At the Weekly Standard, Chris Conover explains.

The NY Times has a long article about the U.S. medical system, in which it notes how much cheaper things are abroad. I’ll leave it to my colleague Michael Cannon and others to comment on the accuracy of the piece, if they see anything worth commenting on. I just want to weigh in on a trade policy aspect. Economist Dean Baker responded to the article with a post that starts off as follows:

The NYT has an article today on the enormous savings available to people who had major surgeries performed in Europe rather than the United States. The piece reports that the cost of hip replacement or knee replacement surgery in the United States are more than five times higher than they are in comparable quality facilities in Europe. (The gap would be even larger with facilities in Thailand and India.)

This shows the enormous potential gains from increased medical trade. In effect, our hospitals, doctors, and medical equipment makers benefit from tariffs on the order of 500 percent or more. If the Obama administration really is interesting in promoting growth through trade it would be difficult to imagine a sector with larger potential gains than trade in medical care. The agreements would focus on setting clear liability rules, accreditation systems, and removing obstacles for insurers and government programs that prevent them taking advantage of lower cost medical services in other countries.

I think he is absolutely right that there are enormous gains to be had here. I’m not sure about the recommendations he makes in the last sentence — I would want to talk to a health care expert about specific barriers before endorsing his proposals. But I have no doubt that making it easier to trade medical services across borders would be of great benefit to consumers. If there are barriers getting in the way of trade, let’s get them out of the way.

But here’s where things get interesting. Baker seems to think he has caught free trade advocates in some hypocrisy. The post is entitled “Will Medical Trade Be Included in the EU Trade Deal and the TPP? If Not, Why Not?,” and he says:

If the trade deals do not include major openings on medical trade then it would be a clear example of why these deals are in fact about selective protectionism rather than free trade. Past trade deals have been quite explicitly focused on putting U.S. manufacturing workers in direct competition with the low paid manufacturing workers in developing countries.

Anyone who believes in free trade would want U.S. doctors and other professionals subjected to the same sort of competition. Otherwise, they really only want to use trade to lower the wages of less educated workers to benefit the the wealthy. (Low wages means cheap help.) It is dishonest to call that policy “free trade.” 

He then tweeted: “For some reason “free traders” don’t understand trade in medical services: Gains from eliminating protections enormous”.

Thus, his suggestion seems to be that there are some free traders out there who are arguing for free trade only in the manufacturing sector, not in professional service sectors, and as a result the two big trade talks going on right now might exclude these services.

Let me respond by noting that I have never met any free traders who take the view that professional services, or any other sectors (except perhaps defense), should be excluded. Of course, if they did, they wouldn’t really be free traders. Free trade doesn’t make a distinction between sectors. So, to Dean Baker, let me just say that I, a confessed free trader, whole-heartedly endorse the idea of free trade in medical services! And I’m pretty sure all other free traders feel the same way.

That’s not to say there aren’t people (i.e., special interest groups) out there who want protection for the medical service sector, just like there are people who want protection for the manufacturing sector. No doubt U.S. doctors would love to impose a 25% tariff on foreign medical services, just like the tariff we impose on imports of SUVs. But that’s just special interests doing what they always do, in all policy areas. It’s our job to fight their efforts, and hopefully Baker will join in. Baker mentions the Europe and Pacific trade talks underway right now. With some good arguments and a bit of luck, those talks will go a long way towards getting rid of any protectionism in these and other sectors.

The Congressional Budget Office has released its cost estimate of the Obama administration’s one-year repeal delay of ObamaCare’s employer mandate and anti-fraud provisions. The CBO expects the Obama administration’s unilateral rewriting of federal law (my words, not CBO’s) will increase federal spending by $3 billion in 2014 and reduce federal revenues by a net $9 billion, thereby increasing the federal debt by $12 billion. If President Obama keeps this up, Congress may have to raise the debt ceiling or something.

Where is that $3 billion of new spending going? The CBO estimates the administration’s action will lead to about half a million additional people receiving government subsidies, including through ObamaCare’s Exchanges:

All told, as a result of the announced changes and new final rules, roughly 1 million fewer people are expected to be enrolled in employment-based coverage in 2014 than the number projected in CBO’s May 2013 baseline, primarily because of the one-year delay in penalties on employers. Of those who would otherwise have obtained employment-based coverage, roughly half will be uninsured and the others will obtain coverage through the exchanges or will enroll in Medicaid or the Children’s Health Insurance Program (CHIP), CBO and JCT estimate.

