Free Markets, Free People

ObamaCare

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Observations: The QandO Podcast for 28 Oct 16

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There’s a chicken-duck-woman thing waiting for us. The FBI seems to have reopened the email investigation on Hillary Clinton, because Anthony Wiener is the gift that keeps on giving. I thought we had already established that she was above the law, so there’s no need to address this moving forward. Vladimir Putin is a scary guy. The Chinese are somewhat less so. Apple’s new Macbooks have no touchscreen and a shitty keyboard. On the other hand, they’re 30% more expensive, so theres that. Obamacare is crashing, so expect to have single-payer health care in the next four years.

This week’s podcast is up on the Podcast page.

First shot in a successful Constitutional war against ObamaCare?

We can only hope so … but then, one should remember that John Roberts sold his soul and his intellectual reputation to make payment for it into a tax.  So we shall see.  But some heartening news today if you’re someone who believes those in government should be held to the Constitution’s restrictions on government.

In a major ruling, Judge Rosemary Collyer, an appointee of President George W. Bush, said the administration does not have the power to spend money on “cost sharing reduction payments” to insurers without an appropriation from Congress.

Collyer’s decision doesn’t immediately go into effect, however, so that the administration can appeal it.

“This is an historic win for the Constitution and the American people,” Speaker Paul Ryan (R-Wis.) said in a statement. “The court ruled that the administration overreached by spending taxpayer money without approval from the people’s representatives.”
At issue are billions of dollars paid to insurance companies participating in ObamaCare so they can reduce customers’ out-of-pocket costs, such as deductibles for low-income people.

The House GOP argued that the administration was unconstitutionally spending money on these payments without Congress’s approval.

Of course that’s an almost daily occurrence for the past few decades.  The lines have blurred and no one is held accountable. Oversight? What a joke.

How far this will go and whether the decision will be upheld is a mystery at this point, but not much of one … see again the first sentence.

The administration, of course, had an answer:

But the administration said it did not need an appropriation from Congress because the funds were already guaranteed by the healthcare reform law in the same section as its better-known tax credits that help people pay for coverage.

Yup, the executive needs no permission to spend your money anymore, just as he or she no longer needs permission to wage war.  Blurred lines becoming even blurrier.  Separation of powers?  Get real.

Imperial presidency?  For quite a while.  The Judge, though, wasn’t buying the explanation:

Collyer ruled that the section only appropriated funds for tax credits and said the cost sharing reductions require a separate congressional appropriation, which the administration does not currently have.

“Such an appropriation cannot be inferred,” Collyer wrote. “None of Secretaries’ extra-textual arguments — whether based on economics, ‘unintended’ results, or legislative history — is persuasive. The Court will enter judgment in favor of the House of Representatives and enjoin the use of unappropriated monies to fund reimbursements due to insurers under Section 1402.”

Good for her. It won’t dismantle the dreadful system, but it does take another chink out of its funding. It’s a start.  But whether the start will later faulter and fail to be upheld is still to be seen.  In today’s world, unfortunately, the likelihood of that sort of a failure is much more prevalent than had this ruling come down 40 or 50 years ago when most people still believed in a much more limited government constrained by the Constitution.

Brave new world … one that promises to be much like the old and oppressive world if some have their way.

~McQ

When government interferes in a market, results are predictable

And it is neck deep in health care.  So, with the passage of ObamaCare, what is the state of medicine?

Oh, just great:

The doctor is disappearing in America.

And by most projections, it’s only going to get worse — the U.S. could lose as many as 1 million doctors by 2025, according to a Association of American Medical Colleges report.

Primary-care physicians will account for as much as one-third of that shortage, meaning the doctor you likely interact with most often is also becoming much more difficult to see.

Now, 2025 is 9 years away and, the “primary-care physician” is the star of ObamaCare because he or she is the “gatekeeper”.  However, which doctor is the worst compensated of all doctors?

Why the gatekeeper of course.  And, that’s by design.  Government design:

Starting salaries in high-paying specialties can range from $354,000 (general surgery) to $488,000 (orthopedic surgery), while primary-care fields tend to bring a sub-$200,000 starting salary, from$188,000 (pediatrics) to $199,000 (family medicine), according to a Merritt Hawkins report.

Why?

