American Elephants

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

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

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

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

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

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

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

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

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

Obamatax by The Elephant's Child

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

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

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

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

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

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

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

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

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

ObamaCare Gummed Everything Up. by The Elephant's Child

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

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

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

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

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

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

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

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

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

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

Do Old People Have a Duty to Die and Get Out of the Way? by The Elephant's Child

Doug Ross@ Journal has a very funny piece that makes a good companion to my post below “A Warning Voice From Across the Water.” The Democrat view, and its results in the Patient Protection and Affordable Care Act now being argued before the Supreme Court, is a serious problem that nobody really wants to talk about.

It has been  a frequent subject in the British press, as the elderly in British hospitals are abused and mistreated in the name of saving money.  What do you do with those annoying old, sick people who need expensive medicine? Does society have a duty to make their lives pleasant and comfortable? Or should we force them to kick the bucket? Elderly family members used to live with their children, who cared for them. Now, with both members of a family often working; with families spread out across the country, situations are different.

Back in 1984, a Governor of Colorado, Richard Lamm, spoke on the “duty” of elderly people who are ill to “die and get out of the way.” People who die without having life artificially extended are similar to “leaves falling off a tree and forming humus for the other plants to grow up. Let the other society, our kids, build a reasonable life.” Nice.

In the wake of Vice President Dick Cheney’s new heart transplant, and aside from the leftist boors who hoped he’d die in the operation, voices were again raised to say that because he is 71, he should not have had access to a transplant. Seventy-one is not as old as it once was, and Mr. Cheney waited far longer for an appropriate transplant than others do, partly because he was unwilling to take any advantage. His operation was a great success, and we wish him many more years of fly-fishing and commenting on national and international affairs. He is a great patriot and an important voice.

What is medicine for? Is it only to fix the broken arms of healthy young kids? Much of the medicine that serves the young (the under 55 group) is precautionary in nature and not all that necessary, if we are comparing needfulness. Most old people are perfectly capable of assessing the value of expensive operations  at their age, and in their condition with the help of their doctors — without interference or regulation from the federal government.

People who fear being old, sick and in pain have voted in “assisted suicide” in the state of Oregon. The old do not want to be a burden to their family, either for care or expense. Then, of course we had Dr. Kevorkian, and a few rather ugly movies, notably “Solyent Green.”

I think the federal government should have no involvement in health care. To the extent that they have been— they do a lousy job of it. Why anyone who is familiar with the Indian Health Service’s record, or Veterans’ health care would want ObamaCare is beyond imagining.

I think assisted suicide laws are passed, like light rail laws, by people who think it would be nice for other people, though they have no intention of using it themselves. I think that caring for the old, sick and frail is an important part of what medicine is all about.

Volunteer to commit suicide if you choose, but don’t be telling other people what they should do. And maybe Doug Ross’s “Codgers” humorous take will do more to make people think about a serious problem than all the scare stories.

Monday, March 26. 2012— It Begins! by The Elephant's Child

The arguments begin on Monday, as attorneys representing 26 states, the National Federation of Independent Business (NFIB), and a few of its individual members square off against U.S. Solicitor General Donald B. Verilli, Jr. and one of his deputies.  Other attorneys appointed by the Supreme Court will  join the fray on two issues.

Heritage spells out the schedule — six hours of oral arguments which will be conducted in four sessions, spread over three days. That’s an unusual amount of time that the Supreme Court has allocated to the cases challenging the constitutionality of the Patient Protection and Affordable Care Act, which we all know and detest as ObamaCare.  The schedule is here.


“Free Medicine” or Free Market Medicine? Hype or Hope? by The Elephant's Child

The case of ObamaCare will be argued before the Supreme Court next week. The Court has given it an unusual five hours for arguments over three days, then the decision is expected to come down some time in June.

The administration plans a coordinated campaign to force an unwilling public to accept ObamaCare. As usual, they will not present evidence, but instead focus on ” better messaging.” Focusing attention of their target audience on dramatic stories of the wonderfulness of the Affordable Care Act and Patient Protection ( I can never remember what comes next). Hopefully not the false story of Obama’s mother’s insurance again. The White House has a lot of persuading to do. Americans don’t like it.

Now events have put it back on the front page: the case brought by 26 states reaching the Supreme Court, the  issuance of a compulsory contraception mandate, and a new cost estimate from the Congressional Budget Office. The bill came with all sorts of budget gimmicks so President Obama could trumpet 10-year costs of $938 billion. Now the CBO is estimating costs for 2013 through 2022 at $1.76 trillion, nearly double the phony original number, and even that is probably understated.  Annual gross costs after 2021 are more than a quarter of $1 trillion forever, every year.  Added to our $16 trillion in debt, of course.

Aside from lying to us about the costs, they lied to us about the need for reform. The cost of health care was NOT spiraling out of control, it had been declining for ten years back towards the normal rate of inflation — caused by advances in medicine, treatments, medicines and management. The part about evil insurance companies was hooey too, as was Obama’s claim that his mother’s insurance denied payment. He got several Pinocchios for that.  The big problem is simply that it won’t work.

