Tag: Obamacare

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.

First Step

The GOP took the first step toward “repeal and replace”, passing a modified version of the AHCA on a narrow party-line vote.

The thing is … I can’t really hit you with a lot of details about the bill because the GOP — which spent years promising transparency in law-making — passed a bill that no one had read, that had no CBO score and, up to the last minute, had provisions slipping in and out (including a provision exempting Congress from the bill). After promising that all bills would be posted three days before passage, they crammed this through with little to no debate (or thought).

We do know that it will cut taxes, allow states to remove provisions protecting people with pre-existing conditions and allow states to remove provisions on even employer-based plans. While it will create “high risk pools” for people with pre-existing conditions, the $8 billion funding will not go far and people with pre-existing conditions could face premiums of tens of thousands a year. The entire market is going to be shaken up but no one really knows how.

Look, I’m not going to sing the praises of Obamacare. Insurers are pulling out to the extent that Iowa will basically not have Obamacare. The ACA defines pre-existed condition so broadly that basically everyone has a pre-existed condition, including assault victims and women who’ve had C-sections.

But passing a bill in haste with no information is not the solution. It’s not what Democrats did with Obamacare; it’s worse. I’m disgusted by the whole thing.

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 Plan is Out

Just a few quick thoughts since I’m frantically packing for the long trip back to the US.

The Republicans finally came out with their official Obamacare replacement plan. From what I can tell, it is basically Obamacare with more debt. It eliminates the insurance mandate tax, replacing it with hiked insurance rate for those who go without coverage — under the logic, I guess, that higher initial premiums will encourage the uninsured to buy insurance. It maintains the coverage mandate, which doesn’t work without a purchase mandate. It keeps the elimination of lifetime caps and coverage for those under 26. It also cuts off funding to Planned Parenthood. It’s basically all the popular stuff about Obamacare without all the unpopular stuff that pays for it.

There’s also no chance it will pass. The Senate is highly skeptical. A number of interest groups and conservative groups are already against it. The proposal is basically DOA.

And frankly, so is the Republican Party if they can’t do better than this. I didn’t think they could come up with something worse than Obamacare but they managed it.

(Note: the response from the Democrats is very illuminating. The overwhelming cry is, “THIS IS A TAX CUT FOR THE RICH!!!!” It’s astonishing how every Democratic policy and every political instinct revolves around soaking those evil rich people.)

The Wheat from the Chaff

Trump has been in office for one week, but it’s an eventful one. Before I get into the heavy stuff, I wanted to take a second to note that, on occasion, we all need to take a deep breath. Yes, some of the things he’s already done are misguided and some of his proposals are poor. He’s showing an alarming egotism and disregard for existing institutions, the law and the Constitution.

But … we’ve got 1460 days of this (at least). It’s important to figure out what to be alarmed by and what not to be alarmed by. Ken White has a great post on this, pointing out that the media and the American people have a tendency to react to stories of government abuse as though they are unprecedented, mainly because they weren’t paying attention while a President they liked was the in the Oval Office.

The urge to indulge in this habit under the thoroughly loathsome Trump Administration is overpowering. Trump and his underlings are scornful of rights and openly fantasize about abusing them. They require dedicated scrutiny. But not every ugly thing that happens now is the result of a Trumpism. Take, for instance, the concern about members of the press being arrested at anti-Trump protests. We should absolutely be vigilant for signs of the criminal justice system being abused to suppress the press and dissent. But cops have always indiscriminately arrested people at protests — including journalists — and falsified masses of improbable riot or assault or obstruction charges afterwards. Reporters have been charged plenty of times before. Sometimes it’s a reflection of law enforcement’s indiscriminate approach to arrests at protests and sometimes it’s a reflection of entrenched law enforcement hostility to press scrutiny. Is the latest incident actually a change — or is the press just noticing because this time they got caught up in it, and they are primed to expect tyranny?

Examples are legion, and not just in the criminal justice arena. Every day you’ll see old policies being cited as new Trump atrocities. Before it happened to Obama, and Bush, and so on ad infinitum.

I’ve decided to impose a 12-hour moratorium on tweeting or blogging any Trump outrage (unless it is something said or done by Trump or his surrogates). Because we’ve developed a huge problem with identifying real Trump outrages from phony ones. Just a few examples

