The White House deemed it “unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people,” but from this blogger’s perspective, it’s exactly the interests of the American people they had at heart.

This was the man who professed any health care plan “that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate.” Good health care, he stressed, “is by definition redistributional.”

So he loved Britain’s collectivized health care system which he described as “not just a national treasure” but “a global treasure” that should serve as a model for the “bloated” American health insurance market. The United States, he added, were trapped in “the darkness of private enterprise” whereas the British model was “generous, hopeful, confident, joyous, and just.”

Which is odd given that Britain’s ombudsman determined this year that the very system was “inhumane” and failed to meet “even the most basic standards of care.”

But wait, it gets worse. Berwick lamented the fact that “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there.” He foresaw the need for what he called “a very difficult democratic conversation,” adding: “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”

Suddenly, Sarah Palin’s “death panels” didn’t seem so preposterous when Berwick’s nomination was announced. This man shouldn’t be anywhere near making health care decisions for anyone. Good riddance indeed!

Defenders of “ObamaCare,” which is how the Patient Protection and Affordable Care Act of 2010 has become known, argue that the Commerce Clause in the Constitution grants the Federal Government the authority not just to regulate interstate commerce but all commercial activity, including health insurance. Forcing people to purchase insurance, they say, is not just legal; it’s the right thing to do because millions would otherwise fail to insure themselves against medical catastrophe.

The appellate court in Atlanta, Georgia on Friday decided otherwise, opining that the Commerce Clause should not be interpreted “in a way that would grant to Congress a general police power.”

As for the mandate, the Eleventh Circuit considered not just the constitutionality of it “but also its implications for our constitutional structure.” If the Federal Government can force people to buy insurance, what can’t it do? There are, in fact, very clear restrictions on federal power in the Constitution and “while these structural limitations are often discussed in terms of federalism, their ultimate goal,” the court points out, “is the protection of individual liberty.”

Even in the face of a Great Depression, a World War, a Cold War, recessions, oil shocks, inflation and unemployment, Congress never sought to require the purchase of wheat or war bonds, force a higher savings rate or greater consumption of American goods, or require every American to purchase a more fuel efficient vehicle.

With the Environmental Protection Agency enforcing “fuel efficiency standards,” that may just be a matter of time but the court’s point is very clear—Congress never has, and never should, compel economic activity or transactions.

The individual mandate is but the most obvious affront to civil liberties that is embedded in the health care overhaul however.

Insurance companies are businesses like any other, entitled to charge premiums that reflect actual risk. ObamaCare would force them to cover almost every American, no matter how ill they are; no matter how bad their health habits; no matter how high the cost of their exotic treatments.

Premiums, logically, will rise for every consumer. In anticipation of the law’s full implementation, insurers are already raising premiums.

Like insurance companies, health care providers have a right to turn a profit. Doctors and nurses are not public servants. They are entitled to charge fees that reflect the value received by all parties to the transaction.

ObamaCare, by driving down permissible fees, will force physicians into a deadly conflict of interest—lose money by doing everything necessary to meet patients’ needs or make money by satisfying minimum bureaucratic standards.

The health care reform law moreover does nothing to address a major impediment to a full and free competition in the health insurance market—antitrust legislation that prohibits insurers from consolidating and operating freely beyond the boundaries of their state. People should be able to buy insurance from whatever company they want, wherever it’s settled. That will drive down premiums very quickly.

Over the next seventy-five years, Medicare’s unfunded obligations will add up to a grand total of $24.6 trillion under current projections. In reality the program, unless reformed, will be far heavier indebted as the official numbers assume $575 billion in savings included in President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Democrats have no plan expect letting Medicare go bankrupt. Republicans have proposed privatizing care delivery for the next generation of seniors, offering them vouchers or “premium support” which is effectively a subsidy to cover part of their insurance costs.

According to economist Paul Krugman, that’s completely unnecessary. In his latest New York Times column, Krugman suggests that Medicare is sustainable “in its current form.” How? By rationing care.

Medicare will have to start saying no; it will have to provide incentives to move away from fee for service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.

It would to people on Medicare. They would not longer be able to afford the sort of medicine and treatments deemed unfit or too expensive by—whom exactly? Who is supposed to say “no”? Who will decide which medical care will be paid for and which will not? President Obama has answered that question already. He would let an “advisory board” of fifteen unelected bureaucrats decide how to trim Medicare spending.

