Category: Health Care

The Health Care Implosion

The Republican attempt to repeal Obamacare is in deep deep trouble. It does not have support from the conservative wing and has fierce opposition from moderates and liberals. It is polling at 57-16 against and has majority opposition from conservatives. The most recent CBO analysis indicates that it will reduce the deficit less while still leaving 24 million uninsured. And Trump, demonstrating the great deal-making ability he boasted about, has told the GOP that if they don’t pass it, he’s done with healthcare reform and will just leave Obamacare in place.

Why is this going so wrong? After passing dozens of repeals over the last eight years, why is the GOP in this morass of pushing a healthcare that no one likes? I think the answer is that they’re trying to deal with 2012’s problems instead of 2017’s.

Let me take a step back. As the Iraq War went south and many people demanded that we leave, I pointed that leaving Iraq was not the same as not having invaded it to begin with. Whether the invasion was right or wrong, there was a mess there that was going to get worse if we left. And indeed, our departure set the stage for the rise of ISIS.

We’re in the same place now. Repealing Obamacare is not the same as not having passed it in the first place. The last chance the GOP had for that, realistically, was 2012. Now that Obamacare is ingrained into the system, simply repealing it — even if that were possible — would be a nightmare. Insurance companies have planned out for Obamacare being there. So have individuals. We’d be talking about a major disruption of a two trillion dollar economy.

As a result, the AHCA finds itself trying to serve too many masters: giving the GOP base the instant gratification of an Obamacare repeal while not getting rid of the Obamacare provisions people like; cutting Obamacare taxes while not exploding the deficit; enacting a long-overdue Medicaid reform while trying to cut Medicaid expansion; putting together something that can pass by reconciliation. And the result is this unpopular, unconservative, hastily-revised Frankenstein mess of a proposal. It will only accelerate the collapse of Obamacare while giving the Democrats the ability to blame Republicans for the collapse of their Frankenstein bill.

The GOP needs to let the AHCA die. Maybe just pass the Medicaid reform, which they could probably get the votes for. The short-term political hit will be fierce. But then they could take a year to put together a reform package that deals with the healthcare system we have now, Obamacare and all, not the system we had before Obamacare. The end result would be a package that is much more palatable to conservatives, addresses the damage Obamacare has done to the system and makes insurance more affordable.

Put it together, have hearings, go through the normal process. And then dare the Democrats to filibuster it. At the very least, they’ll have something to run on in 2018 or 2020. And at best, they’ll pass it and fix the mess Obama handed to them.

Thoughts on the CBO Scoring

I haven’t written much about the Republican healthcare plan because it’s fairly obvious that it’s never going to happen. Another nail was put in the coffin yesterday when the CBO released their analysis of the Republican healthcare plan. The bottom line is that it would cut spending by $800 billion over ten years, cut taxes by $500 billion over ten years but increase the number of uninsured by about 24 million through both cuts to Medicaid and the elimination of the insurance mandate. The reaction has been about what you’d expect: conservative touting the deficit reduction and downplaying the uninsured numbers; liberals doing the opposite and accusing Republicans of literally murdering people to get “tax cuts for the rich”.

A few thoughts on this:

First of all, I would take any projections about the number of insured with several large helpings of salt. This number is infamously difficult to project. The CBO previously overestimated how many people were going to enroll in the Obamacare exchanges to the tune of 8-10 million. A lot will depend on what’s happening with the economy, what the states do, etc.

In many ways, the GOP is being more honest here with their CBO analysis. As McArdle reminds us, the Democrats heavily gamed the CBO projections of Obamacare:

During the process of passing the Patient Protection and Affordable Care Act, or PPACA, many of us complained that Democrats were gaming the CBO process, tossing out desperate cuts and pay-fors over and over until they got the score they wanted, in much the way video-gamers try to kill a hard boss. They ended up jamming in a bunch of provisions that made Obamacare’s finances look sturdier than they were, but realistically, had no hope of ever taking effect (among my favorites: a never-never long-term care program, and a requirement that everyone in the country had to issue 1099s to anyone who sold them more than a few hundred dollars worth of stuff). We certainly can’t accuse Republicans of that!

They also phased in the tax hikes years ahead of the spending hikes so that it appeared to balance over ten years even though it was running a deficit by the end of the window.

