American Elephants


The Despicable Fraud Perpetrated on The American People: by The Elephant's Child

Democrats have clearly demonstrated their desire to whip people into better order with a raft of government regulations, directives and plain old force. We focus on the regulation and the directives, but let’s face it. The problem is the people.

We are talking about millions of human beings, individuals with their own ideas, their own likes, their own prejudices, their own desires, their own sensitivities, their own knowledge, their own beliefs and their own general resistance to doing what they are told to do. That’s simple human nature. In repressive societies people learn to fear the government and hide their resistance lest they face punishing reprisal.We all know about the societies with the gulags, concentration camps, slave labor camps, where the choice is between facing punishment or facing death.

Democrats have long regarded free health care for the people as the biggest, most wonderful thing they could give to the people, which would endear their party to the people permanently. The problem, of course, was how to pay for it.

Well, nevermind, that can be figured out as we go along. Rich people will just have to pay more. That’s how it all started and bureaucrats started writing rules and regulations, and although there were pages and pages of them, they had three and a half years to finish it up.

Phase One was the big rollout, and the technical failure. It might have been avoided had there been some competence in the management, but it was never tested, the basic code for the back-end was never written, and there was no security for the customer at all. The rollout was a disaster and a great embarrassment for the administration. So they said they would postpone it till the first of December when it would all be fixed. Uh huh. The President ordered up a tech surge to get everything working, but that is apparently only 6 people. Experts say the security is worse than ever.

And it seems that that part for which the code has never been written was the part that told the insurance company that you had signed up and transferred the first payment. They are advising those who think they have signed up successfully to call the insurance company and see if they have confirmed your enrollment and received your payment.

Phase Two was the revelation that the entire ObamaCare enterprise is the largest deliberate fraud ever inflicted on an unsuspecting American public.  The promises of “if you like your plan you can keep it” have turned out to be not an accident, but a phony sales pitch that was deliberately deceptive. On top of that ObamaCare forces insurance companies to engage in dishonest practices like selling maternity coverage to men and postmenopausal women, and pediatric insurance to the childless. The worst case scenario could turn up on January 1, as insurance companies begin dropping people who formerly had their insurance through their employers, and there will be a lot of them.

Obama promised insurance that would cost $2,500 less that our previous policies. Another part of the fraud. Medical insurance comes in two kinds: there is indemnification against risk, which is true insurance; and there is pre-payment for expected costs. Risk is a heart attack, or a stroke, a broken arm or broken back. Insurance company actuaries are very well paid because they are very good at math. They get reports on the numbers of heart attacks or strokes in a year, and determine mathematically how many they are going to have to pay off on. The trouble arises when Democrats want to have lots of benefits for everyone, and want everyone to pay for it. Health insurance is usually age related, because the risks are different at different ages, but when everybody has to pay for maternity care, and pediatric vision care, Alzheimers and shingles, it gets very, very expensive.

That bit about people with pre-existing conditions was nice, but the President made it sound like there were thousands of them. Part of the sales pitch. Those who signed up in the first three years for this desperately needed insurance that they’d been denied 107,000 people out of a population of 330,000,000.  Looks like 10 million people will lose their employer-provided health insurance. The governments’ goal for next year is to sign up about 7 million people. It was the government that made sure that most insurance policies would get cancelled, not the insurance companies. It is written right into the law.

Everybody knew this, except for ordinary folks. And they’re just stuck. How will this play out? Will the whole thing collapse on its own? Will the people get their backs up and demand that it be repealed? The administration played the insurance companies, promising them many more customers in exchange for their cooperation. The health care industry? Scared? Unorganized? I don’t know. With the president spinning dramatic tales of the blessings of health care for all, and the media completely willing to play along with whatever he said, the evidence of industries destroyed, companies brought to heel, there was certainly in America a real fear of the government.

I think it will come close to collapse but they will tinker and lie and try to keep it afloat, and in the end try to enlist Republicans into saving it for the good of the country. It would be a lot simpler if they would just recognize it as a mistake that cannot be fixed.



