Hoist By Their Own Petard

Let’s remember, for just a moment, how Obamacare was passed. It was cobbled together by a team of industry insiders to cater to all the special interests. It was then sent to Congress, where it would be honed and passed. But when Scott Brown won the election in Massachusetts, they suddenly did not have a filibuster-proof majority. So they rushed it through on a budget reconciliation. As a result, the bill contains a lot of bad language, poor wording and unclear statutes. Nancy Pelosi famously said we had to pass it find out what was in it. And now we’re finding out that what’s in it could destroy it.

Earlier this week, the DC Circuit Court ruled that the Obamacare subsidies could not be given to people whose states had not set up insurance exchanges because the law did not specify it. Liberals screamed blue murder about activist courts and people losing insurance and other arguments from the “Oh Come On!” school of jurisprudence. They said that Michael Cannon and Cato and other people arguing that the subsidies were meant to be withheld to force states to set up exchanges were “sociopaths” who would say anything to take insurance away from the poor. They’re livid that Obamacare might be overturned by what they’re calling “a typo”:

his week, Jonathan Gruber appeared on MSNBC to assert that the DC Circuit appellate court got the ObamaCare statute all wrong in its Halbig decision. Gruber, one of the key architects of the ACA and of the Massachusetts “RomneyCare” law that preceded it, insisted that the state exchange requirement for subsidy payment was purely accidental. “It is unambiguous this is a typo,” Gruber told Chris Matthews. “Literally every single person involved in the crafting of this law has said that it`s a typo, that they had no intention of excluding the federal states.”

Even if that were true, these kind of typos are what you get when you shove a law through without reconciliation. And while “everyone” might agree that Congress intended the mandates to be universal, it’s difficult to tell what Congress intended because Congress barely debated the fucking thing.

But is it true that Congress intended the subsidies to be universal? For that, we should ask one of the architects of Obamacare such as … um … Jonathan Gruber?

Two years ago, though, Gruber gave a much different explanation for this part of the ObamaCare statute. Speaking at a January 2012 symposium for a tech organization that this was no typo. It was, Gruber said, a deliberate policy to twist the arms of reluctant states to set up their own exchanges — and that a failure to do so would mean no subsidies for their citizens.

You can go to Hot Air and watch the video, including the full video that shows this was not taken out of context. Gruber has since said his words were a “speak-o” and he was mistaken. If so, this Obamacare architect — who was paid a cool $400,000 for his contribution — now appears to have made that “speak-o” multiple times.

As Ed Morrissey points out, this doesn’t really matter for the court case. The Court will be considering Congressional intent not consultant intent. And to be perfectly frank, Gruber is a hack who will say whatever the Obama Administration wants him to say. If he got a memo saying that Obamacare was actually French Toast, he’d be handing out eggs and butter at these meetings.

But it does make for some great entertainment to watch these guys flounder around trying to explain what the bill really means.


Day After Thoughts on Hobby Lobby

So I’ve had a few days to digest the Hobby Lobby decision and wanted to put up some further thoughts.

First, a lot of Leftists are claiming that this decision “proves” that we need single payer to make all these issues go away. Of course, the Left saw yesterday’s World Cup game as proof we need single payer. But the argument from the Hobby Lobby case is so poor that even Ezra Klein sees right through it:

At the core of the case is the fact that Obamacare had to decide which health-care services absolutely needed to be covered and which services didn’t. One of the services Obamacare deemed essential was contraception. That’s what led to the Hobby Lobby case: prior to Obamacare, there was no federal law forcing employers who offered insurance to cover contraceptive care, and so no need for employers to seek exemptions to that law.

A single-payer system heightens the stakes on this kind of decision. The assumption behind some of the Hobby Lobby-based arguments for single payer is that a single-payer system would cover contraception and that would mean everyone’s insurance covers contraception. But a Republican-led government could decide that taxpayer dollars shouldn’t be going to cover contraception at all, and then a single-payer system means no one’s insurance covers contraception.

An example comes from one America’s current single-payer systems: Medicaid. While Medicaid does cover contraception, Congress decreed years ago that it can’t, under any circumstances, pay for abortions. So while people buying private insurance can choose a plan that covers abortion if they want (and, in fact, about two-thirds of private health-insurance plans cover abortions), people in the Medicaid system have no option to choose a plan that covers abortion.

