In 2017 my Website was migrated to
the clouds and reduced in size.
Hence some links below are broken.
One thing to try if a “www” link is broken is to substitute “faculty” for “www”
For example a broken link
http://www.trinity.edu/rjensen/Pictures.htm
can be changed to corrected link
http://faculty.trinity.edu/rjensen/Pictures.htm
However in some cases files had to be removed to reduce the size of my Website
Contact me at rjensen@trinity.edu if
you really need to file that is missing
Universal Health Care Messaging
Bob Jensen at
Trinity University
February 15, 2010 (including Health Insurance in Germany)
November 10, 2009 (The Most Frightening Legislation in the Shrinking History of the United States)
Finding and Using Health Statistics --- http://www.nlm.nih.gov/nichsr/usestats/index.htm
Bob Jensen's threads on economic statistics and databases ---
http://faculty.trinity.edu/rjensen/Bookbob1.htm#EconStatistics
Introduction
Finding and Using Health Statistics --- http://www.nlm.nih.gov/nichsr/usestats/index.htm
Best Medical Schools in the World (2013) ---
http://studychacha.com/discuss/139694-best-medical-school-world.html
More of the Top 50 are in the USA relative to any other nation.
World Health Organization ranking of health systems in 2000 ---
https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000
From Our World in Data
Financing Health Care ---
https://ourworldindata.org/financing-healthcare/
Lots of interesting comparisons here
Added considerations should be that having insurance with enormous deductibles
is like having no insurance for people who cannot afford thousands of dollars in
deductibles before the insurance kicks in,"
Added considerations include having insurance that the major providers
(hospitals and doctors) refuse to accept is like having no insurance.
World Health Organization: World Health Statistics 2015 --- http://www.who.int/gho/publications/world_health_statistics/2015/en/
Harvard: Where Both the ACA and AHCA Fall Short, and What the Health
Insurance Market Really Needs ---
Jensen Comment
The biggest problem for Medicaid and other lower-end covered ACA people is that
the medical coverage is crap coverage.
Major hospitals in Chicago will no longer serve patients
insured in Obamacare exchanges (except in true emergencies) ---
http://beta.hotair.com/archives/2016/10/24/chicago-hopenchange-major-hospitals-bail-obamacare-2017/?utm_source=hadaily&utm_medium=email&utm_campaign=nl
News Item Prior to November 8 Election of President Trump
Major Chicago Hospitals Not In 2017 Obamacare Marketplace Plans ---
https://www.wbez.org/shows/wbez-news/major-chicago-hospitals-not-in-2017-obamacare-marketplace-plans/f55d6c23-d9b1-452f-8c75-73635bd83d07
Some of Chicago’s largest hospitals said they will not be part of any Cook County Affordable Care Act marketplace plans in 2017.
University of Chicago Medical Center and Rush University Medical Center both said they don’t plan to be in network for any Obamacare marketplace plans next year.
The change means patients with doctors at those hospitals will either need to find a plan off the marketplace, and lose Obamacare subsides, or find a new doctor.
Northwestern Memorial Hospital said it will also be out of the marketplace, but will have exceptions for some of its partner hospitals.
Continued in article
According to emergency room physicians Obamacare made it much worse for
emergency rooms.
American College of Emergency Room Physicians
The Uninsured: Access to Medical Care Fact Sheet ---
http://newsroom.acep.org/fact_sheets?item=30032
Medicaid Is Free. So Why Does It Require a Mandate?
https://www.wsj.com/articles/medicaid-is-free-so-why-does-it-require-a-mandate-1489529946?mod=djemMER
The Congressional Budget Office is out with its analysis of the House Republicans’ ObamaCare replacement, the American Health Care Act (AHCA). The CBO’s report includes an implicit but powerful indictment of Medicaid, America’s second-largest health care entitlement.
Medicaid has been around since 1965; it was a core part of LBJ’s Great Society entitlement expansion. The program’s idiosyncratic design requires states to chip in around 40% of the program’s funding, while only getting to control about 5% of how the program is run. The federal Medicaid law—Title XIX of the Social Security Act—mandates a laundry list of benefits that states must provide through Medicaid, and bars states from charging premiums. Copays and deductibles cannot exceed a token amount.
Medicaid is the largest or second-largest line item in nearly every state budget. But for all practical purposes, the main tool states have to control costs is to pay doctors and hospitals less than private insurers pay for the same care. As a result, fewer doctors accept Medicaid patients, making it very hard for Medicaid enrollees to get access to care when they need it. Poor access, in turn, means that Medicaid enrollees—remarkably—have no better health outcomes than those with no insurance at all.
That brings us back to the AHCA. According to the CBO, able-bodied adults on Medicaid receive about $6,000 a year in government health-insurance benefits. They pay no premiums and minimal copays. You’d think that eligible individuals would need no prodding to sign up for such a benefit.
And yet, according to its analysis of the GOP ObamaCare replacement, the CBO believes that there are five million Americans who wouldn’t sign up for Medicaid if it weren’t for ObamaCare’s individual mandate. You read that right: Five million people need the threat of a $695 fine to sign up for a free program that offers them $6,000 worth of subsidized health insurance. That’s more than 1 in 5 of the 24 million people the CBO (dubiously) claims would end up uninsured if the AHCA supplanted ObamaCare.
On its face, there’s reason to doubt the CBO’s view. The mandate is enforced through the income-tax system, and enforcement of the mandate has been spotty for those in low tax brackets. Many of those eligible for Medicaid don’t work or file returns. Under rules established by the Obama administration, those who do can leave the “I have insurance” box blank and face no penalty.
Still, it’s remarkable that the CBO believes people need to be fined into signing up for Medicaid. That tells us something about the CBO’s assessment of Medicaid’s value to those individuals—and it buttresses the GOP’s case that Medicaid needs substantial reform.
Not coincidentally, the AHCA represents the most significant Medicaid reform since 1965, and thereby the most significant entitlement reform in American history. The 1996 welfare reform law is hailed by many conservatives as the most important domestic policy achievement of the past 25 years. Fiscally speaking, the AHCA is 10 times as significant.
The AHCA would put Medicaid on a budget, increasing Medicaid spending per beneficiary at the same rate as the medical component of the Consumer Price Index. This isn’t a far-right concept; President Clinton first proposed reforming Medicaid this way in 1995, as an alternative to the GOP idea of block grants. The 1996 law ended up including neither provision.
Combined with administrative reforms that may come from the Department of Health and Human Services, the bill would give states more flexibility to manage Medicaid’s costs in ways that could increase access to doctors and other providers, while reducing Medicaid spending by hundreds of billions in its first decade and trillions thereafter.
Ultimately, Medicaid for able-bodied low-income adults should be merged into the system of tax credits that the AHCA proposes for those above the poverty line. In that way, all Americans, rich and poor, would have the ability to choose the health coverage and care that reflects their needs, and build nest eggs in health savings accounts that could be passed on to their heirs.
Medical
Malpractice Lottery for Lawyers or Criminals or Both ---
http://faculty.trinity.edu/rjensen/Health.htm#Malpractice
Bob Jensen's Threads and Timeline
for Obamacare ---
http://faculty.trinity.edu/rjensen/Health.htm
Bob Jensen's threads on medicine ---
http://faculty.trinity.edu/rjensen/bookbob2-Part2.htm#Medicine
History Timeline of Health Care Reform in the United States
Something AARP Wants Kept Secret
Introductory Quotations and Links
Full Text of H.R. 3962 ---
http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3962
Obamacare ---
http://en.wikipedia.org/wiki/Obamacare#Term_.22Obamacare.22
Although President Obama never proposed using that term, eventually he said is
was an honor for him to assi8ate his name with this legislation that he promoted
to be the crowning achievement of his Presidency. "President
Obama endorsed the nickname, saying, "I have no problem with people saying Obama
cares. I do care."
First of all, it’s called the ‘Affordable Care Act"
House Minority Leader Nancy Pelosi more unhappy with the
use of the word "Obamacare in 2014.
Brookings: The Patient Protection and
Affordable Care Act (links to hundreds of studies) ---
http://www.brookings.edu/research/topics/affordable-care-act
"Chuck Schumer: Passing Obamacare in
2010 Was a Mistake: The Senate’s No. 3 Democrat says that his party
misused its mandate," by Sarah Mimms, National Journal, November 25,
2014 ---
http://www.nationaljournal.com/congress/chuck-schumer-passing-obamacare-in-2010-was-a-mistake-20141125
Chuck Schumer upbraided his own party Tuesday for pushing the Affordable Care Act through Congress in 2010.
While Schumer emphasized during a speech at the National Press Club that he supports the law and that its policies "are and will continue to be positive changes," he argued that the Democrats acted wrongly in using their new mandate after the 2008 election to focus on the issue rather than the economy at the height of a terrible recession.
"After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs and built on the partial success of the stimulus, but unfortunately Democrats blew the opportunity the American people gave them," Schumer said. "We took their mandate and put all of our focus on the wrong problem—health care reform."
The third-ranking Senate Democrat noted that just about 5 percent of registered voters in the United States lacked health insurance before the implementation of the law, arguing that to focus on a problem affecting such "a small percentage of the electoral made no political sense."
The larger problem, affecting most Americans, he said, was a poor economy resulting from the recession. "When Democrats focused on health care, the average middle-class person thought, 'The Democrats aren't paying enough attention to me,' " Schumer said.
Continued in article
"Sen. Chuck Schumer: Obamacare Focused
'On The Wrong Problem,' Ignores The Middle Class" by Avik Roy,
Forbes, November 26, 2014 ---
http://www.forbes.com/sites/theapothecary/2014/11/26/sen-chuck-schumer-obamacare-focused-on-the-wrong-problem-ignores-the-middle-class/
Despite the enduring unpopularity of Obamacare, Congressional Democrats have up to now stood by their health care law, allowing that “it’s not perfect” but that they are proud of their votes to pass it. That all changed on Tuesday, when the Senate’s third-highest-ranking Democrat—New York’s Chuck Schumer—declared that “we took [the public’s] mandate and put all our focus on the wrong problem—health care reform…When Democrats focused on health care, the average middle-class person thought, ‘The Democrats aren’t paying enough attention to me.’”
Sen. Schumer made his remarks at the National Press Club in Washington. “Democrats blew the opportunity the American people gave them…Now, the plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed,” Schumer maintained. “But it wasn’t the change we were hired to make. Americans were crying out for the end to the recession, for better wages and more jobs—not changes in health care.”
“This makes sense,” Schumer continued, “considering 85 percent of all Americans got their health care from either the government, Medicare, Medicaid, or their employer. And if health care costs were going up, it really did not affect them. The Affordable Care Act was aimed at the 36 million Americans who were not covered. It has been reported that only a third of the uninsured are even registered to vote…it made no political sense.”
The response from Obama Democrats was swift. Many, like Obama speechwriters Jon Lovett and Jon Favreau and NSC spokesman Tommy Vietor, took to Twitter. “Shorter Chuck Schumer,” said Vietor, “I wish Obama cared more about helping Democrats than sick people.”
Jensen Comment
So what's wrong with the ACA?
Firstly it expanded the piñata for fraud --- Medicaid. Half the people on
Medicaid in Illinois were found not to be eligible for Medicaid. It's bad
in most other states that just are paying for audits while the Federal
government is paying the tab.
Secondly it's a windfall for ACA insurance companies since the Federal government guarantees their profits and promises taxpayer money if they begin to fail. In capitalism, business firms are supposed to take on financial risks.
Thirdly, the affordable policies have 40%-60% co-pays that essentially prevents insured people from going to doctors, medical clinics, and hospitals unless they are really, really sick because of what it costs them up front. Insurance companies love that, because they are selling insurance that people don't use as much as they should be using that insurance.
Fourthly, insurance companies love the ACA because paying for medical services and medications for people behind on the payments of their ACA premiums are passed on to doctors and hospitals after 30 days. Is it any surprise that so many doctors and hospitals are refusing to accepted patients with ACA insurance?
And the list of complaints against the ACS goes on and on --- See below
I'm in favor of nationalized health
care. Between 2008 and 2010 the Democrats had substantial majorities in the
House and Senate and an enormously popular President Obama could've legislated
nationalized health care without any help from a single Republican. Instead the
Democrats blew it and gave birth to an abomination that is yet another
unfunded entitlement nail in the coffin of the United States.
But every system has rationing in some form or another. Rich Canadians unwilling to wait many months for treatments pay cash in the USA for immediate health care. Rich Swedes go elsewhere as well, often to Switzerland or the USA.
