American Elephants


Promises, Promises: Obama Doesn’t Understand His Own Bill by The Elephant's Child

On March 23, 2010, President Barack Obama signed into law what he billed as a triumphant reform of America’s health care system. Two days later in a speech at the University of Iowa, the president declared:

From this day forward, all of the cynics, all the naysayers — they’re going to have to confront the reality of what this reform is and what it isn’t. … They’ll see that if Americans like their doctor, they’ll be keeping their doctor. You like your plan? You’ll be keeping your plan. No one is taking that away from you. … It wasn’t Armageddon.”

“If you already have insurance, this reform will make it more secure and more affordable. … Costs will come down for families, and businesses, and the federal government, reducing our deficit by more than $1 trillion over the next two decades. That’s what reform is going to do.”

Last week. President Obama responding to Max Baucus’ comment that ObamaCare was a looming “train wreck,” He claimed it’s all much ado about nothing. “A huge chunk of it’s already been implemented.”

Well, no. All that’s been implemented so far are a mandate to cover children up to the age of 26, and a more generous Medicare drug benefit. Democrats have put off the bulk of the law — the massive market regulations, the government-run exchanges, the mandates to buy coverage and all sorts of taxes and fees — until 2014, both to hide the true cost and to keep the public ignorant before the 2014 election.  Polls have shown that well over 40% of the public don’t know anything about ObamaCare. They probably think it’s free health care.

For the 85% to 90% of Americans who already have health insurance…they don’t have to worry about anything else

The Congressional Budget Office expects 7 million workers to lose their employer coverage because of ObamaCare, and perhaps as many as 20 million. Small businesses now offering coverage face huge rate hikes because of ObamaCare’s regulations and benefit mandates.

“The other stuff’s been implemented and it’s working fine. We’re going to be able to drive down costs…and that will save the country money as a whole over the long term.”

The high risk pools have been a disaster, attracting only a third as many people as predicted while costing far more than was budgeted. HHS had to issue more than 1,200 waivers to companies who said the laws initial insurance market rules would have forced them to cancel coverage for millions of workers. The small business tax credit has also been a bust. Obama’s own number crunchers say ObamaCare will force national health care spending up by at least 7.4% in 2014, and add billions more cost in the next decade.

It was built on lies in the first place, but the reality is turning out to be far worse than even its detractors believed. Seven to twenty million workers will lose their jobs or their jobs will become part-time — less than 30 hours a week. And the cost of their health care will go up dramatically, while they have less money to pay for it.  Forced onto Medicaid? There aren’t enough doctors to go around.



ObamaCare Raises Costs and Kills Jobs. Here’s Proof. by The Elephant's Child

Powerline offers definitive proof that ObamaCare raises costs and kills jobs. A reader of their blog who heads an investment group came across this disclosure in a prospectus issued in connection with the recapitalization of a family oriented restaurant chain. This is clearly not a political statement, it is a legally mandated disclosure to prospective investors, which renders the issuer liable if the disclosure is not true.

It is worth reading the whole thing. It exposes the false claims of the Obama administration fully and completely. Fewer full-time jobs, rising health care costs, and higher restaurant prices. This is what some of you voted for, though I cannot for the life of me understand why.



Are You Ready for ObamaCare Sticker Shock? by The Elephant's Child

obama-pelosi-obamacare

The nice folks who created ObamaCare in some back room in Congress ignored virtually every actuarial principle that governs rational insurance pricing. Consumers will experience another series of price shocks later this year when some see their premiums skyrocket thanks to ObamaCare. Premiums are already reflecting some of their neglect.

One of the central provisions of ObamaCare is the 1). requirement that health insurers accept everyone who applies (guaranteed issue). And 2). cannot charge more based on serious medical conditions and 3). coverage mandates that force insurers to pay for many uncovered medical conditions.

Guaranteed issue gives folks the incentive to forgo buying a policy until they get sick and need coverage, and drop the coverage when they get well. ObamaCare imposes a penalty (a tax?) but it isn’t enough to keep people from gaming the system.

Some actuaries are predicting 50% increases in premiums. Large employer groups will be less affected because the law grandfathers in employers that self-insure.

President Obama repeatedly claimed that health-insurance premiums would be $2,500 lower by the end of his first term, they are actually about $3,000 higher. He also claimed during the fiscal-cliff negotiations, a claim that he kept repeating, that “We don’t have a spending problem.  We have a health-care problem.”