Second, if you want to know why so many people despise the Left, check out the verbiage being used to describe this. The Republicans are “taking away” people’s health insurance and “giving” money to the rich. They are “stealing from the poor and giving to the rich”. This is “class warfare” of the rich against the poor. This is high-grade horse manure but unfortunately what passes for thought in Left Wing circles. You can’t “take away” something that you’re giving to people free of charge. And you can’t “give” money to people that is already theirs. A more accurate description is that the Republicans are taking less from the rich to give to the poor. That’s fair enough and if you think that it is the government’s job, fine. But please stop with this “taking from the poor and giving to the rich” line. It’s nonsense and a mangling of the English language.

Third, ignore any claims that the Republicans are literally killing people here. We were told, when Obamacare passed, that lack of health insurance killed 100,000 Americans every year. If that had been the case, we should have seen a big drop in mortality since the bill was passed. We haven’t (in fact, mortality has ticked up a bit). The benefits of Medicaid, in particular, are highly disputed.

Fourth, I have no idea, given the inevitable lashing the GOP will endure, why they’ve written the bill this way. Since they’re going to be accused of murdering people anyway, why go with Obamacare Light?

Finally, let’s not forget something important. It’s not like the Republicans are fixing a problem that doesn’t exist. The ACA is teetering, with insurance rates skyrocketing, insurers pulling out of the exchanges and the beginnings of a death spiral in the individual insurance market. The problem with the ACA is that it did nothing whatsoever to make insurance “affordable”. All it did was shift the burden around, taking money from one group of people to make insurance “affordable” for another. But the price of health insurance remained what the price of health insurance is. And since numerous people are deciding they would rather pay the fine than astronomical insurance rates, the system is on the brink of collapse.

The Republican plan, however, does not address this problem at all. If anything, it makes it worse, replacing the Obamacare tax with higher insurance premiums for those currently uninsured, thus making the death spiral even steeper. It’s simply a terrible idea, both financially and politically. Because if the Republicans pass this law and the Obamacare markets collapse, they will take the blame for it.

Many are suggesting that the Republicans should just let Obamacare collapse so that the Democrats take the blame. I’m dubious about this. First of all, I don’t like using millions of people’s healthcare coverage as some kind of political tool. Second, the Republicans will almost certainly be blamed anyway. In fact, many liberals are blaming Republicans right now for eliminating the risk corridors — the subsidies paid out to insurance companies to keep the exchanges afloat. That’s how bizarre politics has gotten — Democrats accusing Republicans of killing poor people by their refusal to subsidize some of the largest businesses in America. Either way, Republicans are going to be blamed for the mess that Obama has created. I don’t see that there’s a good option here. But passing the AHCA is certainly a worse option than doing nothing.

Ultimately, our efforts at healthcare reform continue to founder on the same rocks: Americans can’t make up their minds what they want. Every healthcare system in the world balances tradeoffs. Ours gives up universal coverage and affordability for quick response and rapid technological innovation. Socialized systems are universal and “free” but sacrifice availability and demand heavy taxation. What the voters seem to want is insurance where they can get all the care they want, see any doctor they want but not have to pay any money for it. That’s simply not going to happen. And until someone — Republican or Democrat — acknowledges that, we will continue to stumble from bad plan to bad plan.

The Plan is Out

Just a few quick thoughts since I’m frantically packing for the long trip back to the US.

The Republicans finally came out with their official Obamacare replacement plan. From what I can tell, it is basically Obamacare with more debt. It eliminates the insurance mandate tax, replacing it with hiked insurance rate for those who go without coverage — under the logic, I guess, that higher initial premiums will encourage the uninsured to buy insurance. It maintains the coverage mandate, which doesn’t work without a purchase mandate. It keeps the elimination of lifetime caps and coverage for those under 26. It also cuts off funding to Planned Parenthood. It’s basically all the popular stuff about Obamacare without all the unpopular stuff that pays for it.

There’s also no chance it will pass. The Senate is highly skeptical. A number of interest groups and conservative groups are already against it. The proposal is basically DOA.

And frankly, so is the Republican Party if they can’t do better than this. I didn’t think they could come up with something worse than Obamacare but they managed it.

(Note: the response from the Democrats is very illuminating. The overwhelming cry is, “THIS IS A TAX CUT FOR THE RICH!!!!” It’s astonishing how every Democratic policy and every political instinct revolves around soaking those evil rich people.)

The Follies Begin

Last night, the Senate passed a budget resolution. This budget included the first step in repealing Obamacare: setting the situation so that key parts can be repealed by reconciliation. Contra the Left, this did not repeal any part of Obamacare; it set the stage for repeal.