The pay disparities reflect America’s “fee for service” health-care model, which compensates providers based on the number and type of services they complete, and which inherently favors specialists.

Anyone know what entity pushes the “fee for service” model?  Can you say “Medicare”?  And yes, the insurance companies follow their lead. Hence, we have doctors in the primary care field looking at specializing because as gatekeepers, they are mostly the chief “referrer” to the other medical specialties … the ones that get paid more.

Wow … what a surprise then that the field of primary care is looking at a future shortage.  It’s another one of those “human nature” things that central planners simply can’t wrap their brains around.

Then there’s the exacerbation of the problem by ObamaCare:

The shortage is one that’s been stewing for decades but of late was exacerbated by passage of the Affordable Care Act, which increased the number of insured people and along with that the demand for doctor access, experts say.

As we’ve mentioned countless times, having insurance does not equal having care.  And as the number of gatekeepers dwindles, that problem will become even more acute.

Of course everyone knows what the answer that will be put forth by our political leaders don’t they?  Why of course more government.  You know, like the UK, where the former head of the NHS just died because the operation she needed was postponed 4 times.

~McQ

News you might otherwise miss

Because, you know, the current political circus has sucked all the air out of the coverage of anything else … or maybe it has distracted everyone so much they aren’t paying attention. But this story is one that is and has been inevitable since the debacle of Obamacare was passed and instituted:

Federal health officials are seeking to deny medical reimbursements to doctors and hospitals that have served patients insured by failed Obamacare health insurance co-ops, according to a Daily Caller News Foundation investigation.

Instead, the Centers for Medicare and Medicaid Services (CMS) are insisting it, not medical providers, has the first right to any remaining funds as 12 of the 24 co-ops go through the liquidation process.

A legal showdown is expected over who pays for the co-op debacle that to date has lost at least $1.4 billion in federal solvency loans. The failures have forced the cancellation of health insurance policies for at least 800,000 customers.

The confrontation now pits medical providers against CMS bureaucrats who claim the federal government should be first in line to get any leftover funds.

The government’s plan has failed, those who trusted the government to implement it properly so they’d be reimbursed have been stiffed, and who is it trying to muscle their way to the front of the line for any money available?  Why the same institution that set up this enormous scam, of course.

That’s what you get when you pass laws no one has read with policies written for and by bureaucrats and special interests, and haven’t a clue as to how any of it will work in the real world.  And no one should forget, this is all on the Democrats, who wrote it, passed it and signed it into law. Every bit of it.

And now, the institution that brought about all this failure is putting those it is supposed to serve at the back of the line for reimbursement.  Of course we’ve seen this before, haven’t we? Think GM bankruptcy and bailout.  Yeah, creditors … back of the line.

Mandy Cohen, CMS’s chief operating officer, was the first Obama administration official to assert the federal government would preempt reimbursements to local or state medical providers. She did so during a Feb. 25, 2016, House oversight subcommittee hearing on health care.

“For federal loans, there is an order of repayment,” Cohen said. “I believe we are at the very top of all of the creditors.”

Well, except for a little thing like the Supreme Court saying the opposite:

Cohen’s testimony also puts CMS on the record as ignoring a 1993 U.S. Supreme Court verdict that held the federal government is next-to-last in line for payment in insurance cases and policyholders are first. Cohen claimed the Justice Department will enforce the CMS policy.

Same bullying government, same guy (and party) in charge.  And of course the Justice Department will enforce “CMS policy” even if “CMS policy” is contrary to the law, because, the law is selectively enforceable under this administration, isn’t it?

~McQ

Obama? He’s just too smart for us on the right!

Or at least that’s the thesis of one Allen Clifton.

Which brings me to President Obama. While I’m not calling him a genius, I do think he’s extremely intelligent. I also believe that his tendency to use “big picture” thinking while drafting policy is something most Republican voters simply can’t understand.

Now understand it this comes from orthodoxy central, aka a site called “Forward Progressives”.  And this is apparently considered “forward thinking”.  We just are too stupid to get it.