Back in 2009, he was claiming that health-care reform “is no longer just a moral imperative, it’s a fiscal imperative,” and ” one of the best ways—in fact maybe the only way— to reduce those long-term costs.” In March, 2009, in a White House speech kicking off the Affordable Care Act in May of that year, he took notice of “one clear, indisputable fact”, which was that “the explosion in health-care costs has put our federal budget on a disastrous path.” He added that controlling those costs “is essential to reducing budget deficits.

A year later just before the Democrats voted to pass what he called “one of the biggest deficit reduction measures in history.” Obama said “Everybody who’s looked at it says that every single good idea to bend the cost curve and start actually reducing health-care costs are in this bill.” He promised that the conversion to electronic health records would produce $81 billion in savings, and make for greater efficiency. Nope. Didn’t happen. There is increasing concern that the switch has actually added to costs.

One dirty little secret was that the health care industry was already controlling costs before the Democrat push for ObamaCare took off. The new diagnostic machinery was hugely expensive, but improved outcomes. New drugs, made affordable for the elderly, prevented more serious disease. Health savings accounts combined high-deductible insurance policies with a tax-free health spending account that rolls over at the end of the year. Democrats killed the incentives in the drug plan, making it cost more, and  ObamaCare declared war on that cost control effort by capping deductibles at $2,000 and making it harder to offer the savings accounts. ObamaCare’s ever-increasing list of benefit mandates will drive up costs.

Doctors take an oath to “first do no harm.” Obama adviser Ezekiel Emanuel has declared that doctors pay way too much attention to their oath.



ObamaCare Promises What It Cannot Deliver. by The Elephant's Child

The biggest problem with ObamaCare has always been the possibility that it would be implemented. The bill is so poorly conceived, so poorly written, that it is bound to be a disaster. What will happen when it is actually fully implemented remains to be seen, but everything the government itself was supposed to do has failed. Everything. Failed completely.

  • The CLASS Act: A pathetic attempt to create long-term care insurance was dumped by the administration after it became clear that it was impossible to do.
  • The 1099 provision: Was absurd. It required businesses to issue a 1099 form to any vendor from whom they purchased $600 of goods or services in a year. It was repealed after Business owners explained what an impossible burden it was.
  • Federal high risk pools: Created and funded, but nobody enrolled. Cost too much and was too complex.
  • Retiree health Subsidies: Large corporations and unions were happy to accept free money for what they were doing anyway (providing health benefits to retirees) but the money ran out in a third of the time expected.
  • CO-OPs: Congress put so many restrictions on what was supposed to be a non-profit health plan in each state that none have come into being despite billions being spent.
  • Small employer tax credits: The complexity and confusion of these credits meant than only a handful of companies applied.
  • Medical Loss Ratios:The MLR Requirements had the predictable effect of discouraging innovation and higher-deductible or “mini-med” health plans.
  • Medicaid expansions: The Supreme Court made these expansions voluntary for the states and it looks like fewer than half will do it.
  • Health IT: The HITECH bill was enacted separately from ObamaCare, and billion have been spent, but reports from the field indicate that the top-down efforts result in lower quality and less efficiency.
  • Limits on FSA funding: The families most disadvantaged by the new $2,500 limit on FSA funding are those with special needs children.
  • Limits on the Medical Expense Deduction: Beginning in 2013, a taxpayer will be able to deduct only those medical expenses that exceed 10% of income, up from the current 7.5%. Those most hurt will be the most medically needy families.

The screw-ups have been such a mess that Kathleen Sebelius has issued thousands of waivers issued to selected companies and unions. There were no qualifying standards for who got a waiver for what. All up to the kind of day Ms. Sebelius was having, I guess.

ObamaCare promises what it cannot deliver. The theory was that giving people health insurance would mean that they could get medical care that the uninsured are not now getting. There are not enough doctors, nurses and hospital personnel, in thousands.  The medical professions have become less desirable, large numbers of doctors say they will retire early, or just quit.

ObamaCare does not pay for itself. There is a huge increase in the demand for care, but no increase in supply. Since people will not be able to find doctors, emergency room use will skyrocket. Democrats lied about the cost, but it is far worse than the worst predictions.

ObamaCare mandates and subsidies will destabilize large sections of the economy. Already happening, as most major national restaurants are switching their employees to part-time to avoid having to pay for insurance that they cannot afford.

The incentives are all wrong. Insurers must charge the same premium regardless of expected costs. All plans will have the incentive to attract the healthy and avoid the sick. The incentive for providers becomes getting adequately paid. The incentive for insurers or government is cutting costs.

