Re: “Obama ‘framework' would lower healthcare spending by $480 billion over 12 years,” ModernHealthcare.com, April 13: This “plan” is a complete fantasy. First, Congress has to pass it. We've seen how contentious their budget fights have been, and that's over cutting only 1% of the budget. Second, every time Medicare payment reductions that are already in the law are about to go into effect, Congress passes a “doc fix” that blocks, or “postpones,” those cuts and usually allows for payment increases. The Patient Protection and Affordable Care Act would result only in deficit reduction if all of the Medicare cuts in the law were allowed to take place. They never are. Third, they will never be able to enact a Medicaid scheme that would pay the same rates in rural Iowa as in downtown Miami or midtown Manhattan. If you think the healthcare unions in the cities have been holding angry rallies now, you will really see some if that is allowed to take effect. Finally, the overarching consideration is that there has been no serious debate about what the federal government is doing getting so enmeshed in the provision of healthcare to begin with. Nowhere in the Constitution is Congress or the executive branch granted the power to provide for or regulate the provision of healthcare. The 10th Amendment grants that power to the states. Healthcare provision should never be a political issue—it's a personal one.
Mark WeinblattActuary New York