Ding! It boggles my mind that people can claim single payer will “take the politics” out of healthcare decisions. I have to believe that the “this supports single payer” claimants really mean something else: with single payer, Obama will be able to force a liberal vision of health insurance on the rest of the nation. That’s fine … as long as he’s President. But what will they say when President Santorum strips out birth control coverage and mandates coverage for gay conversion therapy? This is what conservatives and libertarians warned about from day one: the further you involve the government in healthcare, the more politicized healthcare decisions will become.

I oppose encroachments of government power. I oppose them even when I like the guy in office. The reason, as Lee pointed out endlessly, is because I know that he will not be in office forever. Eventually, someone I don’t like will be in. And he’ll have all the power we gave the last guy and take even more. See: Obama, Barack and Surveillance State.

Second, I am amazed at just how silly some of the commentary has gotten. Many commentators have clearly not read the decision or even vaguely familiar with its contents. Megan McArdle deals with some of the silliest talking points here. Eugene Volokh explains the narrowness of the ruling and why it was a statutory not Constitutional decision here. I’m hoping Ann Althouse, who has read the entire decision and is an expert on Constitutional Law and religion, will do some more blog posts on it. One of her first posts is this one, taking on the talking point that businesses can now do anything if they say it’s in the name of religion:

Under the Religious Freedom Restoration Act, when the federal government imposes a substantial burden on the exercise of religion, it must justify that burden by showing that it is the least restrictive means of achieving a compelling governmental interest. In Hobby Lobby, the compelling governmental interest is comprehensive preventive health care for women, and the majority said that requiring the employer to include coverage of all FDA-approved contraceptives in its health care plan was not the least restrictive way to to serve that interest. There are other ways the government could get the cost of contraceptives covered, ways that wouldn’t rope in the employer.

So the government’s interest could be served without imposing the burden on religion.

But when the government bans race discrimination, it is serving a compelling interest in banning race discrimination and there is no alternative way to achieve that end.

Exactly. The RFRA is designed to apply a common-sense limitation on government action where religion is concerned. It’s not a blanket that can allow human sacrifice or a refusal to pay taxes. In this particular case, the Court decided that the government can make sure women have access to birth control without requiring religious people to compromise their beliefs. And that was all it could rule on at this time.

Importantly, the Court did not decree that “corporations are people” or give them First Amendment rights (although they do have First Amendment rights in the context of free speech). They ruled that the people running closely-held businesses have First Amendment rights and that the RFRA requires the government to respect that. Don’t like it? All you have to do is revise the RFRA. Good luck with that.

Third, what’s amazing about the commentary is the number of catch-22′s the liberal intelligentsia places the Court in. When the Court ruled that birth control coverage could be refused for religious reasons, they started screaming, “Well, what about blood transfusions! What about psychiatry? What about gelatin? Huh? Huh? Huh?” But when the Court declined to specifically address those issues — because they can’t — the liberals then accused the Court of foisting their own religion on the country and ignoring everyone else’s.

They accused the Court of scientific illiteracy when they ruled on the methods Hobby Lobby believes are abortifacients (although, having poked around, I don’t the case that they aren’t is as ironclad as claimed). But when the Court clarified that coverage for all methods of contraception could be declined, they went ape again that the ruling was overly broad.

(I also must keep harping on this point: insurance-provided birth control is not “free”. You pay for it with your work. And you pay for it specifically with money your boss gives to the insurance company instead of you. Mother Jones — always a good source of mathematical garbage — put up a calculator showing how much birth control will cost a woman over her reproductive life. But she’s going to pay that price whether she is insured or not. In fact, there are good reasons to believe she will pay more by getting it through her insurance. What happens is that people get birth control through their employer’s insurance … and then wonder why their insurance premiums went up $50 a month.)

The one idea I keep returning to, however, is this: the Left should not be angry. Miffed a bit, sure. But they shouldn’t really be angry.

They should be ecstatic.

We now live in a country where insurance coverage of contraception is mandated by law for all but a small segment of employers. And those will almost certainly be covered when Obama expands the compromise that the Court gave their assent to (although he will probably let women swing in the wind until after the election). The conservative wing of the Court did not dispute that the government can provide birth control coverage. Nor did they dispute that insuring women have access to birth control was a compelling interest of the government. Griswold is in no danger of being repealed. A slight wrinkle has been thrown out in how birth control is paid for. And there are some states where Republicans are attacking programs that help pay for birth control for poor women. But overall, women are in a far better position with respect to controlling their reproductive systems than they have ever been.