I also like Germany's combination of public and private health insurance
system for a number of reasons, including the fact that it like the health plans
of most other nations is a pay-as-you go plan.
Health Insurance in Germany ---
http://www.toytowngermany.com/wiki/Health_insurance
Don't confuse wanting a government-managed health care system like the one in Germany with the private insurance company rip off in the ACA in the USA where insurance companies have guaranteed profits while shifting the bad debts to the doctors and hospitals.
To add pain to misery these ACA insurance companies are offering over-priced policies with enormous deductibles that discourage patients from having medial treatments except in emergencies.
Hopefully, President Hillary Clinton will have the courage to reduce for-profit insurance companies to offer only supplemental elective plans like they do in Germany and for Medicare in the USA.
I vote for the German system that operates a lot like Medicare for all ages of citizens but with better fraud controls. I used to lean toward the Canadian system, but it's elective medical procedure delays for new hips, knees, and shoulders forces too many Canadians to pay cash for such procedures in the USA. when they grow weary of waiting out Canadian health plan approval.
What bothers me the most are the blatant lies our leaders broadcast to voters just to get a health care bill passed. I would be much less critical if they had flat out been honest about what they really intend for this legislation to cost. One example of a political lie is that Cadillac insurance plans will be taxed. The unions didn't object very loudly because they know full well that by 2018 when the tax is supposed to commence, Congress will have repealed all or most of the Cadillac tax. The same is true with many other provisions of the legislation that can be altered at taxpayer expense. Also our leaders promised that nearly a half trillion dollars will be saved by reducing third party payments to physicians. But those projections are easily altered if physicians truly demand higher reimbursements.
I just wish that Congress had passed a pay-as-you-go tax as part of this legislation, where people at all levels of income and wealth pay their fair share of the health benefits they receive. Middle class America should foot their own bills for health care through substantial tax increases on the middle class.
"A Simple Theory for Why School and Health Costs Are So Much Higher in the
U.S.," by Andrew O’Connell, Harvard Business Review Blog, April 7,
2014 ---
http://blogs.hbr.org/2014/04/a-simple-theory-for-why-school-and-health-costs-are-so-much-higher-in-the-u-s/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29&cm_ite=DailyAlert-040814+%281%29&cm_lm=sp%3Arjensen%40trinity.edu&cm_ven=Spop-Email
Jensen Comment
One reason higher education costs more in the USA is that more
attempts are made to bring college education to everybody with
nearby physical campuses such as community colleges and online
degree programs from major universities. In Europe and most other
parts of the world higher education is available only to a much
smaller portion of the population. In Germany, for example, less
than 25% of young graduates are admitted to college and
opportunities for adult college education are much more limited than
in the USA. Those other nations, however, often offer greater
opportunities for learning a trade that does not require a college
education.
There are many reasons health care costs more in the USA. One reason is that the USA is the world leader in medical and medication research. Another reason is that the USA imposes a costly private sector insurance intermediary where other nations offer insurance from a more efficient public sector.
Still another reason is that malpractice lawsuits are a legal punitive damages lottery in most parts of the USA such that hospitals and physicians must pay ten or more times as much for malpractice insurance relative to nations like Canada that restrict malpractice to actual damages only, leaving out the lottery for lawyers.
Still another reason is that the USA keeps extremely premature babies alive that other nations throw away. Even more expense if what Medicare spends on keeping people hopelessly and artificially alive, dying people that other nations let slip away without all the very costly artificial life extensions.
On November 22, 2009 CBS Sixty Minutes aired a video featuring
experts (including physicians) explaining how the single largest
drain on the Medicare insurance fund is keeping dying people
hopelessly alive who could otherwise be allowed to die quicker and
painlessly without artificially prolonging life on ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November
22, 2009 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
National Bureau of Economic Research: Bulletin on Aging and Health --- http://www.nber.org/aginghealth/
Leading ACA Act Blogs ---
http://www.zanebenefits.com/
WHO: World Health Statistics --- http://www.who.int/gho/publications/world_health_statistics/e
The Australian Health Care System Sounds a Whole Lot like the German
System of a Choice Between a National Health Care Plan or a Private Insurance
Plan
Obviously the private plans would not survive unless there was value added when
paying for private insurance
Is Australia's Health Care Plan Better Than Ours ---
http://www.americanthinker.com/articles/2017/05/is_australias_healthcare_better_than_ours.html
Jensen Comment
Since Australia has slightly over 30 million people with relatively few medical
schools compared the USA with over 320 million people and many more medical
schools, one has to question whether Australia can provide the highly
specialized services (think neonatal care) available in the USA and India and
other nations having many more medical schools for research and clinical
service. For example, medical schools in the USA do a lion's share of the
clinical testing of new drugs and devices for big pharmaceutical companies.
National health care systems, including the Australian system, handle
malpractice claims more efficiently than in the USA where medical malpractice
insurance alone can cost over $200,000 per year for some physicians.---
https://digital.lib.washington.edu/dspace-law/bitstream/handle/1773.1/689/13PacRimLPolyJ163.pdf?sequence=1
Canadian Malpractice Insurance Takes Profit Out Of Coverage," by Jane Akre, Injury Board, July 28, 2009 ---
Click HereThe St. Petersburg Times takes a look at the cost of insurance in Canada for health care providers.
A neurosurgeon in Miami pays about $237,000 for medical malpractice insurance. The same professional in Toronto pays about $29,200, reports Susan Taylor Martin.
A Canadian orthopedic surgeon pays just over $10,000 for coverage that costs a Miami physician $140,000. An obstetrician in Canada pays $36,353 for insurance, while a Tampa Bay obstetrician pays $98,000 for medical malpractice insurance.
National health systems, including the Australian system, avoid much of the
useless cost of keeping terminal patients hopelessly alive in near vegetative
states.
On November 22, 2009 CBS Sixty Minutes aired a video featuring experts
(including physicians) explaining how the single largest drain on the Medicare
insurance fund is keeping dying people hopelessly alive who could otherwise be
allowed to die quicker and painlessly without artificially prolonging life on
ICU machines.
"The
Cost of Dying," CBS
Sixty Minutes Video, November 22, 2009 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
As I read it its much more common to withhold life-sustaining treatments for
terminally ill patients in Australia.
More on the comparisons of national health care systems ---
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633404/
For years I've been a
proponent of a national healthcare plan supplemented with discretionary private
insurance much like the system in Germany. Some other national healthcare plans
are falling apart ---
http://faculty.trinity.edu/rjensen/Health.htm
Nationalized
healthcare is not all it's cracked up to be
---
http://www.businessinsider.com/nationalized-healthcare-is-not-all-its-cracked-up-to-be-2016-9
. . .
Back home, though, Canadians seem far more critical of the system. If you follow the internal Canadian debate, you’ll hear the word “crisis.” In fact, many Canadian healthcare economists warn that their system is headed for a major collapse. The aging population has continued to stress an already fragile system. This is the same system that many proponents of the Affordable Care Act, or Obamacare, pointed to as a model.
Another model of national health care cited by fans of the ACA is the UK’s National Health Service (NHS). Like the Canadian system, there seems to be one attitude for export and another for domestic consumption. You may recall the odd tribute to the UK’s National Health Service (NHS) in the opening ceremony of the 2012 Olympics. The NHS was portrayed as a sea of Mary Poppins bliss. At home, though, Brits had reason to complain. The UK was rated as having the worst patient care and lowest cancer survival rates in the Western World.
The NHS is in even worse shape now, and complaints are growing louder. According to the committee that represents UK hospitals, the NHS is on the verge of collapse. The former health minister Paul Burstow warned of this outcome two years ago. At the time, increases in the NIH budget were limited to the rate of inflation. But that did not allow for the increased cost of a growing elderly population. The NIH effort to find £30 billion in “efficiency savings” was already putting enormous strains on the system.
When a healthcare system is overloaded, it’s not just the aged who suffer. A Lancashire man operated on himself when he was put on a long waitlist for a surgery that he badly needed. With waitlists growing, the Royal College of Surgeons reports that financially challenged clinical groups are denying services to patients who are obese or smoke. Often, delayed treatment will increase medical costs in the long run.
So it shouldn’t be surprising that the Affordable Care Act, which was inspired by the Canadian and British systems, is in deep trouble. Though I predicted it, it is worrisome when the act’s biggest supporters, including The New York Times, admit the program’s flaws.
The growing aged population is a huge financial burden
Obamacare doesn’t deal with the real source of rising healthcare costs: the increase in age-related diseases due to a growing elderly population. It is mathematically impossible to cut societal medical costs while at the same time providing adequate healthcare to a growing and increasingly expensive older population.
This is not just a problem with health care. Social Security and pension funds are running deficits, which will also worsen. Alan Greenspan, former chairman of the Federal Reserve, recently said that he has lost the optimism that he has long been known for. The reason is that “we have a 9 percent annual rate of increase in entitlements, which is mandated by law. It has got nothing to do with the economy. It has got to do with age and health and the like.”
Greenspan points out that politicians refuse to deal with the “third rail” of entitlements. I agree, but I think there’s a solution. Politicians claim that voters won’t accept delayed retirement. But the evidence shows that most people would like to work longer and save more to pay their own way. Zoya Financial reports that almost two thirds of Americans have to retire earlier than planned, largely due to problems with their own health or a spouse’s.
Anti-aging biotechnologies are in labs right now that could lengthen health spans and working careers. This would allow us to save our entitlement systems. But economists and politicians still have no clue about the biotechnological progress that has marked the start of the 21st century. This will change because it must… but I hope it happens soon
Continued in article
OECD Health Statistics 2016 --- http://www.oecd.org/els/health-systems/health-data.htm
50% of health and social-care funding is spent on 4%
of people . . . About 25% of all hospital inpatient spending during a person’s
lifetime occurs in the final three months.
"The (British) National Health Care Service is a Mess," The
Economist, September 10, 2016, pp. 48-49 ---
http://www.economist.com/news/britain/21706563-nhs-mess-reformers-believe-new-models-health-care-many-pioneered
. . .
Like health-care systems around the world, the National Health Service (NHS) is struggling to provide good care at low cost for patients such as Mrs Evans (not her real name). Its business model has not kept up with the changing burden of disease. For as more people enter and live longer in their dotage, demand increases for two costly types of care. The first is looking after the dying. About 25% of all hospital inpatient spending during a person’s lifetime occurs in the final three months. The second is caring for those with more than one chronic condition. About 70% of NHS spending goes on long-term illnesses. More than half of over-70s have at least two and a quarter have at least three. In south Somerset 50% of health and social-care funding is spent on 4% of people.
. . .
If one fallacy about the NHS is that it is the envy of the world, as its devotees claim, another is that it is a single organisation. In fact it is a series of interlocking systems. Public health, hospitals, general practitioners (or GPs, the family doctors who provide basic care outside hospitals) and mental-health services all have separate funding and incentives. Social care, which includes old-folks’ homes and the like, is run by local councils, not the NHS
. . .
So the NHS must do more with what it already spends. A sign of inefficiency is the 6,000 patients in English hospitals who are ready to go home but not yet discharged, up from 4,000 in 2013. They cost the service hundreds of millions of pounds per year and obstruct others from treatment. The bed-blockers themselves are harmed, too. Elderly patients lose up to 5% of muscle strength for every day they are laid up in hospital. Some delays are the result of council cuts: about 400,000 fewer old people receive social care than in 2010, meaning that hospitals are sometimes used as expensive alternatives to care homes. But most are due to how hospitals are run.
. . .
On average, the framework made GPs some of the highest-paid family doctors in the world when it was introduced in 2004. But since then it has become less generous. GPs’ real-terms income has fallen by one-fifth. This, and poor planning, has led to a shortage of them. England needs 5,000 more in the next five years. The NHS is mulling a deal with Apollo, whereby the Indian health-care firm supplies enough doctors to fill the gap.
. . .
The move from “volume to value”—that is, from paying providers for the procedures they carry out to paying them for the outcomes they achieve—has helped to stem the cost of Medicare, the American health system for pensioners. The expansion of ACOs as part of Obamacare led to reduced mortality rates and savings for providers of about 1-2%. But Dan Northam Jones, a visiting fellow at Harvard, warns that the potential for savings is greater in systems like Medicare, where there is no cap on spending.
And yet ACOs reflect a growing belief that if you want radically to improve health care you have to change how you pay for it. They will not solve all the problems of the NHS, some of which are inherent in its taxpayer-funded model. But perhaps its business model may yet catch up with how illness is changing. The NHS should forget being the envy of the world, and instead learn from it.
