American Elephants


ObamaCare Has Barely Begun, And The Horror Stories Start! by The Elephant's Child

President Obama is crowing about enrolling 8 million Americans in ObamaCare. The number seems to have no relation to reality. Nobody is enrolled until they have paid.

In Georgia, insurers received more than 220,000 applications for health coverage in the Affordable Care Act’s exchange as of the official deadline of March 31, according to state officials. The Insurance Commissioner, Ralph Hudgens says that premiums have been received for only 107,581 of those policies which cover 149,465 people. Half.

In California open enrollment is closed, many of the newly insured are finding they cannot find doctors, landing them in a state described as “medical homelessness.” One of the major claims was that ObamaCare would reduce the use of emergency rooms by the uninsured. Uh huh.

Kaiser says it will only get worse. Aging baby boomers increasingly need more care. The  growing medical needs of that group are creating a huge burden for the existing health care workforce. The retirement of many doctors in the boomer cohort is compounding the problem. The federal government estimates the physician supply will increase by 7 percent in the next 10 years. The number of Americans over 65 will grow by about 36 percent. Medical students are avoiding primary care and are choosing specialties instead. 20 percent of Americans live in areas with an insufficient number of primary care physicians, 16 percent in areas with too few dentists and 30 percent in areas with a lack of mental health providers.

Well why can’t we have single-payer health care like, say, Sweden? Sweden is always raised as a rare example of a socialist country that works. But a closer look at its health care system tells a different story. Universal public health care means the average Swede with ‘high risk’ prostate cancer has to wait 220 days for treatment. The overall quality of their universal public health consistently ranks among the very best. That quality can be achieved by regulating treatments to follow specific diagnoses as well as standardizing procedures.

But Sweden’s problem is access to care. According to the Euro Health Consumer Index 2013, the average wait time from referral to start of treatment for ‘intermediary and high risk ‘ prostate cancer is 220 days. For lung cancer the wait between an appointment with a specialist and a decision about treatment is 37 days.

The waiting is what economists call “rationing,”— the delay or even failure to provide care due to government budgeting decisions. The number of people seeking care far outweighs the capabilities of providers— insurance in name but not in practice. This is the inevitable result of ObamaCare as well. That’s why there is the Independent Payment Advisory Board (IPAB) who will decide what the federal government will pay for.

Stories of people in Sweden suffering stroke, heart failure and other serious medical conditions who were denied or unable to receive urgent care are frequently reported in the Swedish media. Recent examples include a one-month-old infant with cerebral hemorrhage for whom no ambulance was available, and an 80-year-old woman with suspected stroke who had to wait four hours for an ambulance. It’s the same deal in Britain’s NHS, which is so admired by the ObamaCare designers.

Here at home, a New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications because of her ObamaCare plan. Margaret Figueroa, 49, suffers from a disease that has her vomiting, she has lost 22 pounds and the pain is unbearable. The ObamaCare plan she purchased assured her that she was covered, but when she went to fill her prescriptions, her insurance card was denied. She cannot find a doctor who will see her. Her congressman,Rep Michael Grimm (R-NY) has intervened to help her obtain vital prescriptions. Grimm says he’s already received calls from at least a dozen Staten Island residents facing the same problem with ObamaCare’s “narrow networks”— extreme restrictions on doctor and hospital access imposed by ObamaCare.

The top cancer centers across the country are not available to those on ObamaCare.  38 percent of all ObamaCare plans only allow patients to pick from just 30% of the largest 20 hospitals in their area. The narrow network horror stories will only continue to grow, and the effects will be disastrous. But Obama is crowing about enrolling 8 million people.



The Debate Is Not Over Until The People Say So! by The Elephant's Child

The debate over ObamaCare, the president declared, is over, and he won! ObamaCare is here to stay, and the debate is over. He claimed a grand total of 8 million subscribers, diagnosed Republicans as fear-mongering, spiteful, obstinate, petulant and obstructive., and added that he “would much prefer a constructive conversation with the Republicans about how we get some stuff done.”  Which is a bit of an odd position to take since for the most part, ObamaCare hasn’t even really taken effect yet.

