Filed under: Bureaucracy, Capitalism, Democrat Corruption, Domestic Policy, Free Markets, Health Care, Law, The United States | Tags: Collapsing Co-ops, Imploding, Spiraling Costs, The Failure of ObamaCare
You have probably noticed that Democrats generally believe that most things are better done by the government than by the private sector. The federal government is not just a bureaucracy, but a bureaucracy of bureaucracies, thousands of agencies, departments. offices, all with their own cultures, rules, traditions, and all striving to grow in importance, size, and share of the federal budget. Service, not so much.
Whereas, the private sector strives to make a profit, clearly a dirty word. They haven’t been elected or appointed. They make too much money, they fire people —sometimes in massive numbers. The federal government tries to make them more responsible and keep corporations from doing bad things. Obviously the important things should all be done by a wise government who can help the common folk out there, who need all the help they can get.
So when the cost of health care seemed to be climbing, and there were people who didn’t have health insurance, of course the Democrats planned to take it over by showing just how good a health insurance plan could be and all the good things that they would include — as quickly as possible while they controlled Congress. Promises, big promises — more affordable, if you like your doctor you can keep your doctor, all sorts of good things — and it just doesn’t work.
The co-ops that were going to save so much in costs are going belly-up at a tremendous rate, more every few days. A New York State audit finds that ObamaCare exchanges have enrolled hundreds of dead people and paid out benefits. Some of the dead people were enrolled after they died. A cover-up is in the works. ObamaCare premiums are projected to soar by 20.3 percent on average in 2016 instead of the 7.5 percent claimed by federal officials.
Supporters credit ObamaCare with helping nine million uninsured Americans find coverage in 2014, but a new paper from the Heritage Foundation suggests that the increase came from adding nearly nine million people to the Medicaid rolls. The wealthy can have health insurance, but at a higher price, but they can afford it. Many middle-class Americans are paying higher premiums that they can barely afford. Millions of other Americans have found themselves forced out of affordable plans with their new premiums rising rapidly.
Regardless of whether there is a President Cruz or a President Rubio in January 2017, regardless of the existence or size of a Republican majority in Congress, the so-called Patient Protection and Affordable Care Act (ACA) has failed. The grand vision of an efficient pseudo-market in health insurance under enlightened federal management — the heart of Obamacare — is not coming to pass. Obamacare, meaning the operating model that undergirded the law that Congress passed and President Barack Obama signed with great fanfare — is dead, and it will not be revived. What remains is fitful chaos.
That’s Kevin Williamson at National Review. His careful explanation for why it doesn’t work is very worth reading. Obama’s ‘promises’ of course have proved as improbable as all of his others. You can’t keep your doctor, It’s going to cost way more, not $2,500 less, and ObamaCare is adding a bundle to the deficit.
The architects of Obamacare are deeply distrustful of the role of for-profit companies in the health-care business because, in their nearly pristine ignorance, they falsely believe profits to be net deductions from the sum of the public good rather than measures of the creation of real social value.
Add in a complete lack of understanding of the role of incentives, some major innumeracy, unbridled confidence in cost-saving gimmicks that were mostly wishful thinking. Republicans are a lot better at this sort of stuff, and they do mostly understand incentives. But they may want to rewrite it, in an attempt to repair the unrepairable.
What I am most concerned about is getting the federal government out of the health care business. They are totally incompetent at it and should never be allowed to have any responsibility for it. The Indian Health Service is a disgrace. The Veterans Administration is embroiled in scandal. Medicaid is a mess, and Medicare is rapidly going broke, along with Social Security. Even more, it is a political debacle as well.
Since it was first enacted, conservative think-tanks have been studying what works and what doesn’t. There are dozens of them, and top scholars have been working on better answers. Let’s get them all on the table. Ask the medical profession for their best ideas. Consult with the Health Insurance Companies instead of regarding them as the enemy to be punished and controlled.
The biggest mistake was to assume that you could take the health care system, layer on a vast bureaucracy of many agencies on top, each striving to increase their budgets, wrap it all up in a package of glitter with fancy logos and music and Life of Julia, pajama boy, and unneeded gifts and expect it to be more efficient and cost less.
Filed under: Capitalism, Democrat Corruption, Domestic Policy, Economy, Health Care, Progressivism | Tags: Canadian Medical Tourism, Escaping Inadequate Care, The Failure of ObamaCare
Democrats like to claim that the inspiration for ObamaCare came from Massachusetts’ Romney Care. They did copy the individual mandate, I believe, and had as an adviser someone who had helped to develop RomneyCare.
However, the main group of Obama’s health care advisers: Ezekiel Emanuel MD, Tom Daschle, Peter Orzag, Donald Berwick MD and Jacob Hacker, were all great admirers of Britain’s National Health Service (NHS). Much of their admiration was centered on the idea that the highest medical costs came from elderly people in their final years, and that to significantly cut costs, they would have to limit those costs in some way.
Why they would admire a system so mired in scandal — with elderly patients dying in hospital from dehydration and starvation — is hard to understand, for the stories are published regularly in the British newspapers, from people who are using super glue to fasten in their teeth due to inability to see a dentist, to patients parked in ambulances outside hospitals to keep the numbers at emergency rooms down.
Back before ObamaCare first passed in this country, we noted that Canadians unable to get the care they needed in Canada were coming to the US for care in droves. They were suffering from long wait times to see a specialist, lack of availability of advanced diagnostic equipment or long wait times to get to use it. Here, an appointment for a CT scan can be had in 45 minutes.
You don’t get sent to a specialist unless you have a potential problem. Some potential problems are far too catastrophic to wait for several months. Now, we learn that today, as many as 41,838 Canadians — out of a population of around 35 million — left the country last year for health care treatment. More than 42,000 did so in 2012, and more than 46,000 sought treatment elsewhere in 2011. The Fraser Institute calls the 2013 figure a conservative number and says that it is deeply damning about Canadian care.