A Personal Experience
Why many physicians will turn away their Medicare patients just like my wife was
turned away by her surgeon in the South Texas Spinal Clinic in San Antonio
because she was on Medicare ---
http://faculty.trinity.edu/rjensen/Health.htm#SpinalClinic
"The Worst Bill Ever: Epic new spending and taxes, pricier insurance, rationed
care, dishonest accounting: The Pelosi health bill has it all," The Wall
Street Journal, November 1, 2009 ---
http://faculty.trinity.edu/rjensen/Health.htm#110709
Jensen Comment
Nancy Pelosi catered to just about every special interest in the United States
(except Medicare patients) and doled out earmark frauds like jelly beans to get
economy/jobs destroying bill through the House. Please pray for Senate
sensibility.
Frightening Clauses in the Pending House Bill (H.R. 3962) in November 2009
Affordable Care Act Chart --- http://faculty.trinity.edu/rjensen/ObamaCareChart.pdf
20 Questions About the Affordable Care Act
The Top Ten Myths About Medicare
A Brief History of Health Insurance
in the United States ---
http://everylearner.com/bm/knowledgenews/americana/health-insurance-history-1.shtml
A key stimulus was in 1945 when the National War Labor Board made it possible
for unions to negotiate coverage.
More importantly, however, business firms could get tax deductions for health
benefits that were not taxable,
Thereby, workers did not have to pay for health insurance out of after-tax
dollars.
Humor
The Wall Street Journal Guide to
the Affordable Care Act, October 14, 2009 ---
Click Here
http://online.wsj.com/article/SB10001424052748704471504574441193211542788.html?mod=djemEditorialPage
"Follow the Money," by Ben Shapiro,
Townhall, October 21, 2009 ---
http://townhall.com/columnists/BenShapiro/2009/10/21/follow_the_money
Fathom the odd hypocrisy that the administration wants
every citizen to prove they are insured, but people don't have to prove they are
citizens.
Ben Stein
October 15, 2010 message from Bob Jensen to the AECM
Hi David,
There are many reasons why people cannot or should not stay in the main careers. Professional athletes are generally over the hill before age 40 in terms of beating out their competitors, but they generally find alternative employment. We can't trust many pilots and bus drivers and combat buddies after age 55. But they too can find alternative employment.
Trinity University has a management professor named Don VanEynde who was a Battalion Commander in Vietnam, earned a PhD from Columbia University after military retirement, and has been one of the most popular, if not the most popular, campus-wide professors for 15 years. He's still going strong even though he's older than me. .
Professors have many advantages in that many physical ailments like Professor Fordham's arthritis do not detract from outstanding performance as long as wisdom, memory, scholarship, and enthusiasm have not yet waned. .
When tragedy does strike at any age that prevents working in virtually any productive capacity, it's possible to start collecting social security and Medicare before the prescribed ages for retirement. Due to being injured on the job as a surgical nurse, my wife commenced collecting SS disability benefits and Medicare when she 54 years old. After her spinal injury (she was ordered by a surgeon to lift a 300 lb instrument table over a power cord and had to be put immediately on traction for 30 days in the hospital) she worked for 10 more painful years before undergoing the first of her eventual 12 spine surgeries. Each surgery led to worse enduring pain --- http://faculty.trinity.edu/rjensen/Erika2007.htm She most certainly is not a poster child for million-dollar spine surgeries. Worker compensation paid for the early surgeries until she was declared eligible for social security disability and Medicare.
The problem is that Congress provided disability entitlements without nearly enough funding such that these entitlements now are enormous drivers of present and future multi-trillion deficits being passed on to current and future children in the United States. Extending SS retirement ages will most certainly increase the numbers of disability claims, but the majority of older workers are gratefully not eligible for disability status before retirement at higher ages. Disabled people can start collecting Medicare at any age as soon as they are declared eligible for SS disability benefits.
Disabled people should've been funded outside the SS retirement system, but members of Congress were too chicken to establish a separate Disability and Medical Fund. They sneaked the financial entitlements of the disabled onto the SS retirement and Medicare systems and passed the funding deficits on to our present and future children.
Between 1776 and 1950 the care of the elderly and disabled was the responsibility of their own savings, their parents, their children, and in extreme cases the County Homes. After the disabled became the responsibility of the Federal government, heirs confiscated their parents' savings and children were unburdened of parental care responsibilities. Federal and state governments took on the housing, care, and feeding of every disabled person. In theory, savings of the elderly are to be used for nursing home care, but fraud is rampant in terms of passing these costs on to taxpayers.
We can argue endlessly whether disabled people should be the responsibilities of their families or taxpayers or employers. For example, perhaps I should've been more financially responsible for my wife's disability than the social security and Medicare systems. On this subject I can truly be an academic who can take on any side in a debate. Perhaps worker compensation insurance should've covered my injured wife for a longer period of time, but the worker compensation insurance firm worked tooth and nail to pass her on to SS and Medicare.
The point is that government funding for the disabled should be a pay-as-you-go system taxation rather than a Ponzi scheme of deficit financing. The present entitlement system is not only unfair to future generations, it threatens the very survival of the United States --- http://faculty.trinity.edu/rjensen/Entitlements.htm
Bob Jensen
Deficit tops $1 trillion second year in a row ($1.29 trillion
before November and December) ---
http://money.cnn.com/2010/10/15/news/economy/treasury_fy2010_deficit/index.htm
Long-term problem:
There has been a lot of political hysteria expressed over the annual deficits of the past two years.Fiscal experts note, however, that the abnormally large deficits incurred in the wake of the financial crisis are not the primary source of the country's biggest fiscal problems.
The biggest source of fiscal concern remains the so-called structural deficit, which is made up primarily of spending on the big three entitlement programs. That structural deficit will continue to balloon faster than the economy grows long after the current downturn has ended.
Indeed, the Government Accountability Office projects that by the end of this decade, the vast majority of all federal tax revenue will be swallowed up by just four things: Interest payments on the country's debt, and the payment of Medicare, Medicaid and Social Security benefits.
The president's bipartisan fiscal commission, charged with recommending ways to get U.S. debt under control, will issue a report in December.
I'm in favor of health care reform that completely nationalizes health insurance phased in reasonably with high tax pay-as-you-go restriction and strict cost-saving caps on punitive damage lawsuits. I really favor former Senator Bill Bradley's long-forgotten Canada-like proposal:
The bipartisan trade-off in a viable health care bill is obvious: Combine universal coverage with malpractice tort reform in health care. Universal coverage can be obtained in many ways — including the so-called public option. Malpractice tort reform can be something as commonsensical as the establishment of medical courts — similar to bankruptcy or admiralty courts — with special judges to make determinations in cases brought by parties claiming injury. Such a bipartisan outcome would lower health care costs, reduce errors (doctors and nurses often don’t report errors for fear of being sued) and guarantee all Americans adequate health care. Whenever Congress undertakes large-scale reform, there are times when disaster appears certain — only to be averted at the last minute by the good sense of its sometimes unfairly maligned members. What now appears in Washington as a special-interest scrum could well become a triumph for the general interest. But for that to happen, the two parties must strike a grand bargain on universal coverage and malpractice tort reform. The August recess has given each party and its constituencies a chance to reassess their respective strategies. One result, let us hope, may be that Congress will surprise everyone this fall.
Bill Bradley, "Tax Reform’s Lesson for Health Care Reform," The New York Times, August 30, 2009 ---
http://www.nytimes.com/2009/08/30/opinion/30bradley.html?_r=1
IOUSA (the most frightening movie in American
history) ---
(see a 30-minute version of the documentary at
www.iousathemovie.com )
I have come to the conclusion that the real reason
this gifted communicator (Obama) has become
so bad at communicating is that he doesn't really believe a word that he is
saying. He couldn't convey that health-care reform would be somehow cost-free
because he knows it won't be. And he can't adequately convey either the
imperatives or the military strategy of the war in Afghanistan because he
doesn't really believe in it either. He feels colonized by mistakes of the past.
He feels trapped by the hand that has been dealt him.
Leftist Leaning Tina Brown, "Obama's Fog War," The
Daily Beast ---
http://www.thedailybeast.com/blogs-and-stories/2009-12-03/what-is-obama-talking-about/
Jensen Comment
And President Obama was the dealer.
Voters are increasingly worried about unemployment,
but Democratic leaders in Congress remain obsessed with passing health- care
reform. Senate Majority Whip Richard Durbin was asked recently if a health-care
bill would pass the Senate by the end of this month. "It must," he said. "We
have to finish it." Still, many in the trenches are uneasy about the sprawling,
complex bill they privately acknowledge has no bipartisan support, doesn't
seriously tackle soaring costs and will increase insurance premiums. That may
explain Majority Leader Harry Reid's haste—he has ordered a rare Sunday session
this weekend to hurry up the debate. Public support for the bill averages only
39.2% backing in all polls compiled by Pollster.com.
John Fund, "Why Dems Are Obsessed by
Health Reform: They believe the liberal base expects them to deliver and
will punish them if they don't," The Wall Street Journal, December 4,
2009 ---
http://online.wsj.com/article/SB10001424052748704007804574575584229775884.html#mod=djemEditorialPage
America spends far more on health care per capita than any other nation in
the world.
One reason is that America spends trillions each year on people that other
nations let go of for cost reasons:
(1) Extremely premature and lightweight newborns that other nations cannot or do not afford to save;
(2) Dying people prolonged by machines in intensive care units that have no hope of leaving ICU alive.
Born at 9.1 Ounces She Would've been
thrown away in most other nations
Cozy in her incubator, set to 81.5 degrees, heart going
at 174 beats a minute as she snoozed in her red, footy pajamas, Oliviyanna
Harbin-Page may be a global record-holder. Born Aug. 5 to 16-year-old Jamesha
Harbin of Eight Mile after 21 to 24 weeks of gestation, Oliviyanna weighed only
259 grams, or 9.1 ounces -- possibly making her, according to the University of
South Alabama Children's & Women's Hospital, the world's smallest surviving
baby. She now weighs 3 pounds 2 ounces. One of three girl triplets -- the other
two are identical, she is fraternal
"Baby who may be world's smallest surviving newborn could go home soon," by Roy
Hoffman, al.com, December 18, 2009 ---
http://blog.al.com/live/2009/12/baby_who_may_be_worlds_smalles.html
What went so wrong in the health care system of the United States?
Mostly what went wrong is our ill-conceived and underfunded attempts to reform
the system!
The New York Times Timeline History of Health Care Reform in the United States ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html
Click the arrow button on the right side of the page.
The $61 Trillion Margin of Error, and What "Empire Decline" Means in
Layman's Terms
This is a bipartisan disaster from the beginning and will be until the end
David Walker --- http://en.wikipedia.org/wiki/David_M._Walker_(U.S._Comptroller_General)
Niall Ferguson --- http://en.wikipedia.org/wiki/Niall_Ferguson
Call it the fatal arithmetic of imperial decline.
Without radical fiscal reform, it could apply to America next.
Niall Ferguson, "An Empire at
Risk: How Great Powers Fail," Newsweek Magazine
Cover Story, November 26, 2009 ---
http://www.newsweek.com/id/224694/page/1
Please note that this is NBC’s liberal Newsweek Magazine and not Fox News
or The Wall Street Journal.
. . .
In other words, there is no end in sight to the borrowing binge. Unless entitlements are cut or taxes are raised, there will never be another balanced budget. Let's assume I live another 30 years and follow my grandfathers to the grave at about 75. By 2039, when I shuffle off this mortal coil, the federal debt held by the public will have reached 91 percent of GDP, according to the CBO's extended baseline projections. Nothing to worry about, retort -deficit-loving economists like Paul Krugman.
. . .
Another way of doing this kind of exercise is to calculate the net present value of the unfunded liabilities of the Social Security and Medicare systems. One recent estimate puts them at about $104 trillion, 10 times the stated federal debt.
Continued in article --- http://www.newsweek.com/id/224694/page/1
Niall Ferguson is the Laurence A. Tisch professor of history at Harvard University and the author of The Ascent of Money. In late 2009 he puts forth an unbooked discounted present value liability of $104 trillion for Social Security plus Medicare. In late 2008, the former Chief Accountant of the United States Government, placed this estimate at$43 trillion. We can hardly attribute the $104-$43=$61 trillion difference to President Obama's first year in office. We must accordingly attribute the $61 trillion to margin of error and most economists would probably put a present value of unbooked (off-balance-sheet) present value of Social Security and Medicare debt to be somewhere between $43 trillion and $107 trillion To this we must add other unbooked present value of entitlement debt estimates which range from $13 trillion to $40 trillion. If the Affordable Care Act passes it will add untold trillions to trillions more because our legislators are not looking at entitlements beyond 2019.
