Free Markets, Free People

Health Care

Discounting human nature

One of the most ironic and, if it weren’t so serious, amusing aspects of central planners is how they come to the conclusion that their plan – despite thousands of years of human nature – will manage to overcome human nature.  What I mean by that akward sentence is they believe they can retrain us to like what they’ll make us do.  Screw human nature.  Screw the laws of economics.  Screw just about every immutable law of nature.  This crap sounded great in the beer haze of the dormitory among their liberal friends.

It’s a correlary of the “the only reason socialism hasn’t worked is we haven’t tried it my way” belief.  And I do mean “belief”.  An act of faith.  More underpants gnomes.

The case in point?  Megan McArdle brings it to us:

In December, I predicted that “doc shock” was going to be a major problem for the U.S. health-care overhaul, as people found out that the narrow networks insurers use to keep premiums low often don’t cover the top-notch doctors you’d like to see if you get really sick:

“If narrow networks could give everyone in the country access to health-care outcomes no worse than 90 percent as good as the folks with the best doctors at 75 percent of the price we’d pay for broader networks, the health-care wonks would jump on that deal as an unbelievable bargain. But I think it’s pretty clear that average folks don’t think like health-care wonks.

So what does ObamaCare do?  Force people into narrow networks despite it being clear to anyone with the IQ of a turnip and a couple of years observing how humans do things, that narrow networks are going to fail.

“So even if narrow networks actually were better, people would resist them. And they’ll fight with every fiber of their being when you tell them to take their kid with leukemia to a community hospital rather than the top-notch children’s hospital nearby. Expect the fight over doc shock to be bitter and long — and to end when insurers cave and start adding pricey doctors back to their networks.”

That’s right … you’re relegated to whatever backwater network of care the particular insurance company you’ve been forced to buy from (or pay a tax too if you prefer) has contracted with.  Want world-class care for your child?  Tough beans.  See your doc at the community hospital instead.

So what has happened?  Well exactly what happened before when something like this was tried:

However much good, sound policy sense narrow networks might make, they are political poison. Regulators and politicians are going to find it very hard to withstand the appeals of constituents who have been restricted to the bargain basement of our nation’s health-care system. I simply don’t think they’ll be able to stand it for very long. This is basically what happened to the managed-care revolution that held down cost growth in the mid-1990s — people in those plans complained bitterly, in their capacity as both voters and employees. A combination of legal and market pressure forced insurers to open up their networks and approve more treatments. And then costs started rising again. As people begin using their Obamacare policies and start running into restrictions, the same sort of pressure will begin to mount.

But did our estwhile leaders learn anything from managed care’s failure?

Nah.

Because, you know, they weren’t in charge at the time and besides, human nature is just overrated.

So, as with every other aspect of this nonsense, watch Obama do what is necessary to ensure the fewest number of people possible are hurt by this … until after midterms, at least and 2016 if Mr. “I can do whatever I want” can swing it.

~McQ

ObamaCare: you wonder how much the government can screw up something?

Well the hits keep on coming with this atrocity of a law known as the Affordable Care Act, aka ObamaCare.  More and more negative nonsense keeps emerging as we get deeper and deeper into its implementation:

In his State of the Union address, President Obama urged Congress to “give America a raise.” Well, it turns out that Obama is giving America a $70 billion annual pay cut, courtesy of Obamacare.

That is the overlooked nugget in the new Congressional Budget Office report detailing the economic costs of Obamacare. While much attention has been paid to the report’s finding that Obamacare will reduce employment by as much as 2.5 million workers, buried on page 117 (Appendix C) is this bombshell: “CBO estimates that the ACA will cause a reduction of roughly 1 percent in aggregate labor compensation over the 2017-2024 period, compared with what it would have been otherwise.”

Translation: Obamacare means a 1 percent pay cut for American workers.

How much does that come to? Since wages and salaries were about $6.85 trillion in 2012 and are expected to exceed $7 trillion in 2013 and 2014, a 1 percent reduction in compensation is going to cost American workers at least $70 billion a year in lost wages.