Liberals get all excited when they want to accomplish single provider insurance. They want to cover everything to prove how nice they are. After all, their aim is to make you completely dependent on them. But things are not free. Somebody has to pay for them, and the only somebody around is taxpayers. When they generously offer to pay for your contraception, the cost goes up.

The Medicare Drug program was designed to cost less than was estimated because of the “donut-hole” provision that gave seniors an incentive to keep their own costs down by using generics and avoiding unnecessary drugs. When a senior’s cost for drugs reached a certain level, they had to pay for their own (incentive) unless they could not afford it, in which case the plan picked it up. Liberals were horrified, and eliminated the provision that kept costs down, which is insane.

President Obama claimed that his health-care plan would lower annual family health insurance premiums by $2,500 before the end of this term. The Kaiser Family Foundation reported that the average family premium has increased by $2,200. The promised long-term care program, called the CLASS Act has been eliminated because it was financially unworkable, but the loss of the premiums that would have been collected wiped out $70 billion of supposed deficit reduction.

Around 50% of employers plan to stop offering health insurance to their employees once the law is implemented. Their choice is to pay $20,000 per family for care or a $2,000 fine. The incentive is to drop coverage. The plan was devise to become single payer.

But nevermind, there won’t be enough doctors anyway. The nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The U.S. now has 352,000 primary-care physicians now. Four new medical schools have opened and have enrolled about 190 students. Some 18,000 students entered U.S. medical schools in the fall of 2009. The big blockage is the three-year residency period; there are about 110,000 resident positions, and teaching hospitals rely on Medicare funding, which Congress capped.  It will probably take 10 years the AAMS’s chief advocacy officer says, to even make a dent in the number of doctors needed.

Add to that the fact that most doctors would now advise their own kids not to go into medicine. And more than 43% of doctors say they are considering retiring within 5 years. Used to be that many families had lots of doctors, but the profession, under ObamaCare, is no longer so rewarding.

Under a program like ObamaCare, the #1 problem becomes cost. When the government has promised all things, they have to find ways to cut those costs. The first choice is to cut the cost of senior citizens, for the highest costs come in a person’s final years. It would be much more convenient if they would not demand (or get) expensive procedures, and expensive care. Obama already took $500 billion out of Medicare payments to providers. The consequence: fewer doctors will accept Medicare patients, more emergency room use. The focus of the entire enterprise becomes eliminating cost.

Under the American health care system, before Obama got his hands on it, the focus was on getting people well, making them healthier, or more comfortable. That’s what all those new treatments, new procedures and innovation was all about. Doctors and hospitals were rewarded for excellence.

I think that’s what they called “the free market.”

ObamaCare Comes Before the Court Next Week. by The Elephant's Child

ObamaCare will be argued next week in the Supreme Court. The justices will be considering the application of the health care law in the light of the United States Constitution. While the justices consider the constitutionality of the law, most of the arguments have to do with the economics of the law.

We were lied to in the first place, directly and purposefully. It was necessary for Democrats to drum up nationalized health care in the back rooms of Congress, because the costs of health care were spiraling out of control, and the only solution was socialized medicine the Affordable Care Act and Patient Protection something or other.  That was not true. Medical costs had been moving downwards towards the normal rate of inflation for a decade. There was NO emergency.

Consider the individual mandate to purchase health insurance. The Obama administration defends the mandate on the ground that a person’s decision to not buy health insurance affects commerce by materially increasing the costs of others’ health insurance. The government adds that health care is unique and therefore can be regulated constitutionally in ways other markets cannot.

The government’s other defense is that the health-care market does not exhibit textbook competition. No market does. The economic features relied upon by the government…are characteristic of many  markets.

Health care, Douglas Holtz-Eakin, and Vernon L. Smith point out, is typically consumed locally, and health-insurance markets themselves primarily operate within the states.

The administration’s attempt to fashion a singular, universal solution is not necessary to deal with the variegated issues arising in these markets. States have taken the lead in pas reform efforts.  They should be an integral part of improving the functioning of health-care and health-insurance markets.

Mr. Holtz-Eakin is a former director of the Congressional Budget Office, and president of the American Action Forum. Mr. Smith is a professor of economics at Chapman University and the 2002 Noble Laureate in Economics.

Professor Richard Epstein argues that the health law’s expansion of Medicaid is problematical. An expenditure of federal funds is unconstitutional when it coerces states rather than encouraging them to participate in a federal policy. ObamaCare transforms Medicaid from a health-care program for the poor into a mandatory federal entitlement— obligatory on both the states and the beneficiaries alike.

What the Supreme Court will do is completely unknown. Speculation does not help. Kind thoughts, prayer, voodoo dolls and worrying probably won’t help either, but  you might try your favorite remedy anyway.

Don’t Make Promises That You Don’t Intend to Keep by The Elephant's Child

   President Obama’s Promises — Under the Presidential Bus

President Obama said “If you misrepresent what is in this [health care] plan, we will call you out.” So we’re calling him out.

