American Elephants


The IRS is So Efficient That We Should Give It Vast New Powers? by The Elephant's Child

The damage done to the nation by this bunch who elevate “winning” in politics above all else, is almost inconceivable. It’s a mindset foreign to most Americans. To win an election, a bureaucracy supposedly acting for the American people in a nonpartisan way, tossed out responsibility, ethics, oaths, decency in order to silence other Americans who only wanted to express their opinions.

They had to be silenced because their opinions differed from those of the administration seeking to be returned to office for another term. That doesn’t work. The IRS is a very large bureaucracy that collects and manages our taxes. A department that depends on a vast amount of trust from the citizens of the country. America has long depended on people voluntarily paying their taxes, and for the most part being honest about it. If the IRS is a corrupt organization, this is a very big deal.

There are vast new powers granted to the IRS as a result of ObamaCare. If Washington’s bureaucrats cannot be trusted, Americans should be concerned. Here are the numbers:

  • There are 18 new taxes in ObamaCare, including 12 that directly violate  Senator Barack Obama’s “firm pledge” that those making under $250,000 a year would see no rise in their taxes.
  • ObamaCare charges the IRS with implementing 47 new provisions, according to the General Accountability Office.
  • The tax if you do not buy “government approved” health insurance is $695 which the IRS will enforce.
  • The IRS will need 1,954 new bureaucrats to manage ObamaCare implementation  and enforcement in the coming fiscal year.
  • The IRS has been charged with improperly seizing 60,000,000 medical records, raising concerns about whether the agency can handle the personal health insurance information all Americans will be required to submit to the IRS.
  • $429,584,000 — The IRS’s request for new spending on ObamaCare implementation in the coming fiscal year. The IRS did not specify how much will go to $30,000 hotel rooms and agency retreats.
  • Americans already devote 6,100,000,000 man hours to tax compliance. A number that will rise significantly with ObamaCare.
  • $1,000,000,000,000 — that’s the new revenue raised by ObamaCare in its first 10 years along according to the Congressional Budget Office, sums that will rise in the future.

Eight arguments for why ObamaCare should be repealed, and defunded.  Under the first list of new taxes, look at it with the incentives in mind.What is it that these taxes encourage people to do? Those who drafted ObamaCare have no understanding of incentives at all. The incentives for doctors are to retire or move to a concierge practice, or find a more rewarding occupation. The incentives for providers are to arrange their practices so they can be adequately paid. The incentives for scientists is to stop the search for new drugs for big problems, for they will be too expensive to be practical. The incentive for improvements in medical equipment is no longer there. What’s the use of developing a miraculous new prosthesis for amputees? This government would not pay for the expense.  What makes expensive new inventions come down in price and be available to all? What makes the cost of medicine go down? The free market — something to which this administration is unalterably opposed. Not fair, you know.

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7 Comments so far
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And so the conservative answer to health insurance reform is what?

I have several questions as a starting point.

1. What are the top five drivers of health care that can be agreed upon with good statistical data?

After all if you are a good business man you will first start with good data, data that has a good population sampling that can be verified.

2. How is the health market different then the product market?

The product market are things like, automobiles, your TV, etc.
We need to understand this so that society can determine what frameworks are needed to ensure an efficient market unless you believe markets are naturally efficient and all players in that market are rational.

One difference is that people do not have leverage in the health market.

If there is one hospital in town how do multiple insurance companies or for that matter one individual have leverage when cost of competitive entry into the market is extremely high?

For example, you cannot use the tried conservative talking point about Lasik surgery for several reasons. First, a person can choose to enter that eye correction market or not and secondly a person has options, contacts or eye glasses. This is not a typical health care market but rather a typical product market.

And of course the old auto insurance analogy is a no brainer for several reasons. First, competitive entry into the auto body shop market is far easier then the health market. Secondly, you have a choice to not get your car fixed and if you do it is not a complicated process of judging price and if the value you receive is sub-standard you are only out of service of your car. (The entry skill level into this market is also significantly lower.)

3. What are you going to do with the free loaders who choose not to purchase health insurance and instead decide to ride the coat tails of us paying insurance?

What do you do when these free loaders have to use services in the health market because their hormones caused them to crash their motorcycle? Do you force a tax collection on them to pay back the services or would that be to tyrannical of the government?

4. How are you going to handle end of life situations?

80% of all Medicare is spent on the last year of a seniors life.

5. How are you going to handle chronic care?

This is by the far the biggest driver of health care. Are you going to service these people in an emergency room where it is more costly and where I end up paying for it through my insurance premium or taxes?

