Category: Healthcare

Here is an Amicus Brief I Fully Support

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There has been a fascinating friend of the court (amicus) brief on the latest Obamacare suits, the “ladyparts are icky” suits from Hobby Lobby and Conestoga Wood Specialties.

It argues that the “Religious Freedom Restoration Act” is an unconstitutional because it is an unconstitutional abrogation of the constitutional role of the courts in interpreting the law:

Arguing that Congress has gone too far to push aside the Supreme Court’s constitutional role in religion cases, a loose coalition of child welfare organizations, survivors of clergy child sexual abuse, and non-believers has urged the Justices to strike down the Religious Freedom Restoration Act when it rules on a new dispute over the federal health care law.

 The amicus brief, written by a prominent academic authority on religion and the law, Cardozo Law School’s Marci A. Hamilton, seeks to add a bold new dimension to the Court’s review of the Affordable Care Act’s “contraception mandate.”

 “RFRA,” the document contended, “is Congress’s overt attempt to take . . . over this Court’s role in interpreting the Constitution. . . . [T]his novel federal statute, which is one of the most aggressive attacks on this Court’s role in constitutional interpretation in history, has fomented culture wars in the courts like the one ignited” in the pending cases by for-profit businesses seeking a RFRA-based exemption from the mandate to provide health insurance for pregnancy-related services to workers.

Normally, I would not expect that this would have any bearing on the court’s decision, but the core of this argument is flattering the court as an institution, so that makes it a bit more likely.

Obama Punts on Equal Healthcoverage Coverage for CEO’s, Lets the 1% Loot Again

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One of the provisions of the PPACA was that senior executives had to get the same sort of insurance as the rest of their workers.

Well, it seems that the Department of Health and Human Services has decided that it’s just too hard to come up with rules to implement this portion of the statute:

The Obama administration is delaying enforcement of another provision of the new health care law, one that prohibits employers from providing better health benefits to top executives than to other employees.

Tax officials said they would not enforce the provision this year because they had yet to issue regulations for employers to follow.

The Affordable Care Act, adopted nearly four years ago, says employer-sponsored health plans must not discriminate “in favor of highly compensated individuals” with respect to either eligibility or benefits. The government provides a substantial tax break for employer-sponsored insurance, and, as a matter of equity and fairness, lawmakers said employers should not provide more generous coverage to a select group of high-paid employees.

But translating that goal into reality has proved difficult.

Officials at the Internal Revenue Service said they were wrestling with complicated questions like how to measure the value of employee health benefits, how to define “highly compensated” and what exactly constitutes discrimination.

Bruce I. Friedland, a spokesman for the I.R.S., said employers would not have to comply until the agency issued regulations or other guidance.

This sh%$ ain’t rocket science.

Either they are dragging their feet, or they are writing Byzantinely complex rules.

The only reason for complexity is to create loopholes that millionaire campaign contributors executives can drive their Beemers through.

One Reason that My Insurance is Not Through the Exchanges

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Because Maryland’s insurance exchange is completely f%$#ed up:

More than a year before Maryland launched its health insurance exchange, senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1.

Over the following months, as political leaders continued to proclaim that the state’s exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project “was a disaster waiting to happen.”

The repeated warnings culminated days before the launch, with one from contractors testing the Web site that said it was “extremely unstable” and another from an outside consultant that urged state officials not to let residents enroll in health plans because there was “no clear picture” of what would happen when the exchange would turn on.

Within moments of its launch at noon Oct. 1, the Web site crashed in a calamitous debut that was supposed to be a crowning moment for Maryland officials who had embraced President Obama’s Affordable Care Act and pledged to build a state-run exchange that would be unparalleled.

Instead, by the next morning only four people had signed up using the Web site — and amazed that anyone had gotten through the system successfully, state officials contacted each of them to make sure they were real. The site’s problems continue to prevent Marylanders from signing up for health insurance. As of Friday, 20,358 people had selected private plans, and state officials have said they do not expect to come close to their initial goal of 150,000 by the end of March.

This report is based on a Washington Post review of thousands of pages of previously undisclosed documents, including e-mails, internal reports, audits and court records, along with interviews with dozens of current and former contractors, state officials and others. The review shows that the creation of the exchange was dysfunctional from the start and that there were repeated missteps at almost every level.

I had to do something, MHIP was going away in June, as a result of the implementation of the PPACA, but the web site is a horror show.

It pushed me to take a serious look at the plan offered by the job shop that cuts my paycheck, and it turned out that an HSA offered through my employer, with the attendant tax advantages of pretax contributions, was the best deal.

