The Patient Protection and Affordable Care Act (PPACA) of 2009 passed the Senate this morning, before dawn, on a strictly partisan vote.  For the first time in history a major piece of legislation was approved without bipartisan support, in the dead of night and against the observed will of the American people.

Rasmussen polling puts the opposition at 55% with support at 41%.  CNN polling agrees reproting a 56% vs 42% plurality in opposition, while noting that is a 6% increase from their last poll showing 36% approval.  This being CNN they also note “CNN found that only 56 percent of respondents opposed the Senate health care bill.” a decrease from the 61% opposition of their last sample.    President Obama now enjoys the lowest approval rating in his first year of any Chief Executive in modern history with 44% approval and 56% opposition.  This is in contrast with President Bush who enjoyed  a peak 89% approval at the close of his first year in office.

Why?

Could it be because the American Public feels that Malpractice Reform should be part of any Health Care Reform efforts by a 2:1 margin while such language has been completely avoided by both Houses?  Or perhaps because the majority feel they will be worse off under the legislation, paying more for less coverage and greater bureaucratic control?  Maybe it’s because “87% believe that before anyone receives government health care subsidies, they should be required to prove they are legally in the United States“, while “the legislation does not require proof of citizenship for those seeking taxpayer-funded health care help.“  There is the prohibition against Federally funded abortions, part of settled law for greater than 20 years, now substantially weakened in the Senate bill despite public opinion 54% against this action.

Maybe it has something to do with unequivocal violations of President Obama’s promise that “if you like your current insurance you can keep it“.  For the 23% (10.3 million) of Medicare recipients enrolled in Medicare Advantage plans, that is manifestly false (unless of course you live in Senator Bill Nelson’s state, where a specific exemption was written into law to secure his vote – more on this below).  Basically the clear, uncontested, majority will of the America people, found across every major polling organization, has been ignored by this Congress and President in a rush to jam through a major structural change in the health care delivery system we all depend on.

How?  How did they get so many Senators to ignore their constituents views, their own political futures, and vote for this divisive POS?

Let’s take a quick look at a few examples…

Many have likely heard of the modern “Louisiana Purchase” whereby Louisiana received $300 million in Federal funds to secure Sen. Mary Landrieu’s vote, or Sen. Chris Dodd’s $100 million earmark for a new UConn hospital.  Of course Dodd’s vote was never in question, he just has the juice to nab a little freebie while the spigot is open.  I find myself increasingly irritated at my own Senators Boxer and Feinstein, whose ideological desire to take over the health care system and use it as yet another wealth redistribution scheme caused them to barter their votes early, before the hand-out train had even arrived at the station.

Of course these examples are small scale in the scope of corruption we’ve seen as part of the move to pass this bill, and likely won’t be the last either.  Realize this monstrosity is nearly 2800 pages long and 800 of those we air dropped this week by Sen. Reid.  I would wager many more will come to light over time.  Here are a couple more…

Sen Ben Nelson, a noted moderate Democrat who stood in principled opposition to Federally funded abortions and increased deficit spending somehow got over his “principles” once the “Cornhusker Kickback” was offered.  As such, Nebraska and Nebraska alone, will bear NONE of the costs of the increased Medicaid enrollment mandated by the bill.  All states receive full federal funding of this mandate for a period of two years, then must pay their share going forwards.  A “special” deal was arranged by Sen. Reid of course, Nevada will be protected from the billions in increased Medicaid costs for a period of seven years, but then hey, he wrote the thing.  But as the last hold out – the all important 60th vote – Sen Nelson was able to arrange to the Federal Government to cover Nebraska’s increased Medicaid cost in perpetuity – as in forever!  When this sleazy affair was brought to light Sen. Nelson first attempted to claim he received no special treatment, then that he was merely acting in agreement with his Republican Governor.  Not so says Gov. Heineman. For the relevant quotes see below(1).  That said, we, all of us, will now pay for the cost impact of this mandate for the citizens of Nebraska.  Guess it pays to be the last hold out… Oh, and by the way, the CBO estimates it as $1.2 Billion over this decade alone.

Not to be left out Sen. Bill Nelson of Florida extracted a remarkable concession himself.  Termed the “Florida Flim-Flam” Sen. Nelson was able to protect his state, or at least the three largest Democratic counties in the state (Brevard, Miami Dade and Palm Beach) from cuts to Medicare Advantage.  So, as residents here in California, or Arizona or anywhere else in the country will have to deal with the loss of these extended benefits, they will also have to pay for Democratic voters in Florida who will continue to receive the benefits they have lost. To read Sen Nelson’s defense of MA plans you’d think you were reading a piece written by some evil insurance executive, extolling the benefits of the program and his desire to protect it.  But somehow, when push came to shove only his Democrat voters in three populous counties were protected.  Read him, in his own words here.  And in case you were wondering, the net cost is estimated at $30 Billion over the next decade.  I guess these Seniors might still vote Democrat in 2010…

So having now touched on “Deceit” and “Corruption”, let’s proceed to “Accounting Fraud” which this Congress has taken to a new art form.