The budget has significant issues, mainly in that it adds $9 trillion in debt over the next ten years, with no significant cuts to spending or entitles and no tax increases or changes. That’s just the baseline right now. If Trump is serious about enacting a giant tax cut when he gets into office, we could be staring down $20 trillion in debt over the next decade, a budget hole that makes Obama and Bush look like models of fiscal rectitude.

As for the Obamacare repeal, I am against a naked repeal of the bill without a replacement in place. Simply repealing the law would throw insurance markets into chaos, throw at least 20 million people off of insurance and roil a sixth of our economy. Indeed, a number of people — including hospitals, insurance companies and state governors — are lining up against a naked repeal for just this reason.

The model I prefer is repeal and replace, enacting a new healthcare reform act. There are several proposals out there but the problem here is getting it passed as one bill. Democrats will oppose and while Obamacare can be repealed with a simple majority, a new bill can not be enacted without a supermajority.

That brings us to the current strategy which is called “repeal and delay”. The idea is that the GOP would repeal Obamacare now, sunsetting it in two years. That would give them two years to come up with a replacement and put Democrats in the position of either supporting the GOP bill or letting Obamacare die.

It’s also one of the most reckless things I can imagine.

Look, we’ve been here before. We have seen Congress enact laws to try to force future Congresses to make tough choices. And it always been a disaster. Because there is no reason to think that future Congress will be any bolder or smarter than present Congress. So we enact tax cuts hoping to “starve the beast” — a trick akin to eating a huge slice of cake to try to force yourself to go the gym. And deficits explode because Congress decides massive debt is politically easier than spending cuts. We enact a sequester thinking that such a dumb way of cutting spending will force Congress to do it more wisely. And the sequester is enacted anyway because choices are hard. “Repeal and delay” is simply shoving 20 million people out of an airplane with a vague promise that you’ll get a parachute to them at some stage.

Trump appears opposed to “repeal and delay” as do many key members of Congress. But they can only delay so long as we are already seeing the beginning of a death spiral in individual insurance markets. This is a problem I have been shouting about ever since Obamacare passed: the GOP needed an alternative. Not a bunch of conflicting vague plans, but an actual plan that the entire caucus had agreed to.

My prediction? I think Trump isn’t so dumb as to think “repeal and delay” is a great idea. I suspect what will happen is that the GOP will pass a series of fixes to Obamacare to gradually repeal and replace it with a sounder and more market-oriented system (step one: allow insurance to be sold across state lines). And as long as it gets rebranded “Trumpcare”, I expected the President to go along with it.

Update: There’s a great tweetstorm from Justin Amash — rapidly becoming one of my favorite members of Congress — about why he voted against the bill.

To read it, click on the date at the bottom of the tweet and then scroll down through the points he makes.

$9 Trillion in debt! WHO YOU GONNA BLAME?

Read the title of my post as a spoof on the whole Ghostbusters song – the good one from back then, not the idiotic PC reboot that Hollywood douched us with last year – because it is appropriate. The other day another old democrat crone was asked for an explanation of why the country accumulated $9 trillion plus dollars in debt with absolutely nothing to show for it (a lot of vote buying there and Hillary still lost), and Pelosi, in her grandeur, blamed Boosh. I am starting to think Boosh might be some kind of inhumane super fiend, because the guy can do everything impossible.

Let’s all sign it, baby: If the left is called out on something bad, who ya gonna blame? “George BOOSH”! Catchy…

Here we go:

House Minority Leader Nancy Pelosi blamed former President George W. Bush and the Republicans on Friday for the more than $9 trillion that has been added to the national debt under President Obama’s watch.

Pelosi argued that under Obama, the annual budget deficit, which contributes to the national debt, has been reduced dramatically, and said that without Obama’s work, the national debt would be even higher. She also mostly blamed Bush for not paying for the wars in Afghanistan and Iraq.

That same old tired trope again. Obama was great for the economy! Boosh’s Wars! This crap has to be because Pelosi knows for a fact that it was Boosh that bombed the twin towers. She must also think (or want everyone to believe) that it was Boosh whom unilaterally decided to invade Iraq. Thusly, poor godsend Obama struggled to end those evil wars, by losing them, and only managed to start conflicts all over the place – because of Boosh’s mind control, according to Pelosi (or was that all because of the evil Noble Peace Prize whispering in his ear?) – destabilizing the ME and the world in the process, had to spend all that money. It could never be that congress, mostly when it was totally controlled by democrats, felt obligated – probably because of Boosh’s evil super powers, again – to spend trillions more than the broken economy the democrats left us with after their social justice home-loan lending schemes imploded, so they could engage in buying votes, enriching special interests, and fattening donkey campaign coffers.