It gets worse. Most of that $70 billion in lost wages will come from the paychecks of working-class Americans — those who can afford it least. That’s because Obamacare is a tax on work that will affect lower- and middle-income workers who depend on government subsidies for health coverage. The subsidies Obamacare provides depend on income. If your income goes up, your subsidies go down. This means Obamacare effectively traps people in lower-income jobs by imposing an additional tax on every dollar of additional income they earn. Working hard to earn a promotion or get a raise, or taking on additional part-time work — all the things people do to pursue the American Dream — are discouraged by Obamacare. As Keith Hennessey, former chairman of the White House National Economic Council, explains it, “Obamacare punishes additional work, education, job training and professional advancement, anything that generates additional income for those trying to climb into the middle class.”

Emphasis mine.  Obamacare provides a disincentive to succeed (as do the majority of government welfare programs).  And what is the old saying?  If you want more of a behavior, reward it.  Want less?  Tax it.

The new twist?  They then subsidize the cost when they’ve knocked the victim’s income down enough to make insurance unaffordable.

Meanwhile Congressional Democrats and the administration are agitating for a raise in the minimum wage.  They take it away with one hand, try to ignore the fact that they’ve done so and demonize the GOP because they’re not pro-minimum wage (or said another way, they actually understand the economic impact of a minimum wage).

If ever there was a picture beside the definition of “dysfunctional government”, it would be this administration’s along with Congressional Democrats.

And beside the definition of “punching bag?”  The GOP.

~McQ

Will the GOP again snatch defeat from the jaws of victory?

And no, that’s not a rhetorical question – it’s a real concern.

Even the left knows they’re in trouble for the 2014 midterms … or should be.  John Judis of the New Republic:

What I’d point to instead is a comparison between where Obama and the Democrats stood in January 2010 and where they stand today. In January 2010, they were about to lose the Massachusetts senate race, and in November 2010 would lose 63 seats in the House and six seats in the Senate. If Obama and the Democrats’ numbers are better now than they were then, they may not be in trouble; but if they’re worse, the conventional wisdom is right. And they’re worse.

The most recent standard of comparison is the ABC/Washington Post poll that asked some of the same questions in January 2010. First, there are the questions about Obama. These are relevant because midterm elections are often referenda on the president and his party. In January 2010, Obama’s approval ratings were 53 approval to 44 percent disapproval of his “handling his job as president.” Today, 46 percent approve and 50 percent disapprove—a 13-point swing. In January 2010, 47 percent approved and 52 percent disapproved of his handling of the economy. Today 43 percent approve and 55 percent disapprove—a seven-point swing.

In January 2010, 57 percent of registered voters thought that Obama understood “the problems of people like you.” Forty-two percent did not. Today, it’s 47 to 52 percent—a 20-point swing. And there is a similar 20-point swing in the question of how much confidence voters have in Obama’s ability to “make the right decisions for the country’s future.” In short, the electorate has far less confidence in Obama now than they did in January 2010.

ABC—Washington Post didn’t ask the same questions about Democrats and Republicans in January 2010 that they asked today, but they did ask these questions in October 2010 on the eve of the Republicans’ sweep. In October 2010, voters thought Democrats would do a better job than Republicans handling the economy by 44 to 37 percent. Today, they think Republicans would do a better job by 44 to 37 percent—a 14-point turnaround. In October 2010, voters said (incredibly) that they preferred Democratic House candidates by 49 to 44 percent. Today, they prefer Republicans by 45 to 46 percent. The number for October 2010 may be inaccurate, but in any case, there is nothing in the current numbers to inspire confidence. In midterm elections, the Republicans have a built-in advantage that allows them to maintain their majority without winning a majority of votes.

