Tag: Healthcare in the United States

Insurance is Not Healthcare

For a long time, conservatives and libertarians have been pointing out that Obamacare has come at a steep price for the insured. Not only are health insurance premiums rising, but the new plans cover less, demand healthcare within ever-shifting networks of approved providers and foist larger out-of-pocket expenses on patients.

Well, looks like the New York Times finally figured this out:

A study by the Commonwealth Fund this month found that the rise in health insurance premiums in employer-based plans had slowed in 31 states since the passage of the Affordable Care Act (good news, right?). But premiums were still rising faster than median incomes (hmm). More important, perhaps, the researchers found that patients were paying more in health care expenses than ever before, during a time of stagnant wages (not so great). In fact, nearly 10 percent of median household income now goes to pay premiums and deductibles, the study found. And that does not include other kinds of health payments that patients now encounter, such as co-pays and uncovered drugs or services.

A recent New York Times/CBS poll found that 46 percent of Americans said they had trouble affording health care, up 10 percentage points in just one year. Some of the cost problems may ease as patients — now known as health care consumers — learn what to expect and how to choose and navigate their plans.

In other words, premiums slowed down … but only because out-of-pocket expenses increased. On balance, that might not be such a bad thing. I’ve long advocated high-deductible plans as a way to bring the healthcare consumer back into the picture. David Goldhill once pointed out that if we replaced Medicaid with a high-deductible plan, we’d save enough money to give every poor person a voucher to cover their deductible.

But this isn’t the high-deductible idea. This is creating a hyper-regulated marketplace in which insurers are expected to provide “reasonably priced” health insurance to everyone, no matter how sick they may be. So doctors flit in and out of approved networks. Out-of-state clinics come to be preferred over in-state ones. And all of this is enforced with the threats of massive bills if you don’t do the insurance company’s bidding. And if you do their bidding, you’re still facing far larger healthcare bills than you were dealing with before Obamacare.

All of this was predictable of course. You simply can not expand health care coverage to ten million people — many of whom couldn’t get coverage because of expensive medical conditions — and not have it make insurance more expensive. We warned people about this for years. We had concrete examples of this in places like New York and Massachusetts. And yet everyone is acting all surprised when they discover that healthcare isn’t free.

Note one thing the story leaves out: the increasing number of doctors who are refusing to see Medicaid patients. Medicaid expansion is a big reason the Obama Administration can claim that they’ve insured ten million people. Only a couple of million have gotten private insurance thanks to Obamacare; most are in the Medicaid gulag.

Given the media’s lag, I expect we’ll start seeing stories about that in about 2019, at which point it will be blamed on President Walker.

Addendum: You may remember that a big pillar of Obamacare was that it would be paid for, in part by the savings from Electronic Healthcare Records. Yeah, that’s not working out either. Again, this was predicted. The one thing we all knew going into this was that EHRs are very expensive.

The Revolving Healthcare Door

Let’s not pretend that we’re surprised:

When the legislation that became known as “Obamacare” was first drafted, the key legislator was the Democratic Chairman of the Senate Finance Committee, Max Baucus, whose committee took the lead in drafting the legislation. As Baucus himself repeatedly boasted, the architect of that legislation was Elizabeth Folwer, his chief health policy counsel; indeed, as Marcy Wheeler discovered, it was Fowler who actually drafted it. As Politico put it at the time: “If you drew an organizational chart of major players in the Senate health care negotiations, Fowler would be the chief operating officer.”

What was most amazing about all of that was that, before joining Baucus’ office as the point person for the health care bill, Fowler was the Vice President for Public Policy and External Affairs (i.e. informal lobbying) at WellPoint, the nation’s largest health insurance provider (before going to WellPoint, as well as after, Folwer had worked as Baucus’ top health care aide). And when that health care bill was drafted, the person whom Fowler replaced as chief health counsel in Baucus’ office, Michelle Easton, was lobbying for WellPoint as a principal at Tarplin, Downs, and Young.