He uses Obamacare as an example of us not getting it:

While many Republicans want to look at the “now” aspect of the Affordable Care Act, they seem unable to grasp the reality that as more Americans get health insurance, giving them access to preventable care, this lowers expenses down the road for everyone. If people can prevent very costly heart attacks, strokes or other debilitating health issues now, that’s an overall savings for practically everyone from consumers to health insurers to doctors who now have more patients. Quite literally, improving the overall health of Americans will improve the health of this country. It even makes sense for our economy. If workers are healthier, because they have access to quality health care, that means there will be fewer people calling in sick to work, showing up sick to work (putting other employees at risk) or relying on government programs because their health conditions (that were preventable) render them unable to work at all.

But to see all of that requires “big picture” thinking and Republicans seem unable to understand anything beyond the spoon-fed bumper sticker talking points they’re given by the GOP and the conservative media.

We could spend 5,000 words and countless hours expounding on how clueless this is.  Health care doesn’t get less expensive if you “subsidize” it by penalizing those who work and earn by making them pay for those who don’t.  Period.  Wealth is something earned by individuals, not governments.  When government’s take other’s wealth to pay for government priorities, it leaves less for the individual who earned it to spend on their priorities.  This isn’t a hard concept to grasp, but seems beyond Mr. Clifton and our brilliant president.  While all the pie in the sky BS about a healthier American work force sounds wonderful, for the most part it isn’t the workforce that’s benefiting from this subsidy.  So while you may want to see this as a “far reaching” plus, it isn’t.  There are certainly ways to approach the lack of insurance, but this isn’t one of them.

Mr. Clifton then doubles down on his ignorance of economies with this “Underpants Gnomes” paragraph:

Minimum wage is another issue you see this with. Republicans constantly paint it as a “job killer” (it’s not) while also rallying against the millions of people who are on government assistance. Funny thing though, a good portion of the Americans who are on government assistance have jobs. If we made sure that no American working full-time had to rely on government programs just to survive, instantly we would save our country hundreds of billions of dollars over the years. Not only that, but when Americans have more money, they have more to spend. And what’s the biggest driver of economic growth? Consumer spending. More consumer spending means higher profits and higher demand, which means – more jobs.

But once again, when it comes to Republicans and explaining job creation, anything outside of “tax cuts create jobs” is often too complex for many of them to understand.

So, where again does the money come from to pay that $15 minimum wage?  The earnings of the business.  And what will a business have to do if it has to pay that wage?  Well it has some choices – raise prices, lay off workers, go out of business, etc.

Would someone have more money to spend?  Yes, if they weren’t laid off or their business didn’t close their doors.

And how big of a jump in spending money would they have?  Well initially a bit.  But then prices would adjust, because, you see, as the price of labor goes up, so do the prices of commodities and goods.  In other words, if they still have a job and they’re earning $15 an hour, fairly quickly prices will catch up with their gain and their purchasing power will be about the same as they previously enjoyed.  Meanwhile, businesses who can keep the doors open are raising prices and laying off workers, or considering automation as a replacement for workers.

Apparently this too is beyond the grasp of Mr. Clinton and the brilliant president.  Half the story, in both cases, is where Clifton stops.  And this is considered just freaking brilliant by the boob.

And you wonder why the left lives in a fantasy world?  This isn’t rocket science nor is there a dearth of examples proving these points.  They are everywhere, throughout history.  Look them up?  Oh, hell no … let’s continue to live in our fantasy orthodoxy and call everyone else stupid.

See climate change for further proof of this nonsense.

~McQ

 

As predictable as the sun rising in the east, Obamacare is failing

Forget the Supreme Court ruling that may gut it, the program is failing all on its own as it is unable to keep or deliver on any of its promises.  Include with that the financial disaster it has become and you have the perfect vehicle for defining “a failure”:

ObamaCare’s supporters would like everyone to believe that with Healthcare.gov now functioning, everything is just fine and dandy. Contrary to what the conservative press (which I guess would include me) has been saying about the many problems of ObamaCare, Vox‘s Ezra Klein declared last September that “in the real world, it’s working.” In February, his fellow Voxland inhabitant Sarah Kliff rattled off eight ways in which the law had proved its critics wrong.

But has it? Not really.

For starters, the exchanges have enrolled about 3 million fewer people than the Congressional Budget Office projected in 2010. And far fewer of the enrollees are from the ranks of the uninsured than hoped. Medicaid enrollment is lower too, for the simple reason that states refused to expand the program.