Rationing care is the favorite resort of leftists who are confronted with the utterly unsustainable nature of their favorite government handouts. The current adminstrator of Medicare and Medicaid, Dr Donald Berwick, is no exception. He complained in 2008 about how America’s then relatively free health insurance market was trapped in “the darkness of private enterprise” and professed to be romantic about the British National Health Service which, he said, was “generous, hopeful, confident, joyous and just.”

Britain’s National Health Service Ombudsman disagreed. He found that medical care for seniors in the United Kingdom was inhumane and “failing to meet even the most basic standards of care.”

Britain already has a rationing board. It’s called the National Institute for Clinical Health (or NICE) and Berwick described it as “a national treasure.” Just how nice is this institute? According to its mandates, each year of added life is worth approximately $44,000 (or £30,000). NICE Chairman Michael Rawlins boasts that at times, his agency has approved treatments costing over $70,000 (£48,000) per year of extended life but the principle remains unchanged—NICE puts a price tag on life. A principle that is readily endorsed by Dr Berwick.

“The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there,” said Berwick. He predicted the need of what he described as “a very difficult democratic conversation” without elaborating all too explicitly of course on what it would entail. But he did announce this:

The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.

Just what does “eyes open rationing” mean? Dr Berwick has yet to answer that question. What’s obvious though is that according to the Medicare and Medicaid chief, the chronically ill and elderly are taking up more than their fair share of America’s health care supply. It’s the government’s job to remedy that injustice.

“Any health care funding plan that is just, equitable, civilized and humane, must redistribute wealth from the richer among us to the poorer and the less fortunate,” said Berwick. Good health care, he stressed, “is by definition redistributional.” He added: “The simplest way to reach these goals is with a single payer system.” Which, as Krugman points out, is what Medicare is—and should remain.

Despite Democrats’ demonization of Paul Ryan, and some Republicans’ unwillingness to stand by him, his plan is currently the only one written by any politician that would save Medicare from bankruptcy.

Last week Medicare’s trustees warned that the program will run out of money in 2024—five years earlier than they projected last year.

Once the main trust fund is depleted, revenues from Medicare taxes will initially be enough to cover 90 percent of expenses but that share will decline to 75 percent by mid century, then rise to 88 percent by 2085.

Under these latest figures, a total worth of unfunded obligations of $24.6 trillion over the next seventy-five years is projected; a $2 trillion increase compared to last year’s estimate. In reality, the shortfall could be even bigger as official projections assume $575 billion in savings achieved under President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Ryan’s plan, which the Republican majority in the House of Representatives approved last month, would end Medicare as it exists for anyone under the age of fifty-five and provide “premium support” to future retirees—a subsidy or voucher with which they could buy insurance on the private market. This, Ryan argues, would enable competition and restrain the increase in insurance costs while forcing insurers and health care providers alike to improve the quality of their services.

Democrats don’t think so. Senate Majority Leader Harry Reid said that Ryan would “turn over seniors’ health to profit hungry insurance companies” and “let bureaucrats decide what tests and treatments seniors get.” In fact, that is the president’s approach. He has suggested to restrain ballooning health care costs by allowing a panel of fifteen unelected and “independent” advisors “review,” i.e., ration care.

Other than that, the Democratic plan, according to House Minority Leader Nancy Pelosi, “is called Medicare”—which will be bankrupt before the next generation retires.

Recent NHS data reveals that 26 percent more English patients were forced to wait beyond the eighteen week threshold in March compared to the same month last year. The number forced to wait more than six months for treatment shot up by 43 percent.

Despite a rising demand for care caused by an increasing number of seniors, the NHS treated over sixteen thousand fewer patients in March 2011 compared to March 2010. According to the British Medical Association, a doctors’ union, the longer waits were inevitable, “given the massive financial pressures on the NHS.”

The shortcomings of Britain’s public health system are far from recent however. Earlier this year, the National Health Service Ombudsman lambasted the NHS for “failing to meet even the most basic standards of care.” He found an attitude, “both personal and institutional,” that failed “to recognize the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.”

The reasonable expectation that an older person or their family may have of dignified, pain free end of life care in clean surroundings in hospital is not being fulfilled.