To be as succinct as possible, the 2014 midterms are the Republican’s to screw up.  And this is where Johnathan Last of the Weekly Standard points us toward the problem (one we’ve been hitting up here lately):

What could have accounted for these diminished prospects for Obama and the Democrats? Oh, it’s hard to say. Probably just tactical brilliance on the part of congressional Republicans. Yes, that’s the ticket. I mean, it’s not like there was a signal event that focused all political attention on a single issue. It’s not like there’s a Topic A that has been demoralizing Democrats, rallying Republicans, moving independents, and providing a constant stream of campaign fodder.

No, no, no, it’s not like there’s one subject which totally unites the Republicans and cuts against Democrats and—mirabile dictu!—where the news keeps getting worse for Obama with every passing week. As Homer Simpson would say, “Right, Lisa. Some wonderful, magical issue.”

Oh, right.

So with the wind at their backs and the Democrats in disarray, late last week the Republican leadership decided that this was the perfect moment to change the conversation to…immigration reform!

To again be as succinct as possible, they’re on their way to screwing it up.

And they wonder why people call them the “stupid party.”

*sigh*

~McQ

ObamaCare – the political gift that keeps on giving

As this Obamanation known as ObamaCare contiunes to unroll and unravell, we find more and more incompetence evident.  At this point, you mostly are so in awe (in a negative way) of how badly this was done, that all you’re left to do is shake your head in wonder.  The latest:

Amy Goldstein of  The Post reveals that the appeals process guaranteed in the Obamacare law does not actually exist. The story outlines an almost comical process that requires citizens who seek a fair hearing to have an innocent, HealthCare.gov-generated mistake corrected to fill out a seven-page paper form that is then inexplicably shipped to Kentucky, where it is entered into a government database that isn’t actually connected to anything. It’s a digital dead end for those who dare to complain. Typical. As a result, 22,000 Americans who have submitted an appeals request remain without proper coverage and they have no recourse. And, according to The Post, in the latest show of non-transparency from this administration, officials have “not made public the fact that the appeals system for the online marketplace is not working.” There is “no indication that infrastructure . . .  necessary for conducting informal reviews and fair hearings had even been created, let alone become operational,” and administration officials are refusing to give any information as to when the appeals process might start moving. This is an administration that wants to hide things rather than fix things.

So, the appeals process is analogus to filling out a long paper form and then just throwing it into a dumpster for all the good it does the person filling out the form.  But has the administration made it clear that the process is – well not broken, how about nonexistent?  Nope.  People are still required to fill our their appeals forms, submit them and wait.  Except there is no mechanism in the current system for anyone to see, much less review, the submission.  The appeal is entered into a data base and that’s the end of the process.  Those waiting are left without recourse.

One more time for the morons in the establishment GOP – here’s your issue.

Or, if you continue to pursue immigration – here’s your sign.

~McQ

How are you supposed to stay informed when the media doesn’t do its job?

Headline:

Study: Flu medications could spread sickness

Body:

WASHINGTON – Could cold and flu drugs help spread the flu? Some researchers think so.

Over-the-counter cold and flu drugs contain ibuprofen, acetaminophen or other drugs that can reduce fever. When patients’ fever is down, they tend to feel better.

But researchers at Canada’s McMaster University concluded that when some patients reduce their symptoms with cold and flu medications, they feel better and return to work or school while still infected. While patients feel fine, they are still able to infect others, according to the study, which is published in the Proceedings of the Royal Society B.

Real answer:  Researchers aren’t saying that at all newspeople.  What they’re saying is if people have the flu, are still contageous, but are made to feel better enough by medicine to go to work, THEY may spread the flu, for heaven sake.

When I read the headline, I was actually thinking they were talking about the flu vaccine. That actually might make some sense. Instead we get this non-report report – and abysmal framing of the study.  So bad they have to point out:

“We aren’t saying don’t take medication. That’s not the message,” David Earn, who specializes in mathematics and disease, said to NBC News. “Be aware that if you take this medication, there is this effective increase in transmission.”

No there isn’t an “effective increase in transmission” if you take the meds.  There’s a POSSIBILITY of an increase in transmission if you feel well enough (and are foolish enough) to go out into public while you’re still contageous.