Which makes the president’s delay of the employer mandate and anti-fraud provisions consistent with his administration’s goal of hooking enough voters on government subsidies to affect electoral outcomes and votes in Congress.

Based on the White House’s past lawlessness and corruption in the service of Obamacare, I’m willing to venture the following prediction:

The Obama administration will announce in August, probably in a classic Friday news dump, that (1) it will offer Exchange subsidies to workers enrolled in multiemployer union plans, and (2) it will pay the FEHBP contribution toward the Exchange premiums for members of Congress and their staffs.

Here’s what makes this prediction interesting: neither of those things would be legal. So, for the record, I really hope this prediction does not come true.

The last time I made a prediction was this one from December 2012:

HHS maintains they’ll have these [Exchange] things up and running by October 2013. I don’t know anyone who is confident about that and I’m ready to predict that they will not.

That prediction proved true when the Obama administration announced the eligibility verification system for Exchange subsidies would not be ready on time, and took the not-legal step of delaying enforcement of the eligibility rules for a year.

ObamaCare’s gravest sin may be that it has offended America’s highest caste: members of Congress and their staffs. Thanks to an amendment by Sen. Chuck Grassley (R‑IA), the law provides:

the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are created under this Act…or offered through an Exchange established under this Act…

In effect, ObamaCare throws members of Congress out of the Federal Employees Health Benefits Program (where most members and staff obtain health insurance) and offers them no other choice but to enroll in coverage through one of ObamaCare’s Exchanges. But here’s the kicker: though the federal government currently pays thousands of dollars of the cost of the congresscritters’ FEHBP coverage, neither ObamaCare nor any other federal law authorizes the feds to apply that money toward a congresscritter’s Exchange premiums. Today’s New York Times reports:

David M. Ermer, a lawyer who has represented insurers in the federal employee program for 30 years, said, “I do not think members of Congress and their staff can get funds for coverage in the exchanges under existing law.”

So ObamaCare essentially delivers a pay cut to members and staff in the neighborhood of $5,000 for single employees and $10,000 for families. 

Even congressional Democrats who voted for ObamaCare are freaking out (and pointing fingers). Again, the New York Times:

Representative Diana DeGette, Democrat of Colorado, said the Senate was responsible for the provision requiring lawmakers and many aides to get insurance in the exchanges.

“We had to take the Senate version of the health care bill,” Ms. DeGette said. “This is not anything we spent time talking about here in the House.”

Another House Democrat, speaking on condition of anonymity, said, “This was a stupid provision that never should have gotten into the law.”

You’d never know they had a choice, and voted for this provision anyway.

Finally, the Times notes, “The issue is politically charged because the White House and Congress are highly sensitive to any suggestion that lawmakers or their aides are getting special treatment under the health law” and, “Aides who work for Congressional committees and in leadership offices, like those of the speaker of the House and the majority and minority leaders of the two chambers, are apparently exempt — though neither Congress nor the administration has said for sure.” That creates the potential for a sneaky, backdoor way that ObamaCare supporters — say, the Senate Democrats who set budgets for congressional offices — could shield their staff from ObamaCare: shift staff from personal to committee and leadership offices.

Or, the White House could just decide to make the same contribution to their Exchange coverage, statute be damned. It wouldn’t be the first time this White House tried to protect ObamaCare by spending money that Congress never authorized.

Congressional watchdogs, be on the lookout. 

As Jonathan Adler and I detail in our Health Matrix article, “Taxation Without Representation: The Illegal IRS Rule to Expand Tax Credits Under the PPACA,” the Obama administration is attempting to rescue Obamacare from oblivion by literally taxing, borrowing, and spending more than $700 billion without congressional authorization. In a recent letter to the editor of the Washington Post, I explain how these illegal taxes are already hurting workers. 

On July 25, chairmen of the House Ways & Means Committee, the House Committee on Oversight & Government Reform, and two Oversight subcommittees sent a letter to Treasury Secretary Jacob Lew demanding information related to the illegal tax-credit rule.

The House Oversight Subcommittee on Health Care has announced it will hold a hearing this Wednesday, July 31, on the IRS’s illegal tax-credit rule titled, “Oversight of IRS’s Legal Basis for Expanding ObamaCare’s Taxes and Subsidies.” Adler will testify alongside Oklahoma Attorney General Scott Pruitt and Missouri physician and small business owners Charles Willey, each of whom has filed suit to block the IRS’s illegal rule. 

On Sunday, The Washington Post published my letter to the editor:

divOn Wednesday, July 31, a House oversight subcommittee will be holding a hearing on the IRS’s illegal taxes, borrowing, and spending.