The individual mandate: If weakly enforced, people will have an incentive to stay uninsured when healthy, enroll after they get sick, then drop coverage when well again. If strongly enforced, it will strain every family budget. There is nothing in ObamaCare that will make medicine or insurance cheaper.

These problems are entirely inherent in the legislation itself, as it was devised.



What Do Doctors Think of ObamaCare? by The Elephant's Child
September 30, 2012, 11:16 pm
Filed under: Election 2012, Health Care, Law, Politics, Progressivism, Taxes | Tags: , ,

Dr, Jill Vecchio, speaking to an Americans for Prosperity rally

From a new report by the Physicians Foundation:

— 52% of physicians have already limited the access of Medicare patients to their practices or are planning to do so.

— 26% have already closed their practices to Medicaid patients.

— More than 50% of physicians will cut back on patients seen, will switch to part-time, switch to concierge medicine, or retire within the next four years.

— 62% believe Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs.

— 59% say PPACA has made them less positive about the future of healthcare in America.

— 57.9% would not recommend medicine as a career to their children or other young people.

— Over one-third of physicians would not choose medicine if they had their careers to do over.

— 77% percent are somewhat pessimistic or very pessimistic about the future of the medical profession.

ADDENDUM: Did anyone think that ObamaCare was going to save us money? Aside from the 158 new departments, bureaus, agencies and offices?  The Tax Foundation has estimated that compliance with ObamaCare is estimated at eight million man-hours.  It will keep 40,000 workers busy doing paperwork and sorting through a confusing pile of government regulations. And Obama claims that regulation is not a problem— just that Republicans are trying to de-regulate Wall Street so they can do it all over again. (No explanation of what he thinks “it” is.)



ObamaCare Is Already A Flop, And It Hasn’t Even Begun. by The Elephant's Child

Hundreds of thousands of American physicians and thousands of hospitals that fail to buy and install costly health-care information technologies by the deadline in just two years, will face penalties through reduced Medicare and Medicaid payments. Prescription records and patient histories will be required to be entered.

This mandate was part of the 2009 Stimulus legislation, and a major goal of health-care IT lobbyists and their allies in Congress and the White House.  Getting it all computerized so anyone could access the records would make medical administration ever so much more efficient, and lower medical costs by up to $100 billion annually.  Doctors have been obediently computerizing, but you will not be surprised that a new study indicates that physician reluctance was justified. The savings are just another myth of ObamaCare.

Since 2009, almost a third of health providers have installed at least some health IT technology. For a major hospital, the full range can cost $150 million to $200 million. But the software is generally not friendly to the user, and inefficient. The claim of savings is mostly hype.

To conduct the study, faculty at McMaster University in Hamilton, Ontario, and its programs for assessment of technology in health—and other research centers, including in the U.S.—sifted through almost 36,000 studies of health IT. The studies included information about highly valued computerized alerts—when drugs are prescribed, for instance—to prevent drug interactions and dosage errors. From among those studies the researchers identified 31 that specifically examined the outcomes in light of the technology’s cost-savings claims.

With a few isolated exceptions, the preponderance of evidence shows that the systems had not improved health or saved money. For instance, various studies found the percentage of alerts overridden by doctors—because they knew that the alerted drug interactions were in fact harmless—ranging from 50% to 97%.

The problem seems to be “true believers” in information technology — certain of their goals and unwilling to hear the concerns of skeptics. It will work— because we believe, a philosophy that has made the design of ObamaCare such a mess. There is even a government agency: the Office of the National Coordinator of Healthcare Information Technology, (an agency of the Department of Health and Human Services). File under the Eternal Life of Government Agencies.

It is already common knowledge in the health-care industry that a central component of the proposed health IT system—the ability to share patients’ health records among doctors, hospitals and labs—has largely failed. The industry could not agree on data standards—for instance on how to record blood pressure or list patients’ problems.

Instead of demanding unified standards, the government has largely left it to the vendors, who declined to cooperate, thereby ensuring years of noncommunication and noncoordination. This likely means billions of dollars for unnecessarily repeated tests and procedures, double-dosing patients and avoidable suffering.

Other news among the true believers: The doctor shortage may swell to 130,000. The U.S. health care law’s process for providing insurance subsidies to middle-income families will produce an IRS quagmire. There is no chance the exchanges will get it right. Compliance with ObamaCare is estimated at 80 million man hours per year. It wasn’t intended to be a jobs program and another huge cost. The true believers who are so sure that they know how to arrange the health care for over 300,000,000 Americans need to face up to the facts. They’re not that smart and their ideas don’t work.



