Tag: Health insurance in the United States

Piling On

Apropos to Alex’s post below, the huge news in the last day is a study from Oregon that looked at the effects of expanding Medicaid. As McCardle points out, the study was done under near ideal circumstances. Oregon could not expand Medicaid to everyone who wanted it, so they created a lottery. Sociologists swooped in and recruited. The result was a study of 6000 people with Medicaid and almost 6000 without. One of the authors was an Obamacare architect. This is the kind of diverse randomly-selected sample that sociologists dream about.

The result is …. not much:

Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively–glycated hemoglobin, a measure of blood sugar levels [and diabetes indicator]; blood pressure; and cholesterol levels–there was no significant improvement.

It’s one of two major RCTs that have ever been done on insurance. And like the first one, it doesn’t show a signficiant effect. That is huge news. Not good news–obviously, it’s much nicer if giving people money to pay for health care makes them obviously much healthier. But big.

And it’s actually bigger, and more important than Obamacare. We should all be revising our priors about how much health insurance–or at least Medicaid–really promotes health. What this really tells us is how little we know about health care, and making people healthy–and how often data can confound even our most powerful intuitions.

In other words, insuring people resulted in more spending by the government, but not necessarily improved health. Gee, I think I’ve heard that before.

As you can imagine, the liberals are spinning as fast as they can. And, to be fair, they have a point. The study covers only of a couple of years and it might take a while for long-term effects to show up. But you know that if the study showed even the slightest improvement in health, they would be shouting it from the rooftops. They have, after all, spent years citing dubious studies that claim that the lack of universal healthcare kills, if I remember the Obamcare rhetoric correctly, at least 17.4 billion Americans every year. And, in fact, when the first Oregon study came out and showed that people weren’t healthier, per se, but felt better, the liberals crowed about it.

The new study is much more difficult to twist abut that’s not stopping their attempts. One thing they have harped on is that the insurance is preventing people from being financially destroyed by a health crisis. But Avik Roy is all over that in a must-read response to liberal excuse making:

Medicaid reduced financial hardship for the poor, by protecting them against catastrophic health risks. Wonderful, but we could have achieved the same outcome for a fraction of the price, by adopting the plan proposed by Florida’s Will Weatherford and Richard Corcoran: Offering low-income Americans a subsidy with which to purchase catastrophic coverage on the open market. That plan was foiled by people—including Republicans—who insisted on expanding Medicaid instead.

Ross Douthat is on the same page:

But what if we lived in a world in which the Republican Party had fully embraced the views of many right-of-center health policy writers (and some G.O.P. politicians, including the John McCain of 2008) and supported an alternative to Medicaid expansion, which would change the tax treatment of health insurance to free up money to create a universal tax credit or voucher designed to spur the purchase of catastrophic health insurance plans? What if the choice, in other words, weren’t between the current health care law and a repeal-plus-nothing G.O.P., but between the current health care law and the best conservative thinking on the issue?

This is, in fact, what most libertarians have advocated for years, including me.

I remind you that this isn’t a trivial question. Obamacare gambles some $750 billion on the idea that Medicaid will improve health outcomes, boost the economy, reunite the surviving Beatles and help us all lose ten pounds with diet and exercise. If the gain from that huge investment is this marginal, it is not worth it. I’m sorry to be cruel, but it not worth $750 billion to save only a few lives.

I do want to repeat my earlier caution that it would be odd to conclude that health insurance has no health benefit. We may not know for a while. But I do think it’s becoming clear that Medicaid expansion is not going to be the miracle breakthrough that so much of the Left has claimed it would be. If lack of insurance really were killing as many people as the Left insists it is, the Oregon data would show it. You might even already see a difference in mortality rates.

I know it surprises some people, but improving our nation’s health is not as simple as simply throwing lots of money around.