Other Voices: by The Elephant's Child

“…it’s worth noting … that there is something fundamentally unpatriotic in the yearning to fundamentally transform your country. I love my wife. Inherent to loving her is loving her for who she is. Gentlemen, turn to your wife and say, “Honey, I love you completely. It’s just that I want to fundamentally transform you into someone else.” See how that plays out. If you want to fundamentally transform the object of your affection so that it conforms to your fantasies, that is not love…” —Jonah Goldberg, National Review

Psychologically (as well as rhetorically), the individual mandate is very important to the left.  Obamacare is all about coercion—about forcing people to do things they don’t freely choose to do—and the individual mandate serves as its coercive core.  It’s what allows Obama to grasp onto the thinnest reed of legitimacy when describing Obamacare as offering “universal coverage,” despite the CBO’s estimate that, even after ten years and $1.8 trillion, Obamacare would cover less than 45 percent of the uninsured (at the whopping cost of $72,000 per newly insured person).  That’s a far cry from “universal coverage.”  But one can think of it—and describe it—as “universal,” so long as one is forcing every American, as a matter of federal law, to do the government’s bidding.  Without the individual mandate, Obamacare would cease to be “universal coverage,” even in the sense of being universally coercive, and would simply become “45 percent coverage.”  That would be demoralizing to the left. Jeffrey H. Anderson, Weekly Standard

…the implication from Democrats that once a bill becomes a law, it is as indelible as the Ten Commandments, etched into rock by the hand of God Himself, is precious when we consider the source. The Democrats, after all, mounted a 10-year campaign against the “Bush tax cuts,” and did so despite defeat after defeat on the issue. Those tax cuts joined a long line of laws that the country later substantially revised or repealed entirely. A partial list includes: the Clinton tax increases, portions of the Reagan tax cuts, the Gulf of Tonkin resolution, portions of the Kennedy tax cuts, the gold standard, portions of the National Labor Relations Act, Prohibition, the direct election of senators, the Sherman Silver Purchase Act, innumerable tariff schedules set during the 19th century, the three-fifths clause, the Kansas-Nebraska Act, the Missouri Compromise, the Second Bank of the United States, the original rules of the Electoral College, the Articles of Confederation, and, of course, the rule of King George III. Jay Cost, Weekly Standard

… it is widely presumed that the president’s wishes should serve as the baseline for the debate. This makes little sense. Yes, the president can veto anything he doesn’t like. But so can the House. Why is it incumbent upon the House to come up with a platform that the president likes and not vice-versa? After all, the House is at the top of the fiscal hierarchy, followed closely by the Senate, and then, last and very much least, by the president, who, remember, is supposed primarily to concern himself with foreign affairs. Sure, Barack Obama may have won election to head up the executive branch. But, this being a constitutional republic not an parliamentary monarchy, that doesn’t give him carte blanche over legislative and fiscal matters. The idea that there is anything wrong with the House demanding fiscal and legislative concessions from the executive branch is absurd. Especially, perhaps, when the point of contention is a deeply unpopular piece of legislation and the matter at hand is fiscal. Charles C.W. Cooke, National Review

…they paled in comparison to the dishonesty of the president’s central claim, which was that the attempt to link defunding to the debt-ceiling fight is illegitimate because Obamacare has “nothing to do with the budget.” I struggle to imagine how the president could have kept a straight face when he said this. This is a law, remember, that was crowbarred through Congress with the questionable use of reconciliation, a parliamentary procedure that is reserved exclusively for budgetary matters; a law that was sold as a deficit-reduction measure; a law that contains a significant spending component, including a 5-10 percent increase in the size of the federal budget; and, alas, a law that boasts a central mandate that was upheld (rewritten) by the Supreme Court as a tax, thus ensuring that any changes to the penalties must be approved by the House. “Nothing to do with the budget”? This is what we call a lie…Charles C.W. Cooke, National Review



ObamaCare is Rolling-Out On a Bumpy and Potholed Road—That Wasn’t Shovel Ready. by The Elephant's Child

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The Inspector General for the Department of Health and Human Services has not assessed whether ObamaCare will be ready to roll out on October 1, a spokesman for the Inspector General said today.