Obamanomics 101: Understanding How the Obama Economy Works by The Elephant's Child

ObamaCare May Not be Unconstitutional, But It Is Very Bad Law. by The Elephant's Child

ObamaCare is much misunderstood. Its advocates talk about the free care they will receive, and fear that they might have a “pre-existing condition.” But ObamaCare is not about medical care or treatment. It is only about insurance.  It is designed to gradually funnel everyone into single-payer, government-run, insurance because that is the earnest intent of the liberals who designed the system. Government will control the entire financial end of the whole system — what you pay and what you get.

What the left is not good at, are the unintended consequences. They’re not good at thinking things through; at least that’s what the evidence seems to show. The costs of insurance will be far higher than estimated. Current estimates expect costs to be much higher than originally set out, and the program hasn’t even been put into effect yet. The only government program in history that has come in under the original estimates, is the Medicare Drug benefit, and Liberals removed the incentives that made thrift possible.

When the government says we’ll just pay for whatever you need, people don’t pay attention to how much something costs, and they go to the doctor for things they might well have treated at home. Result: soaring costs.

Great attention has been paid to rules and regulations, but physicians have been totally ignored, except for plans to hold down payments for their services. There aren’t enough doctors. There is a current shortage of thousands of physicians. Doctors hate ObamaCare and very large numbers plan to find some other occupation, or to retire. Medical schools and teaching hospitals, as they exist today, are incapable of turning out the numbers of doctors needed.

When all those folks who were uninsured are forced to buy insurance or pay a big fine, than the young healthy people won’t use medical care much, and will pay for the older folks who require more care. And you won’t have all those people with no insurance running up the costs for the nation’s emergency rooms. The uninsured are not signing up in droves. But the organization of emergency room physicians has pointed out that the greatest emergency room use is not by the uninsured, but by insured people who cannot find a doctor to care for them.

ObamaCare has taken $716 billion out of Medicare between 2013 and 2022, to pay for ObamaCare. That means a $260 billion payment cut for hospital services.  A $39 billion payment cut for skilled nursing services. A $17 billion payment cut for hospice services. A $66 billion payment cut for home health services. A $33 billion payment cut for all other services. A $156 billion cut in payment rates for Medicare Advantage programs. $56 billion in cuts for DSH Payments for low-income patients, and $114 billion in cuts in other provisions in Medicare,Medicaid and CHIP. What this means is that fewer doctors will be willing to treat Medicare and Medicaid patients. This is already a growing problem, and ObamaCare hasn’t even kicked in yet.

Should ObamaCare not be repealed, these problems will grow and fester. The government will have no option but to federalize the medical profession so doctors work for the government for a fixed salary. Otherwise there will simply be no doctors to serve patients. Where will they get those doctors? Medicine will no longer be an attractive profession, nor a rewarding one. Standards will necessarily decline, and the best students will no longer go into medicine. Where will the doctors come from?

 



Obamatax by The Elephant's Child

Romney: ‘Day One’ by American Elephant
May 18, 2012, 1:47 pm
Filed under: Conservatism, Election 2012, Politics | Tags: , ,



Everybody Playing by the Same Rules? Nah. by The Elephant's Child

You remember, the huge disagreement between the Obama administration and the Catholic Church. HHS Secretary Kathleen Sebelius issued a ruling that all organizations would have to pay for health  insurance  that covered contraceptives, sterilization and abortifacient drugs for all their employees or students. Ms. Sebelius is Catholic, so you would assume that she would understand the Church’s position.

When Catholic Bishops made the Church position clear, the Administration rewrote the mandate to say that the insurers would have to pay for the drugs and contraceptive, but this was merely a matter of words, not fact, as the Church would still be paying the bill. The administration obviously wasn’t taking the Catholic position seriously.

Franciscan University has announced that they will no longer cover health-insurance at all. Before, the Catholic institution required all students to carry health insurance, those who did not have insurance were required to buy it through the school. PPACA additionally increased the mandated maximum coverage amount for student policies to $100,000 for the next school year. Dozens of Catholic institutions have insisted that they will not comply, but the Obama administration has not been concerned, figuring that they would fall in line.