The Meaning of "Unbooked" versus "Booked" National Debt
By "unbooked" we mean that the debt is not included in the current "booked"
National Debt of $12 trillion. The booked debt is debt of the United States for
which interest is now being paid daily at slightly under a million
dollars a minute. Cash must be raised daily for interest payments. Cash is
raised from taxes, borrowing, and/or (shudder) the current Fed approach to
simply printing money. Interest is not yet being paid on the unbooked debt for
which retirement and medical bills have not yet arrived in Washington DC for
payment. The unbooked debt is by far the most frightening because our leaders
keep adding to this debt without realizing how it may bring down the entire
American Dream to say nothing of reducing the U.S. Military to almost nothing.
Niall Ferguson, "An Empire at Risk: How Great Powers Fail," Newsweek Magazine Cover Story, November 26, 2009 --- http://www.newsweek.com/id/224694/page/1
This matters more for a superpower than for a small Atlantic island for one very simple reason. As interest payments eat into the budget, something has to give—and that something is nearly always defense expenditure. According to the CBO, a significant decline in the relative share of national security in the federal budget is already baked into the cake. On the Pentagon's present plan, defense spending is set to fall from above 4 percent now to 3.2 percent of GDP in 2015 and to 2.6 percent of GDP by 2028.
Over the longer run, to my own estimated departure date of 2039, spending on health care rises from 16 percent to 33 percent of GDP (some of the money presumably is going to keep me from expiring even sooner). But spending on everything other than health, Social Security, and interest payments drops from 12 percent to 8.4 percent.
This is how empires decline. It begins with a debt explosion. It ends with an inexorable reduction in the resources available for the Army, Navy, and Air Force. Which is why voters are right to worry about America's debt crisis. According to a recent Rasmussen report, 42 percent of Americans now say that cutting the deficit in half by the end of the president's first term should be the administration's most important task—significantly more than the 24 percent who see health-care reform as the No. 1 priority. But cutting the deficit in half is simply not enough. If the United States doesn't come up soon with a credible plan to restore the federal budget to balance over the next five to 10 years, the danger is very real that a debt crisis could lead to a major weakening of American power.
The Meaning of Present Value
Initially it might help to explain what present value means. When I moved from
Florida State University to Trinity University in 1982, current mortgage rates
were about 18%. As part of my compensation package, President Calgaard agreed to
have Trinity University carry my mortgage. I purchased a home at 9010 Village
Drive for $300,000 by paying $100,000 down and signing a 240 month mortgage at
12% APR and a 1982 present value of $200,000. At payments of $2,202 per month my
total cash obligation (had I not refinanced from a bank when mortgage rates went
below 12%) would've been $528,521. However, since money has time value, the
present value of that $528,521 was only $200,000.
In a similar manner, Professor Ferguson's $104 trillion present value translates to over $300 trillion in cash obligations of Social Security and Medicare before being tinkered with changed entitlement obligations.
The "Burning Platform" of the United States Empire
Former Chief Accountant of the United States, David Walker, is spreading the
word as widely as possible in the United States about the looming threat of our
unbooked entitlements. Two videos that feature David Walker's warnings are as
follows:
David Walker claims the U.S. economy is on a "burning platform" but does not go into specifics as to what will be left in the ashes.
The US government is on a “burning platform” of unsustainable policies and practices with fiscal deficits, chronic healthcare underfunding, immigration and overseas military commitments threatening a crisis if action is not taken soon.
David M. Walker, Former Chief Accountant of the United States --- http://www.financialsense.com/editorials/quinn/2009/0218.html
An "Empire at Risk"
Harvard's Professor Niall Ferguson is equally vague about what will happen if
the U.S. Empire collapses from its entitlement burdens.
Niall Ferguson, "An Empire at Risk: How Great Powers Fail," Newsweek
Magazine Cover Story, November 26, 2009 ---
http://www.newsweek.com/id/224694/page/1
This is how empires decline. It begins with a debt explosion. It ends with an inexorable reduction in the resources available for the Army, Navy, and Air Force. Which is why voters are right to worry about America's debt crisis. According to a recent Rasmussen report, 42 percent of Americans now say that cutting the deficit in half by the end of the president's first term should be the administration's most important task—significantly more than the 24 percent who see health-care reform as the No. 1 priority. But cutting the deficit in half is simply not enough. If the United States doesn't come up soon with a credible plan to restore the federal budget to balance over the next five to 10 years, the danger is very real that a debt crisis could lead to a major weakening of American power.
The precedents are certainly there. Habsburg Spain defaulted on all or part of its debt 14 times between 1557 and 1696 and also succumbed to inflation due to a surfeit of New World silver. Prerevolutionary France was spending 62 percent of royal revenue on debt service by 1788. The Ottoman Empire went the same way: interest payments and amortization rose from 15 percent of the budget in 1860 to 50 percent in 1875. And don't forget the last great English-speaking empire. By the interwar years, interest payments were consuming 44 percent of the British budget, making it intensely difficult to rearm in the face of a new German threat.
Call it the fatal arithmetic of imperial decline. Without radical fiscal reform, it could apply to America next.
Empire Collapse in Layman's Terms
In 2010, hundreds upon hundreds of people will daily sneak across the U.S.
border illegally in search of a job, medical care, education, and a better life
under the American Dream. By 2050 Americans will instead be exiting in
attempts to escape the American Nightmare and sneak illegally into BRIC nations
for a job, medical care, education, and a better life under the BRIC Dream.
A BRIC nation at the moment is a nation that has vast resources and virtually no entitlement obligations that drag down economic growth --- http://en.wikipedia.org/wiki/BRIC
In economics, BRIC (typically rendered as "the BRICs" or "the BRIC countries") is an acronym that refers to the fast-growing developing economies of Brazil, Russia, India, and China. The acronym was first coined and prominently used by Goldman Sachs in 2001. According to a paper published in 2005, Mexico and South Korea are the only other countries comparable to the BRICs, but their economies were excluded initially because they were considered already more developed. Goldman Sachs argued that, since they are developing rapidly, by 2050 the combined economies of the BRICs could eclipse the combined economies of the current richest countries of the world. The four countries, combined, currently account for more than a quarter of the world's land area and more than 40% of the world's population.
|
Brazil, Russia, India and China,
(the BRICs) sometimes lumped together as
BRIC to represent fast-growing developing economies, are selling off
their U.S. Treasury Bond holdings. Russia announced earlier this
month it will sell U.S. Treasury Bonds, while China and Brazil have
announced plans to cut the amount of U.S. Treasury Bonds in their
foreign currency reserves and buy bonds issued by the International
Monetary Fund instead. The BRICs are also soliciting public support
for a "super currency" capable of replacing what they see as the
ailing U.S. dollar. The four countries account for 22 percent of the
global economy, and their defection could deal a severe blow to the
greenback. If the BRICs sell their U.S. Treasury Bond holdings, the
price will drop and yields rise, and that could prompt the central
banks of other countries to start selling their holdings to avoid
losses too. A sell-off on a grand scale could trigger a collapse in
the value of the dollar, ending the appeal of both dollars and bonds
as safe-haven assets. The moves are a challenge to the power of the
dollar in international financial markets. Goldman Sachs economist
Alberto Ramos in an interview with Bloomberg News on Thursday said
the decision by the BRICs to buy IMF bonds should not be seen simply
as a desire to diversify their foreign currency portfolios but as a
show of muscle. "BRICs Launch Assault on Dollar's Global Status," The Chosun IIbo, June 14, 2009 --- http://english.chosun.com/site/data/html_dir/2009/06/12/2009061200855.html Their
report, "Dreaming with BRICs: The Path to 2050," predicted that
within 40 years, the economies of Brazil, Russia, India and China -
the BRICs - would be larger than the US, Germany, Japan, Britain,
France and Italy combined. China would overtake the US as the
world's largest economy and India would be third, outpacing all
other industrialised nations. The first economist, an early Nobel Prize Winning economist, to raise the alarm of entitlements in my head was Milton Friedman. He has written extensively about the lurking dangers of entitlements. I highly recommend his fantastic "Free to Choose" series of PBS videos where his "Welfare of Entitlements" warning becomes his principle concern for the future of the Untied States 25 years ago --- http://www.ideachannel.com/FreeToChoose.htm |
"Social Security to See Payout Exceed Pay-In This Year," by Mary
Williams Walsh, The New York Times, March 24, 2010 ---
http://www.nytimes.com/2010/03/25/business/economy/25social.html?hp
The bursting of the real estate bubble and the ensuing recession have hurt jobs, home prices and now Social Security.
This year, the system will pay out more in benefits than it receives in payroll taxes, an important threshold it was not expected to cross until at least 2016, according to the Congressional Budget Office.
Stephen C. Goss, chief actuary of the Social Security Administration, said that while the Congressional projection would probably be borne out, the change would have no effect on benefits in 2010 and retirees would keep receiving their checks as usual.
The problem, he said, is that payments have risen more than expected during the downturn, because jobs disappeared and people applied for benefits sooner than they had planned. At the same time, the program’s revenue has fallen sharply, because there are fewer paychecks to tax.
Analysts have long tried to predict the year when Social Security would pay out more than it took in because they view it as a tipping point — the first step of a long, slow march to insolvency, unless Congress strengthens the program’s finances.
“When the level of the trust fund gets to zero, you have to cut benefits,” Alan Greenspan, architect of the plan to rescue the Social Security program the last time it got into trouble, in the early 1980s, said on Wednesday.
That episode was more dire because the fund could have fallen to zero in a matter of months. But partly because of steps taken in those years, and partly because of many years of robust economic growth, the latest projections show the program will not exhaust its funds until about 2037.
Still, Mr. Greenspan, who later became chairman of the Federal Reserve Board, said: “I think very much the same issue exists today. Because of the size of the contraction in economic activity, unless we get an immediate and sharp recovery, the revenues of the trust fund will be tracking lower for a number of years.”
The Social Security Administration is expected to issue in a few weeks its own numbers for the current year within the annual report from its board of trustees. The administration has six board members: three from the president’s cabinet, two representatives of the public and the Social Security commissioner.
Though Social Security uses slightly different methods, the official numbers are expected to roughly track the Congressional projections, which were one page of a voluminous analysis of the federal budget proposed by President Obama in January.
Mr. Goss said Social Security’s annual report last year projected revenue would more than cover payouts until at least 2016 because economists expected a quicker, stronger recovery from the crisis. Officials foresaw an average unemployment rate of 8.2 percent in 2009 and 8.8 percent this year, though unemployment is hovering at nearly 10 percent.
The trustees did foresee, in late 2008, that the recession would be severe enough to deplete Social Security’s funds more quickly than previously projected. They moved the year of reckoning forward, to 2037 from 2041. Mr. Goss declined to reveal the contents of the forthcoming annual report, but said people should not expect the date to lurch forward again.
The long-term costs of Social Security present further problems for politicians, who are already struggling over how to reduce the nation’s debt. The national predicament echoes that of many European governments, which are facing market pressure to re-examine their commitments to generous pensions over extended retirements.
The United States’ soaring debt — propelled by tax cuts, wars and large expenditures to help banks and the housing market — has become a hot issue as Democrats gauge their vulnerability in the coming elections. President Obama has appointed a bipartisan commission to examine the debt problem, including Social Security, and make recommendations on how to trim the nation’s debt by Dec. 1, a few weeks after the midterm Congressional elections.
Although Social Security is often said to have a “trust fund,” the term really serves as an accounting device, to track the pay-as-you-go program’s revenue and outlays over time. Its so-called balance is, in fact, a history of its vast cash flows: the sum of all of its revenue in the past, minus all of its outlays. The balance is currently about $2.5 trillion because after the early 1980s the program had surplus revenue, year after year.
Now that accumulated revenue will slowly start to shrink, as outlays start to exceed revenue. By law, Social Security cannot pay out more than its balance in any given year.
For accounting purposes, the system’s accumulated revenue is placed in Treasury securities.
In a year like this, the paper gains from the interest earned on the securities will more than cover the difference between what it takes in and pays out.
Mr. Goss, the actuary, emphasized that even the $29 billion shortfall projected for this year was small, relative to the roughly $700 billion that would flow in and out of the system. The system, he added, has a balance of about $2.5 trillion that will take decades to deplete. Mr. Goss said that large cushion could start to grow again if the economy recovers briskly.