Britain’s coalition government has not quite singled out the NHS from budget cuts in the face of an unprecedented fiscal crisis but it is prevented by campaign promises from fundamentally reforming the system.

Deputy Prime Minister Nick Clegg explicitly vowed to protect the NHS from privatization two months ago, saying he would not let the “profit motive drive a coach and horses” through it. Prime Minister David Cameron at least recognizes that “a little bit of extra money” will not “smooth over the challenges” but believes that little reforms within the collectivist framework can somehow fix all that is wrong with the NHS.

Medicare, which finances health care for the elderly, is expected to run out of money in 2024, five years earlier than projected last year. Once the main trust fund is depleted, revenues from Medicare taxes will initially be enough to cover 90 percent of expenses but that share will decline to 75 percent by mid century, then rise to 88 percent by 2085.

As a result of the adjusted projections, Medicare’s trustees estimate a total worth of unfunded obligations of $24.6 trillion over the next seventy-five years; an increase of $2 trillion compared to last year’s estimate.

In reality the program, unless reformed, will be far more indebted as the official projections assume $575 billion in savings included in President Barack Obama’s health reform law and a 29 percent reduction in physician reimbursements in 2012. That is unlikely to happen. Time and again, Congress has overwritten payment reductions and it’s almost certain to do so again, especially during an election year.

Medicaid spending, which subsidizes health care for the poor, has exploded over the past two decades, from nearly $74 billion in 1990 to more than $427 billion last year. Because Medicaid is paid for by the states, its rising costs increasingly crowd out investment in other areas, including education and infrastructure. Yet under the president’s health reform law, some twenty million additional Americans would be eligible for coverage.

The Social Security trust fund is now projected to last until 2036 but once it is depleted, the annual payroll taxes that pay for the program will only be sufficient to cover 75 percent of the retirement benefits it is required to pay seniors.

In 2010, Social Security spent $49 billion more in benefits that it took in from its payroll tax. This year, that deficit will be approximately $46 billion. Between now and 2085, the pension program’s trustees estimate a $9.1 trillion deficit.

Republican lawmakers have offered a long term solution for at least one of the three entitlement crises. Their budget proposal for fiscal year 2012 includes a gradual privatization of Medicare that excludes citizens in or near retirement from any changes but provides “premium support” for future generations of retirees. While thus retaining a subsidy, opponents have lambasted the conservative plan as “extreme”, claiming that it threatens the “dignity” of American seniors.

Both Democrats and a number of prominent Republicans have been skeptical and unwilling to reform entitlement programs that are popular with their millions of beneficiaries. Former House Speaker Nancy Pelosi professed last year that reform should do “what is right for our seniors, who are counting on the bedrock promises of Social Security and Medicare.” Senate Majority Leader Harry Reid in January described Republicans’ efforts to repeal the president’s health reform law as “a gesture in futility” and said that Social Security was not in a crisis. “This is something that’s perpetuated by people who don’t like government,” he opined. Potential Republican presidential contender Newt Gingrich this weekend characterized his own party’s Medicare reform effort as “radical.”

A jury in St Louis rejected the hospitals’ claim. According to an official from Lorillard, one of the companies in the case, “evidence was presented to the jury, including testimony from hospital witnesses, that confirmed the hospitals were not financially damaged as they asserted.”

Whether they were or not, the notion that cigarette producers are to blame for the averse health effects of smoking is absurd. If people chose to smoke, knowing full well that it’s detrimental to their health, tobacco companies cannot reasonably be held accountable for the consequences.

Hospitals, moreover, have no moral obligation to treat patients who can or will not pay for health care. If they do, that’s their right and their choice but they should not expect others to foot the bill.

48 percent of those over the age of sixty-five favor the Wisconsin congressman’s approach that would privatize the program and entitle people to “premium support” or vouchers with which to buy health insurance on the private market. 42 percent support Barack Obama who has promised that he will not leave seniors “at the mercy of the insurance industry.”

You wouldn’t know it listening to Democrats though. They say the Ryan plan “ends Medicare as we know it” and claim that more seniors would “suffer and die” as a result of it.

