Tag: Healthcare reform

The Single Payer Con

So yesterday, Bernie Sanders introduced his “Medicare for All” proposal. Single payer has suddenly become chic in Democratic circles with all of the 2020 hopefuls jumping on board. Because, apparently, the lesson they learned from 2016 was that they weren’t socialist enough.

I’m not going to get into the debate over single payer … ah, who am I kidding? I’ve written about it many times. Years ago, I wrote a post detailing why the claims that single payer would be more efficient were nonsense. It’s actually gotten worse since then. Medicare has tried to institute quality controls which have imposed billions in compliance costs on hospitals. Meanwhile, Medicare and Medicaid pay 80 cents and 60 cents on the dollar of what private insurers do. Switching to that would mean a lot of providers leaving the field. Which means fewer services and longer waits. It would also slow the pace of innovation, which I’ve previously identified as my biggest fear with regard to socialized medicine. I worry about the cures and miracle treatments we won’t get because our government controls the purse strings.

It would also put Congress in charge of deciding which medical procedures get covered and which don’t. This would not be based on any scientific evaluation but on politics. We’ve seen this already. Research has repeatedly shown that the guideline used for mammograms — every year or two after age 40 — is outdated. The new recommendation is that women get them every other year after age 50. The main reason is that mammography for low-risk women is more likely to result in unnecessary surgery than finding a cancer that wouldn’t be detected by other means. Congress, however, under intense pressure from women’s groups and mammography providers, overrode that decision. And this is not the first time they’ve done that.

Anyway, I don’t want to get too far into the weeds here because, in those two paragraphs above, I’ve already invested more thought into this than the Democrats have. Suderman

To call it a plan is, in some sense, too generous: Although it envisions a sweeping and generous system that would make government the primary payer for nearly all health care in the United States and virtually wipe out employer health coverage in the space of just a few years, it is not really a plan. Instead, it is a legislative fantasy built on a combination of wild overconfidence in government and an almost comical refusal to grapple with costs or trade-offs.

The likely outcome of such a transition would be massive, sustained chaos across the health care sector. Even if the chaos were somehow manageable, the easy access that Sanders promises would be swiftly undermined by service disruptions and other complications stemming from the changeover. In making his case, Sanders tends to ignore all of this. His plan exists in an imaginary world without economic tradeoffs or consequences.

Nowhere is this more obvious than in its promise of benefits. Sanders frequently argues that his preferred system would merely put the United States in line with other developed nations. On the contrary, it would go far beyond what other countries with single payer systems offer. The Sanders plan would offer a far greater array of benefits than Australia, the Netherlands, or Canada—a country that Sanders often uses as a comparison with the U.S., but where the majority of the population relies on supplementary private insurance to cover the gaps left by the government system. Many international single-payer systems also require some form of copayment from the individual seeking service; the Sanders plan would make all of its benefits available without any individual contribution.

Instead, it would be paid for entirely through tax increases. Which tax increases would those be? On who, and for how much? On these questions, the Sanders plan is silent.

This is the real tell in Sanders’ pitch. Although it is willing to imagine long lists of benefits in great detail, but it has essentially nothing to say about how to pay for them. It is a fantastical sales pitch for a luxury product with no price tag attached.

One can support universal healthcare. I’m somewhat neutral on it. But one has to acknowledge that it’s going to be expensive. You can not insure million of currently uninsured people and save money. We’ve been down this road before. For example, we were told that Obamacare would save money because people wouldn’t need to go the ER as often. But ER visits actually rose under Obamacare, as anyone with two brain cells to rub together could have predicted. When healthcare is cheap, people use more of it. As P.J. O’Rourke famously quipped, if you think healthcare is expensive now, just wait to see how much it costs when it’s free.

The Democratic “plan” doesn’t grapple with this at all. It says nothing about controlling costs or how to pay for all this. It’s just a collection of vague promises. In this sense, it’s way worse than the Trumpcare fiasco which, for all its massive flaws, at least acknowledged the tradeoffs.

To be fair to Sanders, specifically, he actually does have a plan to pay for this. He just couldn’t get any of his fellow Democrats to sign on if it was included. And it’s easy to see why. Here are the details on it. It includes an 11.5% payroll tax, the elimination of tax breaks for insurance, an income tax rate as high as 52%, capital gains taxed at income rates, a massive estate tax, a wealth tax, etc., etc. All told, the wealthiest Americans would be facing marginal tax rates of 82% — just for federal. With state and local taxes, marginal rates could exceed 100%.