Indeed, the Congressional Budget Office’s projection shows the ravages of the recession easing in the next few years, with small surpluses reappearing briefly in 2014 and 2015.
After that, demographic forces are expected to overtake the fund, as more and more baby boomers leave the work force, stop paying into the program and start collecting their benefits. At that point, outlays will exceed revenue every year, no matter how well the economy performs.
Mr. Greenspan recalled in an interview that the sour economy of the late 1970s had taken the program close to insolvency when the commission he led set to work in 1982. It had no contingency reserve then, and the group had to work quickly. He said there were only three choices: raise taxes, lower benefits or bail out the program by tapping general revenue.
The easiest choice, politically, would have been “solving the problem with the stroke of a pen, by printing the money,” Mr. Greenspan said. But one member of the commission, Claude Pepper, then a House representative, blocked that approach because he feared it would undermine Social Security, changing it from a respected, self-sustaining old-age program into welfare.
Mr. Greenspan said that the same three choices exist today — though there is more time now for the painful deliberations.
“Even if the trust fund level goes down, there’s no action required, until the level of the trust fund gets to zero,” he said. “At that point, you have to cut benefits, because benefits have to equal receipts.”
Where Did Social Security Go So Wrong?
Social Security in the United States currently refers to the Federal Old-Age,
Survivors, and Disability Insurance (OASDI) program. It commenced only as an old
age ("survivors:") retirement insurance program as a forced way of saving for
retirement by paying worker premiums matched by employer contributions into the
SS Trust Fund. Premiums were relatively low due heavily to the proviso that the
SS Trust Fund got to keep all the premiums paid for each worker and spouse that
did not reach retirement age (generally viewed as 65). Details are
provided at
http://en.wikipedia.org/wiki/Social_Security_(United_States)#Creation:_The_Social_Security_Act
If Congress had not tapped the SS Trust Fund for other (generally unfunded social programs of various types), the SS Trust Fund would not be in any trouble at all if it were managed like a diversified investment fund. But it became too tempting for Congress to tap the SS Trust Fund for a variety of other social programs, the costliest of which was to make monthly living allowance payments to each person of any age who is declared "disabled." In many cases a disabled person collects decades of benefits after having paid less than a single penny into the SS Trust Fund. It's well and good for our great land to provide living allowances to disabled citizens, but without funding from other sources such as a separate Disability Trust Fund fed with some type of other taxes, the disability payments mostly drained the SS Trust Fund to where it is in dire trouble today.
The obligation to pay pensioners as well as disabled persons was passed on to current and future generations to a point where the Social Security and Disability Program is no longer self-sustaining with little hope for meeting entitlement obligations from worker premiums and employer matching funds. The SS Trust Fund will have deficits beginning in 2010 that are expected to explode as baby boomers collect benefits for the first time.
Where Did Medicare Go So Wrong?
Medicare is a much larger and much more complicated entitlement burden relative
to Social Security by a ratio of about six to one or even more. The Medicare
Medical Insurance Fund was established under President Johnson in1965.
Note that Medicare, like Social Security in general, was intended to be insurance funded by workers over their careers. If premiums paid by workers and employers was properly invested and then paid out after workers reached retirement age most of the trillions of unfunded debt would not be precariously threatening the future of the United States. The funds greatly benefit when workers die before retirement because all that was paid in by these workers and their employers are added to the fund benefits paid out to living retirees.
The first huge threat to sustainability arose beginning in 1968 when medical coverage payments payments to surge way above the Medicare premiums collected from workers and employers. Costs of medical care exploded relative to most other living expenses. Worker and employer premiums were not sufficiently increased for rapid growth in health care costs as hospital stays surged from less than $100 per day to over $1,000 per day.
A second threat to the sustainability comes from families no longer concerned about paying up to $25,000 per day to keep dying loved ones hopelessly alive in intensive care units (ICUs) when it is 100% certain that they will not leave those ICUs alive. Families do not make economic choices in such hopeless cases where the government is footing the bill. In other nations these families are not given such choices to hopelessly prolong life at such high costs. I had a close friend in Maine who became a quadriplegic in a high school football game. Four decades later Medicare paid millions of dollars to keep him alive in an ICU unit when there was zero chance he would ever leave that ICU alive.
On November 22, 2009 CBS Sixty Minutes aired a video featuring experts
(including physicians) explaining how the single largest drain on the Medicare
insurance fund is keeping dying people hopelessly alive who could otherwise be
allowed to die quicker and painlessly without artificially prolonging life on
ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009
---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
What is really sad is the way Republicans are standing in the way of making
rational cost-benefit decisions about dying by exploiting the "Kill Granny"
political strategy aimed at killing a government option in health care reform.
See the "Kill Granny" strategy at ---
www.defendyourhealthcare.us
The third huge threat to the economy commenced in when disabled persons (including newborns) tapped into the Social Security and Medicare insurance funds. Disabled persons should receive monthly benefits and medical coverage in this great land. But Congress should've found a better way to fund disabled persons with something other than the Social Security and Medicare insurance funds. But politics being what it is, Congress slipped this gigantic entitlement through without having to debate and legislate separate funding for disabled persons. And hence we are now at a crossroads where the Social Security and Medicare Insurance Funds are virtually broke for all practical persons.
Most of the problem lies is Congressional failure to sufficiently increase Social Security deductions (for the big hit in monthly payments to disabled persons of all ages) and the accompanying Medicare coverage (to disabled people of all ages). The disability coverage also suffers from widespread fraud.
Other program costs were also added to the Social Security and Medicare insurance funds such as the education costs of children of veterans who are killed in wartime. Once again this is a worthy cause that should be funded. But it should've been separately funded rather than simply added into the Social Security and Medicare insurance funds that had not factored such added costs into premiums collected from workers and employers.
The fourth problem is that most military retirees are afforded full lifetime medical coverage for themselves and their spouses. Although they can use Veterans Administration doctors and hospitals, most of these retirees opted for the underfunded TRICARE plan the pushed most of the hospital and physician costs onto the Medicare Fund. The VA manages to push most of its disabled veterans onto the Medicare Fund without having paid nearly enough into the fund to cover the disability medical costs. Military personnel do have Medicare deductions from their pay while they are on full-time duty, but those deductions fall way short of the cost of disability and retiree medical coverage.
The fifth threat to sustainability came when actuaries failed to factor in the impact of advances in medicine for extending lives. This coupled with the what became the biggest cost of Medicare, the cost of dying, clobbered the insurance funds. Surpluses in premiums paid by workers and employers disappeared much quicker than expected.
A sixth threat to Medicare especially has been widespread and usually undetected fraud such as providing equipment like motorized wheel chairs to people who really don't need them or charging Medicare for equipment not even delivered. There are also widespread charges for unneeded medical tests or for tests that were never really administered. Medicare became a cash cow for crooks. Many doctors and hospitals overbill Medicare and only a small proportion of the theft is detected and punished.
The seventh threat to sustainability commenced in 2007 when the costly Medicare drug benefit entitlement entitlement was added by President George W. Bush. This was a costly addition, because it added enormous drains on the fund by retired people like me and my wife who did not have the cost of the drug benefits factored into our payments into the Medicare Fund while we were still working. It thus became and unfunded benefit that we're now collecting big time.
In any case we are at a crossroads in the history of funding medical care in the United States that now pays a lot more than any other nation per capita and is getting less per dollar spent than many nations with nationalized health care plans. I'm really not against the Affordable Care Act legislation. I'm only against the lies and deceits being thrown about by both sides in the abomination of the current proposed legislation.
Democrats are missing the boat here when they truly have the power, for now at least, in the House and Senate to pass a relatively efficient nationalized health plan. But instead they're giving birth to entitlements legislation that threatens the sustainability of the United States as a nation.
In any case, The New York Times presents a nice history of other
events that I left out above ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html
"THE HEALTH CARE DEBATE: What Went Wrong? How the Health Care Campaign
Collapsed --
A special report.; For Health Care, Times Was A Killer," by Adam Clymer, Robert
Pear and Robin Toner, The New York Times, August 29,
1994 ---
Click Here
http://www.nytimes.com/1994/08/29/us/health-care-debate-what-went-wrong-health-care-campaign-collapsed-special-report.html
November 22, 2009 reply from Richard.Sansing [Richard.C.Sansing@TUCK.DARTMOUTH.EDU]
The electorate's inability to debate trade-offs in a sensible manner is the biggest problem, in my view. See
Richard Sansing
The New York Times Timeline History of Health Care Reform in the
United States ---
http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html
Click the arrow button on the right side of the page. The biggest problem with
"reform" is that it added entitlements benefits without current funding such
that with each reform piece of legislation the burdens upon future generations
has hit a point of probably not being sustainable.
Call it the fatal arithmetic of imperial decline.
Without radical fiscal reform, it could apply to America next.
Niall Ferguson, "An Empire at Risk: How Great Powers Fail,"
Newsweek Magazine Cover Story, November 26,
2009 ---
http://www.newsweek.com/id/224694/page/1
. . .
In other words, there is no end in sight to the borrowing binge. Unless entitlements are cut or taxes are raised, there will never be another balanced budget. Let's assume I live another 30 years and follow my grandfathers to the grave at about 75. By 2039, when I shuffle off this mortal coil, the federal debt held by the public will have reached 91 percent of GDP, according to the CBO's extended baseline projections. Nothing to worry about, retort -deficit-loving economists like Paul Krugman.
. . .
Another way of doing this kind of exercise is to calculate the net present value of the unfunded liabilities of the Social Security and Medicare systems. One recent estimate puts them at about $104 trillion, 10 times the stated federal debt.
Continued in article
This is now President Obama's problem with or without new the Affordable Care Act entitlements that are a mere drop in the bucket compared to the entitlement obligations that President Obama inherited from every President of the United States since FDR in the 1930s. The problem has been compounded under both Democrat and Republican regimes, both of which have burdened future generations with entitlements not originally of their doing.
Professor Niall Ferguson and David Walker are now warning us that by year 2050 the American Dream will become an American Nightmare in which Americans seek every which way to leave this fallen nation for a BRIC nation offering some hope of a job, health care, education, and the BRIC Dream.
Bob Jensen's threads on health care ---
http://faculty.trinity.edu/rjensen/Health.htm
Bob Jensen's threads on entitlements ---
http://faculty.trinity.edu/rjensen/entitlements.htm
Quotations
Let me get this straight.
We're about to get a health care plan shoved down our
throats that is Written by a committee whose head says he doesn't understand it,
Passed by a Congress that hasn't read it but exempts themselves from it, signed
by a president that also hasn't read it, With funding administered by a treasury
chief who was caught not paying his Taxes, overseen by a surgeon general who is
obese, and financed by a Country that's nearly broke.
What could possibly go wrong?
IS THIS A GREAT COUNTRY OR WHAT!
Forwarded by Maureen
Video Shocker
"Health Care Shocker: Special Democratic Voting Counties Would Get Protected
Medicare Benefits," Brietbart ---
http://www.breitbart.tv/healthcare-shocker-special-democratic-voting-counties-would-get-protected-medicare-benefits/
"How can Obama Top a Great Speech," by
Joan Walsh, Salon, September 10, 2010 ---
http://www.salon.com/opinion/walsh/politics/2009/09/10/healthcare_speech/index.html
Jensen Answer
Dear Ms Walsh, President Obama can top his great speech by filling in details of
truthful estimates of the Affordable Care Act costs and how he plans to finance these added
costs of wider coverage of health issues and more people covered. Thus far his
sweeping claims of cost savings sound like snake oil.
Video tutorial on the President's strategy and the legislative process for passing health reform legislations --- http://www.kaiseredu.org/tutorials/reformprocess/player.html
H.R. 3200 Summary
http://faculty.trinity.edu/rjensen/Health.htm#HR3200
Introduced in
the House on July 14, 2009
Also see
http://www.defendyourhealthcare.us/houseandsenatebills.html
H.R. 676 Summary ---
http://faculty.trinity.edu/rjensen/Health.htm#HR676
Introduced in House on January 26. 2009
U.S. Debt/Deficit Clock --- http://www.usdebtclock.org/
Bob Jensen's threads on pending
economic disaster ---
http://faculty.trinity.edu/rjensen/Entitlements.htm
Jensen Comment
Because of the present health care
system in the United States is unjust and inefficient, I am in favor of a
National Health Plan modeled after the Canadian National Health Plan where
Canadians are taxed for a huge portion of their health services irrespective of
their levels of income. Any system that does not make users of the system share
heavily in the cost of the services will be unjust, abused, and inefficient ---
http://faculty.trinity.edu/rjensen/Health.htm#Canada
Having said that I prefer a Canadian-style national health plan for the U.S., I wish democrats in Congress would use their power and vote one in in spite of protests around the country. With a 60-vote surplus in the House and only needing 51 votes in the Senate, the Democrats could vote in National Health Care in an instant. The reason they won't is that most of them would be voted out of office the next time they come up for re-election. They know this!