Now, as Politico’s “Influence” column briefly noted on Tuesday, Fowler is once again passing through the deeply corrupting revolving door as she leaves the Obama administration to return to the loving and lucrative arms of the private health care industry:

As I said in my election post: had Obamacare been proposed by John McCain or Mitt Romney, the Left would have suddenly realized that the healthcare industry was lining up to support it. They would have noticed what a huge payout it was to the insurance and pharmaceutical industries. They would have denounced it as corporate welfare. Some principled liberals, like Greenwald, did (albeit mainly because they want single payer). But most turned away or absurdly accused the opposition as being an astroturf industry-funded campaign.

The SCOTUS Prequel

I have to agree with the commentators that the Supreme Court is clearly screwing with the media. Usually, the Court is more forthcoming about which decisions are going to be handed down each day. But I feel like the judges are getting a kick out of watching the media work itself up into a frenzy each morning (and occasionally accidentally publish pre-written opinion pieces) hoping for an Obamacare decision only to groan as other decisions are handed down.

While we wait, you can amuse yourself with some of the pre-emptive pearl clutching from Left Wingers getting the vapors over the idea of the Court protecting the Commerce Clause. You can prepare yourself for the Summer Olympics gymnastics competition by enjoying the incredible contortions the Left are making to argue that the Right Wing of the Court … and only the Right Wing … are partisan douchebags (as Althouse points out: it’s apparently pure partisan chicanery that Republican Presidents have not appointed a liberal justice since Souter; but it’s sound jurisprudence that Democratic President have not appointed a conservative justice since Sherman Minton.) You can read about what happens when the government healthcare programs attempt to “economize” here.

But there are two pieces that are absolutely critical. The first is from Ezra Klein, who shows that guaranteed issue without a mandate basically destroyed the insurance market in Washington State. If SCOTUS only strikes down the mandate, we are suddenly going to be in a very serious crisis. Insurers will have to issue policies to anyone. This will need immediate action by Congress to either repeal guaranteed issue or pass a mandate that passes Constitutional muster. I don’t see either happening. (You can also read Wonkblog’s analysis of Romney’s reform in Massachusetts. Even they have to admit that it has blown up the State’s budget.)

Second is a new study of Oregon’s Medicaid expansion. It did bring healthcare coverage and better health to many people. But it did not save money the way liberals insisted it would. If we want more healthcare, we’re still going to have to pay for it. “Preventative care” is the Laffer Curve for liberals.

The decision will probably come this week. Hold on to your butts. The political wailing and gnashing of teeth will be the entertaining part. But the really important part is what we do after the decision is handed down.

There is a lot more to this story…

Everyone is up in arms about the new school regulation banning bake sales in MA. The parents that usually use these sales to raise money for school sports and other such activities are incensed.

Bake sales, the calorie-laden standby cash-strapped classrooms, PTAs and booster clubs rely on, will be outlawed from public schools as of Aug. 1 as part of new no-nonsense nutrition standards, forcing fundraisers back to the blackboard to cook up alternative ways to raise money for kids.

At a minimum, the nosh clampdown targets so-called “competitive” foods — those sold or served during the school day in hallways, cafeterias, stores and vending machines outside the regular lunch program, including bake sales, holiday parties and treats dished out to reward academic achievement. But state officials are pushing schools to expand the ban 24/7 to include evening, weekend and community events such as banquets, door-to-door candy sales and football games.

Everyone but the bureaucrats and the schools pushed by those bureaucrats thinks the rule is dumb. Basically the schools are using a SCOTUS decision about allowing schools to regulate or punish behavior outside of school, some guy that held up a “Bongs for Jesus” sign was basically told in one of the most ridiculous rulings that his out of school activity impacted students, and hence the school could punish em, to justify this nonsense.

The angle nobody pushes is that schools are all under tremendous pressure from the MA politicians to change eating habits. And that drive is primarily because the MA politicians are first and foremost concerned with controlling healthcare costs. Obesity and medical complications caused by obesity, seems to be one of the primary drivers of medical costs these days.

Whether you believe obesity is a problem or not, the bigger issue this brings to the forefront is whether we have freedom to determine what we eat or not. The big government controlled healthcare types tell us constantly they wouldn’t do shit like this, but have no doubt they are behind this effort, be it directly or indirectly, to control what people eat, because they see that as a critical step towards controlling government run healthcare costs. Sooner than later, for our own good they will tell us too, of course, they will start controlling not just what we eat, but everything else we do. Of course big nanny state lovers will see very little wrong with that until they tell them they can’t do something they want to do, or have to do something they don’t, death panels come to mind, but by then it will already be too late.