Yeah, we once had 97% marginal tax rates. Very few, if any, people ever paid those rates. Bernie is almost certainly massively overestimating the revenue he’ll raise. Even with his rosy assumptions, analysts in 2016 estimated that he was many trillions of dollars short in paying for Medicare for all. In the end, as I’ve said many times, you can only pay for a welfare state with heavy taxes on the middle class. That’s how the European welfare states do it; that’s what we would have to do.

One last thing. The slogan of Bernie’s circus and of the Medicare-for-all movement is that healthcare is a “right”. This is straight garbage. You can not have a right to things. You can not have a right to people’s labor. Real rights — like freedom of speech — are unlimited. When I exercise my right to free speech, that does not preclude you from exercising yours. But if I exercise my right to healthcare, that may take it away from someone else. Doctors can only treat so many patients. There are only so many organs to go around. Yes, our healthcare system grows. But at any one moment, those resources are limited. If there’s only one heart available for transplant, which patient gets it? Who has the “right” to it?

That’s not necessarily an argument against universal healthcare. No one has a “right” to food, but we can make sure people don’t starve because we are a wealthy and generous nation. No one has a “right” to housing, but we can keep people off the streets because we are a wealthy and generous nation. That may sound like hair splitting, but it’s an important hair to split. Because the minute you decide people have a “right” to healthcare, you change the shape of the debate. It suddenly becomes a race to give away as much as possible and an effort to keep the hated evil rich from getting care that’s too good.

So apart from the Democrats having unveiled a comically incomplete plan that makes no hard choices and promises to plunge us into a bureaucratic nightmare and an orgy of spending while destroying a major industry … how did you like the play?

Free Stuff Don’t Come Cheap

California has a tough financial future. Their employee pension program is underfunded by tens of billions. Their business environment has gotten increasingly poor. They have one of the highest ratios of inequality in the country. So what to do?

Triple the budget, apparently:

The latest stop on this magical mystery tour of progressive health care plans is California, where U.S. Sen. Bernie Sanders (I-Vermont) has been campaigning on behalf of a proposed state-run single-payer system. On Monday, state lawmakers in Sacramento got their first look at the price tag for the proposal, which rings in at a whopping $400 billion annually.

The Sacramento Bee notes that, even after accounting for an estimated $200 billion that could be saved by replacing current state-run health programs with the single-payer program, the state would still need to come up with $200 billion annually.

This year’s state budget in California, by the way, is about $180 billion. That means that implementing a single-payer health care system would require doubling (at least) the state’s current tax burden. The analysis of the health care proposal presented to lawmakers on Monday suggests a 15 percent increase to the state’s payroll tax to provide the necessary revenue.

Even accounting for the money employers would “save” by not having to buy insurance, they would still have to come up with $50-100 billion more.

California’s system would be beyond what even the most socialized countries on Earth do. Most “single-payer” systems have some out-of-pocket expenses or private co-insurance. This has a way of keeping costs down. California’s proposed system would pay everything for everyone including illegal aliens. Considering how the costs on … well everything … have been beyond expectations, I would put the cost at more $500-600 billion.

Colorado and Vermont voters overwhelmingly rejected single-payer schemes because of the cost. This one is being put out by California’s state legislature, which is controlled almost entirely by Democrats. So it has a chance of passing. Which means California has a chance of being bankrupt even sooner than expected.

The Media Myth Cycle

For eight years, we heard a lot about how the anti-Obamaites were crazy. They believed crazy things, they said crazy things, they posted crazy things on social media. The fact-checkers were working overtime to stem the tide of BS.

Well, they had a point. There was a lot of garbage out there. But there was also a lot of legitimate concern about what Obama was doing and a lot of legitimate opposition to his polices.

Trump is in power now. And we’re seeing the same thing: legitimate concerns but a whole lot of BSery too. Only this time, the BS isn’t being called out. The latest was in the wake of the AHCA’s passage. Many many media outlets and liberals claimed that Republicans had made rape a pre-existing condition for denial of health insurance or claims. Elizabeth Nolan Brown — no Trump supporter she — actually looked into this.

Yeah, it’s garbage:

None of this is true. Like, not even a little bit. And the fact it’s not just being shared by shady social-media activists and their unwitting dupes but by ostensibly-legitimate media outlets is another sad indictment of press standards these days.

Nothing in the new Republican health care bill specifically addresses sexual assault or domestic violence whatsoever. What it does say is that states can apply for waivers that will allow insurance companies, under certain limited circumstances, to charge higher premiums to people based on their personal medical histories—that’s it. (States that are granted the waivers must also set up special high-risk insurance pools to try and help defray costs for these people.) Under Obamacare, no such price variances based on preexisting conditions are permitted.