Ezra Klein hasn’t visited the “real world” in years (Dale and I asked him once if he’d visited a VA hospital after he waxed enthusiastic about how good the VA was. Of course, he hadn’t).  And, as expected, the government’s predictions, which were used to justify Obamacare, were woefully wrong.  No surprise to some of us.

Two:

The core of President Obama’s sales pitch to America was that the program, which he called the Affordable Care Act, would “bend the health care cost curve” and save an average family $2,500 on their premiums each year. How would it accomplish this feat? Essentially, he said, by forcing uninsured “free loaders” who show up in the emergency room to obtain free care to either buy (subsidized) coverage on the insurance exchange or sign up for the expanded Medicaid program. The point was that if they had coverage, they’d get cheaper care sooner in a doctor’s office rather than more expensive care later in a hospital emergency room.

Things don’t seem to be working out that way. ObamaCare is indeed bending the cost curve — but up, not down.

In fact ER visits are up under Obamacare, not down (another supposed justification for the law).  As for rates?  They continue to go through the roof:

Every year, companies selling coverage through ObamaCare’s exchanges have to ask state regulators to approve their premiums for the following year — a practice more appropriate for the Soviet Union than an allegedly free-market economy. And this year, according to several news reports, some are requesting increases of over 50 percent.

In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6 percent in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3 percent increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4 percent across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25 percent.

Some states are even higher.

The reason is called “economics”.  It is a fairly simple concept to grasp.  When you subsidize millions who don’t pay full price or any at all with the money those who do pay full price pay, the cost curve for those paying has nowhere to go but up.  Surprise, that’s precisely what is happening, despite promises to the contrary (which we here knew were full of hot air when they were first uttered).

And there are more hikes on the horizon:

What’s more, these hikes are likely just a prelude to far bigger ones in future years. Why? Because two programs — risk corridor and reinsurance — that were meant to “stabilize” rates in ObamaCare’s first few years so that insurers could obtain the right mix of enrollees are set to expire next year. (The risk corridor program slaps a fee on insurance companies that have lower-than-expected medical losses, and compensates those that have more. The reinsurance program imposes a fee on insurance policies and funnels it to insurers with high-risk individuals.) With these programs gone, the challenge of maintaining a balanced risk pool will become even harder.

The expanded Medicaid program is no picture of robust health, either. It has produced no cost-saving decline in emergency room visits, nor has it contributed to hospital profitability, as was hoped.

What a freakin’ mess.  So?

So, to recap: ObamaCare has fallen short of its enrollment target, hiked insurance premiums, failed to cut down on ER visits, and flopped in its attempt to improve hospitals’ bottom line.

But its real problem is the lawsuit? Maybe treatment for delusions is covered under ObamaCare!

Hey, like I said, some people think the VA system is the cat’s meow.  There is no hope for them.

~McQ

ObamaCare – the numbers are in

“It’ll save the average family $2,500 a year!”  That was the promise.  Here’s the reality:

… It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.

… The numbers are daunting: It will take $1.993 trillion, a number that looks like $1,993,000,000,000, to provide insurance subsidies to poor and middle-class Americans, and to pay for a massive expansion of Medicaid and CHIP (Children’s Health Insurance Program) costs.

Offsetting that massive outlay will be $643 billion in new taxes, penalties and fees related to the Obamacare law. …

Enjoy!

~McQ

This and that

As you’ve probably surmised, I’m taking a bit of a break the last two weeks of the year.  Decompress, catch up on other things and generally relax.  That said, I was happy to see that Erb and the anti-Erb have managed to provide the best in entertainment for the QandO faithful.

Looks like the anti-police riots and ambushes are reaching their natural end.  That’s what happens when you overreach.  I’m not at all implying that some protest isn’t necessary or warranted.  But when it goes beyond that to murder, well, then you’re likely to lose any sympathetic audience you might of had prior to that.  And that’s pretty much what has happened.

I’m also finding if pretty interesting to watch de Blassio sink in his own man-made rhetorical swamp.  Great choice, NYC.  Now live with it.

Of course we’re having to live with the choice of enough of America’s voters that we’re into year 6 of the 8 year nightmare presidency.  And what do we have on the horizon?  More of the same.  A Bush/Clinton run?  If so, we’re worse off than I think.  No more of either family … please!