But Americans at all levels of income would have to
agree to much higher taxes
The average Canadian family
spends more money on taxes than on necessities of life such as food, clothing,
and housing, according to a study from The Fraser Institute, an independent
research organization with offices across Canada. The Canadian Consumer Tax
Index, 2007, shows that even though the income of the average Canadian family
has increased significantly since 1961, their total tax bill has increased at a
much higher rate.
The Fraser Institute,
April 16, 2007 ---
http://www.newswire.ca/en/releases/archive/April2007/16/c5234.html
Jensen Comment
I put the portion of the Canadian tax dollars going into comparable health and
social services contained in the Affordable Care Act legislation to be about 40% of each
Canadian's tax dollar where malpractice coverage and government fraud is greatly
controlled relative to the United States ---
http://faculty.trinity.edu/rjensen/Health.htm#Canada
Canada greatly restricts the number of free riders in the system and negotiates
much lower prescription drug prices relative to insurance companies and Medicare
in the United States. Malpractice awards in Canada are tightly controlled.
So the present (health care) system is an
unsustainable disaster, but you can keep your piece of it if you want. And the
Democrats wonder why selling health care reform to the public has been so hard?
Ramesh Ponuru, "the Affordable
Care Act's Fatal Flaw:
Democrats claim their plans will save money, but they have too many conflicting
goals," Time Magazine August 17, 2009, Page 35
Jensen Comment
The problem is that they keep adding expensive medical services that sound great
on paper, but few people, companies, and certainly not government can afford
these uncapped benefits.
YouTube - ABC's John Stossel Destroys/Pulverizes/Crushes Obama's anti-American 'Health Care' Plan --- Click Here
Congressman Mike Rogers' opening statement on Health Care reform in Washington
D.C. ---
http://www.youtube.com/watch?v=G44NCvNDLfc
Jacob Hacker: Fixing America's Healthcare System (not humor)
---
http://fora.tv/2008/07/21/Jacob_Hacker_Fixing_America_s_Healthcare_System
Jack Webb on Health Care and America (Humor) ---
http://pubsecrets.wordpress.com/2009/09/05/just-the-facts-barack/
Video: Jon Stewart reveals Glenn Beck speaking about health care from
both ends of his digestive tract ---
http://www.thenation.com/blogs/notion/462437/breaking_rush_newt_and_sarah_supported_death_panels_too
Americans who want to tip the debate in the most
progressive direction should take advantage an opening provided at the last
minute during negotiations to get a bill approved by the House Energy and
Commerce Committee. And they should do so by advocating even more aggressively
for
single-payer health care.
John Nichols, "Why Single Payer
Advocacy Matters Now More Than Ever ," The Nation, August 4, 2009 ---
Click Here
Jensen Comment
Passionate advocates of universal health care are screaming "yes, yes, yes"
without even caring how health care will be funded or whether or not it will
further destruct the U.S. economy. The cannot care because they're so willing to
vote yet before a funding proposal is even put forth. I actually favor
single-payer nationalized health care but I'm unwilling to destroy by beloved
homeland in a passionate rage for the gold plated version that this debt-ridden
nation can ill afford at the present time ---
http://faculty.trinity.edu/rjensen/Entitlements.htm
"Schumer: Healthcare Changes This Year 'No Matter What'" ---
Click Here
U.S. Debt/Deficit Clock ---
http://www.usdebtclock.org/
Jesus, the Great Healer, wants Obamacare
according to MSNBC (even if top preachers are "dreadfully silent").
Watch the video ---
http://hotair.com/archives/2009/08/13/msnbc-host-hey-wouldnt-jesus-want-us-to-have-universal-health-care/
But what helps many Americans as individuals may
hurt society as a whole. That's the paradox. Unchecked health spending is
depressing take-home pay, squeezing other government programs—state and local
programs as well as federal—and driving up taxes and budget deficits. The
president has said all this; he simply isn't doing much about it. He offers the
illusion of reform while perpetuating the status quo of four decades: expand
benefits, talk about controlling costs. The press should put "reform" in quote
marks, because this is one "reform" that might leave the country worse off.
Robert J. Samuelson, Health Reform
That Isn't: Despite the Rhethoric, Costs (and trillion dollar deficits)
Will Rise, Newsweek Magazine, August 3, 2009, Page 26 ---
http://www.newsweek.com/id/208439/page/2
Samuelson is the author of The Great -Inflation and Its Aftermath.
For starters, $1 trillion of extra debt-financed
spending would cause the government to pay about $300 billion of extra interest
in the next decade. Moreover, the CBO's method of estimating the cost of such a
program doesn't recognize the incentives it creates for households and firms to
change their behavior. The House health-care bill gives a large subsidy to
millions of families with incomes up to three times the poverty level (i.e., up
to $66,000 now for a family of four) if they buy their insurance through one of
the newly created "insurance exchanges," but not if they get their insurance
from their employer. The CBO's cost estimate understates the number who would
receive the subsidy because it ignores the incentive for many firms to drop
employer-provided coverage. It also ignores the strong incentive that
individuals would have to reduce reportable cash incomes to qualify for higher
subsidy rates. The total cost of ObamaCare over the next decade likely would be
closer to $2 trillion than to $1 trillion.
Martin Feldstein, "ObamaCare's
Crippling Deficits The higher taxes, debt payments and interest rates needed to
pay for health reform mean lower living standard," The Wall Street Journal,
September 7, 2009 ---
http://online.wsj.com/article/SB10001424052970203585004574393110640864526.html?mod=djemEditorialPage
In 1935 President Franklin Roosevelt engineered the Social Security Act with honest and well-defined components of benefits and costs. It was intended to only be a supplemental pension program to force people to save something for their retirements. Later on Congress muddled the program up by adding social services (such as lifetime pensions for disabled people of all ages and death benefits for families of soldiers who died in service). Medicare and Medicaid health coverage was later added to massively increase the entitlements obligations of Social Security as pension fund (as originally crafted).
The Wall Street Journal Guide to Obamacare, October 14,
2009 ---
Click Here
http://online.wsj.com/article/SB10001424052748704471504574441193211542788.html?mod=djemEditorialPage
Bumper Stickers --- http://www.upyoursobama.com/
Obamacare: Call us when you're shovel ready
Bankrupt America? Yes we can
America needs a leader, not a (teleprompter) reader
Congressional pirates are the worst kind
Are you better off than $5 trillion before?
Community organize Timbuctoo
The Promise and Peril of Big Data --- http://www.aspeninstitute.org/sites/default/files/content/docs/pubs/InfoTech09.pdf
Frightening Clauses in the Pending House Bill (H.R. 3962) in November 2009
Full Text of H.R. 3962 --- www.defendyourhealthcare.us .
"We Pay Them to Lie to Us," by my hero
John Stossel, Townhall, November 25, 2009 ---
http://townhall.com/columnists/JohnStossel/2009/11/25/we_pay_them_to_lie_to_us
When you knowingly pay someone to lie to you, we call the deceiver an illusionist or a magician. When you unwittingly pay someone to do the same thing, I call him a politician.
President Obama insists that health care "reform" not "add a dime" to the budget deficit, which daily grows to ever more frightening levels. So the House-passed bill and the one the Senate now deliberates both claim to cost less than $900 billion. Somehow "$900 billion over 10 years" has been decreed to be a magical figure that will not increase the deficit.
It's amazing how precise government gets when estimating the cost of 10 years of subsidized medical care. Senate Majority Leader Harry Reid's bill was scored not at $850 billion, but $849 billion. House Speaker Nancy Pelosi said her bill would cost $871 billion.
How do they do that?
The key to magic is misdirection, fooling the audience into looking in the wrong direction.
I happily suspend disbelief when a magician says he'll saw a woman in half. That's entertainment. But when Harry Reid says he'll give 30 million additional people health coverage while cutting the deficit, improving health care and reducing its cost, it's not entertaining. It's incredible.
The politicians have a hat full of tricks to make their schemes look cheaper than they are. The new revenues will pour in during Year One, but health care spending won't begin until Year Three or Four. To this the Cato Institute's Michael Tanner asks, "Wouldn't it be great if you could count a whole month's income, but only two weeks' expenditures in your household budget?"
To be deficit-reducers, the health care bills depend on a $200 billion cut in Medicare. Current law requires cuts in payments to doctors, but let's get real: Those cuts will never happen. The idea that Congress will "save $200 billion" by reducing payments for groups as influential as doctors and retirees is laughable. Since 2003, Congress has suspended those "required" cuts each year
Do you feel the leaked information from a global warming alarmist organization is meaningful? This was an illegal information leak that should be ignored It makes me question my belief in global warming activists It's an example of dangerous scientific politicization I haven't really heard about the controversy
This was an illegal information leak that should be ignored (1 %)
It makes me question my belief in global warming activists (8 %)
It's an example of dangerous scientific politicization (86 %)
I haven't really heard about the controversy (5 %)
Our pandering congressmen rarely cut. They just spend. Even as the deficit grows, they vomit up our money onto new pet "green" projects, bailouts for irresponsible industries, gifts for special interests and guarantees to everyone.
Originally, this year's suspension, "the doc fix," was included in the health care bills, but when it clearly pushed the cost of "reform" over Obama's limit and threatened to hike the deficit, the politicians moved the "doc fix" to a separate bill and pretended it was unrelated to their health care work.
Megan McArdle of The Atlantic reports that Rep. Paul Ryan of Wisconsin asked the Congressional Budget Office what the total price would be if the "doc fix" and House health care overhaul were passed together. "The answer, according to the CBO, is that together they'd increase the deficit by $89 billion over 10 years." McArdle explains why the "doc fix" should be included: "They're passing a bill that increases the deficit by $200 billion in order to pass another bill that hopefully reduces it, but by substantially less than $200 billion. That means that passage of this bill is going to increase the deficit."
From the start, Obama has promised to pay for half the "reform" cost by cutting Medicare by half a trillion over 10 years. But, Tanner asks, "how likely is it that those cuts will take place? After all, this is an administration that will pay seniors $250 to make up for the fact that they didn't get a Social Security cost-of-living increase this year (because the cost of living didn't increase). And Congress is in the process of repealing a scheduled increase in Medicare premiums."
Older people vote in great numbers. AARP is the most powerful lobby on Capitol Hill. Like the cut in doctor's pay, the other cuts will never happen.
I will chew on razor blades when Congress cuts Medicare to keep the deficit from growing.
Medicare is already $37 trillion in the hole. Yet the Democrats proudly cite Medicare when they demand support for the health care overhaul. If a business pulled the accounting tricks the politicians get away with, the owners would be in prison.
Something AARP Wants Kept Secret
"McCain Urges Seniors to Abandon AARP," Fox News,
December 3, 2009 ---
http://www.foxnews.com/politics/2009/12/03/mccain-aarp-betrayed-senior-citizens/
"Medicare Part D 'Reforms' Will Harm Seniors An ObamaCare
change will cost taxpayers a bundle and lead to poorer drug coverage," Tom
Scully, The Wall Street Journal, December 7, 2009 ---
http://online.wsj.com/article/SB10001424052748704107104574569930258127214.html#mod=djemEditorialPage
There is a little-noticed provision buried deep in both the House and Senate health-care reform bills that is intended to save billions of dollars—but instead will hurt millions of seniors, impose new costs on taxpayers, and charge employers millions in new taxes.
As part of the Medicare Modernization Act in 2003, Congress created a new drug benefit—called Medicare Part D—for retirees at a cost of about $1,900 per recipient per year. Many private employers already provided drug coverage for their retirees, and the administration and Congress did not want to tempt employers into dropping their coverage. Actuaries calculated that if the government provided a subsidy of at least $800, employers would not stop covering retirees.
The legislation created a $600 tax-free benefit (the equivalent of $800 cash for employers), and it worked. Employers continued to cover about seven million retirees who might have otherwise been dumped into Medicare Part D.
It was a good arrangement for all involved. An $800 subsidy is cheaper than the $1,900 cost of providing drug coverage. And millions of seniors got to keep a drug benefit they were comfortable with and that in many cases was better than the benefit offered by the government.
