American Elephants


Daniel Hannan Warned Us in 2009. We Didn’t Pay Attention. by The Elephant's Child

I posted this warning from Britain’s Daniel Hannan, Member of the European Parliament way back in 2009, about imitating their National Health Service. He urged us then not to copy their system. But we didn’t have a choice. Democrats controlled both houses of Congress and the Presidency. They drew it up in Congressional back rooms, behind locked doors, and passed it without a single Republican vote and without any Republican input. It’s just kind of interesting to see how far we have come since 2009.

If you remember, many on the right posted this diagram of the enormous bureaucracy that was necessary to administer ObamaCare added on top of the networks of insurance companies and the medical profession. Each of these offices and agencies and bureaus is filled with bureaucrats who have to be paid high Beltway salaries and whose healthcare and pensions have to be paid for with taxpayer dollars. They expected to pay for this by taking $500 billion out of Medicare, paying doctors and hospitals less, limiting networks of providers, and eliminating your ability to get care if you travel. ……….(click to enlarge)

ObamaCare flow chart



Another “Glitch!” More to Come. by The Elephant's Child

Those who purchase health care coverage outside the exchanges cannot claim subsidies, even if they qualify for them, according to the Centers for Medicare and Medicaid Services — the agency overseeing implementation of the Affordable Care Act. Automatic enrollment directly through an insurer would avoid the exchanges — and any subsidies, entirely.

This means that the 14 million people who currently have individual insurance policies don’t get any subsidies if they stay in a grandfathered plan, or if they are enrolled by their insurer into a new ACA compliant plan. You expected any of this to make sense? There are over 20,000 pages of regulations.



Common Sense, Briskly Expressed! by The Elephant's Child

A short piece by Bob Krumm caught my eye this morning. titled “IT’S NOT BUSINESS; IT’S STRICTLY PERSONAL”

Republicans want a delay in Obamacare.  Because of the many significant problems with the rollout of Obamacare, and because he has delayed parts of the law himself some 19 times, President Obama should want a delay in Obamacare too.  One year gives Democrats an opportunity to fix systemic errors in the software, the regulations, and the law.  One year gives nothing at all to the Republicans–nothing–except the opportunity to crow a little bit.

That the President can’t compromise in a way that gives him everything he wants, plus the extra time he needs, is not about business.  It’s strictly personal.

I love it when someone sums up all the arguments of the past few weeks, wraps it up in a brief package and sums it up in a quotable manner. Nice going.

 



Obama Promised Your Premiums Would Go Down $2,500. Uh huh. by The Elephant's Child

Back in 2008, three eminent Harvard economists who were advising the Obama campaign on matters economic — David Cutler, David Blumenthal, and Jeffrey Liebman — wrote a memo claiming that Senator Obama’s health-care plan could reduce national health spending by $200 billion a year.

Candidate Obama had already claimed that health care costs were spiraling out of control, were going to destroy the economy, wreck the budget, so reducing the out-of-control cost of health care was a very big deal indeed. The advisers took that figure and divided [it] by the country’s population, multiplied by four—for a family of four, and using economist math, rounded it down a little to a nice round number: $2,500. Mr. Obama, delighted, then took that number out on the campaign trail:

And he said he’d lower premiums by $2,500 in his first term as President of the United States. Avik Roy writes the Apothecary blog at Forbes magazine about health care, so with new numbers from the experts working for Medicare’s actuary, he used the same economist math. He took the latest year-by-year projections, divided by the projected U.S. population to determine the added amount per person and multiplied by four—for a family of four. With the best economist math Obamacare will increase health spending by $7,450 for a typical family of four. He even included a dandy graph:CostperFamily

Health care costs have been going down since 2006. New diagnostic tools are in place and paid for. Important new drugs like Statins are saving lives and a lot of heart surgery. It was the president’s claim of $2,500 savings that was completely wrong, but that was the basis on which ObamaCare was sold.