This pretty well demonstrates the state of science reporting in the media today.   And they wonder why we don’t buy into the global warming hype?

~McQ

ObamaCare: the myth and the reality

Perhaps I should say the building myth and the reality.

What is the building myth?  That the worst is behind it.  Megan McArdle fills you in:

Many of the commentators I’ve read seem to think that the worst is over, as far as unpopular surprises.

But she then takes a chain saw to that particular notion:

In fact, the worst is yet to come.

· 2014: Small-business policy cancellations. This year, the small-business market is going to get hit with the policy cancellations that roiled the individual market last year. Some firms will get better deals, but others will find that their coverage is being canceled in favor of more expensive policies that don’t cover as many of the doctors or procedures that they want. This is going to be a rolling problem throughout the year.

· Summer 2014: Insurers get a sizable chunk of money from the government to cover any excess losses. When the costs are published, this is going to be wildly unpopular: The administration has spent three years saying that Obamacare was the antidote to abuses by Big, Bad Insurance Companies, and suddenly it’s a mechanism to funnel taxpayer money to them?

· Fall 2014: New premiums are announced.

· 2014 and onward: Medicare reimbursement cuts eat into hospital margins, triggering a lot of lobbying and sad ads about how Beloved Local Hospital may have to close.

· Spring 2015: The Internal Revenue Service starts collecting individual mandate penalties: 1 percent of income in the first year. That’s going to be a nasty shock to folks who thought the penalty was just $95. I, like many other analysts, expect the administration to announce a temporary delay sometime after April 1, 2014.

· Spring 2015: The IRS demands that people whose income was higher than they projected pay back their excess subsidies. This could be thousands of dollars.

· Spring 2015: Cuts to Medicare Advantage, which the administration punted on in 2013, are scheduled to go into effect. This will reduce benefits currently enjoyed by millions of seniors, which is why they didn’t let them go into effect this year.

· Fall 2015: This is when expert Bob Laszewski says insurers will begin exiting the market if the exchange policies aren’t profitable.

· Fall 2017: Companies and unions start learning whether their plans will get hit by the “Cadillac tax,” a stiff excise tax on expensive policies that will hit plans with generous benefits or an older and sicker employee base. Expect a lot of companies and unions to radically decrease benefits and increase cost-sharing as a result.

· January 2018: The temporary risk-adjustment plans, which the administration is relying on to keep insurers in the marketplaces even if their customer pool is older and sicker than projected, run out. Now if insurers take losses, they just lose the money.

· Fall 2018: Buyers find out that subsidy growth is capped for next year’s premiums; instead of simply being pegged to the price of the second-cheapest silver plan, whatever that cost is, their growth is fixed. This will show up in higher premiums for families — and, potentially, in an adverse-selection death spiral.

In fact, she is exactly right.  Note how many of these surprises happen before 2016.  And, as they come true, perhaps … just perhaps … when voters are told that the rest of this nonsense is likely to come true too (it is the law, you see), they might believe it.

Perhaps.  The “Cadillac tax” was inartfully delayed until after the election.  However, the snowball will already be rolling down hill by then and you’d think the public would be open to believing that the rest of this abomination, that which was delayed, will indeed happen.  And you’d also believe they’d want to do something about that (that, of course assumes Obama doesn’t wave the magic executive pen and waive all of this until after the election).

But then, doing something would depend on what?  Well, getting elected officials that want to actually get rid of most of this monstrosity and are willing to say that and then do it.  Uh, that won’t be Democrats (well except perhaps blue dog Democrats, if they’re not extinct by then).

What it all boils down too is that voters will have to depend on Republicans to do the heavy lifting.  The question is will they do that if elected?  In other words, will Republicans be up to the job?

If I had to base it on the current crop – yeah, not so much.

~McQ

Administration has no idea who has or hasn’t paid for ObamaCare

You remember the post a couple of days ago when I broadly hinted that you shouldn’t believe a single statistic (or most of anything else) this administration proffers?

