Blog No. 134. Repeal and Replace: R.I.P. (Hello, Rescue and Repair and Goodbye, Freedom Caucus)

It is clear that “Repeal and Replace,” the Republican mantra for several years, is dead. And while there were several who bear responsibility for its demise, none was more prominent than the Freedom Caucus. has never been an admirer of the Freedom Caucus and, indeed, our preferred term has been the Oozlum Caucus, named[…]

Blog No 74 Part I. The Supreme Court: The Affordable Care Act, Same-Sex Marriage and Other interesting Issues.

Part I. The Affordable Care Act and Same-Sex Marriage The end of the Supreme Court term produced two major decisions, on the Affordable Care Act and same-sex marriage, that generated extensive comment by politicians and pundits and drew attention in every form of media. There is little need at this point for extended discussion or[…]

Guest Blog. Redirecting Health Reform: A Real Republican Opportunity

A couple of years ago, Jeff Bauer and I and our wives shared a nightly dinner on a transatlantic crossing and became friends. Jeff and I stayed in touch and exchanged thoughts on various subject, including healthcare, a subject on which he is an expert and I am not. I was impressed by his expertise and intrigued by his perspectives on that challenging issue and I talked him into doing a guest blog. I believe that readers of will find it both informative and thought-provoking. ~ DMP.

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Redirecting Health Reform: A Real Republican Opportunity

By Jeffrey C. Bauer, Ph.D.


The intensely partisan debate over repairing or repealing the Affordable Care Act (ACA) is a waste of everyone’s time. Democrats begrudgingly admit that Obamacare is flawed, but they refuse to modify its core goal of reducing the number of uninsured Americans. Meanwhile, Republicans keep voting to repeal the law without offering a viable alternative for solving the serious problems of our medical care system.

Expanding access to a dysfunctional system will only make the situation worse, but returning to the pre-ACA marketplace will not make things any better. As I argue in Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness (CRC Press, 2015), it’s time to start from scratch. A new approach to reform is sorely needed to extract us from today’s lose-lose confrontation between defenders of a poorly crafted law and opponents who would return us to the failed marketplace that Obamacare attempted to address. […]

Blog No. 48. Dying in America: Yes, There Is a Better Way

“Most people envision their own death as a peaceful and an ideally rapid transition. But with the exception of accidents or trauma or of a few illnesses that almost invariably result in death weeks or months after diagnosis, death comes at the end of a chronic illness or the frailty accompanying old age. Few people really have the opportunity to know when their death will occur.”

That unsurprising but sobering observation was included in the Preface to a report issued on September 14 by the Institute of Medicine (IOM), “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” The IOM is an affiliate of the National Academy of Science and the report was prepared by a nonpartisan committee that included physicians, nurses, insurers, lawyers, and gerontologists. The goal of the report was to offer a road map to providing care at the end of life that is “person-centered, family-oriented, and evidence-based.” To that end, the report proposed sweeping reforms to end of life care, including the nature of care provided, how the government and insurers compensate for medical service, and the focus of medical education. It is a lengthy report, some 507 pages, that reflects the complexity of the issues and the care that went in to the study of them by the IOM committee. It is a document that deserves the attention of the medical community, patients and their families, political leaders, and the public at large. […]

Blog No. 42. Contraceptive Confusion: The Puzzlements of Hobby Lobby and Wheaton

On June 30, The Supreme Court issued an opinion in Sebelius v. Hobby Lobby Stores and Conestoga Wood Specialties v. Sebelius (collectively Hobby Lobby) invalidating regulations under the Affordable Care Act (ACA) that require that insurance provided by employers cover a broad range of contraceptive medications and devices. The employers in each case objected to coverage for four specific types of contraceptives that they consider to be abortifacients, i.e., causing an abortion. The employers claimed that the requirement to provide that coverage infringed their rights under the Religious Freedom Restoration Act (RFRA). A five-justice majority of the Court agreed in an opinion by Justice Alito. The immediate controversy over the decision was quickly heightened when, three days later,the Court entered a preliminary stay in Wheaton College v. Burwell relieving Wheaton, a Christian college, of complying with an alternative procedure that the Court had appeared to endorse in Hobby Lobby. […]

Blog No. 22. Obamacare and Contraception: Science, Freedom of Religion and Politics

JUSTICE - religion and ACA BLog 22 version 2 LOGOThe Supreme Court has agreed to hear two cases challenging the requirement of the Affordable Care Act (ACA) that insurance plans provided by employers must include coverage for certain contraceptive drugs and devices. Circuit courts hade reached conflicting decisions as to whether that requirement infringes the rights of corporate employers or their stockholders under the Religious Freedom Restoration Act (RFRA), and the Court will resolve that conflict.  The cases raise interesting legal questions and, like most of the more interesting cases in the Supreme Court, they have stimulated political reactions of which more no doubt lie ahead. will not predict how the Court will rule, or even take a firm position as to how it should, but will merely attempt to clarify the issues.  As a political issue, however, we will suggest that the cases probably represent more of a risk than an opportunity for Republicans and that they should treat  the Court’s eventual decision with some caution. […]

Blog No. 20. What now for Republicans? (Schadenfreude is not a policy.)

Schadenfreude: a feeling of enjoyment that comes from seeing or hearing about the troubles of other people.

Republicans may be forgiven if they have indulged themselves in a bit of Schadenfreude over the continuing debacle of Obamacare.  To be sure, that debacle could hardly have come at a more opportune time. The furies unleashed by the website failures and the cancellation of insurance policies served to soften, if not erase, the public disdain for the Republicans’ recent antics: the ill-advised gambits with the government shutdown and the debt ceiling. Nevertheless, those furies, and the agonies they have produced in Democrats, may prove to be ephemeral. A diet of Schadenfreude does not provide much nutrition, and it surely is not a policy. […]

Blog No. 17 Health Insurance Cancellations: The Continuing Mystery and the President’s Tap Dance. was among the first to call attention to the fact that Obamacare had led to the cancellation of hundreds of thousands of health insurance policies with millions more cancellations likely to follow. We pointed out, as others had, that such cancellations appeared to make a mockery of President Obama’s oft-repeated pledge that “If you like your health insurance, you can keep it.” (Special Bulletin, October 27, 2013, “What did the President know and when did he know it (or Who’s minding the store?).”  Indeed, Glenn Kessler, Fact Checker for The Washington Post has now given the President his highest “award:” Four Pinocchios.


Special Bulletin Updates: Obamacare and Merkel

The Special Bulletin of October 27 pointed out that HHS had adopted regulations that eviscerated the President’s promise that “If you like your health insurance you can keep it.” A lengthy and informative report by NBC News indicates that “the Administration” knew of that fact three years ago. The report also give useful examples of[…]