A new Fox News poll says that sixty-one percent of respondents in the poll released Thursday said Obama lies at least some of the time on important issues. Only 15 percent believe the president is completely truthful. Only 31 percent of Democrats said the president is always truthful. It seemed a useful poll in this context.

For the first time in the history of our country, one political party has forced the American people to buy a product devised by that party for their own benefit, that the American people have shown no indication that they wanted. The Democrats defied public opinion, rammed ObamaCare into law using the Cornhusker Kickback, Gator Aid, the Louisiana Purchase and all sorts of unseemly gimmicks to force unwilling Democrats to vote to pass it.

It funnels unprecedented amounts of power and money to Washington D.C. and out of the pockets of everyday Americans. It incentivises employers to refrain from hiring people and to cut hours for millions of their employees. It bans millions of people’s health insurance policies because they don’t conform to the rules designed in the backrooms of Congress. Obama crows over insurance policies, but doctors are so disgusted with the program that they are leaving medicine in droves. Since July 4, 2009, according to Real Clear Politics, 458 polls have been taken on ObamaCare. Twenty have shown Americans liking it, five have shown ties, and 433 (95%) have shown them disliking it. The five most recent polls have shown Americans opposing ObamaCare by double digits. And it hasn’t really started yet!

The president proclaims the debate is over and ObamaCare is here to stay.

Charles Blahous, the director of spending and budget initiative at the Mercatus Center at George Mason University, and a public trustee for Social Security and Medicare, said :

It is quite possible that the ACA is shaping up as the greatest act of fiscal irresponsibility ever committed by federal legislators. Nothing immediately comes to mind as comparable to it. Certainly no tax legislation is, because tax rates rise and fall frequently, such that one Congress’s tax cut can be (and often is) undone by a later tax increase. The same is true for legislation affecting appropriated spending programs. But the ACA is a commitment to permanently subsidize comprehensive health insurance for millions who could not otherwise afford it, which the federal government has no viable plan to finance. Moreover, experience shows that it is very difficult to scale back such spending once large numbers of Americans have been made dependent on it.

This is an expansion of spending commitments that is comparable to enacting Social Security, Medicare or Medicaid. Our biggest financial problems today come from Medicare, Medicaid and Social Security costs rising well beyond original projections. Nobody planned on the Baby Boom generation. The Congressional  Budget Office now estimates that the gross costs of the ACA’s coverage expansion will be $92 billion in FY2015, or about 0.5% of our total GDP of roughly $18 trillion. This far exceeds  the initial costs associated with the entirety of Social Security and Medicaid and is comparable to the startup costs for all original parts of Medicare combined. Only five years after enactment, the ACA will absorb more of our total economic output than Social Security did fully sixteen years after it was enacted. And government programs always, always,  cost more than the estimates.

The ACA was enacted when legislators knew, or should have known, that they were living in a fiscal environment in which such extravagance was unaffordable. Deficits and Debt are far higher today than when other major entitlement programs were created. Baby Boomers are just beginning to turn 65, and their numbers swell exponentially until 2029. The sheer irresponsibility is breathtaking.

The ACA’s “CLASS” long-term care provisions were originally projected to generate $37 billion in net premiums through 2015. CLASS was suspended due to its long-term financial unworkability. That money is not coming in.

The employer/individual mandate penalties were expected to have brought in $12 billion through 2015, $101 billion over the first ten years. Obama has delayed enforcement repeatedly, and they haven’t brought in much of anything. Some ACA advocates are suggesting ditching those mandates altogether, though they were essential to the financing scheme.

The ACA was supposed to be financed in part by cuts to Medicare Advantage, the extremely popular program for seniors. This is typical of government programs. Establish the program, get everybody signed up, then start taking funding out of it to support something else. That was supposed to be $31 billion through FY2015, $128 billion over the first ten years. The White House recently announced that planned cuts will not go into effect after all —probably not till after the election.

We still have the “cost-saving” decisions of the Independent Payment Advisory Board— the 15 unelected bureaucrats who will decide what Medicare will pay for, and what it won’t. The ObamaCare people have always pointed out that most of the costs of health care come in the final years of seniors’ lives, and old people just don’t need such expensive treatment when they have so little time left.  And they are sure that they can reduce costs by just paying providers less—which means good luck finding a doctor.