Expensive Obamacare pilot project fails miserably: LSM covers for them

Oh what irony that another liberal feel good-do good program not grounded in reality, falls apart. In this case we are talking about the program to insure uninsurable people that was touted as one of the biggest successes of the ACA. From the WaPO article that does its best to pretend this is only a bad thing in so far that the program is no longer taking more people, instead of the fact that it is basically dying because, like everything else this ACA comprises, that was the intent from the start.

Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from a program designed to help them because funding is running low. Obama administration officials said Friday that the state-based “high-risk pools” set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state. But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected.

“We’re being very careful stewards of the money that has been appropriated to us and we wanted to balance our desire to maximize the number of people who can gain from this program while making sure people who are in the program have coverage,” said Gary Cohen, director of the Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight. “This was the most prudent step for us to take at this point in time.”

The program, which was launched in summer 2010, was always intended as a temporary bridge for the uninsured. But it was supposed to last until 2014. At that point, the health-care law will bar insurers from rejecting or otherwise discriminating against people who are already sick, enabling such people to buy plans through the private market.

Did you notice that even as the news they have to deliver is that the program is a total failure, that they have couched it in the most positive language possible? I had to laugh, and laugh hard, at that “We’re being very careful stewards of the money that has been appropriated to us and we wanted to balance our desire to maximize the number of people who can gain from this program while making sure people who are in the program have coverage,” quote. What a pile of bullshit! Government is never careful with anything other than covering its own ass and growing itself and its power. We don’t have trillions of new debt dollars added each year, by accident, under these collectivists. It’s the designed plan.

There are a couple of important pieces of information hidden in this fluff piece. The most important of all is that government, the very government that now plans to take health insurance over completely and then, with the power to decide who gets care and who doesn’t, yet again, failed at something. And they failed running something that was a fraction of what they ambitiously pretend they will be better at than the evil profit makers. Evil profit makers! Better eat shit and die than let make profits! Enough pointing out how progressivism is a mental disorder. Let’s deconstruct some more of the bullshit from the WaPo article, and see what important facts the leftard conveniently forgot to bring up and let the people be aware of.

From the start, analysts questioned whether the $5 billion that Congress appropriated for the Pre-Existing Condition Insurance Plan — as the program is called — was sufficient.

Oh, NOZE! They gave the program too little money! That’s why it was so bad. I think the big and glaring obvious fact that everyone should immediately picked up from this lack of funding thing was that we have been sold a massive lie about the costs of the ACA behemoth, let alone the massive and glaring lie that it actually will save us money of any kind. In fact, as many of us pointed out repeatedly, the whole CBO cost projection that the leftards and their surrogates in the LSM pushed so hard on the premise that the ACA would lower costs and government spending, was nothing but a pile of massive bullshit. And saying it was massive bullshit is an understatement.

We already also have had numerous admissions, more often than not couched in language to pretend otherwise or soften the blow, that Obamacare will never save any money for the tax payer. In fact, every single revisited projection has been to drastically increase the cost estimates of whatever was being looked at without the political pressure to sell the ACA as a good deal. And I guarantee you that even those drastic increases do not mirror how bad the ACA program costs will be in reality. I can rehash all the stories about how the politicians excluded themselves, and so many donkey friends and special interests to boot, from this horrendous government power grab masquerading as health insurance reform. Or I could talk about how so much of this thing is anti-constitutional or will end up costing far, far more than projected, and in numbers that will cripple our economy. But since that has already been rehashed, repeatedly, with the same excuse makers pretending that those of us pointing out how we are being lied to and manipulated by the scumbags that want to sugar coat the ACA shit sandwich are the ones not being honest, for now let’s stick to this specific case and the failure of this single program.

Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive.

So the WaPO tells us that the defenders of Obamacare felt the money allocated for this program was too little, and that a really large number of people would sign up for the it, but the facts bear out that they failed on both counts. I am not surprised. Its government work we are talking about here anyway. So what was the actual number of people that signed up?

But it was also because the pools are open only to people who have gone without insurance for at least six months. The result is that, while only about 135,000 people have gotten coverage at some point, they are proving far more costly to insure than predicted.