In al local newspaper, New Jersey Congressman Steve Rothman forecast “suffering, pain and terror” for tens of millions of seniors this week. “Where would they turn?” he wondered. “Charity? Family members? Early death? And why?”

Rothman acknowledged that the country faces an unprecedented fiscal crisis and believes that “all options should be on the table”—except reforming Medicare.

He notes that under the Republican plan, “the average senior would see their out of pocket health care costs double to $12,150 per year, $6,400 more than today,” which is real money but far from condemning them to early death.

“Medicare is an essential and successful American program that has worked extremely well for the past forty-six years,” according to Rothman but it won’t anymore. The Congressional Budget Office predicts that before the end of this decade, Medicare will have bankrupted itself unless significant reforms are enacted.

In the demonization of Paul Ryan, Democrats won’t let facts stand in the way of scoring political points. They are trying to convince retirees that Republicans intend to take their health care away even though the Ryan plan wouldn’t change a thing for people over the age of 55. They are pretending that America won’t need to rein in entitlement spending even as the explosive growth of Medicare and Social Security is utterly unsustainable, if only because Americans live longer than they did half a century ago when these programs were created.

Paul Ryan’s plan has its shortcomings and doesn’t even attempt pension reform yet. For all the Democrats’ demagoguery, nearly half of all seniors fortunately realize that it may be the only way to preserve health support for the elderly well into the future.

Krugman notes that health care providers are expected to behave according to higher standards than the average professional because they have to make life and death decisions, sometimes under severe stress. Doctors aren’t just “people selling services to consumers of health care,” he writes, because the service they’re selling is health—sometimes life.

That’s fine but doctors still expect to be paid and rightly so. The service they’re providing may be far more important than those provided by managers and economists but there’s no such thing as free care.

Health care professions aren’t like other professionals but Krugman never explains why patients shouldn’t be seen as consumers. He focuses entirely on the providers on care—which is refreshing given that the rights of medical professionals were largely forgotten in last year’s health care debate—but he hardly mentions those receiving care.

In essence, patients are consumers. They pay their doctors for medical advice and treatment. The only reason to pretend that they aren’t is to legitimize a system of care in which patients don’t have to pay, or not pay in full, the care they receive. That is, the sort of public health system Paul Krugman supports.

I remember a few years ago a network news anchor reading a story on the cost of obesity and the controls that must be imposed on those who inflict our medical system by being overweight. With a tone of scathing moral superiority, he declared that “the rest of us will have to pay for it.” A few weeks later, a diagnosis of lung cancer unfortunately forced him permanently off the air after decades of smoking. But he had voiced one of the two key propaganda tools by which the government destroys our individual rights in health care.

The first tool is guilt. Patients must be morally disarmed by convincing them—not of their own responsibility for their health—but of their guilt. You may not make your own decisions because you eat too much, or too many trans-fats, or too much salt or too many sodas. You recklessly smoke, or drink alcohol or coffee or use drugs. You don’t exercise enough or drive safely. Therefore you must accept your guilt and do what you are told.

That is the opposite of taking individual responsibility and facing consequences.

The second tool is to disable your judgment and your mind. Neither you nor your physicians are capable of making correct medical decisions. Only the government knows the effective treatment and hence the drugs and medical equipment to permit. Who are you to know what is best? Politicians, not physicians, have become the ultimate source of wisdom in health care.

The clear implication of such decrees is that physicians must become enforcers who turn in their patients to the government for failure to follow medical instructions.

It must be said that there is considerable financial pressure on the states due to soaring Medicaid costs. ObamaCare will push tens of millions of additional people into Medicaid—with the states forced to match spending (one of the more deceptive accounting tricks used to disguise the total cost of the legislation.) But that does not excuse the unleashing of the health care police on American citizens.

Those who accept that they have a “right” to health care which the government forces others to provide will gradually discover that they lose all freedom to decide what treatment they will actually receive. They will have surrendered their judgment and moral self respect to politicians. They will have to accept government punishment for not buying insurance, punishment for smoking, punishment for eating too much, punishment for drinking and punishment for deciding how they want to live their own lives. Physicians who follow their own best judgment instead of government protocols will be financially punished.

A government that pays for the health care of our bodies will decide that it owns our bodies. Illness will be judged a result of our criminally irresponsible negligence.

The only remaining choice will be to restore freedom to the practice of American medicine.