Free Markets, Free People

ObamaCare

A doctor’s lament will become a patient’s nightmare

Thought you’d like to see this letter to a Congressman from a doctor in Decatur, AL.  He outlines the problems that ObamaCare has put on that profession and correctly identifies what is going on as a “war on doctors”.  The obvious losers in all of this will eventually be the patients, both current and future as the government further pushes itself between doctors and their patients.  It will also provide a disincentive to those who might possibly be entertaining entering the health care field as doctors in the future.

This has nothing to do with markets and voluntary exchange.  This is about government intrusiveness, regulatory overkill and rampant bureaucracy in action:

Dear Congressman Brooks,

As a practicing family physician, I plead for help against what I can best characterize as Washington’s war against doctors.

The medical profession has never before remotely approached today’s stress, work hours, wasted costs, decreased efficiency, and declining ability to focus on patient care.

In our community alone, at least 6 doctors have left patient care for administrative positions, to start a concierge practice, or retire altogether.

Doctors are smothered by destructive regulations that add costs, raise our overhead and ‘gum up the works,’ making patient treatment slower and less efficient, thus forcing doctors to focus on things other than patient care and reduce the number of patients we can help each day.

I spend more time at work than at any time in my 27 years of practice and more of that time is spent on administrative tasks and entering useless data into a computer rather than helping sick patients.

Doctors have been forced by ill-informed bureaucrats to implement electronic medical records (“EMR”) that, in our four doctor practice, costs well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.

Washington’s electronic medical records requirement makes our medical practice much slower and less efficient, forcing our doctors to treat fewer patients per day than we did before the EMR mandate.

To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give.

In addition to the electronic medical records burden, we face a mandate to use the ICD-10 coding system, a new set of reimbursement diagnosis codes.

The current ICD-9 coding system uses roughly 13,000 codes. The new ICD-10 coding system uses a staggering 70,000 new and completely different codes, thus dramatically slowing doctors down due to the unnecessary complexity and sheer numbers of codes that must be learned.

The cost of this new ICD-10 coding system for our small practice is roughly $80,000, again driving up health care costs without one iota of improvement in health care quality.

Finally, doctors face nonpayment by patients with ObamaCare. These patients may or may not be paying their premiums and we have no way of verifying this. No business can operate with that much uncertainty.

On behalf of the medical profession, I ask that Washington stop the implementation of the ICD-10 coding system, repeal the Affordable Care Act, and replace it with a better law written with the input of real doctors who will actually treat patients covered by it.

America has enjoyed the best health care the world has ever known. That health care is in jeopardy because physicians cannot survive Washington’s ‘war on doctors’ without relief.

Eventually the problems for doctors will become problems for patients, and we are all patients at some point.

Sincerely yours,

Dr. Marlin Gill of Decatur, Alabama

This is the face of government run healthcare.

~McQ

Imperial White House cancels Medicare Advantage cuts to help Dems in mid-terms

The White House has once again bowed to screaming Democrats worried about the mid-term elections and this time cancelled cuts to Medicare Advantage. As you recall, these cuts were made to pay for ObamaCare:

The Obama administration announced Monday that planned cuts to Medicare Advantage would not go through as anticipated amid election-year opposition from congressional Democrats.

The cuts would have reduced benefits that seniors receive from health plans in the program, which is intended as an alternative to Medicare.

Under cuts planned by the administration, insurers offering the plans were to see their federal payments reduced by 1.9 percent, which likely would have necessitated cuts for customers.
Instead, the administration said the federal payments to insurers will increase next year by .40 percent.

The healthcare law included $200 billion in cuts to Medicare Advantage over 10 years, in part to pay for ObamaCare.

The Centers for Medicaid and Medicare Services (CMS) said that the cuts weren’t necessary because of an “an increase in healthy beneficiaries under Medicare.” That, of course, makes little sense. Medicare is a mandatory insurance program for people 65 and older. How that demographic suddenly got “healthier” remains a mystery, but there you have the “reason” for the decision. Well, that and mid-term elections.

As for cost, someone needs to explain how ObamaCare is to be funded if the mechanisms set in place to pay for it keep getting delayed or cancelled.

When CBO analysts most recently looked at the gross cost of expanding Medicaid and giving subsidies to individuals to purchase insurance through the new exchanges — the bulk of the law’s spending — they came up with slightly more than $2 trillion for 2015 through 2024.

After deducting some offsets from the law — such as penalty payments from employers and individuals due to insurance mandates — CBO estimated the net cost at nearly $1.5 trillion.

The CBO hasn’t done a standalone deficit analysis on Obamacare since 2012, but at that time, its analysts estimated the law would reduce deficits by $109 billion, once all tax increases, cuts to Medicare and other savings are taken into account.

When referring to the “cost” of Obamacare, the fair thing to do is cite the $2 trillion figure — and no, that isn’t just because it’s a higher number. The gross figure represents how much the federal government will have to spend on expanding coverage through Obamacare, at least according to the CBO. If the government weren’t spending $2 trillion on insurance coverage, that’s money that could be going to reducing the deficit, spending more on infrastructure or a host of other theoretical policies.

As mentioned above, that $2 trillion cost had about $500 billion in offsets. But the penalty payments from employers and individuals has been delayed and now the $200 billion in Medicare Advantage cuts/offsets is cancelled, or so says the imperial presidency. That, of course, doesn’t change the cost, it only increases it.

Short term political pandering aimed at winning elections as usual from this administration. Ironically, it has been more effective than the Republicans in dismantling portions of the atrocity known as ObamaCare. So, thanks to the mid-terms, Republicans get one of the cuts they wanted reversed cancelled. Of course they won’t get credit for it – but then that’s the plan isn’t it?

