Obama’s Sequester strategy is slowly crumbling. The White House dreamed up the sequester idea to force Republicans to fall in line. They thought that big cuts to Defense would force Republicans to cave. Progressives are not in politics to tinker with the existing system; they are in politics to achieve “social justice” and transform the way Americans live. Through government programs they will make everyone equal and take care of everyone in need. They can’t be having Republicans cut back on the funding they need to achieve their goals.
Republicans did not cave, so Obama had to enumerate all the layoffs and furloughs and children who wouldn’t get their vaccinations, park restrooms locked, and White House tours cancelled. Schoolchildren whose visit was spoiled, left Obama talking about bake sales and how he didn’t know anything about it, it was all the Secret Service’s fault. The ongoing list of horrors produced mostly a sharp decline in Obama’s believability, so now he is embarked on a “charm offensive” which even aides say is just for show. There is a budget battle coming up.
President Obama has clearly stated that he does not believe that spending is a problem. No one knows how he arrives at that delusional idea. He believes that the problem is the rising costs of health care, which ObamaCare will arrest.
It’s hard to understand why Democrats don’t see that the glorious future they hope to achieve has been tried over and over and always failed. Europe is the only the most recent example. Creating a massive government program that would absorb one-sixth of the economy and make every American dependent on government for health care, they saw as a major stepping stone to the ‘fundamental transformation’ of America. They are completely oblivious to the crumbling breakdown of their vision, sure that they can fix anything with a few new rules or regulations.
ObamaCare is a dreadful mess, and a law that will break down of its own weight. It is going to cost more than anyone dreamed, the law is stifling medical innovation, there are far from enough doctors, so the intent is to palm patients off on nurses, and import doctors from other countries. Now we learn that wives will be dropped from husband’s employer-provided health insurance. Insuring ‘children” until they are 26 will put an enormous burden on Insurance policies, and employers will have a strong incentive to drop spouses. ObamaCare requires a “per life” fee from companies that insure their workers, now $1 or $2 will be $65 in 2014. Some companies will simply require their employees to pay a spousal surcharge rather than drop them from the insurance rolls.
Democrats were astonished to learn that Paul Ryan’s budget plan includes the repeal of ObamaCare. The depth of the delusion is apparent when you recall that when ObamaCare passed, it’s supporters insisted the law would “bend the cost curve down,” and reduce the deficit.
The Senate’s budget plan (after 4 years of delay) not only does not halt the massive spending in ObamaCare, it adds an estimated $1.2 trillion for subsidies to individuals for purchasing coverage through the exchanges., and $638 billion in matching funds for states to expand their Medicaid coverage. (possibly useless since few doctors will accept Medicaid patients).
Today, the Congressional Budget Office (CBO) estimates ObamaCare will add almost $1.6 trillion in new spending over the next ten years. It obligates an estimated $1 trillion for subsidies to individuals for purchasing coverage through government exchanges and $644 billion for states agreeing to expand their Medicaid programs. To pay for the new entitlements, it takes over $700 billion out of Medicare, a program headed for insolvency without reform. They assume they can just pay doctors and hospitals less, and the medical professionals will still see those patients.
Supporters are desperate to hide ObamaCare’s failures and shortcomings, so the next phase has ideas such as strengthening the individual mandate penalty, expanding the powers of the Independent Payment Advisory Board. (IPAB) (Death Panels) Their only ideas are more force (mandates, fines and penalties), cutting the pay of providers, and denying service. You will participate, you can spend your days trying to find a doctor or go to the emergency room for any little thing raising costs dramatically, and if you are in such pain you need surgery, we’ll supply you with pain pills instead.
Every one of the major think tanks has brilliant ideas for replacing ObamaCare. Hospitals are reorganizing to save money and for greater efficiency. But individual doctors are coming up with different ways to practice. We have a number of “concierge’ doctors here— you pay an annual fee, and they become your doctor. I know a physician who bought a big motor home, outfitted it as a doctor’s office, and arranged to park it at a local mall. I wrote recently about an Oklahoma Surgery Center that has reduced costs remarkably. Doctors are many of our best and brightest, and quite capable of finding innovative solutions. Pity that Democrats didn’t think to get their help. Of course they didn’t consult the American people either. Just Dump it
A week ago the Medicare Trustees issued their annual report. It showed that Medicare is heading for insolvency even earlier than expected. The Hospital Insurance Trust Fund (which funds Medicare Part A) will be insolvent in 2024, and the promised benefits that are not paid for will amount to $24.6 trillion.