They have not done in-depth inspections of specific parts of the law, the spokesman said. “Whether the Affordable Care Act will be able to be up and fully functional on October 1, is not something that we have done assessments of,” said Donald White, a department spokesman.

That immense stack of paper is a printout of the Affordable Care Act. Nancy Pelosi thought she was being cute when she said “We have to pass it to find out what’s in it.” It wasn’t funny, but unbelievably crass. Passing a bill with not so much as a single word included from a  Republican, a bill ginned up in a back room, passed with the most corrupt form of bribes, and without a single Republican vote — is not the way things are supposed to work.That alone should be enough to fire every single Democrat congressman.

Democrats have long wanted single-payer health care, like the British have. Because it is paid for through taxes and a reduced standard of living, the Brits believe that their health care is free at the point of service. If it’s free, then you can run off to the doctor for every sniffle and cold, and over-use becomes a real problem.

But the British have long been glad to return to power whoever promises not to interfere with their “free” healthcare. Unfortunately, the service is terrible; waits for service long; hospitals are filthy; the aged are left without water, clean sheets, or care to die from neglect. The scandals are real, people die, because the incentives are all wrong. Doctors are servants of the system, the newest medicines or newest diagnostic tools are too expensive to buy. Patients are encouraged to over-use the system, hospitals and doctors offices are encouraged to treat more patients in less time so it will cost less. And Doctors and hospitals are desperate to be paid adequately for their services. Incentives are really important.  So, as was completely inevitable, Britain’s National Health Service is going broke.

Forbes magazine reports that ObamaCare will increase the average Individual-market insurance premiums by 99% for men, 62% for women.  The technology problems involved in the exchanges are huge, and it doesn’t look like they’ll be ready or functional at all. The U.S. has had to delay the deadline for finalizing the final agreements with  insurance plans. In some cases they say they’re ready, but nobody has checked.

The architects and supporters of ObamaCare had wonderful visions about the possibilities of information technology, the kind of visions held only by those who have never been more deeply involved with their computer than moving the mouse around. Megan McArdle said she worked in an IT consultancy, and she thought setting up this system would be something like an eight-year job. You should hear the doctors who have to switch from handwritten notes to entering data in a laptop. My doctor says the errors are going through the roof (how often do you have a typo? And it’s worse with numbers) and endangering patients.

A Price-Waterhouse study found that “insurers passed over major medical centers” in many states to keep premiums down. Those buying a Blue Cross plan in California’s exchange will have access to 47% fewer doctors and 22% fewer hospitals than subscribers can get today. The Blue Cross plan in New Hampshire excludes more than half of the state’s hospitals. That’s what the incentives direct insurers to do, and how the best intentions go astray. Having an insurance card does not guarantee access to specialists or other providers.

At the Clinton Global Initiative on Tuesday, President Obama did admit that  his health care law does raise taxes after all. ” So what we did— it’s paid for by a combination of things. We did raise taxes on some things.

Sowell



It Really Is An Approaching Train Wreck. Can We Stop It? by The Elephant's Child

The Obama administration lied to you from the beginning. They claimed that health care costs were spiraling out of control and by reforming health care they would bring costs down. In fact, the costs of health care were slowly coming down in response to new diagnostic tools and new medicines that saved higher hospital costs. They claimed that they were echoing Massachusetts health plan, but the president’s advisers on health care  were all great admirers of Britain’s National Health Service.

The advisers looked at the cost of health care and determined that most of the cost for any person came in the final years of their lives. If they could get rid of that cost, then American health care would cost lots less. So if someone was in their 80s or 90s, they shouldn’t be allowed to rack up big costs for operations or expensive treatments.

A new report on Britain’s National Health Service notes that as many as 13,000 needless deaths have occurred in 14 NHS hospital trusts since 2005. This is no fluke. It’s the result of socialized medicine, done by experts.