Canada has companies devoted to arranging medical tourism, including Costa Rica, India, Thailand and the U.S. Some companies send clients to Mexico, Turkey, Poland and the Dominican Republic. Those who leave Canada for treatment do so for reasons related to the country’s government-run health care system: better outcomes, avoidance of the consequences of wait times, concerns about the quality of medicine in a country whose system destroys the incentives needed to build more advanced facilities and develop higher tech medicine. [Note the word “incentives” in that last sentence.]
It is hard to tell, but ObamaCare seems to be in a death spiral — the insurance pool equivalent of bankruptcy — when too many older and sicker people sign up for insurance relative to the number of younger healthier people. According to figures released this week over half the people who have enrolled are over the age of 45, and only 24 percent are between the ages of 18 and 34, half the number needed to keep premiums affordable.
Democrats will not admit the depth of the problems, and most probably will attempt to switch it to a “single-payer” plan which is what they wanted all the time like Britain’s failed NHS.
The most frightening possibility is attempts to patch, jigger, or reform the current plan. Obama is determined to do whatever is necessary by executive order, but how far he will take that is unknown. ObamaCare cannot be fixed. The most basic need is to get government out of the business of running American health care. They are not competent to do so.
Free markets, free people — and let innovation triumph.
Filed under: Capitalism, Democrat Corruption, Economy, Health Care | Tags: The Failure of ObamaCare, The Medicare Actuarys' Report, The Medicare Trustees
A week ago the Medicare Trustees issued their annual report. It showed that Medicare is heading for insolvency even earlier than expected. The Hospital Insurance Trust Fund (which funds Medicare Part A) will be insolvent in 2024, and the promised benefits that are not paid for will amount to $24.6 trillion.
Tacked on page 266 was a note from the Medicare Actuary. An actuary is someone who is really good with math. Specifically— a statistician who calculates insurance premiums, risks, dividends, and annuity rates. The Medicare Actuary said that the Trustees’ financial projections “do not represent a reasonable expectation for actual program operations.”
Late Friday, the Office of the Actuary released a separate analysis. He said: “the projections…should not be interpreted as our best expectation of actual Medicare operations in the future but rather as illustrations of the very favorable impact of permanently slower growth in health care costs, if such slower growth can be achieved.” (emphasis mine)
The big differences are rooted in the severe statutory cuts to Medicare provider reimbursement that are already in current law under ObamaCare. The Actuaries believe that ObamaCare’s cuts in payments to providers will harm seniors’ access to care if Congress allows them to go into effect.
The “Sustainable Growth Rate formula calls for scheduled reductions to physician payments, which would next year in 2012 cut the reimbursement to doctors by an astounding 30 percent. The Trustees assume that the cuts will occur. The Actuaries say that if they did Medicare payment rates would fall to 57 percent of private insurance payment rates. That’s similar to what is happening with Medicaid, the government’s biggest welfare program, where physicians are fleeing in droves. They just stop seeing Medicaid patients. Medicaid patients who can’t find a doctor go to emergency rooms. Costs skyrocket. Same thing will happen with Medicare.
Democrats, always uninterested in unintended consequences, assume that you can just pay doctors less than they require to cover their costs and they will spend a little less time with patients and all will be well. The real world doesn’t work that way. Doctors will just stop seeing Medicare patients. There is already a shortage of 45,000 primary care doctors nationwide, expected to grow to 150,000. Fewer bright students will go into medicine, Doctors will retire early. If Congress delays the cuts, Medicare will just go broke faster.
ObamaCare also plans to reduce payment to hospitals and other providers. This would cause 15 percent of hospitals, skilled nursing facilities and home health agencies to become unprofitable by 2019, and increasing to 40 percent by 2050. That means they go out of business.
Those fees are already well below what the private sector pays, however. For example, Medicare pays doctors almost 20 percent less than what private payers pay. It pays hospitals almost 30 percent less. In the future, that discrepancy will grow wider with each passing year.To achieve the necessary targets, the new law gives an Independent Payment Advisory Board the power to recommend cuts in reimbursement rates for providers of health care. Congress must either accept these cuts or propose its own plan to cut costs as much or more than the panel’s proposal. If Congress fails to substitute its own plan, the board’s cuts will become effective. In this way, the growth rate for Medicare spending is officially capped. Moreover, the advisory board is barred from considering just about any cost control idea other than cutting fees to doctors, hospitals and other suppliers.
Physicians and Hospitals can only do so much cost-shifting. Then there would be no more private rooms, but large wards, there would be reduced access to expensive technology. If some doctors and hospitals began offering concierge services to the more affluent, how long would that be legal? When would they nationalize physicians to force them to serve everyone? When would hospitals be nationalized? How soon will they force all private insurance companies out of business? The attention of doctors and hospitals would turn from patient care to the constant effort to get adequate repayment from government. These are things that could well become unintended consequences of ObamaCare.
That’s what happens when you devise a bill based on ideas of “managed care.” The Accountable Care Organization rule book is already 200 pages long. They think that they can manage competition. The competition part is belied by words like mandate, control, consolidate, nonnegotiable, rules, regulations. The Obama administration’s deep unfamiliarity with the free market, and their contempt for the free market is notable.
Meanwhile, Democrats are in full-throated attack mode on Paul Ryan’s “Path to Prosperity.” Democrats have been claiming that Republicans are trying to starve Granny ever since Medicare was created as part of Lyndon Johnson’s failed Great Society. They’re just taking the same old false accusations to new and disgusting lengths.
Pathetic. Really pathetic.