First, understand that the accounting rules applied by Congressional advocates and echoed by President Obama would make an Enron Executive blush.  What they have done is simply count the anticipated savings from the Medicare program twice; once to increase the period before Medicare runs out of money by 9 years and again to fund the expansion of insurance entitlements.  Sen. Jeff Sessions uncovered this chicanery, probably one of many such scams within the bill and part of the reason it was kept under wraps until four days before the vote.  But it is not just the Republican opposition who hold this view.  In fact, the CBO director states, “The key point is that the savings to the HI trust fund under the [Patient Protection and Affordable Care Act] would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs […] To describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement of the government’s fiscal position.”

The Chief actuary at CMS ( Center for Medicare Services)  agrees stating, “The combination of lower Part A costs and higher tax revenues results in a lower federal deficit based on budget accounting rules. However, trust fund accounting considers the same lower expenditures and additional revenues as extending the exhaustion date of the Part A trust fund. In practice, the improved Part A financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions under the PPACA) and to extend the trust fund, despite the appearance of this result from the respective accounting conventions.”

Recall that even these statements fail to address the fact Congress is using 10 years of taxation to pay for 6 years of a program slated to go on in perpetuity.  The next decade will be worse.

So perhaps this litany of issues helps to explain why the Senate remained in session until Christmas Eve, and voted on this bill before sunrise, on a day when people’s attention wasn’t exactly focused on Washington.  Between the inaccuracies of public statements ( “you can keep your plan”), the unpopularity of the provisions (60:40 against), the special deals offered some to secure the 60th vote needed for cloture and the bald faced accounting fraud used to support claims of budget neutrality this is perhaps the worst piece of legislation in history.

Clearly the Democratic leadership understands all of the above.  They may be duplicitous, but they are not stupid.  Speaker Pelosi is well aware that 2010 will likely see losses for many moderate to conservative Democrats and may cost her control of the House.  So the obvious question is WHY?  Why would Pelosi/Reid push such unpopular, costly legislation; legislation that requires such reprehensible machinations to win support of even their own party ?  I believe the answer is simple: despite what they have claimed all along, it is worth any price to get in place a framework, no matter how weak (no Public Option) that will expand the entitlement sector of the American electorate.  It is after all the expansion of Government that defines the “Progressive” wing of the Party and they know that no matter how weak, once in place they will be able to tighten the screws incrementally and indefinitely to give them desired control.  This was never about “bending the cost curve”, increasing insurance “competition”, or even combating waste.  It is quite simply another LARGE step in the process of taking over the delivery of Health Care in America and 1/6th of our economy.

Just as the SCHIP program expansion was a ruse sold as “covering poor children” it is in fact a grab for power and control.  For SCHIP, 77% already had private insurance and half of new recipients in some states were adults; budgetary gimmicks were employed – like assuming all new recipients would lose coverage after 4 years – to keep the CBO score at a mere $35 billion.  Here too it is about what they can sell to the public. Failing that (which polls show they have) it quickly became whose votes they could buy with taxpayer handouts.  That one needs to read a blog post such as this, or search for data on the CBO Directors blog to obtain accurate information is a travesty from which the New York Times et. al. will never recover.

As a final slap to the bill I would point out that the language prevents future Congresses from repealing or modifying one aspect: the empowerment of the United States Preventive Services Task Force to set Federal policy and payment rules.  Recall these are the folks who brought us Mammography only for women over 50, a policy recently imposed on poor women here in CA for strictly financial purposes.  Apparently the legislation makes it such that a 2/3 majority is required to modify this power, a barrier unlikely to be breached.  Legal challenges are being prepared at this time attacking the constitutionality of this clause.  But if my arguments above have failed to persuade, if the concept of Death Panels seemed like breathless hyperbole, read these links (1,2) on the imposition of such rules here in the Golden State.  As Reagan once said, the most frightening words in the English language are “I’m from the Government and I’m here to help”.  California has now made this fear reality for over 311,000 poor women under 50 (the number served by this program in 2009).

The move to push this legislation on Christmas Eve is a remarkable and cynical departure from the usual comity of the Senate.  No one deserves such nasty lumps of coal in their stocking.  To bad the Democrats in Congress don’t agree.  I advise you America, be VERY wary of what these people are trying to sell.