More proof.  You might recall a number of administration spokespersons and Democrat mouthpieces telling us that millions have enrolled and paid?

Yeah, not so fast:

An official from the Centers for Medicare & Medicaid Services admitted at a House hearing today that no one knows how many people have actually paid for Obamacare coverage.

“So we don’t know at this point how many people have actually paid for coverage?” asked a member of Congress.

“That’s right,” the CMS official conceded.

Inept, incompetent and unfortunately, in charge.

~McQ

ICYMI

Of course “ICYMI” is internet shorthand for “In Case You Missed It“.  And in case you missed a couple of things I found interesting I thought I’d throw them up here.

For instance:

According to the White House, 79% of those enrolled in Obamacare need subsidies because they cannot otherwise afford the premiums that have, in some cases, nearly doubled. Only 21% did not need subsidies.
As Businessweek noted, people “earning up to four times the poverty rate—as much as $96,000 a year for a family of four”—can get Obamacare subsidies from the federal government.

79%.  That’s right, 79%.  And why do they need subsidies?  Because they can’t afford their insurance premiums anymore.  And why can’t they afford their insurance premiums anymore?

ObamaCare.

Catch 22.

Oh, and here’s a great chart on something else you might have missed:

Yes, that’s right … when all is said, done and figured, the real unemployment rate is around 11%, not 6.7%.  No wonder those 79% need subsidies.

I threw that in because this is the state of the job market and that has an effect on who is going to enroll in this boondoggle of a government program.  But right now, it appears young people –  you know, the one’s Obama et al are counting on paying for this – aren’t enrolling.

But hey, is the White House worried?  Nah, they – as usual – have it all figured out:

About 30 percent of new enrollees are under 35. White House officials say that’s an acceptable mix, and they expect more young people to come on board closer to the March 31 deadline. “We think that more and more young people are going to sign up as time goes by, based on the experience in Massachusetts,” Gary Cohen, deputy administrator at the Centers for Medicare and Medicaid, said on a conference call with reporters. “We’re actually very pleased with the percentage that we have right now, and we expect that percentage to increase.”

This is the usual whistling past the graveyard this administration is so prone too.  They have no idea what will happen.  They “think” more will sign up.

Uh huh …

ObamaCare says it needs an enrollment of 38% of youth to pay for this monstrosity.  24% are enrolled.  And, apparently knowing youth better than I do (“Insurance?  I”m not sick.  Beside, I want that new 60″ TV.”) they’re sure they’ll make the time and effort to enroll and throw their money into the pit before March.

Not going to happen.  I’d suggest those who are going to enroll have, for the most part, enrolled.

Of course that doesn’t mean the administration won’t claim to have 38%.   But I’ll remind you they also claim unemployment is at 6.7%

~McQ

The law with the Orwellian name continues to lose support

The Affordable Care Act, the monstrosity of Democratic legislation with the Orwellian name, continues to lose supporters.   And, as an added special feature, people in employer based programs are now paying more out-of-pocket for their medical expenses than before ObamaCare.  Very “affordable”, no?

Support for the Affordable Care Act has plummeted since late last summer, and people with employer-based health insurance say they increasingly are paying more for out-of-pocket medical expenses, a new Bankrate.com survey released Wednesday revealed.

When Bankrate.com first polled people in September—right before the launch of Obamacare insurance exchanges, there was an even split between those who said they would repeal the Affordable Care Act if given the power to do so and those who would keep it: 46 percent each. (The rest either had no opinion or didn’t know how they felt.)

But three months later, after the botched launch of those government-run exchanges, the number of people who said they would gut Obamacare had risen to 48 percent, while the number of respondents who said they would keep it as law had plunged to 38 percent.