“When President Obama stood on the steps on the Capitol eight years from next week, the [budget] deficit was $1.4 trillion — one year deficit,” she said. “It’s reduced by 70 percent in his administration. Much of the increase in the national debt that has occurred from this time still springs from two unpaid-for wars, cost that we owe our veterans following that, giveaways that they gave to the pharmaceutical industry, and the high-end tax cuts that have carried forward without any job production. Absent the work of President Obama, this national debt would be even higher.”

Pelosi has some gall. Let me point out that $1.4 trillion dollar deficit was done by the congress she ran after the 2006 election, which remind everyone overrode evil Boosh to spend that money. Those of us that understand who decides how tax payer money gets spent, and who can sign for it or veto it, that is, if they can avoid that congressional override. Based on her own words, we are left basically connecting her accusations of that money being given to fat cats, with her. But somehow it still is Boosh’s fault they did that. Then you got this:

Pelosi noted the work done by former President Bill Clinton to balance the budget or leave a surplus.

You mean the work done by Newt Gingrich, thrice before it stuck? Gingrich dragged the smarter Clinton kicking and screaming away from the leftward turn his people and that crime syndicate capo he married for political convenience had been driving us for the first 2 years of his administration, and dismantled a lot of the horribly costly and wasteful welfare state. I wonder how that expensive welfare state fared under Obama, and if that coupled with the depressing and miserable Obama economy might have more to do with?

And then we have the other shoe about to drop: Obamacare. A monster that is poised to bankrupt America, if it is not slain soon. I bet Pelosi would like us to believe that was also Boosh’s fault even though not a single republican voted for this monstrosity and Boosh was on his ranch in Texas clearing brush. This is the Obama legacy, but the tools want you to believe someone else is responsible for 8 years of amateur hour.

Lets all sing it now: If you are a democrat, and you get called out on being crooks, who ya gonna blame? “George BOOSH”! If someone points out, you fucked America over good, who ya gonna blame? “George BOOSH”!

Catchy indeed. That Boosh guy is the most powerful villain in human history I tell you..

It won’t go away

And while the DNC operatives with bylines are trying their best to ignore the reality, we are forced to use foreign sources to again point out that Hillary got away with a huge number of crimes because Obama would have gone down with her. From the article:

It appears US President Barack Obama lied to the US public when he said that he found out about Democratic Presidential candidate Hillary Clinton’s email scandal on the news, with new leaked emails from Clinton’s campaign manager John Podesta seemingly contradicting Obama’s version of events.

Included the 18th batch of the Podesta Emails, released by WikiLeaks, is a March 7, 2015 email sent by Clinton spokesperson Josh Schwerin to communications director Jennifer Palmieri, press secretary Nick Merrill and others, referring to comments Obama made about the Clinton email scandal.

No, it doesn’t appear to be the case that Obama lied: Obama lied. His presidency, after promising transparency never seen before, has been about one where they have foisted lie after the lie on the American people. If you were still wondering why Hillary was running for the office of POTUS instead of making license plates in an orange jumpsuit, then you now have the obvious answer: Obama made sure she walked because he would have gone down with her.

Crooks the lot of them. They have destroyed our economy, wrecked healthcare, pissed away trillions buying votes with one government scam after the other, abused the office, destabilized the world and made it a far more dangerous place – the usual suspects will of course love you to buy their lies that was done by someone else I will not mention despite the fact that our Nobel Peace Prize winner now has 5 concurrent wars going onwrecked the relationship with America’s allies while kissing up to its enemies, with little or no success to change their hatred and hostility towards us or their abuses of that trust, ground our military into the dirt, and emboldened some of the most frightening and dangerous actors on the planet to challenge stability. The man has been a complete failure. And he was aided in doing all this crap by Clinton, whom now wants to double down on the same policies and go even further than Obama. But our election remains about people with little credibility saying Trump saying bad things to women!

Go figure…

It’s confirmed! Obamacare ‘s real purpose was…

So, those of us that pointed out Obamacare was designed from the start to fail, so the collectivist scumbags could force an unwanted single-payer system on us, and that they would do so in a way that would allow them to blame others for this horrible monstrosity that became law on a party-line vote, have been vindicated:

An email leaked by WikiLeaks Tuesday appears to suggest that Hillary Clinton wants the Affordable Care Act to fail — presumably as a pretense for implementing single-payer, government-controlled health care.