But now that subsidy is coming in to be clipped. This fall congressional staff, looking for a new revenue source to pay for health reform, proposed eliminating the tax deductibility of the subsidy to employers. The supposed savings were estimated by congressional staff to be as much as $5 billion over the next decade.
It sounds smart—except that nobody asked how many employers will drop retiree drug coverage. Clearly, many will. The result is that, instead of saving money, the proposed revenue raiser will force Medicare Part D costs to skyrocket as employers drop retirees into the program.
The careful calculation that was made in 2003 to minimize federal spending and maximize private coverage will go out the window if this provision becomes law. Any short-term cost savings that Congress gets by changing the tax provision will be overwhelmed by higher costs in the long run.
Some members in the House want to mitigate the cost of this provision by mandating that employers maintain existing levels of retiree coverage despite the reduced subsidy. But it's not that simple. A mandate would increase costs on businesses, which in turn would make it harder for those businesses to hire new employees. The mandate would effectively be a tax on employers that provide retiree benefits; this in turn will simply induce some unknown number of employers to terminate their retiree drug programs before the mandate kicks in.
In short, if the changes that are proposed for employer subsidies in the current Medicare Part D program are enacted, everyone will lose. Unions will lose as employers seek ways to drop retiree drug coverage. Seniors will lose as employers drop them into Medicare Part D. Medicare and taxpayers will lose as they face higher costs. And employers will lose as they find it harder to provide benefits.
To make matters worse, accounting rules for post-retirement benefits will require companies that keep their retiree benefits to record the entire accrued present value of the new tax the day the provision is signed into law. This would cause many employers to immediately post billions in losses, which could significantly impact our financial markets.
There are many reasons to pass health-care reform. There is no reason to hurt seniors, employers and taxpayers in the process. Businesses are struggling, and the Medicare trust funds have plenty of problems as it is. It makes no sense to make these problems worse.
Mr. Scully was the administrator of the Centers for Medicare and Medicaid Services from 2001-04 and was one of the designers of the Medicare Part D benefit.
"What the Pelosi Health-Care Bill Really Says: Here are some important passages in the 2,000 page legislation," by Betsy McCaughey, The Wall Street Journal, November 7, 2009 --- Click Here
The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.
What the government will require you to do:
• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.
• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.
On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.
• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.
• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.
• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.
Eviscerating Medicare:
In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.
• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."
A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.
• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.
• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.
• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
Video Shocker
"Health Care Shocker: Special Democratic Voting Counties Would Get Protected Medicare Benefits," Brietbart ---
http://www.breitbart.tv/healthcare-shocker-special-democratic-voting-counties-would-get-protected-medicare-benefits/• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."
Questionable Priorities:
While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.
• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."
These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.
• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.
• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."
• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.
For the text of the bill with page numbers, see www.defendyourhealthcare.us .
Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York state.
Reason Magazine's Really Important Concerns about Medicare-for-All
The Contradiction at the Heart of Bernie Sanders' Medicare for All Plan ---
https://reason.com/2019/04/24/the-contradiction-at-the-heart-of-bernie-sanders-medicare-for-all-plan/
There is a huge contradiction at the heart of Bernie Sanders' Medicare for All plan.
On the one hand, Sanders not only wants to expand government-provided coverage to everyone in the country, he wants that coverage to be significantly more generous than Medicare, private insurance, or comparable government-run systems in other countries. On the other hand, he wants to drastically cut payments to hospitals, many of which lose money on Medicare right now, making up for the program's relatively low payments by charging much higher prices to private insurers.
What Sanders is proposing, in other words, is that the government finance a significant increase in government services while also radically reducing the amount it pays for those services. Even making generous assumptions, it's almost impossible to see how his plan could work.
Let's start with the promises Sanders makes about Medicare for All. No networks, premiums, deductibles, or copayments. Under his plan, essentially all non-cosmetic services would be free at the point of care for everyone.
Sanders calls this Medicare for All, but what he's describing isn't Medicare as we now know it. As The New York Times noted earlier this year upon the release of a Sanders-inspired Medicare for All bill in the House, the new program would "drastically reshape Medicare itself," changing both what it pays for and how. In many ways, it would be a completely different program. Medicare for All, in other words, isn't really Medicare.
And that program would be far more expansive and expensive than nearly any other comparable system. It would cover more, and require less direct financial outlays (not including taxes), than either today's Medicare or typical private insurance plans in the U.S.
It would also be substantially more generous than the national health systems set up in other countries. Sanders likes to unfavorably contrast America's mixed public-private health care system with foreign systems where the government is more directly involved. When he announced the 2017 version of his Medicare for All plan, for example, he bemoaned the state of affairs in the United States "a time when every other major country on earth guarantees health care to every man, woman, and child." Discussions about health care policy on social media often include some variant of the question, "If every other country with a developed economy can do it, why can't the United States?"
The problem with this line of questioning is that what Sanders is proposing isn't what other countries do. Canada, for example, has a single-payer system, but it doesn't cover dental care, vision, drugs, or any number of other services. A majority of Canadians carry private insurance in order to cover those services. In Britain, which offers a fully socialized medical system where health care providers are government employees, many resident still buy private coverage. Sanders, on the other hand, would effectively wipe out private coverage in the space of just four years.
There are similar limitations on coverage in other countries, like the Netherlands. It's also true in Australia, where patients typically pay a percentage of the cost of specialty services. It's true that in these countries, government plays a more central role in health care financing. But their systems have also reckoned with costs and tradeoffs in a way that Sanders, after so many years, has not.
Indeed, the main trade-off that Sanders seems willing to discuss is the elimination of insurance companies, which he portrays as greedy middlemen driving up the cost of health care. Wiping out the industry in one fell swoop, as Sanders has proposed, would be a unprecedented and disruptive move that would have significant economic repercussions, including the probable loss of thousands of insurance industry jobs. But it still wouldn't do much to bring down the cost of health care, because so much money in the nation's health care system is tied up in provider payments, especially hospitals.
And therein lies the (first) contradiction.
Most people probably think of hospitals as places where you go to get health care services. Politically and economically, however, they also fulfill another role: They are hubs for stable middle-class jobs, paying reasonably good wages to thousands of highly trained workers, most of whom are not doctors or specialists earning stratospheric salaries.
To acquire the revenue to pay for all these jobs, hospitals rely on a mix of private and public payments. Public payments make up a somewhat larger share of total hospital budgets, but private payers are typically charged much higher prices.
Hospitals like to argue that Medicare and Medicaid payments are too low to cover their costs, and that as a result, higher private payments effectively subsidize public health coverage. Critics (with some evidence) often respond that hospitals either overstate or don't really understand their own costs, and that this is just a ploy to extract more money from government health programs and private payers.
But when considering Medicare for All, the particulars of this debate are largely beside the point, because there is simply no question that eliminating private insurance and payment for all services would drastically reduce the amount of revenue for hospitals.
Yet that is exactly what Sanders wants to do. His plan calls for paying for health care services at Medicare rates, which means that, practically overnight, hospitals would end up with far, far less revenue. Exactly how much is unclear, but one estimate indicated that payments could drop by as much as 40 percent.
That would leave hospitals with a couple of difficult choices. They could eliminate services. They could try to force some employees to take pay cuts. They could fire large numbers of workers. Or they could simply shut down. As a recent New York Times report on how Medicare for All would affect hospitals noted, rural hospitals—many of which are already struggling to stay afloat—would be particularly at risk of closing.
Whatever ended up happening, there is simply no way most hospitals would or could continue operating as they do now under the payment regime that Sanders envisions. Lots of middle class jobs would disappear. Services would be eliminated or cut back.
Yet Sanders not only imagines that hospitals would continue to operate as they do now, but that they would expand their services to even more people, since more people would have coverage. And since he also imagines a system with no deductibles or copays, those people would almost certainly end up dramatically increasing utilization of hospital services.
Studies of health insurance have consistently shown that expansions of health insurance result in increased demand for (and use of) health care services; more people with coverage means more people lining up to get care. (Relatedly, introducing even very small copays—on the order of just a few dollars—can reduce the number of visits to doctors and hospitals.) Greater utilization of health care services does not necessarily translate into measurably better physical health outcomes. But it does increase the strain on the health care delivery system—which is to say, it puts a huge amount of pressure on hospitals.
Continued in article
Jensen Comment
Another contradiction is that to pay for Medicare-for-All program Bernie Sanders
wants to tax most of what high-income workers earn, and the highest income
professionals in the USA on average are physicians. There is currently a
shortage of physicians. This shortage will become critical as medical care
becomes virtually free and often overused as a free service by hundreds of
million residents of the USA.
Here's the second contraction
Taxing physician income at 70% or more will discourage students from becoming physicians and will give existing physicians incentives to retire early or work at leisurely part-time doctoring. Far better work two days per week and pay a 30% income tax rate than to be a 60--hour week highly stressed, and overworked physician being taxed at 70% of every extra dollar earned.
Medicare-for-All is a Tragedy of the Commons ---
https://en.wikipedia.org/wiki/Tragedy_of_the_commons
Vox: The Bernie Sanders national medical plan has
lots of details about what single-payer would cover. It has less information on
how to pay for it (well over $3 trillion per year and growing for more generous
coverage than all other national health plans) ---
https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all
. . .
Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens. Private insurance plans often spring up to fill these gaps (in Canada, for example, vision and dental insurance is often sponsored by employers, much like in the United States).
The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analog among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted. . .
But who pays how much more is a key question this Sanders bill doesn’t answer yet. Until there is a version that does, we can’t know whether the health system the Vermont senator envisions could actually become reality.
Jensen Comment
The Sanders plan eliminates all private-sector medical insurance companies and
eliminates Medicare and Medicaid.
The good news for us retired folks is that long-term care insurance that is not covered presently under Medicare will cover us retired folks. Hooray for Bernie! I can eat, drink, and be merry on my long-term care savings.
Two things Bernie does not like to discuss is the impact on doctors and hospitals. At present many (most?) of the top physicians and hospitals refuse Medicaid patients because of caps placed on fees. Many also reject Medicare patients, but more of them are covered because of supplemental private insurance benefits that can be added to Medicare insurance. Presently Erica and I pay over $1,200 for supplemental benefits that will not be allowed under the Sanders' plan.
I think Sanders does not like to discuss caps that will be placed on physician billings and hospital rates because the medical profession would otherwise crank up an huge lobbying effort against his plan. The medical profession has only begun to fight.
Also Sanders does not like to discuss the shortage of physicians and hospital services that will arise when bringing tens of millions of people into his plan (think nearly 20 million undocumented residents that will be covered in rural areas already underserved with doctors and hospitals).
Also Sanders does not like to discuss the transition costs in creating the vast government bureaucracy that does not exist for processing medical insurance claims. At present Medicare and Medicaid outsource claims processing to the private sector. Bernie plans to kill that outsourcing sector.
Bernie Sanders: "You’re Damn Right We’re Going to Destroy Private Health
Insurance" ---
Click Here
And he will limit the number of doctors by regulating what they're allowed to
earn.
And Bernie plans on taxing high income earners in the USA by taking away 70% or more of what they now earn. What will be the incentive for spending years of misery to become a physician good at a craft that will be taxed to death rather than rewarded after all those years of misery?
The problem with becoming a physician is not just the cost of medical school. The problem is the ordeal --- those years of education and training needed to become masters of their crafts. The time needed varies with specialties, but you don't become a neurosurgeon without years of ordeal in training before you can bill your first paying patient. And there's a lot of blood, sweat, and tears in those training years. Even worse is that there's a lot of weekly tension and risk of burn out in the years of practice that follow. Tell that to the advocates of Medicare-for-All combined with soaring taxes!
Why did Cuba
abandon its socialist/communist dream of equality for everybody?
The Guardian: This was the
egalitarian dream of Cuba in the 1960s: For years in Cuba, jobs as varied as
farm workers and doctors only had a difference in their wages of the equivalent
of a few US dollars a month.
https://www.theguardian.com/world/2008/jun/12/cuba
Jensen Comment
Only now is Cuba backtracking from its egalitarian dream by uncapping wages and
legalizing profits while liberals in the USA want to return again to the 1960s
Cuban dream.
But is Denmark socialist? …Denmark doesn’t at
all fit the classic definition of socialism, which involves government ownership
of the means of production. It is, instead, social-democratic: a market economy
where the downsides of capitalism are mitigated by government action, including
a very strong social safety net. …The simple fact is that there is far more
misery in America than there needs to be. Every other advanced country has
universal health care and a much stronger social safety net than we do.