Dying With Your Stethoscope On

I’ve been mulling over this absolute must-read for some time:

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Growing up in a medical family, I can confirm that this is mostly true. I know several medical people who want the last full measure but many more want nothing more than some pain meds. It’s not just doctors either. Rich people die this way too. If they can afford their own in-home nurse, they will go home, make sure they have enough opioids and die peacefully (and cheaply). It’s the ultimate irony of our broken Medicare system that you have to be rich to die on the cheap.

It got lost in all the talk of “death panels”, but end-of-life nonsense is a huge and avoidable contributor to Medicare’s bloated budget. For many people, almost inhuman procedures drag out death for days and tally up hundreds of thousand in costs. You can read personal story in Goidhill’s article, which is still, 2.5 years later, the best thing written about healthcare in the United States.

The thing is, the system is set up this way. In the absence of specific orders, hard coding is the default. Part of it is defensive medicine — although the silly misinformed twats who do their studies of “defensive medicine” don’t include it when they assure us defensive medicine only costs 2% of the bill. Doctors can be sued and even prosecuted for “pulling the plug” if they don’t have legally binding instructions from the patient.

Another part is that if a patient is unable to make decisions, the responsibility falls to the family. And families often choose to go the last full measures since (a) they have trouble letting go; (b) they don’t want to take the responsibility for killing grandma; (c) they often have a poor understanding of precisely what’s involved; and (d) it’s the government’s dime anyway. Unless the patient had legally binding orderes written in advance, they will almost go out in misery.

The thing is, most people don’t want this. But they end up getting it because they don’t know it’s standard. They end up getting it because they left no legally-binding orders. They end up getting it because they didn’t want to deal with the fact that they were going to die one day.

Well, tough. When you’re on the taxpayers’ dime, I don’t think you get the luxury of pretending you’re not going to get sick and die. This is why I support a change to Medicare: to enroll in the system, you must write end-of-life orders. There’s no restriction on what you can do — if you want the last full measure, you can get the last full measure. Or you can hoose, if you want, to get a home nurse and some drugs. But you have to make a decision (albeit one you can revisit if you change your mind).

Over the long haul, this would save the taxpayers hundreds of billions and save millions of people from needless anguish. Just ask the doctors.

What’s stopping it? Mostly, there’d be too much of a political price to pay. The epic brouhaha over Terri Schiavo is too fresh in many minds. Even suggestions of end-of-life counseling brought out cries of “death panels”. And the Democrats are in a glass house, since you can bet the farm they would say the same or worse if a Republican proposed such a thing. And so we sit here, year after year, sending hundreds of thousands of our citizens shrieking into the afterlife while our national treasure burns up.

CBO numbers fail again.

Recently I posted about how the CBO had to downgrade the effects it was claiming for the Patronage Bill. Certain people then proceeded to not just question that this was what happened, while trying to defend this epic trillion dollar failure, but to imply I was purposefully being dishonest about the CBO being dishonest – leaning left in that dishonesty – or the way the LSM reports on this crap. Well, the the usual suspects at the CBO were at it again:

A recent report from the Congressional Budget Office (CB0) says, “The share of income received by the top 1% grew from about 8% in 1979 to over 17% in 2007.” This news caused quite a stir, feeding the left’s obsession with inequality. Washington Post columnist Eugene Robinson, for example, said this “jaw-dropping report” shows “why the Occupy Wall Street protests have struck such a nerve.” The New York Times opined that the study is “likely to have a major impact on the debate in Congress over the fairness of federal tax and spending policies.”

But here’s a question: Why did the report stop at 2007? The CBO didn’t say, although its report briefly acknowledged—in a footnote—that “high income taxpayers had especially large declines in adjusted gross income between 2007 and 2009.” No kidding. Once these two years are brought into the picture, the share of after-tax income of the top 1% by my estimate fell to 11.3% in 2009 from the 17.3% that the CBO reported for 2007.

WHAT? The CBO rigged a report in such a way that it could advance a collectivist talking point? NEVAH! It’s not like we have a history of them doing this – as I pointed out in the comments, only to be rebuffed. We saw the same shit with the CBO scoring of Obamacare. Granted, the CBO got off easy because they claim they where “told” to score it that way by the usual suspects, but that’s nonsense considering there is a history there of doing things like that.