The great goal of getting those who can’t afford insurance signed up for Medicaid is confronted by recent studies showing that people who do without insurance actually do better than those who are insured by Medicaid.

Charles Blahouse concludes:

When new enrollment figures were released last week, the national discussion focused on whether the ACA is fulfilling its coverage expansion goals. The largely unwritten and more important story, however, is that the ACA is rapidly becoming a colossal fiscal disaster as enrollment proceeds heedless of the concurrent collapse of the law’s financing structure.



A Conservative Guide to Liberal Thought: by The Elephant's Child

The common conservative response to a liberal pronouncement is “You’ve got to be kidding!” Can they possibly believe what they are saying? The real divisions between liberals and conservatives are deep and wide, but Andrew Klavan takes a shot at explaining what it is that liberals believe, and how liberals think. It may be helpful, but —It’s not pretty!



Attempting to Regulate Our Way Out of Recession by The Elephant's Child

Capitol Building

President Obama has liked to emphasize the depth and general awfulness of what he calls “the Great Recession”— a term that pleases him because it associates his recession with Franklin Roosevelt’s Great Depression. Roosevelt cheerfully tried to tackle the Great Depression with constant experimentation. Obama has confronted his recession with regulation without end, in the unfortunate delusion that more control would fix things.

Washington set a new record in 2013 by issuing final rules taking up 26,417 pages in the Federal Register. The rules came from various agencies, but Obama remains at the helm and leadership matters. By sheer numbers, President Obama stands at the pinnacle for numbers of rules. The federal Register contained 3,659 “final” rules (which mean you have to obey them), and 2,594 proposed rules on their way to join the others.

Neither politicians nor the media regard this effort to control as anything out of the ordinary, nor important. Yet if you wonder why the recovery has been so far below average —there it is. The bulk of this year’s regulation comes from ObamaCare—a 2,700 page law that has metastasized into a 7 foot tall stack of documents, and Dodd-Frank. Things don’t get done because nobody has the authority to make them happen.

I wrote about the pressing need to protect and update our electrical grid, vital and essential to all life in America, but there is no active plan to rebuild the grid, because the government cannot make the decisions needed to approve it. The average length of environmental review for highway projects, according to a study by the Regional Plan Association, is over eight years. Eight years!

The results and costs of the legal system are not just monetary, everything is too complicated. There are rules in the workplace, rights in the classroom, and government is bogged down in bureaucracy. Responsible people do not feel free to make sensible decisions. We are pushed around by lawsuits, and unable to move for fear of punishment for barely understood regulation.

The point of regulation is to try to make things run smoothly, make sure things work in a crowded society, but rules have consequences, and not always those intended. We now have a court system where even referendums voted on by the public have been taken over by the court system in which judges now feel free to decide these matters. The objections to “judicial activism” are richly deserved, and now even judges are mistrusted.

Consider the case of a fictional Pasquale’s Pizza chain. The typical restaurant has their pizza menu on a large lighted sign behind the counter where you place your order. The federal government has decided that nutritional values for each ingredient must be listed on the menu. Impossible on the customary lighted sign. What to do? How much will it cost? The profit margin is already slim. Pizza chains have dozens of ingredients, and changing featured recipes to entice customers. ObamaCare requires a restaurant to provide health insurance for full-time workers. The cost of policies has gone up sharply. Cut back all employees to 30 hours? Female employees and male employees must work the same number of hours for the same wage.

The requirement for ethanol in gasoline has raised the cost of pizza ingredients. It has also raised the cost of transporting supplies. Requiring a portion of power to come from wind and solar has raised the cost of electricity. Fuel-efficiency regulations have raised the cost of trucking. And all that is before regulations and taxes at the local, state and national levels.

