill, Whitehouse said killing Keystone and pushing ahead with stronger regulations could jolt polluting industries into working on climate legislation.

“That’s what’s going to bring them to the table very quickly,” Whitehouse said. “And as soon as the polluters want it, then obviously the Republicans are right there with them.”

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The Project to Replace ObamaCare Begins Now

As 2013 begins, encouraging a discussion about how to replace the president’s health-care law might strike some observers as a case of particularly bad timing. After all, in the year just ended, the Supreme Court upheld most of the provisions of the law and the president won reelection. As a consequence, the best opportunities to remove the law from the books before it ever really got started are now gone. The tough reality now is that Obamacare is not going to be undone during the next four years. So why bring up an alternative plan at this point?

The answer is that replacing Obamacare is by necessity a long-term project; you have to start somewhere. Moreover, it remains essential. Like it not, health-care policy is central to the struggle over the size and scope of governmental power. Without a better approach than Obamacare, there will be no success in limiting government or in lessening the dependence of citizens on the state.

It is also going to take a lot of work and political effort to build the political coalition necessary to move health-care policy in a different direction. Indeed, one of the reasons Obamacare passed in the first place is because opponents of government-dominated health care never coalesced around a serious and workable alternative in the years prior to 2009. Moreover, those efforts that did take place to promote a real alternative, such as Senator John McCain’s proposal from the 2008 campaign, fell far short because they were not preceded by the necessary policy and political groundwork.

But all is not lost. Obamacare is flawed legislation that is already forcing employers to cut back their hiring and limit their employees’ hours. It will soon send premiums sky high for many Americans who already have insurance. Promises about the law’s coverage and cost-control effects were greatly exaggerated. There will come a time — sooner rather than later — when Americans will be ready to hear again about an alternative to Obamacare’s government-heavy approach. At that moment, which might coincide with the 2016 presidential contest, Obamacare’s opponents must be ready with a viable, center-right, market-based alternative that can win public support. And the only way to be ready for a debate on health care in 2016 is to get to work now on the alternative plan. It takes that long to develop a workable framework, get it analyzed with credible numbers, and refine it to ensure it has broad appeal.

In that spirit, I am circulating again two essays on this subject from 2012. The first, co-authored by myself and Robert Moffit of the Heritage Foundation and published in the journal National Affairs, describes what we see as the fundamental principles of an effective, market-based reform plan. The second — a sequel of sorts to the first — is my effort to provide more detail on some of the key features of a workable alternative plan. It was published last month by the American Enterprise Institute in its Health Policy Outlook series.

Advocates of expansive governmental power are always more comfortable than their limited-government opponents talking about health-care policy. It is far easier to sell “the government will take care of it” than to explain why a decentralized, market-driven approach will be better for voters anxious for certainty about their health-care needs. Nonetheless, this fight cannot be avoided. Health care is too important to fiscal policy, to the American economy, and to the concerns of voters to be set aside as an unwinnable issue.

It is of course true that full replacement of Obamacare with a workable, market-based alternative will be an extremely difficult undertaking. But it is also true that a new direction in health care is crucially important for the country. And so, that being the case, it’s far better to get started on the effort now than to delay and thereby handicap the possibility of future success.

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