Before you ask what the problem was with what the CBO reported about Obamacare, let me point it out in brief. The CBO scored it over a decade, 10 years for those that are math challenged, and then factored in tax income from day one while only factoring the really big outlays after 4 if not 5 years of collecting taxes. That was all done so they could make the ludicrous claim that Obamacare would save us a measly $112 billion or such. Anyone that understands basic math, ignoring the obvious shenanigans and double counting of outlays/savings from Medicare and other such systems they claim they will raid for cash to make these numbers work, sees two things. The first is that there is no way these numbers produced by the CBO bear out even if you focus only on the narrow window they looked at. If this boondoggle follows historical precedent – and you can look at the bits and pieces they have so far put in place for proof this will be more of the same – it will cost at least twice as much as they predicted. So, unless you also believe in Unicorns, it is clear that we will not have any savings at all, but be running a deficit before the first decade is over.

Then, the second obvious issue, which comes at the end of that decade the CBO scored for, clearly shows that we are looking at massive deficits to fund this program. There is not enough rationing that can be done to make these numbers work. Obamacare is going to cost us trillions in just the next 2 decades.

Back to our CBO bullshit du jour. Maybe it is not just the fact that the Keynesians are economic illiterates but signs of an actual plan in motion, one that advances and explains what Obama means when he talks about “social justice” and “wealth redistribution”, that gets pointed out by this passage in the WJS article:

The larger truth is that recessions always destroy wealth and small business incomes at the top. Perhaps those who obsess over income shares should welcome stock market crashes and deep recessions because such calamities invariably reduce “inequality.” Of course, the same recessions also increase poverty and unemployment.

The author then goes through some details to point out precisely why the CBO chose to ignore 2007-2009 in that report. The evil wealthy, those 1%ers, took a huge hit when things went south and that 17% number the left uses to tell us how unfair it is that the wealthy have money, would drop considerably and then seriously undermine the class warrior’s agenda. Further more, it shows that whenever government tries to fleece the producers, they don’t just roll over and play along, but take active measures to shield their wealth (How evil of them! – that was sarcasm BTW). And that what this obviously and purposefully rigged CBO analysis, done to create more class warfare collectivist talking points, really should have reported was the following:

In short, what the Congressional Budget Office presents as increased inequality from 2003 to 2007 was actually evidence that the top 1% of earners report more taxable income when tax rates are reduced on dividends, capital gains and businesses filing under the individual tax code.

Of course, that doesn’t fit the ultimate goal of the current narrative – that government should be collecting more money, and once the wealthy have been fleeced they can simply turn to the rest of us – so no chance we ever see that from the CBO. I wonder how many of the usual LSM suspects, like the ones at WaPo mentioned in this article, which was quick to carry water for the collectivists when the rigged numbers worked in the favor of the class warrior/collectivist narrative, will actually report on what this WSJ author points out. I am not taking bets unless I am able to bet against them reporting, BTW. I don’t do stupid. But we can keep pretending that whenever we point out how unreliable these LSM cum CBO collectivist talking points are, that the fault is with those of us that call them out on their lies.

After all, as comrade Obama pointed out in his speech just the other day, what Americans need is more social justice, and if it needs to come at the expense of their freedom, well dog gone it, that’s just dandy. After all, the old slave & land owning doofuses that produced that pesky constitution weren’t as wise as the class warrior class fancies themselves to be. In the mean time we march on to a tyrannical, but “socially just!!!1!!” country molded after Greece. Great.

The Efficiency of Fraud

Remember, friends: Medicare is the model for how we should reform healthcare. Medicare for all is what Van Jones Propaganda Party, among others, is demanding.

On Tuesday, a jury found Iruke, his wife and an employee who worked for the couple guilty of healthcare fraud and conspiracy to commit fraud in a scheme that involved more than $14 million in illegitimate Medicare claims.

Authorities said Iruke and associates often supplied power wheelchairs to Medicare patients perfectly capable of walking on their own —including one who did jumping jacks to show agents he never needed one. Also among the patients Iruke and his associates filed reimbursement claims for were two people who were deceased, according to court papers.

fter purchasing the wheelchairs at about $900 wholesale and paying for the prescriptions, he pocketed the remainder of about $6,000 in taxpayer money he received as Medicare reimbursements, according to court documents. The pastor operated four medical equipment supply companies between May 2002 and September 2009 as part of the scheme, according to authorities.