As for Elizabeth Warren?  Yeah, let’s again go for a junior Senator who has never run anything or done anything except claim minority status to get a good paying gig in academia that certainly didn’t tax her “work ethic”.  Let’s again let some smooth talking “populist” promise us the moon and deliver Ecuador.  And, yes, I’m talking to the press.

The GOP?  Name someone with a chance for a nomination and you’ll likely name someone I wouldn’t want anywhere near the Oval Office.

Then there is the GOP Congress.  It appears Obama is saying he will have a new use for his pen these last two year – the veto pen.  I say that’s good news.  Here’s a chance for the GOP and Congress to use an opportunity to drop the onus for being obstructionist on the President.  If they have the plums to do that.  By the way the “obstructionists” in the past wasn’t the GOP but Harry Reid who wouldn’t bring passed House legislation to a vote in the Senate (not that the press ever caught on) – that problem, theoretically, no longer exists).  Do I have any faith the Congressional GOP will inundate the President with legislation he will have to sign or veto?  No.  None.  Recent history gives me no warm and fuzzy about that – especially while McCain and Graham are still in the Senate.  Look for McCain and his lapdog Graham to again resurrect the “Maverick” brand and spend as much time as Reid screwing up any plans the Senatorial GOP might have to push legislation to Obama’s desk.

Oh …. guess what the NY Times has discovered?  There may not be enough doctors to cover any expanded insurance rolls … especially Medicaid.  Why?  Well for one thing, there are a finite number of doctors that can see a finite number of patients and having insurance hasn’t changed that fact one bit.  But, what is a determiner in who may or may not get to see a doctor is how much that doctor gets reimbursed for his/her work.  And Medicaid is cutting that amount by about 43%.  That means doctors will likely opt out of seeing Medicaid patients (or at least new ones).  In essence then, not much changes in the real world despite the utopian plans of our betters.  While more may have insurance, emergency rooms will be the “primary care” unit for most and “preventive care”, a supposed goal of this abomination we call ObamaCare, is still a fantasy without realization.  Funny how ignoring immutable facts (number of doctors and how humans respond to incentive or lack thereof) always ends up with predictable results.

Bah … enough.  I’m supposed to be taking a break.

See you next year.  In the meantime, happy New Year!

~McQ

 

 

 

If anyone else did this, it would be prosecuted as “FRAUD”!

Actually, the “American voter” wasn’t as stupid, as Jonathan Gruber claimed, because, as he admits numerous times, they had to resort to outright fraud to get the ACA past those voters.  Brian Faughnan summarizes:

So Gruber is previously on the record saying Obamacare subsidies are available ONLY in states that set up exchanges – not in all states. He has also said the law was sold in a deceptive way to fool stupid voters. Now we see him claim that the Affordable Care Act was actually a way to get rid of employer-provided health care, but it had to be done secretly so the American people would go along with it:

“It turns out politically it’s really hard to get rid of,” Gruber said. “And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people when we all know it’s a tax on people who hold those insurance plans…

Gruber explains that by drafting the bill this way, they were able to pass something that would initially only impact some employer plans though it would eventually hit almost every employer plan. And by that time, those who object to the tax will be obligated to figure out how to come up with the money that repealing the tax will take from the treasury, or risk significantly adding to the national debt.

“What that means is the tax that starts out hitting only 8% of the insurance plans essentially amounts over the next 20 years essentially getting rid of the exclusion for employer sponsored plans,” Gruber said.

But to these ethically crippled jerks, it’s not fraud, it’s “clever(ness)”:

A video that surfaced this week shows Gruber telling a Rhode Island audience in 2012 how the feds will collect a tax on high-end policies without families realizing they’re actually paying the tax via insurers: “(I)t’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter.”

Basic “exploitation” – comforting to know that your government actually and purposely was deceitful with the aim of  fooling the public into accepting something the law wasn’t.  Name a fraudster anywhere who doesn’t think he’s “clever”.

Now tell me — what do we usually call such attempts?

FRAUD.

And what do we do with those who attempt to defraud the public?

We put them in jail.

But, you know, that would be “accountability”.

We apparently don’t do “accountability” in the US.  So fraudsters are free to brag about how they did what they did without worrying about facing any consequences.

And the left – well, here’s what they’re worried about:

Former White House press secretary Jay Carney told CNN that Gruber’s remarks in general were “very harmful politically to the president.”

~McQ

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