You end up with schools that make fools of themselves over zero-tolerance regulations that do nothing to prevent violence, school lunches that kids won’t eat. You have armed federal agents raiding the Gibson Guitar Company and confiscating their guitars and their materials ostensibly because the wood used for guitar frets violated and environmental law. The wood was legally imported, meeting all the standards of the country of origin, but the costs to Gibson were huge. You not only cannot fight city hall, but you must surrender even though you are in the right, just to avoid further financial damage. There is case after case of people subjected to an armed SWAT raid, accused of violating a regulation they’ve never heard of, and ruined financially.

What business is going to take a big risk, invest a lot of money in a new venture, expanding, hiring new workers in such a climate? There is risk in everything we do. Trying to legislate risk out of our lives just leaves us with rules that keep people hunkered down, trying to avoid bureaucratic attention. In this climate, politicians cannot even get the big things done, let alone attempting to undo the web of regulation that is crippling society.



Other Than That, ObamaCare is Doing Fine… by The Elephant's Child

When the Democrats started digging old plans out of dusty drawers, they decided, since they controlled both houses of Congress and the presidency, to go for government sponsored health care; they were absolutely sure that the American people were going to love it. Big mistake.

The cost of American health care had been climbing significantly, and Democrats were sure that they could significantly cut the costs of medicine by making the medical profession more efficient and insisting that they learn from the best practices of industry stars. Another mistake.

Democrats believed that the uninsured were a huge problem because people with no insurance were flooding emergency rooms and driving up costs. Turned out that most of those who used emergency rooms had insurance, they just couldn’t make appointments with their doctor for immediate help. Turned out that a large percentage of the uninsured did not have insurance because they could not afford it, but because they didn’t want to pay for insurance. They were healthy and unconcerned. Oops!

Democrats believed that if they added some nice benefits that people had never had before on their insurance like therapeutic massage, birth control and pediatric dentistry, the government insurance would be even more popular. They would just spread the costs of the new benefits across the board so the expense would not be noticed. They didn’t have an insurance actuary figure out the costs of including those benefits on a policy for 55 and 60 year-old folks who had no need for birth control or pediatric dentistry.

The CBO has issued a report that appears to show that ObamaCare will cost less and cover more people than expected. But their projections seldom turn out. There are just too many variables. The latest report says that ObamaCare will cost $104 billion less over the next 10 years than it thought just two months ago. The numbers rest on the CBO belief that premiums will be flat next year, but the industry has already warned of double-digit rate increases— a sharp rise that will drive costs up far beyond the CBO’s estimates.

Out of the blue, the Census Bureau has changed how it counts health insurance, just at the moment when ObamaCare is roiling the insurance markets. The effect will muddy comparisons between pre-ObamaCare and post-ObamaCare numbers. A lot of things we would like to know, like how many people gained or lost insurance under ObamaCare? Did government crowd out individual insurance? It will apparently take several years before we have answers to those questions.

The one thing that is increasing dramatically is unhappiness among physicians. Nine out of ten doctors discourage others from entering the profession. 300 doctors commit suicide every year. Depression among doctors is not new, but the level of unhappiness is on the rise. Being a doctor has become a miserable and humiliating undertaking, and many doctors feel that America has declared war on physicians and doctors and patients are the losers.

Many doctors just want out. More are running for Congress. Medical students opt for high-paying specialties so they can retire as soon as  possible. MBA plans for physicians are flourishing,  they promise doctors a way into management. The website called the Drop-Out-Club hooks doctors up with jobs at hedge funds and venture capital firms.

Some, including President Obama, seem to believe that doctors are paid way too much and if the government needs to save costs, they can just pay doctors less. This is the mindset that reduced Medicaid to such a point that those who go without health care may do better than Medicaid patients. Same goes for Medicare and the other government controlled health care systems.

More doctors refuse to accept health insurance. Some have gone into concierge medicine, where for an annual fee, the doctor is at your service for the year. The federal government is hoping to go after that escape from ObamaCare, and they are still intending to end Medicare Advantage plans.

Just processing insurance forms costs $58 for each patient encounter, according to Dr. Stephen Schimpff, an internist and CEO of the University of Maryland Medical Center.  Physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes, in which the doctor probably spends most of the time interacting with his computer.

