Tag: Obamacare

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.

JAMA Jumps In Bed With Obama

Wut:

An author named “Barack Obama, JD” published an article on Monday in a scholarly journal. No prizes for guessing the topic: It’s an assessment of the Affordable Care Act as well as policy recommendations for the next president to improve the U.S. health care system.

The article, titled “United States Health Care Reform: Progress to Date and Next Steps,” was published by the Journal of the American Medical Association.

The piece, which contains 68 footnotes to academic journals and government publications, claims to present evidence showing that the number of Americans without health insurance has dropped dramatically, and resulted in lower hospital readmission rates. Obama also used the article to recommend the introduction of a “public option” plan in parts of the U.S. and for the federal government to push down drug prices.

Seriously, JAMA? You guys decided to publish an unrefereed buffed-up propaganda piece?

I blogged about the public option earlier this week. Almost everyone — including the advocates of the public option — recognizes that it is a Trojan Horse for socialized medicine, a program that will finish the job of bankrupting private insurance companies so that the public option quickly becomes the only option (except for the elites, who will be allowed to keep their boutique private plans). And the result will be a system that somehow manages to be just as expensive but less efficient than the system we have now.

“But, wait, Hal!” you say. “Government insurance if more efficient because they don’t turn obscene profits!” Well, first of all the profit-margin in the insurance industry is not obscene, but fairly normal at a few percent. Second, as I noted earlier, Medicare’s “efficiency” mainly consists of hiding costs and allowing gigantic amounts of fraud.

But the real proof is in the pudding. One of the things Obamacare did was create insurance co-ops, non-profit insurance companies that were supposed to show what we could have without those evil evil profits. We even gave them government loans to prop them up. Well, 16 of the 23 co-cops have failed, sucking up $1.7 billion in taxpayer funds. This shouldn’t be a surprise. Every insurer is struggling to make Obamacare work because … get this … it turns out that when you just hand out insurance policies, sick people are the most likely to take them. Just imagine what would be happening to insurance markets if “sell-out” Republicans hadn’t stood firm and gotten the public option jettisoned.

Obamacare is turning into a slow-rolling disaster whose end-game is shoving all of us plebs into a socialized system. Again … this is why the GOP holding onto Congress is so important. Even if we can’t repeal Obamacare, we can pass an overhaul that moves it more toward a real market system (e.g., allowing insurance to be sold across state lines). Clinton and a Democratic Congress will only complete the job they’ve started.

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: Highmark Jumps

Remember when Nancy Pelosi said we had to pass the healthcare bill to find out what was in it? Well, we’re finding out ever more:

Citing an estimated $500 million loss last year on health insurance plans sold on the Affordable Care Act marketplace, Highmark Inc. said Friday it plans to reduce what it pays doctors who treat patients with the plans.

Highmark plans to reduce payments to the physicians by 4.5 percent starting April 1 as part of a broad effort to stem losses related to the federal marketplace, said Alexis Miller, Highmark’s special vice president of individual and small group markets.

Miller estimated the insurer paid about $500 million more for patients’ care in 2015 than it collected in premiums for the plans sold on the federal marketplace, resulting in the loss. Highmark officials have said the people who signed up through the health law’s marketplace were sicker than the insurer expected.

This is precisely what was feared. Guaranteed issue would mean lots of sick people would sign up for insurance, costs would soar and insurance companies would either have to raise rates (triggering a possible death spiral) or cut what they pay doctors (driving some out of the system).

Keep something else in mind: Bernie’s Sanders absurdly optimistic single payer plan depends on cuts to reimbursement that are at least four times what Highmark is considering.

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.

The Culture War Rout Is On

So, this week George Takei called Clarence Thomas a “clown in black face” for this dissent in Obergefell. He has since apologized for the remark, claiming that he said it in a moment of anger.

As you know, I’m not one for the Outrage of the Day. What set Takei off was Thomas’ argument that government can not take away your dignity no matter what it does; dignity is intrinsic. Thomas used the internment camps as an example and Takei, who was interred, was angered by that comparison. That’s understandable.

However …

The reaction to Takei’s remarks has little to do with him. It has everything to do with a racial smear campaign that has pursued Clarence Thomas since the day he joined the Court. Just as Takei’s comments have their origin in his long experience with racial and anti-gay discrimination, the backlash to them has its origin in 24 years of liberals slagging Clarence Thomas, all too often in racist language. Thomas is a race traitor. Thomas is an Uncle Tom. Thomas doesn’t know his history. Thomas is an idiotic sock puppet of Scalia (actually, the Scalia-Thomas pairing isn’t even in the top ten for SCOTUS). Thomas never writes any significant opinions (I recently cited his wonderful dissent in Kelo; he’s written many many others).