I call bullshit. The government’s own website, puts it at a number below 100K. But I am not surprised to find that a DNC propaganda organ lies in favor of the leftard establishment and agenda. That number their site shows didn’t even break 1/3 of the number they estimated would sign up. I would not be surprised to find out that the numbers reported on that site are actually exaggerated on the high side and not true, either. We are dealing with people that have no compunction about lying constantly to favor their collectivist agenda. And the lack of enthusiastic support for this program has been another in the long series of unreported real black eyes for the collectivists. I suspect that they spent most of this $5 billion trying to sign up more people so they wouldn’t look like the idiots they are, and as usual, failed miserably.

The point that the WaPo conveniently failed to grasp and elucidate on, is that with less than 1/3 of the numbers they projected signing up, the program ended up eating all the money that was allocated, and then 2 years ahead of schedule. This is a red flag for anyone looking at the effectiveness and cost of the ACA. Those of us that are not math and logic challenged can extrapolate form how things played out in the real world – and this extrapolation is not done in a vacuum, but based on many such other instances of reports they got the numbers too low – that the real cost numbers needed were upwards of 4 times the money allocated to cover the numbers they put up. They got a little lucky that the program bombed and so few signed up. They would have blows that $5 billion in the first year if they had gotten the real numbers they expected. Anyone can clearly see that the rest of Obamacare cost projections will very likely suffer the same economic scale problem because they are all underestimating costs. I have repeatedly said that I believe that when the unicorn worshippers get their way it is going to cost us at least 3 or more times what they pretended it would, and that then, unable to afford the cost, they would ration care and control access. But that’s all a built in feature of Obamacare. I will explain why after this.

About 129 millionpeople nationwide have a medical condition or prior illness that would make it hard for them to buy their own insurance plan. Large numbers of them can and still do obtain full coverage through employer-sponsored plans, which generally do not treat sick people differently.

An additional 215,000 people are insured through separate high-risk pools that 35 states fund through their own budgets — although the policies often do not pay for treatment of the person’s preexisting illness, only covering new illnesses the person may develop. Between 9 million and 25 million people with preexisting conditions are uninsured, depending on the estimate.

Let those numbers sink in, then extrapolate what the cost would really be for the rest of this monster. Anyone still buying the numbers that they bandied about to get enough people to go along with their “We have to vote for it for you to find out what will be in it” scheme deserves the shit sandwich they are about to be force fed. The cost of Obamacare will be crippling. Even with massive rationing in place. It’s why they did this so quietly. But as I already pointed out, Obamacare destroying the economy and crippling healthcare and access to healthcare is all part of the plan. I saw my health insurance costs go up this year even though I had changes that reduced the number of participants I pay for. Have you heard anything about how this is happening from the LSM? Not me.

Look, the end goal for the collectivists has always been for government to take complete and total control of healthcare. They want access to that massive amount of money, for one. They can then control people, and more importantly, control which people get care. Have no doubt that they will use access to healthcare as a hammer to keep people in line. They are collectivists after all, and the state knows what’s best. Stalin or Mao would be proud. This shit is Machiavellian in nature. Don’t for a second let them fool you into thinking otherwise.

The fact is that healthcare is not a right, and that with limited resources some will always suffer. And those that pretend otherwise are doing so, so they can profit from the gullible. This is another great example of how the road to hell was paved with good intentions, except in this case the truth it is closer to the analogy of the devil selling you the illusion of bliss for your soul. We have all been had. Even when worried democrats pretend the problem is in the implementation, remember that this thing is intended to destroy our healthcare system and working as intended. At least I take consolation that those that gave us 4 more years of this asshole will pay the most for their stupidity. There is justice in the universe.

College Health

How many times have I said it? When you outlaw cheap insurance, you create more uninsured:

Some colleges are dropping student health-insurance plans for the coming academic year and others are telling students to expect sharp premium increases because of a provision in the federal health law requiring plans to beef up coverage.