Here’s where it gets interesting. ObamaCare uses Social Security’s language of the Internal Revenue Code to determine who is eligible for “religious conscience” objection to the insurance mandate. The law provides exemptions for adherents of “recognized religious sects” that are “conscientiously opposed” to accepting benefits from any insurance, public or private.

So—Muslims may claim a religious exemption that is denied to Christians and Jews. Islam believes insurance is haraam (forbidden) and likens insurance to gambling, so the religion is excluded from requirements, mandates, or penalties set forth in the bill. Others who fall into the same category are the Amish, American Indians, and Christian Scientists. But not Catholics nor Jews. Although the U.S. Constitution grants all Americans equal protection of the law — some Americans are more equal than others.

Max Baucus (D-MT),Chairman of the Senate Finance Committee indicated that the purpose of ObamaCare is as much about redistributing income as it is about reforming health care. Another fine example of the iron fist of leftist government putting income distribution and religious discrimination in the hands of ‘wise’ government bureaucrats.

ObamaCare has soared off on its own, completely unrestrained by the Constitution, logic, or common sense. The young are to support he elderly, non-Muslims are to support Muslims, and the Obama mantra of  everyone having a fair shot, doing their fair share, and everybody playing by the same rules was just words, and thrown under the bus when not convenient — as is the norm for this administration.



ObamaCare Gummed Everything Up. by The Elephant's Child

ObamaCare is in the lap of the Supreme Court, and in spite of all the analysis and dissection of motives and personalities, we don’t know what the justices will do.  The battle has changed America, derailed the recovery, and changed health care in ways that we don’t really understand yet.

Traditionally, many doctors were pleased if their children chose to go into medicine. A family with many members in the medical profession was not unusual.  Now physicians aren’t as happy with their chosen life’s work, no longer advise family members or friends to go into medicine, and according to polls are thinking about getting out.

Hospitals are consolidating, many are putting doctors on salary. Our hospital is developing satellite centers for urgent care, classes, outreach, while the hospital itself grows and expands. They are developing a different model, in reaction to ObamaCare and ObamaCare’s potential development in the future. I can’t say that I fully understand the ways in which it is changing, but it is different.

Business has examined their operations and ways of doing business in an effort to protect themselves from what the future might hold, in the light of what it has done so far. The body of regulation that has descended on companies has made them cautious, careful. The National Federation of Independent Businesses (NFIB) is a co-plaintiff in the lawsuit challenging the constitutionality of ObamaCare. That, as Liz Peek suggests, should give the supporters of the legislation pause.

And for the rest of us, our health care has changed— no matter what the Supreme Court does.  Are we stuck with the socialized medicine model that a vast majority of Americans hate? If it is not struck down, do we then engage in a tremendous civil war to get it repealed?  If it remains, can we abide the endless tinkering it would require to make an unworkable law even begin to be functional? What were liberals thinking? Did they not understand that the American people…well, no they didn’t.

Liberals do not understand the American people, though they are Americans. They don’t understand human nature. They think they can fix it, so the people who disagree with them don’t disagree any more.  In extremis, they speak of putting the’ far-right wing nuts’ in camps where they can’t annoy the better people any more. They hate to be disagreed with because they don’t know how to answer — except to call names.

They don’t understand the free market, because there are no guarantees. There is risk. There’s a reason why liberals flock to government work and to foundations. They can feel safe. The free market rewards people who take risks and face up to challenges. Life is a risk, and there is no sure security except in hard work and striving. We have safety nets, but what government gives today, it can take away tomorrow.

Obama recently said that in America, we are greater together, when everyone engages in fair play, everyone gets a fair shot, everyone does their fair share. That may be true, but in Obama’s America, the hard-earned dollars of taxpayers are turned over to union supporters, regulations are devised to shut down legitimate businesses, take away people’s rights to their own land, deprive people of their jobs. Ringing phrases come easy, but accomplish nothing.

Obama brags that he saved the auto industry, but the future was yanked away from hundreds of private businesses overnight—auto dealers with hundreds of employees were summarily put out of business. Bondholders, depending on a consistent flow of interest from their holdings in the car companies were guaranteed first call on the assets of a company in case of bankruptcy, were suddenly broke. Taxpayer money goes, not to governmental tasks, but to cronies— buddies who helped the president to get elected.

If ObamaCare is overturned, the world cannot be put back the way it was. Everything is changed, no matter how it all turns out — and not in a good way. Trust is gone or diminished. Security is damaged. And for what? Good governance is not a cheap political game — but you made it so.




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