This is an Expected Consequence of Obamacare

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I have repeatedly stated that the first problem with healthcare is not the price of healthcare, not the cost of healthcare.

Absent fiat regulation, it is more important to initiate price competition both in insurance and in medical services, which means that the pricing will be clear, and high price insurance will be eschewed by consumers, and high price medical services will be eschewed by the insurance companies.

Therefore, it comes of no surprise that insurance companies are cutting the big name providers who charge a premium:

Americans who are buying insurance plans over online exchanges, under what is known as Obamacare, will have limited access to some of the nation’s leading hospitals, including two world-renowned cancer centres.

Amid a drive by insurers to limit costs, the majority of insurance plans being sold on the new healthcare exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centres, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country.

This was not just foreseeable, it was the inevitable consequence of the Heritage Foundation designed plan.

In the long run, this is a good thing, because the consolidation of hospitals over the past few years has not been about efficiencies, but rather about the accumulation of pricing power.

You may not like that Sloan Kettering is not in your network, but in the long run, some for of price controls are essential to fixing our broken healthcare system,

You are Welcome to Our Health Care System Design, But We Insist that in Compensation, Rob Ford Be Appointed Mayor of Some Town in Vermont…*

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While we are talking about the progress of Obamacare, it is important to note that Vermont is going with a full up single payer system:

All but ignored in the multitude of media coverage about the ACA and its problems, Vermont has become the first state in the union to pass a single-payer universal health care law for its residents. It has a snappy slogan: Everybody in, nobody out.

The system will be fully operational by 2017, funded by Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. Everyone will be able to go to any doctor or hospital in the state free of charge. No plans to figure out, no insurance forms to sweat over, no gotchas.

………

Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings. Employers will suddenly be free to give raises to their employees instead of paying for increasingly expensive health benefits. All hospitals and health-care providers in Vermont will be nonprofit. Medicare recipients will no longer need to wade through an inch-thick book to choose supplemental plans and sort out other complex options in their Medicare enrollment.

If (and it is a big if) Vermont can decide on the funding method, it should be fully implemented by 2017.

* Not my bon mot. Stolen from TP at the Stellar Parthenon BBS.

Not Eleventy Dimensional Chess, Just a Clusterf%$#

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The latest adjustment to Obamacare is a complete mess.

This is why he should have pushed for single payer, and settled for a public option, but Obama buys into the neoliberal consensus, so he took a rather uninspired idea from the f%$#ing Heritage Foundation, brushed off the dust, and presented it as the liberal “Great White Hope.”

While I will be saving a chunk of change next year, Obama chose what is the worst possible way of improving our failed healthcare system.

Why any Healthcare Reform Should Start With the Goal of F%$#ing the Insurance Companies

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I’m shocked, shocked to find that gambling is going on here!

Who could have imagined that Anthem Blue Cross and Wellpoint would used Obamacare as a mechanism to cheat their customers:

Anthem Blue Cross tricked tens of thousands of Calfornia policyholders into giving up health insurance plans from which they could not be dropped and pushing them into policies that Anthem knew would be cancelled, according to two lawsuits filed in Los Angeles.

 The lawsuits, filed Monday in Superior Court, may signal an emerging customer pushback against the approximately 900,000 cancellations in California alone of individual health insurance policies that will take effect Dec. 31.

 Before the Affordable Care Act, or Obamacare, was passed March 23, 2010, California policyholders who bought individual insurance policies and kept up with premiums were grandfathered in, meaning the insurer cannot drop them. However, policy holders who purchased their insurance after March 23, 2010, or who switched out of plans purchased before the law was enacted, are not grandfathered and must, by Jan. 1, 2014, pay for a policy that is compliant with Obamacare. In some cases that means premium increases, especially for those who don’t qualify for federal subsidies. Others will lose access to their personal physicians or trusted specialists.

 The two lawsuits allege that Anthem Blue Cross, California’s largest insurer and a unit of insurance giant WellPoint Inc., deceptively enticed tens of thousands of Californians to switch out of their grandfathered plans, a practice known as “twisting,” in violation of a state law and to cut its own costs.

This is why Obama’s initiative to bring in the insurance companies as “Stakeholders” was a disastrous decision.

They were not stakeholders, they were among healthcare’s worst offenders. Bringing them into the decision making process is akin to bringing in Willie Sutton as a bank security consultant while he was still robbing banks.*

*It should be noted that after he left the slam, Sutton did serve as a security consultant for banks, but that was after he stopped robbing banks.

Why the US Healthcare System Sucks Wet Farts from Dead Pigeons,

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How many of you have an Albuterol inhaler for Asthma?