So far, the only examples offered as evidence that such discrimination is common have fallen far short. In CNN’s story, a woman’s insurance application was rejected for unspecified reasons that she believes were related to her history of domestic abuse, though the insurance company didn’t actually provide any reason. She was able to get health coverage from another insurer not long after.

In the story getting much more attention, a woman who had been sexually assaulted was prescribed anti-HIV medication as a precaution. When she tried to apply for new insurance coverage not long after, her application was denied because of a company policy against insuring anyone who had been on the HIV medication recently. The insurers did not initially deny her claim because she was a rape victim—they weren’t even aware of that information at first, though she says she did later inform them. If anything, the company is guilty of not treating this woman differently based on her history of sexual assault.

Be sure to read the whole thing. Many people immediately denounced Brown as, in her words, a “lying libertarian harpy”. But all the major news outlets are now admitting — haha! — she’s right. Some have only backed down to saying, “well, the PTSD or anti-retrovirals used as treatment for rape could be a pre-existing condition”. That’s true, but that’s not specific to rape. PTSD or anti-HIV meds from any cause could be classified as a pre-existing condition, depending on what exactly the states do with pre-existing conditions.

In all honesty, the Democrats are doing a huge disservice to this country by focusing on pre-existing conditions. I don’t mean to downplay the pre-existing condition issue, but this is a small part of the problem of people being uninsured. Almost everyone with an employer plan or a government is not affected by this and that constitutes 90% of the insured. At its peak, Obama’s program for people with pre-existing conditions enrolled a little over 100,000 people. Most people who are uninsured are uninsured because they can’t afford it or because they choose to spend their money elsewhere, problems Obamacare addressed but not well.

Pre-existing conditions are important on an actuarial basis for insurance companies because some of these people can be among the most expensive to insure. My wife and I sometimes joke that we are mostly paid in anti-MS meds. This is one of the reasons the Republicans want to split the pre-existing into high-risk pools (albeit underfunded ones) because that’s a big driver of soaring health insurance premiums. But the Democrats are focusing on the wrong thing here. Of the millions the CBO thinks will lose coverage under AHCA, the vast majority will lose it because they will lose subsidies or Medicaid, not because of pre-existing conditions.

Look, I’m willing to debate healthcare all day. There are real debates to be had about whether people have a “right” to health insurance or whether we should have universal coverage or single payer or whatever. We could look at Singapore’s system, which relies heavily on private insurance. Or Australia’s system, which has a single-payer floor but where the government covers a similar percentage of healthcare cost as ours does. Or no system. Fine.

But that debate needs to on honest terms. And claiming that women will be denied insurance because of rape is not having the debate on honest terms. It’s trying to frighten millions of voters. Which, I guess, is why the Democrats love it so much. Because it covers up their lack of ideas.

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 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.

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.

Sunday Triple Play

Three thoughts on unrelated topics:

Brexit:

When it came to the Brexit vote, I was partial to Remain, mainly because I am an avid supporter of free trade. And I’m worried that the departure of the UK could trigger an eventual dissolution of the EU, with bad economic consequences and an empowerment of Russia. I still worry about this but … I think the reaction of the Remain faction has been hysterical. Vox alone has run a few dozen articles rending their garments and gnashing their teeth over this. To borrow a thought from Greg Guttfield, this is about ten times as many articles as they’ve run on Venezuela, which is having an actual economic meltdown right now, with severe shortages of good, medicine and power. For Americans to go into hysterics because the UK’s economy might be a little weaker going forward while ignoring the Lord of the Flies situation developing in our own hemisphere is insane. McArdle argues they are lamenting the decline of this idea that we will no longer be citizens of nations but “citizens of the world” — a notion that has a lot of sway in elite circles.

Warren Meyer has a great post up, contrasting the “it was racism!” explanation that is now the default on the Left against the real regulations coming down on things like tea kettles. It’s worth a read but here’s a critical point:

The real crime from a US perspective is the actions of our President. Mr. Obama has told the British that by voting for Brexit, they go to “the back of the line” for trade negotiations with the US. This is, amongst a lot of stupid things politicians say, one of the stupidest I have ever heard. My response as president would have been to move Britain to the front of the line, offering them a free trade treaty with the US the day after the Brexit vote. Like most politicians, unfortunately, President Obama does not view trade as a vehicle for the enrichment of individuals but as a cudgel to enforce his whims in the foreign policy arena. Why on Earth has President Obama threatened to undermine America’s strong interest in trading with the UK merely to punish the UK for not staying in the EU, a transnational body this country would certainly never join?

The UK would be one of the most logical countries in the world for us to have a free trade agreement with. I have little hope that our next President will grok this.