  • Last week, the internet erupted because Trump had “scrubbed” pages from the White House website on climate change and LGBT rights. But it turned out that this was not unusual. When Trump assumed office, all of Obama’s web pages were moved to a new site and the only pages that went up were ones Trump’s team had put together. You could complain that this means LGBT rights and climate change are not priorities with Trump (which we already knew). But saying they’d been “scrubbed” was ignorant.
  • A day later, the internet erupted because Trump had declared his inauguration day a “National Day Of Patriotic Devotion”. This was creepy, but … Obama declared his to be a “National Day of Renewal and Reconciliation”. So this was ultimately much ado about nothing.
  • Yesterday, the Bulletin of Atomic Scientists advanced the “Doomsday Clock” to 2.5 minutes to midnight. This is utterly meaningless.
  • Yesterday, the internet also erupted because several senior State Department staff resigned. This is a bit alarming because Trump has not filled almost all the senior positions at State (and even the most ardent small-government conservative would admit that foreign relations are the Federal Government’s job). But, as Alex noted, the resignations were not unusual or unprecedented. In fact, most senior government officials resign when a new Administration takes office. Some are just held on for continuity.
  • There’s been a bit of hubbub over the Administration telling government scientists not to communicate with the public. It’s not clear how common this is or how extensive. I am very concerned that the Administration may be politicizing science. But this is not unprecedented — the previous Administration was more than happy to indulge in pseudo-scientific trafficking “studies”. For the moment, I am holding back on a full-scale blast until it’s clear what’s going on.

The problem with these pseudo- or semi-controversies is that they obscure really bad stuff the Administration is actually doing that is not in question at all. To wit:

  • Issuing an executive order last week that has HHS grant more waivers to insurance mandates under Obamacare. That may sounds good. But since insurance companies are still forbidden from blocking insurance due to pre-existing conditions, this is only going to enhance the insurance death spiral.
  • Wallowing in conspiracy theories about voter fraud. Trump is obsessed with his popularity and is now proposing a massive investigation into mythical millions of illegal aliens voting. If masses of illegal aliens voted in 2016, they were just as skilled as the mythical Russian hackers who supposedly stole the election for Trump. They somehow disguised themselves as well-established demographic trends, voted Republican down-ballot and concentrated all their power in California, which Clinton was going to win anyway. This fantasy of Trump’s ends in one place: a national ID card and national voter database.
  • Reopening CIA black sites and resuming torture. This was one of my biggest breaks with the Republican Party and remains so. The black sites create a space where torturers can operate outside of the law, outside of the Geneva convention and outside of the rules of war. And the CIA’s record in defense of their program — destroying evidence, lying to Congress, spying on Congress — is a huge black mark against them. Trump has decreed that torture “absolutely” works despite overwhelming evidence to the contrary. And whether it works or not, it is a violation of the law, our treaty obligations and basic human decency. He’s talking as though to defeat ISIS, we need to become ISIS.
  • Trump, a supposed Culture War moderate, restored the gag order that prevents NGO’s from getting money if they perform abortions or even counsel women about abortions. But he extended it further to all international health organizations, not just those involved with family planning. Organizations fighting HIV/AIDS could see their funding cut if they even mention abortion. (To be fair, this reeks of that Culture War dunderhead Pence. But Trump signed it, probably not knowing what he was signing.) This seemingly innocuous move could kill thousands, even potentially undoing Bush 43’s greatest legacy: the tremendous progress made in fighting AIDS in Africa.
  • Trump, as promised, banned immigration from several Muslim countries, including countries where we created the refugee crisis and applying even to people who helped us and are now at risk of retaliation. Oddly, or maybe not so oddly, the ban does not apply to countries where Trump has business interests.
  • He continued to make false claims about surging crime, saying DC and Philadelphia are experiencing huge surges in murder (they aren’t). He also threatened to send in the feds to deal with Chicago, which really is seeing a surge of violence. But as Radley Balko pointed out, the Feds already did look into Chicago and concluded that the policing culture, which includes such “politically correct” things as black sites, beatings, smashed dash cams and cover-ups, is the biggest problem.
  • Trump cancelled TPP, to the delight of China and the despair of the people who would have benefitted. And he’s now supporting a “border adjustment tax” that will spike the cost of consumer goods. Yesterday, it was touted as the way Mexico will pay for his stupid wall although it does not such thing. And his angry tweeting about Mexico caused the Mexican President to cancel a meeting — not a good thing for our third biggest trading partner.

Since I wrote the above, I’ve been trying to think of anything good Trump has done in the first week. He froze regulations, which is sorta good but there are few on things like airline safety that we kind of need. He froze government hiring, which is fine. He removed the ban on the Keystone Pipeline, which is fine, but not nearly the economic stimulus he thinks it will be. That’s pretty much it and all stuff we could have gotten out of a generic Republican sans the bullshit.

Look, there are bunch of you that support Trump. I get that. But you can’t claim that a man who wants political control of science, torture, baseless investigations into supposed voter fraud, hard restraints on immigration, a global gag order on abortion and a thousand other policies that clamp down on us is, in any way, a supporter of freedom or the Constitution. I said before the election that Trump had the makings of a thug. We’re only a week in but I’ve seen nothing to make me reassess that opinion.

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.

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.