It’s great, isn’t it?

The drug is out of patent, so it’s cheap, and it works.

It’s not like a big pharma would lobby to get the FDA to ban the cheap inhalers because of their miniscule use of CFCs, and then wrap new propellants in a patent web and jack up the price, right?

Oh, silly me, that IS what they did:

The arsenal of medicines in the Hayeses’ kitchen helps explain why. Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented.

 “The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 co-payment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter.

………

 Unlike other countries, where the government directly or indirectly sets an allowed national wholesale price for each drug, the United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s health care arena — a surprising number of lifesaving drugs are made by only one manufacturer — and businesses often successfully blunt market forces.

 Asthma inhalers, for example, are protected by strings of patents — for pumps, delivery systems and production processes — that are hard to skirt to make generic alternatives, even when the medicines they contain are old, as they almost all are.

………

 But in the United States, even people with insurance coverage struggle. Lisa Solod, 57, a freelance writer in Georgia, uses her inhaler once a day, instead of twice, as usually prescribed, since her insurance does not cover her asthma medicines. John Aravosis, 49, a political blogger in Washington, buys a few Advair inhalers at $45 each during vacations in Paris, since his insurance caps prescription coverage at $1,500 per year. Sharon Bondroff, 68, an antiques dealer in Maine on Medicare, scrounges samples of Advair from local doctors. Ms. Bondroff remembers a time, not so long ago, when inhalers “were really cheap.” The sticker shock for asthma patients began several years back when the federal government announced that it would require manufacturers of spray products to remove chlorofluorocarbon propellants because they harmed the environment. That meant new inhaler designs. And new patents. And skyrocketing prices.

 “That decision bumped out the generics,” said Dr. Peter Norman, a pharmaceutical consultant based in Britain who specializes in respiratory drugs. “Suddenly sales of the branded products went right back up, and since then it has not been a very competitive market.”

 The chlorofluorocarbon ban even eliminated Primatene Mist inhalers, a cheap over-the-counter spray of epinephrine that had many unpleasant side effects but was at least an effective remedy for those who could not afford prescription treatments.

………

 A result is that there are no generic asthma inhalers available in the United States. But they are available in Europe, where health regulators have been more flexible about mixing drugs and devices and where courts have been quicker to overturn drug patent protection.

 “The high prices in the U.S. are because the F.D.A. has set the bar so high that there is no clear pathway for generics,” said Lisa Urquhart of EvaluatePharma, a consulting firm based in London that provides drug and biotech analysis. “I’m sure the brands are thrilled.”

………

And here is the money quote:

This year the price of Advair dropped 10 percent in France, but in pharmacies in the Bronx, it has doubled in the last two years.

For what it is worth this is not technically a failure of the free market.

These companies’ profit margins are being directly supported by the state. That is the nature of patents and other exclusive licenses that we grant, particularly in the drug industry.

Then we allow for these exclusive licenses to be extended ad infinitum through evergreening.

The problem is that we as a society allow people to patent nothing at all, and sometimes we grant exclusive right to people who didn’t invent anything at all, as in the case of colchicine, where exclusivity was granted for a study of the drug which consisted primarily of a survey of the historical literature.

The price of colcicine went from $0.09 a pill to $5.00 a pill.

So, Now We Know What Makes Andrea Mitchell Go Postal………

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It was former “Real World” cast member and current Congressman Sean Duffy, who was arguing that Obamacare is to blame the Republicans holding military death benefits hostage: (at about 11:20 in the vid)

With all due respect, this is about military death benefits to kids, 19-year-old kids who died in Afghanistan and who are not returning home, this is about what their families are entitled to by law and what they are not getting.

This is not about what you want in Obamacare and not about what the president wants on the debt ceiling.

And yes, for Andrea Mitchell, this is going postal.

Also, how did this guy get elected when he is too stupid to cut his own meat?

He keeps going back to the his belief that Jon Stewart gave a puff interview to Kathleen Sebelius, head of HHS as evidence that journalists are biased.

Hello, Jon Stewart is a f%$#ing commedian. Jeebus.

You Cannot Make this Sh%$ Up

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Ted Cruz just engaged in a mammoth talk on the Senate floor, (it was not a filibuster) talking about the evils of Obamacare.

At one point, he read from the children’s classic Green Eggs and Ham, while talking about how awful the PPACA will be.

As Senator Claire McCaskill observed, Ted Cruz does not get the Dr. Seuss story, which is all about not prejudging things:

During Sen. Ted Cruz’ marathon talk-a-thon, he dramatically read one of his children’s favorite books, Dr. Seuss’ Green Eggs and Ham, saying it was a good-night story for his children.