We’re told that Thomas doesn’t understand or care about race relations. We’re told this of a man who was born in the segregationist South; who experienced vile racism in his early life; who was and is an admirer of Malcolm X; who is thoroughly versed in our country’s racial history; who can cite you chapter and verse about how our country has perverted the law and the Constitution to screw over black people. Thomas is well aware of his race, conscious of it and proud of it. But he the temerity to disagree with liberals about how the Constitution should be applied to the law. And so none of that matters.

But there’s something here even beyond the usual Clarence Thomas race-baiting. Let’s take a step back. For the last week, numerous Republicans have been responding angrily to the gay marriage and Obamacare decisions. Rick Santorum, Mike Huckabee and Bobby Jindal, among others, have questioned the Court’s legitimacy. We’re told that this is a sign of how insane Republicans are. But … you’ll see equal amounts of rage from the Left when the Court doesn’t go there way. Hell, just last week, people were responding to Scalia’s dissent with angry tweets and articles about Bush v. Gore and Citizens United, decisions which liberals responded to by … gasp! … questioning the legitimacy of the Court.

Look, it’s understandable that people get mad at the Court when it makes decisions they don’t like. Hell, I’m still upset about Kelo. That’s fine. I really don’t see anything unusual or alarming about anti-gay-marriage politicians being angry about the recent decisions. We have to accept the Court’s decisions as a matter of law; but that does not mean we have to accept them into our hearts. Be angry when you think the Court has gotten it wrong.

What’s striking, however, is how angry the Left gets when they win. Granted, most of the Left is just plain happy about last week’s decisions. But there’s a not insignificant faction that’s just furious that the conservative bench had the nerve to dissent.

As Clark at Popehat recently noted, the Culture War in this country has had two distinguishing features: an incredible series of wins for the Left and an even more incredible series of whinges about it:

The problem I have is that the blue alliance has been on a winning streak, and with recent Blue success in gay marriage, immigration of client populations, university-and-media roll-up, etc. I feel like the culture war is over and the victors are going around (metaphorically) humiliating and shooting survivors of the losing side, and conducting mop-up operations. Witness team Blue forcing bakers to bake cakes and forcing photographers to shoot photos for partnerships that they consider immoral. Witness blue team arguing that innocent people should go to jail for rape, because – and I’m quoting Ezra Klein here – we “need to create a world where men are afraid.” Red team men, I take that to mean. Football players. Frat boys. Not nice guys like Ezra.

Look at how the reasonable Left, who would never question the legitimacy of the Court, responded to last year’s Hobby Lobby decision. Just to remind you: the Supreme Court decided that the government could force almost all employers to provide unrestricted contraception coverage to their employees. But because of the RFRA, they decided that a small subset of businesses — privately owned or closely held businesses — could refuse coverage for a small subset of birth control methods that they considered abortificients. It’s exactly the kind of compromise that the Left always claims to want; one that respects our diverse and pluralistic country. In fact, it’s better: they got about 99.5% of what they wanted, with a small bone thrown to religious conservatives. Even better, the Court’s decisions was grounded in a law that can be repealed, not in any supposed First Amendment rights of corporations. By any definition, it was a big win for them.

And yet .. the “reasonable left” who would never question the legitimacy of the Court, responded by proclaiming that we were in a corporate theocracy. They disparaged Catholics on the Court. We were told that it turned back the clock on women’s rights. You can see a bunch of “reasonable” tweets here, including a comparison to Plessy vs. Ferguson (remember when Republicans comparing SCOTUS decisions to Dred Scott was over the line? Good times.)

That’s when they “lose” by such a tiny amount it’s really a huge victory. But last week, the Left won outright. And granted, most liberals are responding with jubilation. My FB feed filled with happy posts about the victory of gay rights. But there is a noisy faction that have spent the last week poring through the dissenting opinions to find something, anything to get in a tizzy over. Jon Stewart has done multiple segments mocking the dissenting opinions and the politicians who didn’t like the rulings. And then, of course, you had Monday’s afterbirth when liberals screamed that the Court has “struck down” limits on mercury emissions (it did nothing of the kind).

So, on it’s own, Takei’s remarks are nothing — something dumb said out of anger. But in the larger context, it was the intersection of two ugly trends: racial animosity toward Clarence Thomas and incessant left-wing whinging about a political battle they have won.

So, yeah, Takei’s apology is fine (Thomas, I suspect, does not care either way). But it’s nothing compared to the long smear campaign against Clarence Thomas and the vitriol with which far too much of the Left has responded to a decision that went their way.

The Culture War is over, guys. You’ve won. Hell, I’m on your side for most of these social issues. We’ve won. Do you really have to ride down your defeated foe?

King Denied

The Supreme Court has just ruled 6-3 that the Obamacare subsidies apply to states that do not run their own exchanges, thus upholding a major provision of the law. I’ll post more when I have time. Discuss.