While the “botched launch” may have had some effect on that “plunge”, my guess is that hitting people’s wallet has pushed it down even more.  Health care insurance isn’t some esoteric policy argument.  It’s something that is important to everyone.  It is about their family and trying to afford the best for their family’s health. When policy negatively effects real people, they react just as negatively (and I do hope that Democrats double down on their support of the law, since it is all theirs anyway) :

The survey also found that people, by a 2-to-1 margin, felt Obamacare had had a more negative than positive impact on their own, individual health care. The poll questioned 1,005 adults, and had a margin of error of 3.6 percentage points.

[…]

His company’s survey also found that a total of 44 percent of people with employer-provided insurance said they are shelling out more dollars in deductibles and copayments than they were a year ago. And 47 percent of that group of people reported having more money deducted from their paycheck to pay the cost of those insurance plans than in 2012.

People earning between $50,000 and $75,000 annually were the most affected group: with 64 percent of them reporting a bigger hit on their paychecks from health insurance. Just 38 percent of the people earning less than $30,000 reported paying more for insurance in payroll deductions as of 2013.

The great leveling.  Apparently you’re “rich” if you earn between $50 and $75k, so it’s okay that you’re paying more – and besides, those “Cadillac plans” just aren’t fair (well, except for the exempt unions, of course … and Congress, and ….).  Don’t forget the tsunami of cancellations that will hit employer based programs hasn’t yet happened.

Obviously it doesn’t take great powers of perception to realize that this is just going to get worse and worse as the months pass.  And as those months pass, those supporting the legislation will become fewer and fewer.  It will be a grand issue on which Congressional Republicans can run (if they actually can figure out how to do that successfully without the usual idiocy).  Unfortunately, politics aside, it is going to be a building disaster for the American people.

Repeal is the best remedy.

~McQ

ObamaCare’s net effect so far? More cancellations than enrollments

Not that anyone should be surprised:

Even without the full number of enrollments, Obamacare’s current net effect is clearly in favor of cancellations. Millions are already seeing Obamacare’s adverse effects — largely due to more mandates for more services.

The mandates?  Well they’re one of the major reasons for most of the cancellation notices – their plan just doesn’t have all the benefits your wise and caring public servants think you should have:

The health-care law requires that all insurance plans cover 10 “essential benefits,” eliminating millions of plans that don’t fit the bill and boosting costs for consumers that have to purchase coverage for services they may not want or need.

All plans must include maternity coverage, for example — including plans for men and post-menopausal women. Even customers without children must purchase plans that cover pediatric services. Other newly established essential benefits include hospitalization, mental-health services and preventive and wellness services.

While a grandfather clause allowed plans purchased before Obamacare passed in 2010 to continue, HHS estimated that 40-67 percent of plans would eventually lose their status and cost millions of Americans their insurance plans.

So you see little horror shows like this family’s acted out all over the nation.

And those cheap affordable plans?  How are they working out so far (if you can even get one).  Well with high deductibles, not so hot (but all the men have maternity coverage, that’s a plus):

Experts are worrying that some new enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. In Miami, for example, 40 percent of bronze plans require consumers to pay the full deductible before coverage kicks in, according to an analysis by online broker eHealthinsurance.com, a private online marketplace, for Kaiser Health News. The average deductible among the examined bronze plans in Miami is $5,735.

Patients in those plans who haven’t yet met their annual deductibles would have to pay the full cost of the visits, unless they were for preventive services mandated by the law. A typical office visit can run $65 to $85, while more complex visits may cost more.

So, as Ed Morrissey puts it:

Put it this way: If the average deductible is $5,735 and a doctor visit is $85, it would take sixty-eight doctor visits before the insurance kicked in — more than one visit per week. And it would start all over again every year.

So how’s ObamaCare going?

About how you’d expect a politically driven piece of law from an incompetent administration to go.

However the apologists have a different reason in mind:

“[S]outhern White radicals vowed to stop implementation of the Obama-care law leading one to wonder if Tea Party members would oppose affordable healthcare if it came from a nonBlack [sic] President,” writes Browne-Marshall.

Yeah, that’s the reason.

~McQ