PROMISE: “If you like your health care plan, you’ll be able to keep your health care plan, period.”
UNDER THE BUS; Research shows that as many as 30 percent of employers will dump their employees out of their existing health care coverage. New coverage mandates are forcing plans to change, even for those who have moral objections.

PROMISE: “I will not sign a plan that adds one dime to our deficits—either now or in the future.”
UNDER THE BUS: The Congressional Budget Office (CBO) reports that the deficit reduction associated with PPACA is based on budget gimmicks, sleights of hand, accounting tricks, and completely implausible assumptions. The new law is actually a trillion-dollar budget buster.

PROMISE: “I will protect Medicare”
UNDER THE BUS: Medicare costs are to be held down by severe cuts in payments to physicians and other medical suppliers. Taxes on makers of medical equipment will reduce availability, and the Independent Pay Advisory Board will decide what tests will be available. Bureaucrats will decide if operations will be available or only palliative care.

PROMISE: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premium by up to $2,500 a year.
UNDER THE BUS: Heritage lists 12 ways that ObamaCare will increase premiums instead of reducing health care costs, like allowing young adults to stay on their parents’ coverage and offer preventive services with no cost sharing.

PROMISE: “Under my plan, no family making less than $250,000 a year will see any form of tax increase.”
UNDER THE BUS:  A list of new taxes and tax hikes shows an increase of more than $500 billion in 10 years. The 2.3 percent tax on manufacturers and importers of medical devices will raise $20 billion between 2010 and 2019.

ObamaCare: Myths, Lies and Backroom Deals by The Elephant's Child

How did we get into this dreadful health-care mess anyway? We were told that runaway spending on health care was having a terrible effect on the national budget, and if we didn’t fix it, disaster would occur.That seems to have been a convenient myth. The growth rate of national health expenditures has been declining for a decade  driven by better medical care and consumer choice.
This chart is from the Centers for Medicare and Medicaid Services, the agency in charge of that sort of data. From the Wall Street Journal:

“New data show that health spending over the past several years has been normalizing toward the rate of general inflation, rather than growing higher and higher, as had been the case almost continuously since the 1970s. This moderation in the growth rate of spending predates the national recession. And it puts the lie to the claim that we need government to put the brakes on an “out-of-control” health-care system.”

“The moderation has been driven by cumulative improvements in medical care and by insurers, and by marketplace disciplines on the demand for medical care. Consumers are finally getting more involved in managing and paying for their own care.”

We have new breakthrough drugs for chronic disease, mental illness, HIV and cancer. Many are generics. The market works. You will notice that the spending starts back up again in 2010.

It took a lot of lies and misstatements to get us into ObamaCare, and ObamaCare is full of illusions and pipedreams. Before ObamaCare, you had three parties—the patients, the medical establishment, and the health insurance companies. ObamaCare assumes that those three groups cannot manage to care for the sick and the well without direction and supervision by many assorted bureaucracies full of smart people who went to all the right schools telling them what to do and how to do it. And those many bureaucracies (over 100 agencies) filled with all those smart people will make ObamaCare cost less? They cannot deny care to the elderly and the frail fast enough to compensate for the added expense of all that bureaucracy.

The goal of the system shifts from improving care for those who need it, to getting paid. In Britain, doctors are on salary and work for the state. Rules and regulations descend from the state. You will cut costs here, you will cut wait times there. So some hospitals parked patients in ambulances, so they wouldn’t be registered as entering the system and messing up the wait-time records. In other hospitals, sheets were used over without washing to save money, and patients were left soiled in their beds. Do the jobs in the medical establishment depend on the excellent care they give to patients or do they depend on meeting budget limits?

But back to ObamaCare: A single committee — the United States Preventative Services Task Force — is empowered to evaluate all preventive health services and decide which will be covered by health-insurance plans. They rate services with grades of ‘A’ through ‘D’. Colon cancer screening for adults age 50-75 must be covered by health-care plans without co-pays. Screening for ovarian or testicular cancer that get ‘C’s and ‘D’s may get eliminated. In 2009, it decided that women age 40-49 shouldn’t get routine mammograms. More recently it cancelled routine prostate-cancer screening and the use of tests that detect the viruses that can cause cervical cancer. Doctors are inclined to look at family history, symptoms, that kind of thing. People are not all the same and can’t be divided up by age categories.

Its advice is often out of sync with conventional medical practice. For example, it recommended against wider screening for HIV long after such screening was accepted practice…Only in 2009 did it finally recommend aspirin for the prevention of stroke and heart attack among those at risk — decades after this practice was demonstrated to save lives and had become part of standard medical practice.

That’s a perfect example of the problem of liberal belief in the overwhelming superiority of the liberal mind. Whatever it is, they just know better.  They went to the right schools, you see. They know the right people. They’re friends of your friends. They don’t require any specialized knowledge of medicine, pharmacology or administration. They’ll just look at some statistics and make the hard decisions.

No problem, unless you don’t fit the statistical norm, then you’re out of luck.


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