Under ObamaCare the incentives are all wrong. The government adds ill-considered benefits to insurance policies in the hope of getting people signed up. This makes the insurance too costly for most people. The push from the government will be a constant effort to cut costs. Hospitals will push for doctors to see more patients in less time, so they can be adequately reimbursed. Doctors will be encouraged to pay less attention to the Hippocratic Oath and more effort to try to get adequately paid, or to get out of the profession—which will encourage the best and brightest to aim for other careers. Watch for a push for increased immigration of physicians from third world countries. Other than that…

 



The Worst Lies Are The Ones You Tell Yourself by The Elephant's Child

Ross Douthat had an excellent column on Sunday about “the serious moral defect at the heart of elite culture in America.”

He began with a look back at a column by a Harvard undergraduate, Sandra Y.L Korn, which got some attention thanks to its daring view of just how universities should approach  academic freedom. She claimed such freedom was dated and destructive and that a doctrine of “academic justice” should prevail instead. Harvard should not permit its faculty to engage in work tainted by “racism, sexism, and heterosexism.”  She could come up with only one contemporary example of a Harvard voice that ought to be silenced, a “single conservative octogenarian” the renowned political philosophy professor Harvey Mansfield. Possibly because there are no conservatives to be found at Harvard.

Douthat says he tries to be a “partisan of pluralism, which requires respecting Mozilla’s right to have a C.E.O. whose politics fit the climate of Silicon Valley, and Brandeis’s right to rescind degrees as it sees fit”… but it’s hard to maintain respect “when these institutions will not admit that this is what is going on. Instead, we have the pretense of universalitythe insistence that the post-Eich Mozilla is open to all ideas, the invocations of the ‘spirit of free expression’ from a school that’s kicking a controversial speaker off the stage.”

It would be a far, far better thing if Harvard and Brandeis and Mozilla would simply say, explicitly, that they are as ideologically progressive as Notre Dame is Catholic or B. Y.U. is Mormon or Chick-fil-A is evangelical, and that they intend to run their institution according to those lights.

I can live with the progressivism. It’s the lying that gets toxic.

Do read the whole thing. We desperately need to clearly understand just what is going on around us. Propaganda fails if everybody knows that it is just propaganda. Lies, recognized, are just embarrassing.

Journalist Jack Kelly asks “Why Aren’t Public Officials Held to Account for Lying?” He contrasts the penalty imposed on a television con man with the whoppers told by government officials, and suggests that the penalties for lying should be equally applied.

It was chiefly the concept of equal protection of the laws — the idea that the rules should apply to the rulers as well as the ruled — that made our government different from most others in the history of the world.

It is the lying that gets toxic.



The Social-Engineering Approach to Health Care by The Elephant's Child

John Goodman offers two fundamental ways of thinking about complex social systems: the economic approach and the engineering approach.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Goodman, the father of the health savings account, calls this “cookbook medicine” which gives doctors rules and protocols for treating patients with various symptoms, and they must record each step along the way. Cookbook medicine does not bother with the differences among people, and is the opposite of personalized medicine which aims to tailor the therapy to the characteristics of the patient.

While it is useful to consider the standard protocols, people are not all the same. Medicine adapted to the genetic makeup of a person is in its infancy, but shows promise. When the cookbook becomes a rulebook to be followed slavishly, we’re in trouble. When complying with endless checklists takes valuable time away from patient care — that’s what’s happening in American medicine. A recent study of emergency room physicians found that they spend more time interacting with screens than patients, clicking the mouse 4,000 times in a 10-hour shift.

The Affordable Care Act was heavily influenced by the engineering model. After all, our bureaucrats are certified experts, and what are experts for if not to tell everybody else what to do and how to do it. Only social engineers would think of running “pilot programs” to control health care costs. What is the purpose of a pilot program if not to find something that appears to work, so you can order everyone else to copy it. Therefore you have the mess of digitizing all medical records and the result that hospitals have different systems that cannot talk to each other?

Dr. Virginia McIvor, a pediatric physician at Harvard Medical School explains the problem:

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind. While primary-care providers are good at prioritizing and staying on time — patient satisfaction scores are another quality metric — the endless box checking and scoring takes precious time away from doctor-patient communication.