I know people want to see this in terms of absolutes: that women have an absolute right to birth control. But living in a country of 300 million people means none of us get everything we want. There are no absolute policies that will work for the entire country.

And yet, with a near complete victory — the provision of almost “free” birth control; a goal they have wanted for decades — they are in hysterics because it wasn’t a complete victory. They are angry because a compromise was reached for people who have a moral objection to certain types of birth control. They are angry because they didn’t get everything they wanted. 85% of employers covered birth control before Obamacare. Nearly 100% will now and the remainder will get it through some kind of compromise. You can be a bit disappointed that it’s not 100%. But proclaiming that SCOTUS has now imposed Sharia Law and made women second-class citizens? Seriously?

Damon Linker:

Where once the religious right sought to inject a unified ideology of traditionalist Judeo-Christianity into the nation’s politics, now it seeks merely to protect itself against a newly aggressive form of secular social liberalism. Sometimes that liberalism takes the relatively benign and amorphous form of an irreverent, sex-obsessed popular culture and public opinion that is unsympathetic to claims of religious truth. But at other times, it comes backed up by the coercive powers of government.

That’s how the Hobby Lobby case needs to be understood: as a defensive response to the government attempting to regulate areas of life that it never previously sought to control. Like, for instance, the precise range of health insurance benefits a business must provide to its employees under penalty of law. Hobby Lobby doesn’t oppose contraception as such, as some Catholic businesses do. It merely opposes four out of 20 forms of contraception that the Obama administration wants to force them to cover — because its owners believe those four to be abortifacients.

From advancing an ideological project to transform America into an explicitly Catholic-Christian nation to asking that a business run by devout Christians be given a partial exemption from a government regulation that would force it to violate its beliefs — that’s what the religious right has been reduced to in just 10 years.

Exactly. The Left Wing has been running up victory after victory in the Culture War. Gay marriage just became legal in fricking Kentucky. Colleges are so eager to make birth control available, they’ll shove it down throat if you sleep with your mouth open. Marijuana is legal in two states and the edifice of criminalization is imploding. Public prayer has been reduced to few non-denominational utterances. Their only conservative “wins” have been a few recent restrictions on abortion and public funding for birth control, policy changes that are likely to be short-lived.

For a long time the Left has claimed that they are the side that wants to compromise and it is conservatives who are intransigent. Yet what is this but rejecting a compromise? What is this but going to tired “war on women” rhetoric at the slightest provocation? No one is being denied birth control. No one’s boss is interfering with their birth control. This is ultimate result of the Hobby Lobby decision: the Federal government will have to make a deal to provide birth control coverage for employees of a small fraction of businesses..

That’s a War on Women? That’s treating corporations like people and women like second-class citizens?

I humbly suggest the rhetoric over this decision needs to be toned down. Because if the Left shout down the heavens for something like this, who’s going to be listening when a state tries to outlaw abortion? Or repeal sexual discrimination laws? Or place heavy restrictions on birth control?

When it comes to long political struggles, you have to choose your battlefields. As much as I oppose much of what the religious right is doing right now, this isn’t the field on which the banners should be unfurled. Accept the near complete victory and move on.

Obamacare update

The other day Black Jesus and the sycophants that follow him around looking for any chance to suckle his cock were all atwitter and telling us how the ACA had enrolled 7.1 million people – a number I think is fake as hell – doing their victory dance, and avoiding giving any details that would leave any reasonable person to conclude that this was all an attempt to put about a ton of lipstick on the ugliest fucking pig ever. Have no fear however, because even the cock sucking sycophants are finding that the evidence that Obamacare is a massive train wreck unable to suppress. Sebelius isn’t resigning: she is being thrown under the bus. She is the proverbial scapegoat. And the problem isn’t the stupid website: the whole idea behind the ACA, what it does and stands for, is a monumental disaster in the making, and that is not disputable. Let’s start with the first important point made:

Before we get to these studies, though, we should recognize why we need outside organizations to validate White House claims in the first place. The Department of Health and Human Services still has no way to quantify important data about those consumers signing up for health insurance through state and federal exchanges.