Tacked on page 266 was a note from the Medicare Actuary. An actuary is someone who is really good with math. Specifically— a statistician who calculates insurance premiums, risks, dividends, and annuity rates. The Medicare Actuary said that the Trustees’ financial projections “do not represent a reasonable expectation for actual program operations.”
Late Friday, the Office of the Actuary released a separate analysis. He said: “the projections…should not be interpreted as our best expectation of actual Medicare operations in the future but rather as illustrations of the very favorable impact of permanently slower growth in health care costs, if such slower growth can be achieved.” (emphasis mine)
The big differences are rooted in the severe statutory cuts to Medicare provider reimbursement that are already in current law under ObamaCare. The Actuaries believe that ObamaCare’s cuts in payments to providers will harm seniors’ access to care if Congress allows them to go into effect.
The “Sustainable Growth Rate formula calls for scheduled reductions to physician payments, which would next year in 2012 cut the reimbursement to doctors by an astounding 30 percent. The Trustees assume that the cuts will occur. The Actuaries say that if they did Medicare payment rates would fall to 57 percent of private insurance payment rates. That’s similar to what is happening with Medicaid, the government’s biggest welfare program, where physicians are fleeing in droves. They just stop seeing Medicaid patients. Medicaid patients who can’t find a doctor go to emergency rooms. Costs skyrocket. Same thing will happen with Medicare.
Democrats, always uninterested in unintended consequences, assume that you can just pay doctors less than they require to cover their costs and they will spend a little less time with patients and all will be well. The real world doesn’t work that way. Doctors will just stop seeing Medicare patients. There is already a shortage of 45,000 primary care doctors nationwide, expected to grow to 150,000. Fewer bright students will go into medicine, Doctors will retire early. If Congress delays the cuts, Medicare will just go broke faster.
ObamaCare also plans to reduce payment to hospitals and other providers. This would cause 15 percent of hospitals, skilled nursing facilities and home health agencies to become unprofitable by 2019, and increasing to 40 percent by 2050. That means they go out of business.
Those fees are already well below what the private sector pays, however. For example, Medicare pays doctors almost 20 percent less than what private payers pay. It pays hospitals almost 30 percent less. In the future, that discrepancy will grow wider with each passing year.To achieve the necessary targets, the new law gives an Independent Payment Advisory Board the power to recommend cuts in reimbursement rates for providers of health care. Congress must either accept these cuts or propose its own plan to cut costs as much or more than the panel’s proposal. If Congress fails to substitute its own plan, the board’s cuts will become effective. In this way, the growth rate for Medicare spending is officially capped. Moreover, the advisory board is barred from considering just about any cost control idea other than cutting fees to doctors, hospitals and other suppliers.
Physicians and Hospitals can only do so much cost-shifting. Then there would be no more private rooms, but large wards, there would be reduced access to expensive technology. If some doctors and hospitals began offering concierge services to the more affluent, how long would that be legal? When would they nationalize physicians to force them to serve everyone? When would hospitals be nationalized? How soon will they force all private insurance companies out of business? The attention of doctors and hospitals would turn from patient care to the constant effort to get adequate repayment from government. These are things that could well become unintended consequences of ObamaCare.
That’s what happens when you devise a bill based on ideas of “managed care.” The Accountable Care Organization rule book is already 200 pages long. They think that they can manage competition. The competition part is belied by words like mandate, control, consolidate, nonnegotiable, rules, regulations. The Obama administration’s deep unfamiliarity with the free market, and their contempt for the free market is notable.
Meanwhile, Democrats are in full-throated attack mode on Paul Ryan’s “Path to Prosperity.” Democrats have been claiming that Republicans are trying to starve Granny ever since Medicare was created as part of Lyndon Johnson’s failed Great Society. They’re just taking the same old false accusations to new and disgusting lengths.