And, this is all likely temporary anyway, even though the White House and Dems won’t spin it as so:

“The changes CMS included in the final rate notice will help mitigate the impact on seniors, but the Medicare Advantage program is still facing a reduction in payment rates next year on top of the 6 percent cut to payments in 2014,” said [AHIP] president Karen Ignagni.

But it will get them through the election cycle, won’t it?

~McQ

Observations: The QandO Podcast for 06 Apr 14

This week, Michael and Dale talk about Brendan Eich and Obamacare.

The podcast can be found on Stitcher here. Please remember the feed may take a couple of hours to update after this is first posted.

As a reminder, if you are an iTunes user, don’t forget to subscribe to the QandO podcast, Observations, through iTunes. For those of you who don’t have iTunes, you can subscribe at Stitcher. And, of course, for you newsreader subscriber types, our podcast RSS Feed is here.

Another reason you should never believe a thing this administration says

Because, as we’ve learned over the years, it’s likely either spin, just not true or both.

For instance, we have the President claiming victory for ObamaCare because it has 7.1 million enrollments.  Note the word – “enrollments”:

‘The goal we’ve set for ourselves – that no American should go without the health care they need … is achievable,’ Obama declared.

The president took no questions from reporters, but celebrated the end of a rocky six-month open-enrollment period by taking pot shots at Republicans who have opposed the law from the beginning as a government-run seizure of one-seventh of the U.S. economy.

‘The debate over repealing this law is over,’ he insisted. ‘The Affordable Care Act is here to stay.’

And, as is usual with this man, he simply declared he’d won and simply threw out “facts” that haven’t at all proven true. Essentially lies in a bigger lie:

‘“The bottom line is this,’ said Obama: ‘The share of Americans with insurance is up, and the growth in the cost of insurance is down. There’s no good reason to go back.’

Of course the “share of Americans” with insurance isn’t up (over 7 million lost their insurance when their plans didn’t qualify under ObamaCare) and costs are certainly not “down”.

Jay “Baghdad Bob” Carney took it from there (Carney is a perfect name for the position, he’s like a carnival barker):

‘At midnight last night we surpassed everyone’s expectations,’ he boasted, ‘at least everyone in this room.’

While he took great pains to emphasize that the total would grow – saying ‘we’re still waiting on data from state exchanges’ – he dodged tough questions about other statistics that reporters thought he should have had at the ready.

Those numbers included how many Americans have paid for their insurance policies, and are actually insured. Also, he had no answer to the thorny question of how few signups represented people who had no insurance before the Affordable Care Act took effect.

But as usual, when ever they drop something like this in a news cycle, the devil is in the details.  For instance, an unpublished RAND study that suggests that relatively speaking, very few of the enrollees were previously uninsured:

The unpublished RAND study – only the Los Angeles Times has seen it – found that just 23 per cent of new enrollees had no insurance before signing up.

And of those newly insured Americans, just 53 per cent have paid their first month’s premiums.

If those numbers hold, the actual net gain of paid policies among Americans who lacked medical insurance in the pre-Obamacare days would be just 858,298.

So effectively, assuming the numbers are correct, less than a million are newly insured.  And, as we’ve read in the past, most of them are Medicaid subscribers.

In other words, we’ve gone through all this hell, all this disruption, the higher costs, the lesser insurance plans, the IRS enforcement, etc. just to enroll 858,298 people – most of whom have ended up on a program that existed prior to this atrocity.

Perhaps the biggest laugh line of all, however, comes from David Axelrod, who declared that ObamaCare was totally going to change “the attitude that government can’t do anything“.  Of course he only felt comfortable saying that on MSNBC.  One can certainly understand why.

Meanwhile, for the most part, the RAND study goes unpublished and, for the most part, unexamined.  The King has declared victory – the big lie has been established – debate over.

~McQ

Observations: The QandO Podcast for 30 Mar 14

This week, Bruce, Michael and Dale talk about arresting climate change deniers, voter fraud, and Obamacare.

The podcast can be found on Stitcher here. Please remember the feed may take a couple of hours to update after this is first posted.

As a reminder, if you are an iTunes user, don’t forget to subscribe to the QandO podcast, Observations, through iTunes. For those of you who don’t have iTunes, you can subscribe at Stitcher. And, of course, for you newsreader subscriber types, our podcast RSS Feed is here.

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

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

I wonder if the GOP will figure this out

I am talking about the establishment GOP – those that think compromise on principle is a good thing if it keeps it all collegial in Congress and the left doesn’t call them bad names.

As the deadline for 2014 enrollment nears, Obamacare is increasingly growing unpopular, especially among the uninsured. A new Kaiser Family Foundation survey finds that about twice as many uninsured people have an unfavorable view of the health-care law than have a favorable one.

Among the uninsured, 47 percent view Obamacare in a negative light versus the 24 percent who view it favorably. That’s a change from 43 percent who viewed it unfavorably last month, and 36 percent who viewed it favorably. Overall, half of Americans view Obamacare unfavorably, while just over one-third have a positive take on the law. ​

More of the uninsured also said Obamacare made them worse off (39 percent) than improved their situation (26 percent), according to the poll.

Got that?  The majority of people find ObamaCare to be a travesty and a plurality of those who are uninsured want nothing to do with it.

Looking for an issue GOP (clue: it’s not caving passing immigration “reform”)?

This mess the Democrats have made is the single issue on whichyou can win.  That’s right, single issue.  This is a subject very near, dear and important to every Americans.  And the Democrats have screwed it up royally. You have no need, in the interim, cave on anything.  There is nothing which requires you to pass legislation that will piss off your base.  None.

Think about it.

Please.

~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