In ObamaCare, the government panel that controls what procedures one may receive (cost effectiveness) is the Independent Payment Advisory Board (IPAB) or as Sarah Palin called it — the Death Panel. It would decide when you could get dialysis and when they pulled the cord.

Then there was the “Liverpool Care Pathway” — an Orwellian death panel operation, where nurses shouted to visitors to not give their dying relatives sips of water for fear it would interfere with the hospital’s death target. “No one was doing anything ‘wrong’ since everything was done by the book,” wrote Jenkins.

Keogh found that as many as 13,000 “needless” deaths were the result, about 3 per day in each hospital district.

The U.K. has seen reform after reform of its health care system, but none has made much difference.

The administration granted a one-year delay in the employer mandate, something that he cannot legally do. The House just passed a one-year delay for the individual mandate, which Obama says he will veto. Obama’s goal is to get as many people signed up or ObamaCare subsidies as he can, as quickly as he can, so that any repeal of the law becomes politically impossible. That’s why the administration is paying people to sign individuals up. Delaying the employer mandate guarantees that hundreds of thousands of people will end up at an ObamaCare exchange after their employers use the delay to drop coverage.

He is even allowing states to take the applicants’ word for it that they don’t have coverage available  to them at work and that their income is as low as they claim it is. It opens the door to fraud, but lax enforcement means more will sign up.

Unions are turning against ObamaCare in a big way, they are learning about the downside. The law will drive up insurance costs, massively increase government spending, create huge shortages of doctors with no way to solve that problem except for long waits to see a doctor, $1 trillion in new taxes, continue to destroy full-time jobs, and do nothing whatsoever to control health care costs.

It is a train wreck. Even Democrats are wanting to repeal and replace.  But they are obsessed with “public” rather than “private”,  “non-profit” rather than “for profit” that they become oblivious to simple basic facts.  Some Democrats see the solution as moving everyone into Medicare, but that would not solve a single problem in ObamaCare.

A warning shot was fired a few months ago when one hospital, Mid-Staffordshire, was found to be a veritable death trap of neglect, misspent funds and starved investment. Now a new report on 14 NHS trusts, released by government-appointed Prof. Sir Bruce Keogh this week, finds that neglect and “needless” deaths are pretty much a characteristic of the entire system.

Socialized medicine simply doesn’t work. The state can cover up big problems, state priorities trump those of the consumer, bureaucracies resist change. Is that really what we need— a system to provide needless death?



A $3.2 Million Advertising Campaign to Sell a Pig. by The Elephant's Child

The Department of Health and Human Services, the designated agency for rolling out and making sense of ObamaCare, under the direction of Secretary Kathleen Sebelius has just doled out a $3.1 million Public Relations contract to improve the image of ObamaCare. Advertising Age reports that Weber Shandwick will help “roll out a campaign to convince skeptical — or simply confused — Americans that the “Patient Protection and Affordable Care Act” ( I can’t write that name without snorting)” is good for them and convince them that they should enroll in a health plan.”

Administration officials insist the ads won’t be political, but just before the 2010 midterm election, HHS spent $3.2 million on an ad campaign featuring the late actor Andy Griffith, who told his fellow old folks that “more good things are coming from Medicare,” but neglected to mention the dramatic cuts to 10 million Medicare Advantage members, who may have already seen their plans ended or can expect to see them end soon. FactCheck said: “The words in this ad ring hollow, and the promise that benefits will remain the same” is as fictional as the town of Mayberry, when Griffith played the local sheriff.

In fact ObamaCare is becoming more unpopular as people begin to “find out what’s in it,” to quote Nancy Pelosi, and are faced with the astonishing rise in their health care premiums or with losing them entirely. Of course, the Democrats sneaky attempt to excuse themselves and their staffs and employees from having to participate, was exposed by the national media, and should sour anyone who is still wavering on the supposed wonderfulness of ObamaCare.