The WH produced numbers, in a vacuum, made claims they then expected us to take at face value, could not produce any details or proof to back their claims, and yet, the cock suckers in the media didn’t bother to push back on them. This train wreck is gathering speed, and the people that know it is going to plow into a station filled with people causing massive casualties, don’t give a rat’s ass, because they do not want to criticize Black Jesus or the left’s cultism. It’s not that the evidence isn’t out there or that we have not had ample time to find it;

More than six months after the initial rollout of Obamacare — and four years after the ACA’s passage — the systems designed by HHS still cannot determine basic and critical information about enrollments such as whether a premium payment has been made. Without a premium payment, a sign-up in the web portal does not mean coverage has been extended.

Furthermore, the systems were not designed to collect important demographic information such as pre-existing coverage, current health status, or even definite age ranges, even though the success of the Obamacare structure depends on getting previously uninsured healthy Americans locked into expensive comprehensive insurance.

Without the “young invincibles” providing new funding for risk pools that now have to cover older and less-healthy consumers under “community pricing” restrictions, premiums will escalate rapidly, forcing more consumers out of the system and triggering the dreaded “death spiral” for insurers.

In order to determine the scope of the celebration, then, we need outside surveys to give us an idea of the size and composition of the actual enrollment population in Obamacare. The first of the independent studies comes from the RAND Corporation, which studied the changes in the health insurance market between September 2013 – just before the rollout of the state exchanges – and the end of the open-enrollment period at the end of last month.

While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates.

Color me surprised. One thing this WH is exceedingly good at is deluding the low information voter and themselves, and this is such a case. Oh, I have no doubt that they know they are full of shit, but as I already mentioned, they need to keep pretending this thing is anything but the disaster it is in order to keep steamrolling us. The facts and data can be ignored, or even manipulated to pretend there is anything to celebrate about this disaster, but the facts speak for themselves;

First, a significant amount of this increase comes from Medicaid enrollments, not private insurance. Almost six million people enrolled in Medicaid, and earlier studies showed that a relatively small number of those came from the expansion built into the ACA; most of these would have been Medicaid-eligible prior to the reform.

Another 8.2 million more people enrolled in employer-provided health care, as 7.1 million left the “other” category and another 1.6 million left the individual insurance markets. Only 3.9 million actually enrolled in insurance plans through state or federal exchanges – not 7.1 million as claimed by Obama. That number falls far short of even the lowered expectations issued by HHS and the White House earlier this year.

Moreover, those who did enroll through the state exchanges didn’t provide the demographic lift and risk-pool support needed to prevent massive increases in either premiums or deductibles, or both, in the near future. Pharmacy benefit manager Express Scripts, which collected more data from insurers than HHS managed through its own exchanges, determined that the incoming enrollees require more medical attention than the previous risk pools, not less – which means that insurers will need to raise premiums even more than first thought.

Their new study shows, for instance, that the enrollees from state and federal exchanges have a 47 percent higher use of specialty medications than in commercial plans in general. “Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients,” the report reminds readers. “Despite comprising less than 1 percent of all U.S. prescriptions,” the report continues, “specialty medications now account for more than a quarter of the country’s total pharmacy spend.”

The medications themselves show that the care costs will increase relative to the existing risk pools as well. The rate for HIV medications in Obamacare exchange plans is four times higher than in existing commercial plans. Medication prescriptions are 35 percent higher, and anti-seizure medication increases 27 percent. Ironically, the only category where exchange consumers have lower demand than commercial-plan customers is in contraception – the focus of a big political battle in the employer mandate.

As Express Scripts, which studied changes in pharmacy benefits concludes that the ACA has succeeded in getting coverage to consumers who need it. However, that comes at a high cost for those who had their existing coverage canceled and saw their premiums and deductibles skyrocket as a result of Obamacare. Furthermore, the number of those who gained coverage may be even smaller than the RAND study concluded.

Well DUH! My premiums have gone up, by double digit numbers, every year since this giant shit sandwich was in the making. This year they jumped by close to 20%. I now do have coverage for maternity care and gynecological services for my son and me though, so bonus I guess. My provider is selling his practice and looking at doing something else for a living: he simply isn’t interested in bleeding even more money and time to allow politicians to rig the system so they can make it worse for his patients. And I am not alone here. Sure, we hear the occasional claim from people that this thing has helped them, and while I don’t want to outright come out and say I find most people that claim this to be bullshitting, unless they fall into the category of people with preconditions or that were uninsurable, the fact remains that if there were more than a handful of these people we would be bombarded with coverage about how great this ACA ass rape was from the LSM. There isn’t enough lipstick on the planet to make this pig look sexy.