The demise of low-cost, low-benefit health plans for students is a consequence of the 2010 health-care overhaul. The law is intended to expand coverage to tens of millions of uninsured Americans, but it is also eliminating some insurance options.

Now the cheap insurance plans colleges offer aren’t great. They are available for about $100 a month or so and only cover the first $10,000 of medical bills. They won’t deal with a dramatic illness. But they do help some students deal with routine checkups, the occasional diagnostic test, the odd broken finger or whatever. But because Obamacare is phasing out lifetime caps on insurance, even these modest plans are either disappearing or seeing price hikes of 1000% or more. You can read more here from Avik Roy, who points out that these plans, while not perfect, fill a useful niche in the market.

What’s the Obama administration’s response to this carnage? Effectively it’s this: that people should pay more for insurance, because it’s for their own good. The costlier, more comprehensive plans offer more protection, and people should be forced to buy that extra protection, even if they think it exceeds their own needs.

In fact, that’s the entire Left Wing’s response to this. They point out that these plans cover only 7% of students, which is meaningless: it still means 600,000 people are being needlessly priced out of the market. They point out that Obamacare allows parents’ insurance to cover students under 26. But this almost meaningless since that was already the case through age 22; I was on my dad’s insurance until grad school. But in the end, it comes down to, “Well, they should get better insurance” as if the money for it is going to magically appear (more student loans, anyone?). And “better” insurance — defined as more expensive — isn’t always a great thing. Roy again:

It’s precisely the proliferation of overly generous insurance plans that causes runaway health costs in the first place. When you have a plan that covers everything, you tend not to be concerned with the cost-effectiveness of the care you receive. And that, in turn, leads to excess health spending, which in turn makes insurance costlier.

I personally would prefer students go in the opposite direction: get major medical, which would cover disasters with a very high deductible, therefore creating consumer pressure to publicize and compete on price. But that’s not in either party’s vision. In fact, the Arizona GOP just killed a law that that would require healthcare providers to publish price lists, creating precisely the kind of competition we need in the healthcare system.

More good news about Obamacare

What’s that you ask? Well, a recent survey by McKinsey Quarterly has found out that fully 1/3 of employers plan to stop offering healthcare come 2014, once provisions of the Affordable Care Act start to kick in, and that’s on top of the 7% employees forced to switch to subsidized-exchange programs we already know about.

While only 7% of employees will be forced to switch to subsidized-exchange programs, at least 30% of companies say they will “definitely or probably” stop offering employer-sponsored coverage, according to the study published in McKinsey Quarterly.

The survey of 1,300 employers says those who are keenly aware of the health-reform measure probably are more likely to consider an alternative to employer-sponsored plans, with 50% to 60% in this group expected to make a change. It also found that for some, it makes more sense to switch.

“At least 30% of employers would gain economically from dropping coverage, even if they completely compensated employees for the change through other benefit offerings or higher salaries,” the study says.

Those of us that warned this was the plan from the start and that the ludicrous claim that people would get to keep their coverage was a huge slight of hand, are yet again vindicated. And this will have a snowball effect. As employers drop their coverage government will have to jack up both the penalties on them and the costs on those that keep them to cover for the shortfall. In the long run everyone will figure dropping coverage is cheaper anyway. And then the left gets what they wanted: government in charge of healthcare. Then the fun can begin!

The response from the WH?

Late Monday, an Obama administration official took issue with the study, saying that it is at odds with findings from the Congressional Budget Office, think-tank Rand Corp. and the Urban Institute. In an email response, the official wrote that when Massachusetts initiated its own reform, the number of individuals with employer-sponsored insurance increased.

Indeed, the Rand study released in April noted: “The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with under 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges.”

Employers with less than 100 employees are the biggest employers in the US. BTW, one of the major reason most of them are not hiring, no matter how booming their business may be, is precisely the risks and unknowns tied to Obamacare. My bet? Employers, especially small business owners, will start dropping heaqlthcare like it’s radioactive as more of this disastrous government takeover of healthcare goes live.