The fix is in.

• Author: Amerling, Richard
• Position: Federal medical law - Health Beat

BEYOND THE RAMIFICATIONS for the continuation of the abominable ObamaCare, the obvious truth illustrated by King v. Burwell is that we are being ruled by a corrupt oligarchy that includes the majority of the Supreme Court. This also was driven home by the discovery by Justice Anthony Kennedy of a right to same-sex marriage in the "shadows and penumbras" of the Constitution, which certainly will ignite another never-ending culture war in the country.

Further legal challenges to Federal overreaching are likely to fail. There are constitutional remedies to this tyranny, as Sen. Ted Cruz (R.-Texas) points out, including action by Congress either to impeach members of the Court, or to limit the Court's jurisdiction. Neither of these options is feasible, given the current weak-kneed Republican leadership, and, of course, a presidential veto. This leaves a constitutional amendment to overturn the decision, originating either in Congress, or in a convention of the states, as specified in Article V.

We are living, as pointed out by radio host Mark Levin, in a "post-constitutional republic," where rules and laws are concocted by a small group of elites--either unelected or elected in perpetuity by a tiny fraction of the eligible voters--who are unresponsive to the will of the people.

The Patient Protection and Affordable Care Act and, more recently the Medicare Access and Child Health Insurance Protection (CHIP) Reauthorization Act (MACRA), solidify bureaucratic control over the practice of medicine. We already have seen the widespread closing of private practices, with now more than two-thirds of physicians working under a hospital umbrella. Those who remain private are under immense pressure, both financial and regulatory, and many will fold their tents. In addition to rigid price controls on their fees, there are never-ending requirements for documentation via the electronic health record of personal clinical details, to be used eventually to direct care centrally.

MACRA cements into place various payment schemes--such as bundling, accountable care organizations (ACOs), and other forms of "payment-for-outcomes"--that will be applied to the Medicare program and, ultimately, to private insurance. All of these systems create financial disincentives to caring for truly sick patients, and will have a devastating effect. Patients increasingly will be subjected to one-size-fits-all care, dictated by...