If you have been to a doctor recently, you have probably noticed the multiplication of forms you must fill out, questions you must answer. I have noticed that the form now contains a line for “refuses to answer,” which may indicate progress of a sort.

John Goodman is the father of the “health savings account” which works precisely as promised and has been a great favorite. He is president of the National Center for Policy Analysis (NCPA) and he blogs regularly on health care matters (you can sign up to receive his columns), and his book Priceless takes on the health care problem.

There are great things happening in medicine that are promising for the future. The engineering rulebook is not interested in other people’s expertise or innovation.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412


The Unaffordable Care Act Becomes More Unaffordable by The Elephant's Child

The health insurance policy rate hikes in excess of 6% in December were the largest reported since Morgan Stanley’s research team first started conducting quarterly surveys of insurance brokers in 2010. The April survey shows the largest rise in small and individual groups perhaps ever. The average increases are in excess of 11% in the small group market and 12% in the individual market. Some state increases are 10 to 50 times that amount. The analysts conclude that the “increases are largely due to changes under the ACA.”

The analysts conducting the survey attribute the rate increases largely to a combination of four factors set in motion by Obamacare:  Commercial underwriting restrictions, the age bands that don’t allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage, the new excise taxes being levied on insurance plans, and new benefit designs.

For the individual insurance market (plans sold directly to consumers); among the ten states seeing some of the sharpest average increases are: Delaware at 100%, New Hampshire 90%, Indiana 54%, California 53%, Connecticut 45%, Michigan 36%, Florida 37%, Georgia 29%, Kentucky 29%, and Pennsylvania 28%.

For the small group market, among the ten states seeing the biggest increases are: Washington 588%, Pennsylvania 66%, California 37%, Indiana 34%, Kentucky 30%, Colorado 29%, Michigan 27%, Maryland 25%, Missouri 25%, and Nevada 23%.

Think of the bride whose intimate garden wedding grows into a society-page extravaganza as the guest list keeps growing. The simple two-tier wedding cake turns into a multi-storied  edifice with elaborate floral icing on each layer. Not going to cost the same, and all those unneeded flowers and loops add to the cost, just as pediatric dentistry for 60 year-olds adds to the cost on an insurance policy. The massage therapy and acupuncture make a nice selling point, but it really isn’t free.

Since these hikes aren’t coming from HHS, but from the insurance companies, where it cannot be put off till “after the election,” it’s going to get interesting. Affordable Care indeed!



Kathleen Sebelius Resigns: by The Elephant's Child

Sebelius in trouble

Health and Human Services Secretary Kathleen Sebelius has resigned. It was noticeable when President Obama gave his “mission accomplished” speech in the  Rose Garden, surrounded by everybody else, and Sebelius was unacknowledged in the speech.

Officials said Ms Sebelius made the decision to resign and was not forced out. I’m somewhat sympathetic. She had an impossible task, trying to make a silk purse out of a sow’s ear. Administration aides have worried that the dreadful problems at HealthCare.gov might result in lasting damage to the president’s legacy. You think? She had an impossible task, nobody can make can make ObamaCare work.

The secretary told the president that the March 31 deadline for sign ups and rising enrollment numbers provided an opportunity for change, and that he would be best served by someone who was not the target of so much political ire, according to Dennis McDonough.” She does hope—all of us hope—that we can get beyond the partisan sniping.”

Nominated to replace her is Sylvia Mathews Burwell, currently head of Obama’s OMB and someone who Obama believes will bring “an intense focus and management acumen to the department.”

Ezra Klein, newly self-described as an advocate of “explanatory journalism” said “Kathleen Sebelius is resigning because ObamaCare has won. President Obama wouldn’t let Sebelius leave unless he was confident ObamaCare was safe.” That’s why he gave her a big hug in the Rose Garden and thanked her profusely for her long five years of service.

 



“Mission Accomplished” says Obama. Now What? by The Elephant's Child

I had a routine doctor’s appointment last week. As she interacted with the new computer system rather than me, my doctor said “I should have gone to secretarial school instead.”