How ironic, Sen. Claire McCaskill, remarked on Morning Joe, that the Texas Republican used that book in a marathon speech opposing a healthcare reform bill he has never tried.

“I went the University of Missouri, I did not go to Harvard, but I’ll tell you that my daughter texted me this morning and said ‘Mom, does he not know the point of the story?’” the Missouri Democrat said.

In the classic Seuss novel, a grumpy character declares “I do not like them, Sam-I-am. I do not like green eggs and ham…I would not like them here or there. I would not like them anywhere.”

Eventually, the character tries the green eggs and ham to appease his persistent friend and finds that he quite likes them: “I like green eggs and ham! I do! I like them, Sam-I-am!”

“It’s that you can’t knock things till you try it,” McCaskill said with a smile. “It’s ironic that he used that in the filibuster because I think when people realize how the these exchanges are going to work…It’s all private insurance companies on these exchanges.”

Not only reading Seuss on the Senate floor, but getting it wrong.

Theodore Seuss Geisel must be spinning in his grave.

Remember When I Said that It’s Not the Cost of Healthcare, It’s the Price of Healthcare*

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Well, the New York Times just looked at the price of a 1 liter bag of saline solution, and it ain’t pretty:

It is one of the most common components of emergency medicine: an intravenous bag of sterile saltwater.

Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer’s price, according to government data, has fluctuated in recent years from 44 cents to $1.

Yet there is nothing either cheap or simple about its ultimate cost, as I learned when I tried to trace the commercial path of IV bags from the factory to the veins of more than 100 patients struck by a May 2012 outbreak of food poisoning in upstate New York.

Some of the patients’ bills would later include markups of 100 to 200 times the manufacturer’s price, not counting separate charges for “IV administration.”

And on other bills, a bundled charge for “IV therapy” was almost 1,000 times the official cost of the solution.

It is no secret that medical care in the United States is overpriced. But as the tale of the humble IV bag shows all too clearly, it is secrecy that helps keep prices high: hidden in the underbrush of transactions among multiple buyers and sellers, and in the hieroglyphics of hospital bills.

At every step from manufacturer to patient, there are confidential deals among the major players, including drug companies, purchasing organizations and distributors, and insurers. These deals so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost.

And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it.

………

But even before the finished product is sold by the case or the truckload, the real cost of a bag of normal saline, like the true cost of medical supplies from gauze to heart implants, disappears into an opaque realm of byzantine contracts, confidential rebates and fees that would be considered illegal kickbacks in many other industries.

………

The charges included “IV therapy,” billed at $787 for the adult and $393 for the child, which suggests that the difference in the amount of saline infused, typically less than a liter, could alone account for several hundred dollars.

………

Eventually the head of the family, an electrician’s helper who speaks little English, complained to HealthFirst, the Medicaid H.M.O. It paid $119 to settle the grandmother’s $2,168 bill, without specifying how much of the payment was for the IV. It paid $66.50 to the doctor, who had billed $606.

Ms. O’Neill defended the markup as “consistent with industry standards.” She said it reflected “not only the cost of the solution but a variety of related services and processes,” like procurement, biomedical handling and storage, apparently not included in a charge of $127 for administering the IV and $893 for emergency-room services.

The patient, a financial services professional in her 50s, ended up paying $100 for her visit. “Honestly, I don’t understand the system at all,” said the woman, who shared the information on the condition that she not be named.

Dr. Frost, the anesthesiologist, spent three days in the same hospital and owed only $8, thanks to insurance coverage by United HealthCare. Still, she was baffled by the charges: $6,844, including $546 for six liters of saline that cost the hospital $5.16.

At White Plains Hospital, a patient with private insurance from Aetna was charged $91 for one unit of Hospira IV [saline] that cost the hospital 86 cents, according to a hospital spokeswoman, Eliza O’Neill.

The charges all stem from a case of food poisoning  in upstate New York, where people were collected by ambulances and sent to emergency rooms.

This is why price controls are necessary.  When you are, “lying on the ground barely conscious,” the market ceases to function.

*Here, and a lot on the Stellar Parthenon BBS as well.

Bait and Switch on Healthcare ……… Again

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This time, it is the out of pocket limits for group plans that has been delayed:

In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.

The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.

Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.

Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.

The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.

Gee, they had only 4 years to get this working, and they “can’t get their computers to work”.

Am I the only one who is beginning to suspect that maybe the real intent of Obamacare is to eliminate employer sponsored health plans?

This is exactly the sort of thing that Obama’s economic brain trust ***cough*** Cass Sunstein ***cough*** would like.