I guess my consolation is that amongst the people hurt the worst are some of the sycophants that voted for Black Jesus and thought they were so cool because they cared about those poor shlobs without coverage. They were all for free healthcare for everyone, an idiotic concept at its face, while they bought the lies that others would foot the bill. Now that they realize it butt fucks them just as hard too, they are all pissy about it. If there is justice in the universe, these people will be made to suffer long and hard for their stupidity. Nothing teaches liberal fools more than the real world. Now if we could only get this shit rolled back and someone could actually do something that did make healthcare better and more affordable, the universe would finally be just.

Lie of the Year: Your Healthcare

Politifact has chosen Barack Obama’s “if you like your healthcare plan, you can keep it” as the Lie of the Year. Prepare for the Left Wing to suddenly turn on Politifact (as they did a couple of years ago when PF picked “Republicans will end Medicare” as their lie). Prepare also for all kinds of explanations as to why Obama’s promise was actually really correct, if you make assumptions X, Y and Z, even if a hundred million people disagree.

But also remember this. As pointed out by numerous others, in 2008, Politifact rated Obama’s claim as true. This shows one of the big dangers of the fact-checkers, one I have harped on many times specifically in reference to Obamacare, but in other respects as well: You can’t fact check something that hasn’t happened yet. That’s especially true when, like Politifact, you didn’t do your homework the first time. But it’s always true. You can’t claim as a “fact” that Budget Deal X will reduce the deficit. You can claim that, in the opinion of the CBO, the OMB or the Illuminati, it will. But if someone disagrees with that prediction, they may be dishonest, pandering or flying in the face of overwhelming evidence; but they are not factually wrong until they are factually wrong.

Domestic policy, economics and healthcare projections are not like laws of physics. Let’s stop treating them like they are.

We Should Hope This Works

As the insurance exchange debacle drags on into its fourth week, the Democrats and the Obama Administration continue to dodge questions, obfuscate and try to find ways to blame Republicans. Yesterday’s hearing featured Democrat Frank Pallone calling the hearing a “monkey court” because Republicans have the temerity to wonder what the hell is going on with an overhaul of one-fifth of our economy. The Democrats’ media dog-washers are trying to silence liberal critics of the system using the “under no circumstances ever agree with conservatives, especially when they’re right” doctrine.

But they can’t keep up the facade. Conservatives, libertarians and honest liberals are detailing the many flaws this system has and the significant hurdles it faces getting online. Those critics are not passe about this; they are livid. And they should be.

One of the memes that is emerging among the Obamacare defenders is that Republicans and other opponents of Obamacare have no right to criticize the utter complete failure of the federal exchanges because we opposed it reform the first place. Since we opposed Obamacare, how can we complain about it? You’ll remember, of course, how that logic was applied to the Iraq War. Those who opposed the war never complained about how the war was executed or what happened in the aftermath of it.

Ahem.

But as an opponent of Obamacare myself, I am highly critical of the rollout because … I actually want the insurance exchanges to work. Everyone — conservative, liberal, libertarian or monarchist — should want the exchanges to work for three very important reasons.

First, the exchanges are one of the few good ideas that got into Obamacare. One of the things that drives up insurance costs is the lack of competition. The exchanges force open competition between the insurance companies, which is a good thing. They’re not perfect, of course or even particularly good. A better exchange system would have cheaper entry-level insurance, allow insurance to be sold across state lines and have fewer coverage mandates (it would also, you know, work). But compared to subsidies, coverage mandates, purchase mandates, Medicaid expansion and the IPAB, the exchanges are almost smart.

Second and more far more important is that if the insurance exchanges don’t work for a long time or if the purchase mandate is delayed, the result could be the complete destruction of the individual insurance market.

A lot of people don’t appreciate how much Obamacare is like a house of cards. Insurance companies can no longer deny coverage and have priced insurance on the exchanges based on the idea that people will be “taxed” for not buying insurance. This only works, however, if people are actually forced to buy insurance. Otherwise, they will wait until they are sick to insure themselves. If people can’t buy insurance or aren’t made to, the result is a death spiral where insurance gets more and more expensive and more and more people wait until they are sick to buy it.