I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”

This is a touchy point among progressives. But you might remember that George W. Bush’s Medicare Drug plan is the only government program known to have come in under estimates and under budget. That is because it had a built-in incentive to encourage seniors to select generics when they had the opportunity to, in order to avoid the “donut hole” where they wouldn’t get a subsidy unless they really needed it. Democrats, of course, thought that was mean, (they don’t do incentives) and eliminated the “donut  hole.”

On the other hand, Andy and Amy Mangione of Louisville, Kentucky and their two boys are just the family of four that should be helped by ObamaCare. They recently got a surprise in the mail.

The insurance charges for the Mangione’s policy was going to almost triple — from $333 a month to $965 a month.

The notice from their insurance company carried this paragraph:

If your policy premium increased, you should know this isn’t unique to Humana — premium increases generally will occur industry-wide.

“Increases aren’t based on your individual claims or changes in health status,” it continued. “Many other factors go in to your premium including: ACA compliance, including the addition of new essential health benefits.”

People who currently choose to purchase a high deductible, low premium policy that’s more affordable for them, are now being required to add all these new benefits to their policy. (Even if they don’t want them).

This tells you how government bureaucrats do economic estimates, and why everything always doubles and triples in cost.  (or more) And why you should never believe their numbers.



We Are Slowly Finding Out “What Is In It,” and It’s Not Good. by The Elephant's Child

Further reports on the coming train wreck: Health Insurance rated in Georgia are rising by up to 198 percent under ObamaCare the Georgia Insurance Commissioner said in a letter to HHS on Monday.

Commissioner Ralph Hudgens asked for more time to investigate and approve the new higher rates. Georgia consumers cannot afford these massive rate increases, he wrote to Secretary Sebelius.

For a 25 year-old male, premiums will rise 65 to 198 percent within the exchanges, and for a 45 year-old  male premiums will rise 40 to 100 percent. It seems to involve “age rating” which requires that insurance companies charge no more than three times what they charge younger people. This means that the restriction will lower prices for the elderly and raise them for younger people.

Indiana has announced that insurance rates are rising 72 percent for an individual plan and 8 percent or a group plan.

The Treasury Department Union is up in arms because they are being forced into the exchanges — and these are the people who are supposed to manage it.



Nancy Pelosi Still Doesn’t Know “What Is In It” by The Elephant's Child

Nancy Pelosi, former Speaker of the House, once famously said that “We would have to pass the bill to find out what’s in it.” They passed it, but she apparently still hasn’t read it. It is long and confusing, but she clearly still doesn’t know what is in it. She can’t get past her extreme partisanship and speak about it honestly. One doesn’t know whether to laugh or cry.

She doesn’t remember, but here she is in 2012, asserting that she did too say everyone’s premiums would be lower. You Tube is so darned inconvenient. Politicians just haven’t caught up with the fact that their words are preserved for eternity.

Premiums are scheduled to double for most people. Premiums for a family are expected to be around $20,000 a year. With a vast shortage of doctors, wait times will increase to match the horrors of Canada and Britain.  How to fix it? Well, just turn it into single payer, which is what the Democrats intended all the time. We were talking about trust and truth telling, weren’t we?

ADDENDUM: The Ohio Department of Insurance announced that based on the rates submitted by insurers, the average individual market health insurance premium in 2014 will come in around  $420, representing an increase of 88% relative to 2013. Lt. Governor Mary Taylor said in a statement: “We have warned of these increases. Consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”

A total of 14 companies proposed rates for 214 plans to the Department. Projected costs from the companies for providing coverage for the required (by ObamaCare) essential health benefits ranged from $282.51 to $577.40 for individual health plans. They have not yet been approved by the Department of Insurance. The biggest drivers are 1) risk pool composition charges — forcing the young to subsidize the old, and the healthy to subsidize the sick. And 2) ObamaCare’s required expansion of insurance benefits. Some have the impression that rates are rising because of the law’s requirement or covering pre-existing conditions, but that represents only a very small part of the rise.



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.




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