One thing I’ll note: I was not surprised. The Roberts Court really hates to overturn legislation. They prefer to let legislators do that. The theme from Roberts in the two Obamacare decisions is basically this: if you want to repeal, repeal the law. We’re not going to do it for you.

Update: The more I think about it, the more I think the Court reached the right decision here, much as it pains me to say so. I don’t think King’s case was “ridiculous” as many liberal pundits opined. It’s never ridiculous to argue that a law should be interpreted as it was written. But I do think it was the language was ambiguous enough and the intent of Congress during the debates plain enough for the Court to defer to them. The message from the Court, as I noted above is “we’re not going to repeal Obamacare for you”.

(And I think the GOP is secretly grateful. As Thrill pointed on Twitter, this decisions basically saved them from having to repair the law.)

The way forward is pretty clear: replacing Obamacare becomes the key GOP electoral issue in 2016. The law, as Justice Roberts noted in his majority opinion, is still a mess. While the number of insured has been reduced, there has been no improvement in overall health. It’s saving some people from crippling financial bills but at enormous cost. And we are still in very real danger of an insurance “death spiral” that will destroy the individual market.

The shape of that replacement is up in the air right now. I prefer a bill that eases the link between insurance and employment, allows insurance to be sold across state lines and encourages the kind of high-deductible insurance that has been shown to reduce healthcare costs with little impact on overall health. But we’ll see what happens. The Court has put the ball into the GOP’s court. Let’s hope they don’t step on it and fall on their ass.

Update: You should read Scalia’s blistering dissent. It’s vintage Scalia, complete with saying the law should now be called “SCOTUScare”. It makes good points, I think, and shouldn’t be dismissed.

Update: Doug Mataconis explains the Court’s reasoning:

As Chief Justice Roberts noted, Courts have always been deferential when it comes to statutory interpretation in order to ensure that Judges are not substituting their judgment for elected representatives. The fact that there is a drafting error, or that language in a bill that was more than a thousand pages long is inexact in some way should not necessarily mean that a Court must interpret a law in a manner that brings down an entire statutory scheme. The alternative would be a world where the lack of a single word, or an in-artfully drafted sentence, would bring down an entire law, and that’s never been the way the Courts have interpreted statutes. In my past comments about this subsidy issue, I’ve been somewhat sympathetic to the argument of the Plaintiffs in this case, but reviewing the pleadings and the oral argument in this case have caused me to reconsider that position. I’m still not a fan of the PPACA, and I think that it’s going to create long-term economic incentives that will make health care more expensive rather than less expensive, but that is a policy matter not a legal one. As it stands, it seems clear to me that the Justices in the majority got it right.

Court Season

The Supreme Court is set to issue a number of landmark ruling this month (saving them for the end of the session, as usual). You can read Doug Mataconis or Evan Bernick for good conservative takes. I’ll do quick hits with how I think the Court will rule and how I think the should rule. And, of course, as each ruling comes down, I’ll put up a post.

The thing about the Roberts Court is that they are very conservative. Not in the political sense, but in the temperamental one. They prefer not to make broad sweeping decisions that upend masses of law and precedent. They tend to defer to legislatures. They like to rule narrowly and specifically. Roberts works very hard to build consensus (see last year’s slew of 9-0 decisions). They have been slow to defend civil liberties except for the First Amendment. So while I expect some landmark decisions, I don’t expect any that will radically reshape the law.

I do expect, however, to hear the losing side of several cases scream that the Court has exercised unprecedented power, set fire to the Constitution and brought plagues of locusts. Whichever side they oppose will be acting in a purely partisan fashion while their side are zealous defenders of the faith. You can decide if that hysteria is warranted.

Read more… »

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.

They’re Lying. Again.

Wow:

The Obama administration included as many as 400,000 dental plans in a number it reported for enrollments under the Affordable Care Act, an unpublicized detail that helped surpass a goal for 7 million sign-ups.

Without the dental plans, the federal government would have had 6.97 million people with medical insurance under the law known as Obamacare, investigators for the House Oversight and Government Reform committee calculated, using data they obtained from the U.S. Centers for Medicare and Medicaid Services.

Federal officials said in September they had 7.3 million people enrolled in coverage through new government-run insurance exchanges. They didn’t distinguish between medical and dental plans, breaking from previous practice without notice.

Blending dental and medical plans let the administration assert that enrollment remained greater than 7 million, the original projection of the Congressional Budget Office. The move also partly obscured the attrition of more than 1 million in the number of people enrolled in medical insurance.

The Administration is saying this was a mistake and the liberal bloggers are spinning, spinning spinning. The main talking point is that Obamcare basically met its goal (6.97 million vs. 7 million) and that, hey, lots of people are now insured. But saying that you met your goal (almost) is a huge political difference from saying you exceeded your goal, especially in … wait for it … the run up to an election.

They’re lying. They always lie. They’re just getting caught now.