The thing is, nobody did know what was in it, nor understood what the consequences  of what was in it were. There are always consequences. People respond to incentives and disincentives. Those who were responsible for drafting this bill were vaguely aware that they needed to figure out how to pay for it, so they decided to add a tax on medical devices. No big deal if granny had to pay a little extra for her walker.

The consequences were more complicated.  Many of the manufacturers of medical devices are small businesses operating on tight budgets, as startups usually do. It’s a rapidly changing field with lots of expensive research and development. They are laying off workers — in an economy already suffering from high unemployment. And in a specific industry with many layoffs, those workers will have a hard time finding a new job.  You can’t just put a new kind of stent, or a new kind of knee-joint out — they have to be tested on real people, and if they don’t work there’s a huge cost for insurance. Then you suddenly have a terrorist bombing in Boston and all sorts of people needing prosthesis. They didn’t plan on that kind of thing. Congress seems to agree that it was a bad idea and wants to repeal that part, but that’s complicated too.

The 22,000-member United Union of Roofers has issued a public statement calling for “repeal or complete reform” of ObamaCare. A Union. At no point since it passed has ObamaCare been regarded favorably by more than 45 percent, and the latest Kaiser Family Health Foundation pegs its nationwide support at only 37 percent.

Insurance premiums are expected to skyrocket next year, and it looks as if key parts of ObamaCare will miss their start date. Secretary Sebelius complained that “no one fully anticipated” the difficulties involved in setting up ObamaCare. (Republicans did) But of course she blamed “obstructionist Republicans” for engaging in “state-by-state political battles” to slow down the creation of the exchanges. Perhaps it would be less complicated if she hadn’t granted  waivers to cronies and Democrats.

Jay Rockefeller (D-WV), one of the main architects calls the bill “probably the most complex piece of legislation” ever passed by the U.S. Congress. Max Baucus (D-MO) says “I just see a huge train wreck coming.”  Coincidentally both Senators are retiring next year. A study by the Society of Actuaries has predicted that medical claims per policyholder will rise by 32 percent in the individual plans in the health care exchanges. In some states the increase could rise to 80 percent.

The Obama administration is preparing for the worst. Michael Cannon of Cato says they are getting ready to spend $600 billion that Congress never authorized on federally run state exchanges in order to ease the possibility of sticker shock. The old hide the increase game.

Advertising firm Weber Shandwick has their work cut out for them.  This is a real case of putting lipstick on a pig, and no matter how you pretty-up the pig, it remains a pig. An emotional appeal  with sob stories? A beloved character to be the public face? A tear-jerker with victims of Sandy, Newtown, or the Boston Marathon? The one thing they cannot do is tell the truth.
It is a pig of a law.



Here’s Why ObamaCare Has to Go! by The Elephant's Child

You may remember this chart which lays out the reach of ObamaCare. [Click to enlarge, then use your mouse to drag it larger]. It shows the reporting lines and lines of responsibility. There are supposedly something like 100 new agencies involved, each with many employees, all of whom receive salaries and benefits. Yet Obama has claimed that it will be less costly than our present health care system, and our costs for insurance will go down— described as “bending the cost curve down.” This, of course, is preposterous. It will be many times more expensive.

We have a lot of misconceptions about the whole health care debate.  First of all, it is not about our health care, it is about insurance. The only interest in actual health care is how to cut expenses. In the case of ObamaCare, it means eliminating the highest expenses which are for old people in the last years of their lives, and for those who serve no useful purpose, the demented, the completely disabled. They want to get rid of the expensive nuisances.

Obama’s health care advisors were uniformly great admirers of Britain’s National Health Service. Even in Britain, those who can afford it have private insurance and go to private doctors and hospitals. James Delingpole offers us some advice.  Surely you have noticed that all of those who are so enthusiastically trying to force us into ObamaCare have excluded themselves from any necessity to participate

Much is made of international comparisons. The United States, we are told spends way more than other countries, therefore we spend too much. Trouble is they try to make these comparisons based on purchasing power parity, and summing up of transactions.  For uncomplicated dental fillings, reimbursement data underestimate total costs by 50% in nine European countries. Countries account for long term care and out-of-pocket spending differently. The accounting treatment of overhead and capital costs also varies. According to the National Center for Policy Analysis (NCPA), an OECD project to harmonize national accounting methods began in 2000, but even when methods are harmonized, the choice of a price adjustment method can alter hospital cost estimates by as much as 400%.