In a chain between Clinton and her senior policy adviser Ann O’Leary titled “Memo on Cadillac Tax for HRC,” Clinton said she’s open to changing her position on the Cadillac Tax — but that the Republican plan to repeal it must pass.

“Given the politics now w bipartisan support including Schumer, I’ll support repeal w ‘sense of the Senate’ that revenues would have to be found,” Clinton wrote. “I’d be open to a range of options to do that. But we have to be careful that the R version passes which begins the unraveling of the ACA,” she continued.

There is no “presuming” that they want failure so they could implement an generally despised single-payer system: that has been the objective from the start. This is how the left gets things people would never accept otherwise: create a catastrophe, then demand they be given even more power so they can be the ones allowed to fix it. Remember the housing crisis and financial markets collapse? More of the same.

Controlling healthcare, currently 1/6 of the US economy, and having the power to make life and death decisions, is incredibly appealing to the people that see the power in government control of institutions that can be used to keep the sheep in line. If it is not obvious to you that once government controls healthcare it will be used as a tool to quiet or control political enemies, just look at the IRS and DOJ scandals.

This must be what they meant when they made the ludicrous claim Obamacare would make healthcare affordable

So the WaPo is running an article titled “Obama administration may use obscure fund to pay billions to ACA insurers” which basically tries to make the criminals in the WH look like heroes, because they have found a way to circumvent congress and the will of the plebes:

The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act, through a move that could circumvent Congress and help shore up the president’s signature legislative achievement before he leaves office.

Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces, according to insurance executives and lawyers familiar with the talks.

The payments most likely would draw from an obscure Treasury Department fund intended to cover federal legal claims, the executives and lawyers said. This approach would get around a recent congressional ban on the use of Health and Human Services money to pay the insurers.

I mean, why not? Aren’t these the same people that paid off Iran and lied about what they were doing to convince people that had stopped Iran from pursuing a nuke and missiles to get them on target, only for us to find out Iran is going right ahead with more of the same and now also grabs US citizens as hostages, because these morons will pay ransom money to avoid us finding out we were had? Isn’t this the same administration that told the FBI to let that criminal Clinton break the law and commit acts that should have resulted in her inability to ever hold any kind of security clearance as well as spend time in an orange jump suit making license plates, because if they had gone after her Obama would have gone down too for knowing this was happening and then lying about not knowing? It was this administration that has set new records for law breaking and abrogation of powers to the executive after the lot of them spend 8 years whining about evil Boosh and promising they would fix everything and also be totally transparent about it?

The lesson here is a simple one: never trust the left. They are liars, crooks, and will always do whatever it takes, because to them the end justifies the means. Nothing should frighten you more than some credentialed collectivist twit telling you they are doing something to help you. What they are doing is to help themselves, and you are sure to be fucked over in the process, sooner than later. Guaranteed.

The Public Option Returneth

With the collapse of the Obamacare exchange markets imminent, the Left Wing is calling for the return of the “public option”. The public option would be a single-payer system run by the government that would “compete” with private insurance, supposedly without subsidies to make things fair. According to the Left Wing, this is “only way” to return competition to the Obamacare exchanges, many of which have shrunk down to a single insurer.

It’s all lies. They know it’s all lies. That entire paragraph above can be exploded with two words: state lines.

For years, the Republicans have advocated that health insurance be sold across state lines, rather than within fifty restricted markets. The reason is very simple: in many states, there is no competition for insurance. In Alabama, for example, Blue Cross is a virtual monopoly, controlling 90% of the private insurance market. Allowing insurance to be sold across state lines would allow at least the big insurers and preferably dozens to compete in every market in America. It would destroy the virtual monopoly many insurance companies enjoy. It would not be a silver bullet — establishing networks of doctors and hospitals is arduous. But it would help.

Democrats have opposed this, claiming that it would cause a “race to the bottom” as employers sought the worst insurance possible. Apart from the bald cynicism, this is hysterical bullshit. We already have established federal guidelines for minimal insurance standards.

But the public option talk exposes several lies at once. The Democrats claim that the public option would not be subsidized. But the public option has a built in subsidy which is … the ability to be sold across state lines. And I would expect other non-subsidy subsidies to follow suit: forcing doctors to accept it; hiding administrative costs in other parts of the government (as Medicare does); exemption from federal and state regulations that drive up the cost of private insurance.

Obamacare was Stage One of moving us toward a single payer healthcare system. Obama said as much himself. The public option is simply Stage Two. If the Democrats wants single payer, then they should advocate for single payer. I’ll oppose them, but at least that would be honest. The public options is simply an attempt to sneak single payer in through the back door.