And what about my son who has a costly chronic disease caused by modern industrial society and poor luck of the gene pool? He gets a bi-monthly infusion costing $5000.
I am lucky enough to have a good paying job that did not suffer to during the economic down turn.

Let’s not forget that before Obama care insurance companies had the right to turn down individuals with pre-existing conditions that through the luck of the straw are burdened with a chronic disease.

I appreciate the fact that my son can be on my plan until 27. By that time hopefully us idiotic Americans will get past our personal egos and get this worked out.

I would be more then happy to listen to an alternative to Obama care based on health care market fundamentals but that is not going to happen anytime soon. Why? Because most politicians and the people that support them do not take the time to understand the macro and micro economics of the health care market. Most people have taken econ 101 and believe they have it figured out or they choose to self-indoctrinate themselves with the pied pipers of talk radio or cable news.

Comment by Mark Baird

Not a well-thought-out bunch of questions. I’ll try to respond. Are you aware that before the Democrats embarked on ObamaCare the cost of health care was going down steadily? That is a fact. New medicines — Lipitor for example, have made a big difference. New diagnostic tools, new treatments.

Are you aware that Obama claimed that the reason for reform was the 30 million people who had no insurance, and that the CBO estimates that after ObamaCare goes fully into effect there will still be at least 30 million people without insurance.
The assumption was that most of the people who went to the emergency room for treatment were those with no insurance, and having insurance would fix that. Not true. Massachusetts, for example found that emergency room use climbed. Emergency room doctors say that most of the people who use the emergency room have insurance. When generous insurance will pay for it, the incentive is to go for care with even the slightest complaint. I have a son who was accident prone — broken bones, appendicitis, a collapsed lung. Every time we went to the emergency room there was someone in the next bed with a rash, ringworm, complaints that could easily be solved at the drug store.

The major problems with health care — pre-ObamaCare, were largely due to government interference in the health care market. Health care is very heavily regulated, and the best people to make decisions about medicine are not a bunch of bureaucrats in Washington. Everybody thinks ObamaCare means free healthcare. Not so. Obama’s promises of keeping your doctor, won’t cost more, all that are completely false, and were from the beginning. They made a big deal out of high-risk patients, but the high risk patients weren’t interested and haven’t signed up. Before ObamaCare people with chronic conditions could get insurance through high-risk pools. It cost more. Health Insurance premiums are set to double or more. Family policies will go for as much as $20,000 a year. The restaurant industry, for example, would be required to offer insurance to anyone working 30 hours or more a week. They operate on slim margins, and the major part simply cannot afford it so are reducing workers to less than 30 hours. Massive layoffs already. Workers than can are taking two 28 hour jobs without insurance.

Democrats do not understand that people respond to incentives. When health insurance covers everything, people use lots of it, costs go up, not down. Only around 35% of people like ObamaCare, and something like 42% don’t even know that it is the law, let alone what is in it. Everyone is forced to buy insurance or pay a fine. People don’t like ObamaCare and will pay the fine. ObamaCare counts on young healthy people to buy expensive insurance to pay for older, sicker people. What are the incentives there? Young healthy people will pay the fine, and costs will spiral. What ObamaCare does to doctors is appalling. It’s a bunch of bureaucrats deciding how physicians will practice medicine. Doctors are retiring early, last election 45 Doctors ran for Congress. They are smart accomplished people, they can do other things. There are NOT ENOUGH DOCTORS, we are something like 49,000 short of needed doctors now, and that will be 90,000 in short order. Our medical schools cannot handle more doctors to train.

I have been studying and reading about health care since they first started talking about it. You are not asking the right questions. There is a search function just above Bob Hope’s head on the main page. You can just enter ObamaCare and see what comes up. Here are a few headlines: “Health Care for High Risk Patients Attracts few, Costs More” “Do Old People Have a Duty to Die and Get Out of the Way?””The Sad Truth About ObamaCare” “What do Doctors Think of ObamaCare?” “Democrats Don’t Understand the Principle of Insurance””ObamaCare Promises What it Can’t Deliver”

I don’t know anything about your and your family, but this is something you need to get informed about.Read the British papers. They have the world’s worst health care system, free at the point of service, but it keeps killing off the people. Incentives decree little innovation, the expensive medicines will be denied. And when you are old you will not get water or food and lie there in dirty sheets and starve to death. You asked “how are you going to handle end-of-life situations?” They cost more. Isn’t that what medicine is about? To take care of the sick and dying, not just give unnecessary treatments to the young and healthy? The other choice is to decide they’re not worth it and bump them off.