The U.S, compares more favorably when real resources are measured rather than monetary accounts. Per capita, the US uses fewer physicians, nurses, hospital beds, physician visits and hospital days than the median OECD country. The average annual rate of growth of real per capita US health care spending is slightly below OE average over the last decade and over the last four decades.

The US infant mortality rates vary a factor of two or three to one across racial and ethnic groups, a cross cities, and across states for reasons that seem to have little to do with health care. The big difference seems to be in national differences in the definition of a live birth.

We spend more on prescription drugs, do more tests, have more major diagnostic equipment, and a better rate of survival for cancers, less pertussis, measles and Hepatitis B, 36% of cases of high blood pressure are controlled. We have short waits for cataract surgery, prompt coronary bypass, rapid hip replacement. We know about waiting times in other countries, but we don’t know about the people who live with pain or poor sight.

Much has been made of the uninsured — but most uninsurance is transitory, while people are between jobs. A major part of the uninsured are uninsured by choice. Obama has made much of bankruptcies caused by medical debt, but the claim conflicts with four decades of economic research. The label “medical bankruptcy” was applied if out-of-pocket medical bills exceeded $1,000, even though out-of-pocket expenses of the average US household were $2,182 in the year studied. Recalculating the study’s data, they concluded that only 17% of the sample had medical expenditure bankruptcies.

Can the free market work in health care? NCPA points out that:

In cosmetic surgery, virtually all payments are out-of-pocket and transparent package prices covering all services are the norm. Even though technological progress is frequently assumed to increase health care costs, the real price of cosmetic surgery has declined over the past 15 years, despite substantial technological progress and a six-fold increase in demand. In corrective vision surgery, out-of-pocket payments and package prices are the norm, and the real price has declined by 30% over the past decade. Price transparency is absent in virtually every other kind of surgery.

Many are now demanding that since Republicans are urging repeal of ObamaCare, the Republican candidate should be able to explain in a sentence or two just what his plan is. It took 2074 pages to enumerate the Patient Protection and Affordable Care Act, and it is reported today that lawyers have already drafted 13,000 pages of regulations for the new ObamaCare tax law.

Scholars at the Heritage Foundation, the American Enterprise Institute, the National Center for Policy Analysis, the Cato Institute, the American College of Physicians, The Pacific Research Institute, and many other think-tanks, foundations and individuals have been working on ideas since Hillary Care. And they have a lot of impressive ideas: tort reform, cross-state border insurance, health savings accounts, Paul Ryan’s plan for direct subsidies for buying health insurance is promising. Above all, they are not looking for power, they are looking for a free-market solution that both gives you care for your own health and that of your family, but preserves your individual freedom.

When a third party (your insurance company) pays for your medical care, there is no incentive to try to hold down costs. Incentives matter. The Medicare Drug Benefit is unique as a government program in that it has come in costing less than estimates because of the incentives to use generic drugs and keep costs down when possible. Republicans believe in incentives because they work.

They started with wrong assumptions; their goals—which seem to be about control of the people—are reprehensible; the results of their sloppy work will do all sorts of damage to the country, and the monumental tax increases may well bankrupt the country. These people are somewhat wanting in economic expertise.



HHS Has Missed One Third of Administrative Deadlines for ObamaCare. by The Elephant's Child

The non-partisan Congressional Research Service has issued a new report, commissioned by Senator Tom Coburn MD (R-OK) and others, finds astonishing proof of the administrative failure in implementing ObamaCare.  According to the report, Health and Human Services has missed one-third of the deadlines contained in the legislation  to be met in the first six months under the new health care regime.

The seven missed deadlines are listed below.  Additionally there were four deadlines where CRS could not reach a conclusion, so more may have been missed. (click to enlarge).




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