A few things to pull out of this. First, how easy it was for these guys to defraud Medicare. Their fraud was so simple and straight-forward but it took the government seven years to spot it. The Feds are boasting about finding $2.3 billion in Fraud with their new strike force. But it’s clearly this is the low-hanging fruit of a crime spree that amounts to tens of billions. Notice also how efficient Medicare is. Surgeons haven’t had price increase in 30 years. But Medicare is shelling out six times the going price for a wheelchair.

This is just another illustration of how dysfunctional the liberal model for healthcare is. As I have argued here and Reason argues here, Medicare isn’t efficient, even if you ignore the massive fraud they tolerate. When you include it, Medicare becomes a boondoggle of epic proportions.

You Mean We Can Get Screwed Too?

Sometimes, you really just have to wonder how dumb some people are:

Last year, health care industry groups gave President Barack Obama’s reform plan the support it needed to become law. Now, those same groups are sweating over what might happen in the debt ceiling talks — because their fortunes might be about to change.

Critics of the reform often attack it as a collection of “backroom health care deals,” and Democrats did have an easier time passing it because powerful groups — like hospitals and the drug industry — endorsed the legislation, or at least agreed to hold their fire. Some of them did get rewarded for their help, by being spared from deeper cuts or other legislation they’ve opposed for years.

But no “deal” lasts forever, and now the groups that supported the reform law are keeping a nervous eye on what health care savings might become part of an agreement to raise the debt ceiling. Obama and congressional Democrats will be under pressure to show they’re really willing to “reduce the cost of health care spending and Medicare and Medicaid in the out-years,” as Obama put it at his June 29 press conference.

You can read the full article for the deals that were cut. The biggest hospitals were given supposed immunity from future budget cuts. Drug companies were told price fixing wouldn’t happen. The AMA — Jesus Christ, the AMA is run by fucking morons — actually believed the SGR cuts would be put off forever.

Now they are shocked, shocked! that the Democrats might stab them in the back and implement those policies anyway. Who could have predicted it? Well, I did:

I suspect the provider group in this bargain is the AMA—long the Benedict Arnold of the healthcare industry. My dad, and many other doctors, quit the AMA when they betrayed us in the 1980’s and 1990’s to go along with Medicare “reforms”, the primary effect of which was to fuck over doctors, especially GP’s. If the AMA supports this, I’m against it by default. They have never understood that, for doctors, making an agreement with the government is like making an agreement with the devil—in the end, they will just get screwed harder and deeper.

This is about, estimating conservatively, the 743 millionth time the AMA has gotten snookered by Congress. They never understand that once Congress gets what they want, they are going to lose interest in whatever it was, in the heat of the moment, they promised to give you ten years from now. To borrow a metaphor Jim used yesterday about Facebook (you should read that post; he’s justifiably proud of it :), Congress is like a horny teenager. They say they love you and promise to marry you one day. And then, the second you sleep with them, they disappear. They’ve gotten what they want; now you’re just a nuisance who won’t stop calling them.

During the debate over Obamacare, my dad sent a message to the American College of Surgeons asking why they were supporting it. When they said that they wanted to “be at the table” my dad told them that that was fine, but being at the table didn’t meal climbing onto it to be eaten. Looks like the Democrats are sharpening up their knives and mixing up the barbecue sauce.

What a surprise.

Another PPACA Ooops

Actually, I don’t think this is an accident:

President Barack Obama’s health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

Obligatory “we have to pass it to know what’s in it” jab.

The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services department.

Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That’s because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps.

That’s on top of the 16-20 million Obamacare already sweeps into Medicaid. And we wonder why the states are screaming about Medicaid costs.

I don’t think this is an accident. Both Bush and Obama have massively expanded the socialized Medicaid system. This system has terrible reimbursement rates and many hospitals and doctors simply don’t accept it. The Medicaid-heavy hospitals are some of the worst in the country. We are slowly and inevitably moving toward a system where most Americans will get substandard cheap care while the elites are taken care of in boutique hospitals.

That’s not a bug; that’s a feature. That’s usually how socialism works.