There are a lot of academic economists out there who hate employer sponsored health insurance.

Healthcare Quote of the Day

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In this New York Times article, they discuss the consequences of the increasingly frenetic pace of mergers among hospitals.

One line of the story is particularly important:

“The rhetoric is all about efficiency,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, a trade group that represents insurers. “The reality is all about higher prices.”

Notwithstanding any “efficiencies”, the price hikes come from the fact larger chains have more pricing power when negotiating with insurance companies and the government.

It serves to illustrate a point: We do not have a healthcare cost problem in the United States, we have a healthcare price problem in the United States.

This is a classic case of a market failure.

Linkage

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Finally a performance, by The Anarchists, my kids band at the Rock Star Jam Summer Music Camp:

Natalie was much more comfortable on stage this year.

More Adventures of the New Party of Jefferson Davis

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Paul Krugman notes that the current attempts by Congressional Republicans to use the threat of a government shutdown to roll back Obanmacare mirrors the actions of the South when they tried to destroy the United States.

You see, Marco Rubio is now claiming that Obama wants to shut down government because he will not end his health care plan.

As Krugman notes, Lincoln nailed this at his Cooper Union speech over 150 years ago:

Under all these circumstances, do you really feel yourselves justified to break up this Government unless such a court decision as yours is, shall be at once submitted to as a conclusive and final rule of political action? But you will not abide the election of a Republican president! In that supposed event, you say, you will destroy the Union; and then, you say, the great crime of having destroyed it will be upon us! That is cool. A highwayman holds a pistol to my ear, and mutters through his teeth, “Stand and deliver, or I shall kill you, and then you will be a murderer!”

To be sure, what the robber demanded of me – my money – was my own; and I had a clear right to keep it; but it was no more my own than my vote is my own; and the threat of death to me, to extort my money, and the threat of destruction to the Union, to extort my vote, can scarcely be distinguished in principle.

The party of Lincoln has become the party of Jefferson Davis.

Gee, What Could Possibly Go Wrong?

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After all, the market solves everything, so the sale of the UK’s primary blood plasma supplier to Bain Capital should work out just fine:

The Government was tonight accused of gambling with the UK’s blood supply by selling the state-owned NHS plasma supplier to a US private equity firm.

The Department of Health overlooked several healthcare or pharmaceutical firms and at least one blood plasma specialist before choosing to sell an 80 per cent stake in Plasma Resources UK to Bain Capital, the company co-founded by Republican presidential candidate Mitt Romney, in a £230m deal. The Government will retain a 20 per stake and a share of potential future profits.

PRUK has annual sales of around £110m and consists of two companies: it employs 200 people at Bio Products Laboratory (BPL) in Elstree, Hertfordshire, and more than 1,000 at DCI Biologicals Inc in the US. DCI collects plasma from American donors and sends it to BPL where it is separated into blood proteins, clotting factors and albumin for supply to NHS hospitals in the treatment of immune deficiencies, neurological diseases, and haemophilia.

Considering the damage caused in the US because the American Red Cross (under the direction of Liddy Dole) and big pharma, both of whom resisted 100% testing for years,and  killed tens of thousands of hemophiliacs in the United States, and many times that world wide, this does not fill em with confidence about the UK blood supply.

It’s Like a Slow Motion Car Wreck

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So, the little people will be required to buy health insurance under the PPACA (Obamacare), but the requirement for big employers has been pushed back a year:

Businesses won’t be penalized next year if they fail to provide workers health insurance after the Obama administration decided to delay a key requirement under its signature 2010 health-care law.

The government will postpone enforcement of the so-called employer mandate until 2015, the administration said today. Under the provision, companies with 50 or more workers face a fine of as much as $3,000 per employee if they don’t offer affordable insurance.

The move addresses complaints from employer groups to President Barack Obama’s administration about the burden of the law’s reporting requirements. The decision pushes the issue past the 2014 midterm congressional elections, as Republicans have sought to make the health law a symbol of government overreach.

“In our ongoing discussions with businesses we have heard that you need the time to get this right,” Valerie Jarrett, a senior adviser to Obama, said in a White House blog post announcing the decision. “We are listening.”

The move may lead some employers to delay providing coverage to workers. The law’s individual mandate remains in effect, a provision that requires most Americans to carry health insurance.

You knew that this was coming.

When big business talks, they, “Are listening.”

When it’s civil libertarians, , the poor and elderly, advocates for financial reform, the Democratic wing of the Democratic Party, etc., it’s, “talk to the hand”.

H/t to my Dad, who sent me a link to a (subscription only) WSJ article.