So after “Obama’s ‘Mission Accomplished’ moment—his triumphal Rose Garden speech claiming ObamaCare is now here to stay—where are we? No one believes Obama’s lofty claims for the numbers of enrolled people, and the number who have actually paid their premiums (the only point at which the numbers are real) are numbers that will have to come from the insurance companies.

The underlying signs of the health of this dreadful medical law are something quite different. Kaiser Health News published the following:

Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.

Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  “I always felt rushed,” said the 56-year-old. “I always felt I was cutting my patients off.”

Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.

Physician stress has always been a normal fact of life, but anecdotal stories suggest a significant increase in the level of discontent, especially among primary care doctors who play the central role in coordinating patient care. Just as millions of Americans are obtaining health insurance through ObamaCare because of the threats of fines, or because their insurance policies were cancelled— often because the benefits they chose did not match the government’s one-size-fits-all standard.

A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those age 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50. A RAND study for the American Medical Association found that nearly half of physicians called their jobs “extremely stressful” and more than one-quarter said they were “burning out.” Unhappy doctors make for unhappy patients, and unhappy patients result in unhappy doctors.

Janice Finer, who left primary care to work with hospital patients, didn’t want to have to deal with insurers, hiring staff, and the business of a practice —sold her practice to a hospital. But hospital administrators dictated the pace. She was required to see 22 to 28 patients a day. At one point, she said, she was scheduled to see patients every 11 minutes. But meeting patients’ needs is not just busy work, but it doesn’t generate revenue.

President Obama contributed billions to help defray providers’ costs of going digital. The goal was a national system that would provide the government with statistics for further control. Not happening. Every hospital may have a different system, and none of them talk to each other. Digital records mean entering numbers and words in lots of repetitive boxes, but the old kind of personal, nuanced information that was in a doctor’s note, aren’t included. “Many physicians told us “I used to be a doctor, now I’m a clerk.” Anyone who uses a computer can recognize the potential for error. Typos are a way of life. Some doctors have started using ‘scribes’ —laptop carrying assistants who fill in the blanks and take notes— which adds another level of cost.

The association of American Medical Colleges estimates that the U.S. will be short about 45,000 primary care doctors in 2020 when 260,000 are projected to be practicing. Doctors used to encourage their kids to go into medicine. They’re not doing that anymore.

President Obama in his “Mission Accomplished” speech stressed the objective of the Democrats who drummed up this mess: “We are making sure that we are not the only advanced county on earth that doesn’t make sure everybody has basic health care.” Tinkering and improving are expected to lead to single-payer health care which is the their ultimate goal.

Nationalizing health care inevitably leads to conflicting problems.Government programs always cost more than was estimated — way more. The government’s sole incentive quickly becomes a demand to reduce costs.

The incentive for hospitals and clinics is the need to get adequately paid for their services. Those incentives lead to a reduction in innovation unless it is proved to reduce costs— so fewer medical inventions, fewer new drugs.

And pressure on doctors and personnel is to do more in less time with fewer and cheaper materials.  The incentive is also for doctors to leave the profession or for doctors to become government employees. What is inevitable is a lot of burned-out doctors who become more cynical and less caring. Ezekiel Emmanuel, who was one of the advisers for ObamaCare, has advocated disposing of the Hippocratic Oath.

The problem for patients becomes getting an appointment, getting use of expensive diagnostic equipment, and facing long waits for seeing a doctor and seeing a specialist and just getting the needed care. A frequent look at British newspapers’ accounts of the latest NHS scandal is proof of where it all leads.

If health care is free or low-cost at the point of service, the incentive is to overuse medical care which is what got us here in the first place. When someone else is paying the bill, there is no incentive for thrift,  which drives up costs and the vicious cycle repeats and  grows slowly worse, and harder to change.  Incentives matter.

 

 



Slash the Budget of the Department of Agriculture! by The Elephant's Child

Just briefly looking around the USDA website convinced me that the Department of Agriculture has way too many bureaucrats employed, and their conception of what they should be doing is way too broad. I have never known anyone who has paid the slightest attention to the USDA’s guidelines as to just what we should be eating, which is just as well because they have mostly been wrong anyway.