Orlando:

The FBI has said that they have no evidence that the Orlando shooter was gay. That doesn’t prove he wasn’t, as the FBI notes. There are still indications from his friends and wife that he might have been. But the narrative that he was actively dating men and a regular at the club appears very unlikely.

The FBI is currently saying “they may never know” his motive, given some of the ambiguity around his sexuality. But given that he called 911 to specifically pledge allegiance to ISIS and Abu Bakr al-Baghdadi, the slightest thought might begin to speculate about the merest possibility of crossing our minds that this was Jihadist terrorism. Especially as Jihadism and killing gay people are not exactly incompatible ideas.

Honestly, theres enough blood to go around. We don’t have to confine ourself to one motive.

Obamacare:

Blue Cross has announced that they are pulling out of the Minnesota individual insurance market. The Kaiser Foundation is projecting steep hikes in insurance premiums. The longer this goes on, the more Obamacare is faltering, slowly destroying the individual market. We’re barely two years into this thing and we are now at the point where it’s not if, but when, Obamacare is going to face a massive overhaul. I don’t know that the insurance market can be repaired after this. But I know that if we dick around for much longer, we’re going to see uninsured rates spike drastically to the point where individual insurance may cease to exist.

Makes you kind of wonder if that was the point.

Pelosi Watch: Poor Hospitals

Nancy Pelosi once said we had to pass Obamacare to find out what was in it. And boy are we finding out:

An Obamacare program that aims to improve American health care may have an unintended side effect: penalizing hospitals that serve the sickest and poorest patients.

The Affordable Care Act penalizes hospitals that have high readmission rates, where patients come back within 30 days to deal with some complication of the initial procedure. The aim of that program was to encourage doctors to do the best job possible on the first hospital visit, improving patients’ experience and saving money by preventing a second trip.

But a new paper from three Harvard health-care experts suggests that the readmission program is penalizing hospitals for the type of patients they see. Hospitals that have high readmission rates tend to see patients who are less educated, more disabled, and more likely to suffer from depression — factors the Obamacare program doesn’t account for.

I suspect that you, like me, are shocked SHOCKED that a bill designed by politicians and wonks to exert control over a massive and complicated system didn’t work precisely as advertised. Keep in mind … this is one of Obamacare’s supposed big successes. They’ve touted the “huge” drop in readmissions (all of … 1%) as a sign of how awesome their reform is.

To be fair, penalizing hospitals for readmissions is not a completely stupid idea. Several insurance companies have been trying out programs to encourage better care. But the Obama people didn’t care for this kind of free-market innovation. To them, providers were greedy monsters doing poor care so they could charge more (remember Obama’s comment about amputating diabetic legs?) So they applied a ham-fisted program that has, on balance, made things work.

Well … at least we’ve seen insurance rates come down, right? Right?

Oh, yeah.

Video Monday: Takei and Hobby Lobby

I bookmarked these two video over the weekend. The first is a TED talk from George Takei. While I’m not fond of TED talks — they often cross me as smug and overly confident in their points — this one explains why George Takei still loves the country that interred him during the war:

(I’ve found this embed tends to hang. If someone has a better link, I’ll update the post.)

This comes close to my view of America. The United States, like all human institutions, is flawed and capable of doing awful things. But the principles on which our nation is founded are a beacon to humanity. And I would take the achievements of America, its role in the world and its history over any other nation on Earth. Takei’s story sounds familiar to me — and probably to many of you as well. Both of my paternal grandparents fled the “Jewish crescent” of Eastern Europe in the early 20th century. Despite the virulent anti-semitism they encountered — they vividly remembered the Leo Frank lynching — they still believed there was nowhere else in the world they would rather be.

The second I couldn’t resist. Takei is calling for a boycott of Hobby after the Supreme Court’s narrow decision last week. This completely useless gesture would accomplish little except making liberals feel better (how many liberals actually go to Hobby Lobby?) Reason, by contrast, proposes some changes to the law that would actually do some good:

The amazing thing about Obamacare is that many liberals believed — many still believe — that Obama “stood up” to the special interests and the healthcare industry. This could not be more false. He “stood up” to the insurance industry by forcing everyone to buy their product, outlawing the cheaper versions of their product and refusing to break the intra-state cartels. He “stood up” to healthcare providers by mandating coverage of expensive procedures and not even considering obvious cost-reducing measure like making birth control available over the counter.

All three of Reasons’s suggestions would be diametrically opposed by the healthcare industry lobbyists who wrote and campaigned for Obamacare. Insurance companies don’t want to offer cheap catastrophic plans. They certainly don’t want to compete across state lines. And providers don’t want more competition And so we can expect the liberal wing to “stand up for the little guy” by continuing to acquiesce to every demand of the industry they supposedly hate.