Do your homework.

Comment by The Elephant's Child

Hey, Mark, we’ll make it simple for you. The conservative answer to health insurance reform is exactly the same as it has always been: portability of insurance, opening markets across state lines, and tort reform. There is more to it, but those three things will do for a start.

(btw, your list of questions looks like they came straight from ThinkProgress – they are not designed to solve the problem, but to cloud the issue with irrelevancies)

Comment by Lon Mead

Thanks Lon. Short and concise. I didn’t need to run on so.

Comment by The Elephant's Child

‘salright. Your blog. ;-)

Comment by Lon Mead

Did I mention that I would prefer the British system? I would not. Also, I do not self-indoctrinate myself at ThinkProgress nor cable news or talk radio.

Is what you are telling me is that one side has all the answers and the other does not. Seems to me this is not what the free markets are about or this Democracy. Both the free markets and Democracy are about the power of collaborative diversity, either actively or passively.

My questions are formulated through my local life experiences by reading papers written by people that have spent their lives studying the health care markets, doctors, researchers, non-profits, etc.

To your answers though.

First, I have no problem with portability of insurance. I think it is a good idea.

I am not convinced of the effectiveness of competition across state lines. While you cannot have portability without it, it may reduce the leverage insurance companies have with hospitals systems that continue to consolidate. It is difficult for me to see how this will keep the cost of health care in line with inflation.

While I agree that if people paid more for their health care and if they had information they might make more cost effective decisions. Given that, where is the Republican plan to provide the type of information and competition that will allow people to make better decisions with the health care that they purchase? Do you assume that portability and competition across state lines will solve that problem?

I do have a problem with tort reform as tort reform typically starts to restrict the access to local courts. Tort reform starts to infringe on my seventh amendment rights as I know all second amendment purist will understand. There have already been plenty of reforms that have drastically impacted the seventh. I have experience with that system.

I was willing to give the Republican plan a try if they would have taken the opportunity when they had majorities but they were to stupid to see that opportunity. They did not and now we have “Obama Care”. So I am willing to give that a try.

I am a pragmatic progressive libertarian. I do not have time for Ed Schultz, Lawrence O’Donnel, Stephanie Miller, Sean Hannity, Glen Beck or Rush Limbaugh or any other pied piper of the right or left. I do not have all the answers but..

I do know this though, I may be right but I also know that I could be wrong. Truth and the search for it are important to me and I am capable of handling the nuances in life that come with that search. I also know that uncertainty is something that will never be dispelled and therefore I cannot allow it to paralyze me.

Comment by Mark Baird

Obama’s original Health Care advisers were Ezekiel Emanuel MD; Tom Daschle; Jacob Hacker; Donald Berwick MD, and Peter Orzag. Look them up. All are far left, and passionate admirers of Britain’s National Health Service. All support single-payer government supplied health care, but didn’t think the American people would accept it right away, and would have to be eased into it. Go to the British papers, all have search functions and enter NHS or try Liverpool Pathway: That’s the Daily Mail, Telegraph, Guardian (far left), and Independent, and read up on British Health Care, the worst in the world. It is free at the point of purchase, but expensive in taxes.People are afraid of losing their free health care and so keep voting Labour in. That seems to be the real attraction.

What Republicans wanted was to keep government out of health care. Everything that is wrong with our current health care is a result of government interference.

    There has never been an industry, a business or a product that competition has not improved.

Each state has its own Insurance Commissioner and the rules vary widely. Many states have few insurance companies allowed to operate in their state. Competition across state lines, so you can pick the policy most suited to you, would bring down the prices dramatically. Republicans believe that prices should be posted up front. For Hospitals, competition would kill the practice of charging $20 for an aspirin.If hospitals want to survive, they would have to increase efficiency— that’s what competition does. Ditto tort Reform. Most of the advances in medical equipment come from doctors who figure out a better way to do something. Competition improves that as well. The free market means more innovation whether in procedures,drugs, or equipment.
Here’s a good example of the kind of health care that Republicans promote.

All of the major think tanks have scholars studying health care. A visit to any of their websites can provide lots of information. Heritage Foundation, AEI, NCPA has lots, Reason Foundation, Cato Institute, Hoover Institution, Manhattan Institute, Pacific Research Institute. Your comments seem long on feelings and attitudes, and short on actual information.

Comment by The Elephant's Child




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