This isn’t some theoretical possibility. It happened in New York:

New York state’s guaranteed issue and community rating rules—the two regulations that limit how insurers can charge based on health history and require them to sell policies to all comers—took effect in 1994. At the time, there were about 752,000 policyholders in the state’s individual market, or about 4.7 percent of the non-Medicare population. But by 2009, according to a Manhattan Institute report by Stephen Parente and Tarren Bragdon, the state’s individual market had practically disappeared, leaving just 34,000 participants, or about 0.2 percent of the non-elderly population. Individual insurance premiums, meanwhile, were among the highest in the nation—about $388 on average in 2007, compared with just $151 in California, another big Democratic-leaning state. In New York City, the annualized premium cost for individuals was more than $9,300 and more than $26,400 for a family.

The result, in other words, was a combination of sky-high premiums and far fewer insured individuals.

The individual markets only survived at all because insurance companies could make up the losses from less stupid states. But Obamacare is national; there is no other state to make money off of.

If people can’t buy insurance, the result will be the complete meltdown of the individual insurance market and millions of Americans becoming uninsured. In fact, many have already lost their insurance as companies cancel individual policies in anticipation of the Obamacare exchanges.

Now maybe you think that’s acceptable. Obamcare will implode, the Democrats will be blamed and Republicans will sweep back into power (assuming they don’t screw it up). But look beyond the politics. Millions of Americans will be cast into an insurance purgatory that they may never get out of. The individual insurance market works because of people being good citizens — buying insurance when they don’t need it so that the market can support those that do. If that culture is destroyed, if Americans get into the habit of waiting until they are sick to buy insurance, they may never get out of it. A good example of this is the Israeli Daycare Study where daycare centers imposed a fine on people for picking up their kids late. The result? More parents showed up late because they could now buy off their guilt. And when the fine was rescinded, the parents kept showing up late because the social norm of being on time had been effectively destroyed.

Once the individual market collapses, we may never be able to rebuild it. We may be in a situation where your insurance choices are either through your employer or through Medicaid. That is an extremely high price to pay for making Obama look bad and maybe winning an election.

(It has been suggested, here and on other blogs, that this sabotage is deliberate; that Obama is deliberately crippling the individual market to lead us toward single payer. I’m open to the possibility of a subconscious desire to wreck the private market. But I have a hard time believing in any conspiracy with this administration. It’s not that they wouldn’t try. It’s that these guys are so incompetent that if they actually tried to sabotage the exchanges, the result would be a perfectly functioning exchange system.)

Now my second point may cause many liberals — who see Obamacare as a stepping stone to single payer — to quietly rejoice. Already, many are blaming this on the private sector. Who will be the first to say this “proves” we should trash private insurance and go with single payer? Who will be the first to say we should just expand Medicaid to everyone who isn’t insured by an employer?

But this idea is mind-bogglingly stupid. If the Democrats destroy the individual insurance market and increase the number of uninsured, Americans will not thank them for it. We are not going to rise up in a mass and say, “Oh, you great ones who took away our insurance. Tell us what to do next!”

And frankly, if anyone thinks Medicaid is the future of health insurance (oh, wait, here’s Krugtron the Ever-Wrong making the case) they need to spend a few weeks working in a hospital that only takes Medicaid. Medicaid is only marginally preferable to no insurance at all, providing a consistently lousy quality of service. That’s how it keeps costs down. In fact, Krugman’s defense of Medicaid is made entirely in terms of costs. His only acknowledgement of the downside of consigning millions to the Medicaid gulag is this:

But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more.

Yes. I’m sure those doctors will take massive pay cuts rather than leave the field. Let’s apply Krugman’s logic to academia, another industry afflicted with runaway costs. We could cut those costs by turning the entire shebang to the community college model. And the problem of finding good professors for those colleges would disappear if they no longer had universities like Princeton able and willing to pay more.

(My apologies to community colleges, who are far better at teaching than Medicaid is at insuring.)

Obamacare is a bad law. It ignores everything we’ve learned about healthcare reform over the last decade and applies a model that at least twenty years old. But the situation with Obamacare could get far, far worse and could do permanent damage to the healthcare system if the exchanges don’t start working. Everyone should hope that they do because this isn’t a political game: this is the healthcare of millions of people. We will never be able to truly reform the system if there’s nothing left to reform.