American Elephants


Is Our Future To Be Found in Medical Tourism to Escape ObamaCare? by The Elephant's Child

Democrats like to claim that the inspiration for ObamaCare came from Massachusetts’ Romney Care. They did copy the individual mandate, I believe, and had as an adviser someone who had helped to develop RomneyCare.

However, the main group of Obama’s health care advisers: Ezekiel Emanuel MD, Tom Daschle, Peter Orzag, Donald Berwick MD and Jacob Hacker, were all great admirers of Britain’s National Health Service (NHS). Much of their admiration was centered on the idea that the highest medical costs came from elderly people in their final years, and that to significantly cut costs, they would have to limit those costs in some way.

Why they would admire a system so mired in scandal — with elderly patients dying in hospital from dehydration and starvation — is hard to understand, for the stories are published regularly in the British newspapers, from people who are using super glue to fasten in their teeth due to inability to see a dentist, to patients parked in ambulances outside hospitals to keep the numbers at emergency rooms down.

Back before ObamaCare first passed in this country, we noted that Canadians unable to get the care they needed in Canada were coming to the US for care in droves. They were suffering from long wait times to see a specialist, lack of availability of advanced diagnostic equipment or long wait times to get to use it. Here, an appointment for a CT scan can be had in 45 minutes.

You don’t get sent to a specialist unless you have a potential problem. Some potential problems are far too catastrophic to wait for several months. Now, we learn that today, as many as 41,838 Canadians — out of a population of around 35 million — left the country last year for health care treatment. More than 42,000 did so in 2012, and more than 46,000 sought treatment elsewhere in 2011. The Fraser Institute calls the 2013 figure a conservative number and says that it is deeply damning about Canadian care.

Canada has companies devoted to arranging medical tourism, including Costa Rica, India, Thailand and the U.S. Some companies send clients to Mexico, Turkey, Poland and the Dominican Republic. Those who leave Canada for treatment do so for reasons related to the country’s government-run health care system: better outcomes, avoidance of the consequences of wait times, concerns about the quality of medicine in a country whose system destroys the incentives needed to build more advanced facilities and develop higher tech medicine. [Note the word "incentives" in that last sentence.]

It is hard to tell, but ObamaCare seems to be in a death spiral — the insurance pool equivalent of bankruptcy — when too many older and sicker people sign up for insurance relative to the number of younger healthier people. According to figures released this week over half the people who have enrolled are over the age of 45, and only 24 percent are between the ages of 18 and 34,  half the number needed to keep premiums affordable.

Democrats will not admit the depth of the problems, and most probably will attempt to switch it to a “single-payer” plan which is what they wanted all the time like Britain’s failed NHS.

The most frightening possibility is attempts to patch, jigger, or reform the current  plan. Obama is determined to do whatever is necessary by executive order, but how far he will take that is unknown. ObamaCare cannot be fixed. The most basic need is to get government out of the business of running American health care. They are not competent to do so.

Free markets, free people — and let innovation triumph.



It Cannot Be Fixed. It’s Time To Pull the Plug. by The Elephant's Child

The entire policy thrust of the Left is towards a command and control economy. They basically believe that government should be run by highly educated experts, like themselves, who can make better decisions, better laws, and better policies for the nation. The people — the great unwashed out there — are unruly, unfair, not generous enough, unreliable, and need to be prodded and regulated into being, well, better.

The Left does not trust the people — “They get bitter, they cling to guns or religion or antipathy to people who aren’t like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.” That happened to be President Obama, Democrats talk about the poor and try to give them all kinds of benefits, Obama phones, extended unemployment benefits, but they don’t do much about growing the economy and growing opportunity.

Their basic drive to regulate and control is just what is destroying the potential for growth. Businessmen are reluctant to hire, to expand, to try to grow their businesses because they don’t know what the Obama administration will do next. Which government agency will descend on them with new regulations, new taxes, new laws. If you wonder why this recovery is so shallow, so slow, it is directly attributable to government action and inaction. The environmental lobby must be appeased, because they help to fund Democrats, so a no-brains project like the Keystone XL pipeline must be put on hold, despite 20,000 needed jobs, not to speak of all the spin-off jobs and growth involved in building the project.

The “experts” were sure that they could devise a health care policy that would be far better than what the free market had offered, which was certainly imperfect, and once they got everybody under their control then it could gradually be moved into their dream of a “single payer” plan like Britain’s, that is killing off the old folks with neglect and rapidly going broke in the process.

But they are not “experts” — and they are proving day by day that they really had no idea how to build a health insurance program. The 30 million uninsured who were the supposed reason for the program will still be there — uninsured. They may be different people, but the numbers of uninsured are expected to be greater. Those millions who couldn’t get insurance because of pre-existing conditions have turned out to be 107,000 people.

People who have supposedly signed up, may not be, if they haven’t paid and their payment sent to the insurance company.  That is supposedly the part of the website that has not yet been written. Huge new deductibles may mean that, barring catastrophic events, the “insurance” isn’t worth it. The appalling part that is just beginning to be brought to our attention are all the people whose insurance is being cancelled as they are in the midst of treatment, surgery, recovery, and they are losing their doctor, access to the hospitals and clinics that they depended upon. People are going to die unnecessarily because of Democrat hubris.

If there were any real “experts,” they would pull the plug on this disastrous attempt at control of the health of the American people at once. Most people who have no urgent medical need may be all right. The program is so bad, so poorly thought out, that the observation of many of those who know most about it, believe that collapse from its own flaws is inevitable.



Just Dump It. It’s Not Worth Saving. by The Elephant's Child

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



You Can’t Keep Medicare the Way it Is. That’s No Longer One of the Choices. by The Elephant's Child

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.

Pathetic. Really pathetic.




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