The schools, unfortunately, have to pay attention because they get funding, but anyone who has ever visited a school lunchroom notices that enormous quantities of food end up in the garbage. The kids have mostly hated Michelle Obama’s school lunch program. The USDA’s high carb diet was all wrong, butter is fine, they’re still trying to reduce “greenhouse gas emissions” although carbon dioxide in the atmosphere is what makes plants grow, and apparently, according to the EPA, soon their mission will be to reduce cow flatulence.

The federal Dietary Guidelines Advisory Committee is currently working on updating nutritional guidelines to conform with Mrs. Obama’s ideas and new scientific evidence. Mrs. Obama has been behind the drastically altered school lunch menus and the federal push to change restaurants’ most popular items to healthier fare and add calorie counts to every menu. She also has a new nutritional food labeling scheme.

One of the committee members, Miriam Nelson,  feels the guidelines shouldn’t be confined to nutrition, but should include the long-term sustainability and environmental impact of crops recommended for eating.  Another committee member is pushing a “plant-based diet” — suggesting that meat eating is not sustainable.

Another new idea under consideration are federal phone texts to obese citizens warning them regularly of their unhealthy eating behavior.

I pay no attention to the “my plate” guidelines, and I’m sure you don’t either, but the work of this committee guides the food purchases by the feds for government cafeterias, school meals across the country, all branches of the U.S. military and the entire federal prison system.

Michelle has insisted that the White House chef change from sugar to fruit purees to sweeten foods, but the White House consumes six different kinds of pie for Thanksgiving, The state dinner for the president of France came in at 2,500 calories per plate — a more-than-healthy whole day’s allowance. Remember that when you get your text-message from the government telling you what to eat, and reminding you that you are officially categorized as obese.



Oh Harry Reid, Harry Reid, For Shame! by The Elephant's Child

Harry Reid glum

Poor Harry Reid is caught between a rock and a hard place, and he’s not up to defending his position. It’s difficult, he’s majority leader of the Senate, and he has to defend the disastrous ObamaCare policy. Really frightening stories are emerging, about cancer patients who are suddenly denied the doctors and the care that was giving them the hope that they might live, and all Harry can think of is to call them all liars. Callous and insensitive doesn’t begin to describe it.

Now he has dissed a fellow senator, a medical doctor who is himself battling cancer, because he pointed out ObamaCare’s disastrous impact on cancer treatment. Senator Tom Coburn (R-OK) noted that the majority of cancer centers in this country aren’t covered under ObamaCare.

“Dr. Coburn is very good at getting into the weeds and trying to find something that he thinks makes sense. But I think we need to look at the overall context of this bill.”

When cancer patient Julie Boonstra appeared in a TV ad telling how Obamacare had jeopardized her treatment with rising and unpredictable premiums and co-pays. Reid took to the Senate Floor: “There’s plenty of horror stories being told. All of them are untrue.”

He also coldly dismissed Edie Sundby, a stage four cancer patient, who was told that the plan that had paid out $1.2 million and helped her to survive, was substandard, and would be cancelled because it didn’t fit the one-size-fits-all ObamaCare standard.

Coburn said that under ObamaCare, out of “Nineteen of the cancer centers in this country, only five are covered under ObamaCare.” Coburn said the cut-rate payments of the Affordable Care Act provides for those treatments. “You know, it’s a market,” Coburn said,”and what they’ve done is they’ve priced it where these cancer centers, a lot of them aren’t going to participate because they don’t get paid [enough] to cover the costs.”

During the government shutdown, House Republicans wanted to pass a stand-alone bill to fund the National Institute of Health so children with cancer could continue to participate in clinical trials. Reid called that move “reckless and irresponsible” by those obsessed with this ObamaCare.” A reporter asked “If you can help one child who has cancer, why wouldn’t you do it?”

Reid said “Why would we want to do that? I have 1,100 people at Nellis Air Force base that are sitting home. [because of the shutdown] They have a few problems of their own.”

I understand that for Senate Democrats, ObamaCare is about power, and more control of the American people. But for the rest of us it is about the American people getting the care that they have been promised, that the rest of us are paying for.




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