Paul Krugman
https://www.nytimes.com/2015/10/19/opinion/something-not-rotten-in-denmark.html
Jensen Comment
What Krugman does not mention is that Denmark is mostly a homogeneous (white)
nation of less than 6 million people. It's much more difficult and expensive to
afford and maintain a similar safety net with over 300 million highly diverse
people located on top of a very porous border with thousands trying to sneak in
daily to enjoy the safety nets.
Welfare Leads to Slower Growth in the Nordic
Nations ---
https://mises.org/wire/paul-krugman-learns-wrong-lesson-denmark
The Swedish Welfare State Leads to Poor
Immigrant Assimilation ---
https://mises.org/wire/swedish-welfare-state-leads-poor-immigrant-assimilation
Ending Jensen Comment
But don't get me wrong! Erika and I will vote for Bernie Sanders since
our possible expensive long-term health care not funded by Medicare will soon be
free. To hell with the future economic engine of the USA. Bring on the Bernie
Sanders' socialism since I'm too old to witness the chaos and economic
destruction that follows in its path. Since Democrats are promising free
everything why shouldn't Erika and I get in on the free everything?
Listen to Big Rock Candy Mountain' performed by Burl Ives ---
Big Rock Candy Mountain' Burl Ives
"But (American) virtuous feelings have been played
on by some facts with more fiction; they have been the dupes of artful
maneuvers, and made for a moment to be willing instruments in forging chains for
themselves.”
Thomas Jefferson
William J. Watkins, Jr., Winter 1999, “The Kentucky and Virginia
Resolutions: Guideposts of Limited Government,”
The Independent Review,
Vol. III, No. 3, pp. 406-407.
March 21, 2019
Hi Elliot,,
You must also realize that when the wealthy people fund the new ventures they are also taking on highe financial risks. For some the payout is more wealth. For others there are huge losses. Bill Gates and Warren Buffet and other billionaires lost big time in Theranos. But Theranos and other more successful ventures got a chance that they would never get in Europe due to all the regulations and red tape entanglements and high taxes.
How many innovative ventures that succeeded and failed have been funded by European nations like the Nordic nations? And in China and Russia these new ventures probably could not get started without having the best ideas stolen/hacked from the USA.
You raised the question:
"At what point do most
people take Sen. Warren or Rep. AOC more seriously and consider
their solutions
as reasonable instead of fringe?"
Do you really think Warren and AOC have thought out "their solutions" even to the satisfaction of their own party?
Most Democrats consider AOC and Warren economics fringe and worry that at adding $100+ trillion in social spending might destroy the USA economic engine.
Consider Medicare-for-All.
The sensible liberal press argues as follows:
The New York Times' David Brooks: ‘Medicare for All’: The Impossible Dream ---
https://www.nytimes.com/2019/03/04/opinion/medicare-for-all.html?action=click&module=Opinion&pgtype=Homepage
Washington Post: You can’t have it all — even with Medicare-for-all ---
https://www.washingtonpost.com/opinions/you-cant-have-it-all--even-with-medicare-for-all/2019/01/31/b0551dcc-24c4-11e9-ad53-824486280311_story.html?utm_term=.7d24dfad68da
If the nation were building a health-care system from scratch, single-payer might be the rational choice. Even now, with many Americans reasonably satisfied with their employer-sponsored coverage, politicians can make an argument that they’d be better off in a different system. But they should not make that argument by exaggerating the benefits or lowballing the costs of single-payer, as Medicare-for-all advocates so often do. Any system will demand tradeoffs and constraints.
Pelosi Drops a Bomb on 'Medicare for All'
---
https://www.rollingstone.com/politics/politics-features/nancy-pelosi-trump-interview-797209/
Also see
https://www.newsweek.com/nancy-pelosi-medicare-all-single-payer-health-insurance-affordable-care-act-1318788
and
https://www.cnbc.com/2019/03/06/2020-democratic-primary-candidates-weigh-medicare-for-all-public-option.html
Kaiser Family Foundation: People love Medicare-for-All until they're told it'll
raise their taxes to the $30+ trillion cost: Then support nosedives ---
https://www.businessinsider.com/ap-poll-support-for-medicare-for-all-fluctuates-with-details-2019-1
The Democratic Party is Split
“You have to make decisions that you’re going to reach certain goals, and some
of our goals
we think are achievable”
Nancy Pelosi
(when criticizing Alexandria's Green New Deal and Basic (Guaranteed) Income
Medicare-for-All)
Click Here
What
do you see in the Warren and AOC solutions that are sustainable from the
standpoint of economic reality?
Yes we can move toward universal healthcare in a number of ways, but certainly
not in the way that the fringe candidates want to do by eliminating all private
sector insurance
in two years.
Thanks,
Bob
Government Medical Research Spending Favors Women ---
https://marginalrevolution.com/marginalrevolution/2018/08/government-medical-research-spending-favors-women.html
Medicare for All: Administrative Costs Are Much Higher than You Think ---
https://mises.org/wire/medicare-all-administrative-costs-are-much-higher-you-think?utm_source=Mises+Institute+Subscriptions&utm_campaign=8a83a2b8d3-EMAIL_CAMPAIGN_9_21_2018_9_59_COPY_01&utm_medium=email&utm_term=0_8b52b2e1c0-8a83a2b8d3-228708937
How to Mislead With Statistics
Left-Leaning VOX: The $21 trillion Pentagon accounting error that can’t pay
for Medicare-for-all, explained ---
https://www.vox.com/policy-and-politics/2018/12/3/18122947/pentagon-accounting-error-medicare-for-all
The US military budget is such a bloated monstrosity that it contains accounting errors that could finance two-thirds of the cost of a government-run single-payer health insurance system. All Americans could visit an unlimited array of doctors at no out of pocket cost. At least that’s a notion spreading on left-wing Twitter and endorsed and amplified by newly elected Rep. Alexandria Ocasio-Cortez, one of Democrats’ biggest 2018 sensations and an undeniable master at the fine art of staying in the public eye.
Unfortunately, it’s not true.
The idea spread like a game of telephone from a Nation article to the US Congress while losing a crucial point of detail: The Pentagon’s accounting errors are genuinely enormous, but they’re also just accounting errors — they don’t represent actual money that can be spent on something else.
Proponents of this vision have the political wind at their backs and continue to deploy the idea effectively to win intra-party arguments without really making any headway on the core obstacles to writing a Medicare-for-all bill that could become law. That said, to the extent that political power rather than concrete legislation is the goal, that’s probably for the best.
Misunderstandings fly around on Twitter all the time, and AOC’s level of policy knowledge is pretty typical for a member of Congress. But this particular flub is telling about progressive frustration over the double standard on military versus non-military spending, and also the fraught state of play regarding the push for a Medicare-for-all program.
The Pentagon’s mystery $21 trillion, explained
The underlying article by Dave Lindorff in the Nation that kicked this off is an investigative report into the Defense Department’s accounting practices. Lindorff reveals that Pentagon accounting is quite weak, that the department keeps flunking outside audits, that funds are shifted between accounts without proper oversight, and that overall documentation of what’s actually happening with the Pentagon’s vast budget is extremely poor.
Lindorff goes beyond these observations to allege that what’s happening amounts to deliberate fraud, the purpose of which is to persuade Congress to increase appropriations levels beyond what would otherwise be approved.
Continued in article
Jensen Comment
We really cannot compare proposed Medicare-for-All plan without more specific
definitions of "Medicare-for-All" and the "cared for population." For example,
Medicare currently does not pay for the enormous cost of long-term nursing care.
Medicare only pays 80% of most of the things it does cover like hospital and
doctor care.
Also Medicare has built up trust funds over the 50 years using payroll deductions from individuals and employers. The trust funds are not sustainable at predicted usage rates, but it's not like the existing Medicare program did not accumulate any finds for the elderly and disabled. A Medicare-for-All plan does not have 50 years of payroll deductions to help pay for an abrupt shock to the system.
Advocates of Medicare-for-All never mention that Medicare for all is mostly a private sector program where claims are serviced in the private sector along with private sector doctor, nursing, and medicine delivery of goods and services. Medicare is not like the U.K. system where most services are delivered by government employees.
The Nation's analysis of the Defense Department's expenses ignores the fact that even if we entirely eliminated the current Army, Navy, and Air Force the government's obligations to retired and disabled former military personnel would carry on for hundreds of billions of dollars into the indefinite future. And how long would the USA and its Medicare-for-All program survive without any Army, Navy, and Air Force?
The Nation's analysis is an example of totally irresponsible and misleading statistics.
WaPost fact-checker gives Ocasio-Cortez four Pinocchios for Pentagon claim
---
https://thehill.com/homenews/media/419730-wapost-fact-checker-gives-ocasio-cortez-four-pinocchios-for-pentagon-claim
Krugman redefines ‘Medicare for all,’ but gets it wrong ---
http://pnhp.org/news/krugman-redefines-medicare-for-all-but-gets-it-wrong/
. . .
Comment:
By Don McCanne, M.D.
“Medicare for all…would mean allowing individuals and employers to buy into Medicare – basically a big public option.” Who says? Well Paul Krugman and many others. This is not simply a debate about labels. This is a debate about fundamental policy. Are we going to accept the status quo with the tweak of a public option, or are we going to address the fundamental defects in our system that have driven up costs, perpetuated mediocrity, and left tens of millions vulnerable with impaired access to health care with all of its consequences and often with intolerable financial hardship?
This is similar to the debate that took place within the Democratic Party just before Hillary Clinton and Barack Obama began jockeying for the 2008 presidential nomination. The Democratic Party machine was in complete control of the policy debate on health care reform. The neoliberal party elite had decided that we were going to “build on what works” – employer-sponsored and union-supported plans – and reject single payer based on their concepts of what was politically feasible. Those of us advocating for the expanded and improved Medicare for all single payer approach were ejected from the conversations (often rudely so – they were in charge!).
Similarly, with the contest for the 2016 Democratic presidential nomination, the debate at the platform committee confirmed that the battle had not changed. The neoliberal leadership, represented by Neera Tanden, was successful in rejecting the single payer Medicare for all plank.
Tanden, of the Center of American Progress, has continued the fight for control of the policy debate by releasing their new proposal, “Medicare Extra For All.” Although some of the tweaks proposed seem beneficial, it basically continues the current dysfunctional, fragmented financing system, but with one important political change. They have stolen the “Medicare for all” label! This has contributed to the ubiquitous deception that the public option is Medicare for all. When the current candidates campaign on Medicare for all but behind the scenes are supporting an option to buy into Medicare while accepting campaign funds from the insurance and pharmaceutical industries, we need to call them on their deception.
It is no wonder the public is confused, even if they do not realize it. When Nobel laureate Paul Krugman jumps in and says Medicare for all is allowing individuals and employers to buy into Medicare as a public option, then we know that the political campaigns are corrupted with deceptions. How can we get the public to understand that a well designed, single payer national health program – a bona fide Improved Medicare for All – is the reform that they crave?
Tapper: Democrats' Obamacare Pitch Was Dishonest ---
Jake Tapper, CNN
http://freebeacon.com/issues/tapper-democrats-obamacare-dishonest/
From the CFO Journal's Morning Ledger on May 11, 2017
Aetna to pull out of Affordable Care Act exchanges
Aetna Inc. said it would pull out of the Affordable Care Act exchanges in Delaware and Nebraska next year, confirming that the insurer will exit all of the marketplaces where it currently sells plans.
The Atlantic: Why So Many Insurers Are Leaving Obamacare ---
https://www.theatlantic.com/health/archive/2017/05/why-so-many-insurers-are-leaving-obamacare/526137/
This article really does not get at the reasons why.
Obama says Bernie Sanders supporters helped undermine Obamacare ---
http://www.businessinsider.com/r-obama-says-sanders-supporters-helped-undermine-obamacare-2017-1
Jensen Comment
I must admit that I too am in favor of a German-style medical insurance system
where there is a national plan funded by taxpayers with added premium plans
funded by companies or people themselves.
The Lies and Deceptions of Obamacare ---
http://faculty.trinity.edu/rjensen/Health.htm
Jensen Comment
One misleading statement that 20 million uninsured got medical insurance under
Obamacare. That may be literally true, but most either got added to Medicaid
(free medical insurance that could have happened without the complicated
legislation of Obamacare) or insurance with such enormous deductibles that those
insured could not afford to use that insurance and went to emergency rooms
instead for free medical care.
The other sad thing about Obamacare (and Medicaid) is that so many doctors and hospitals refused to accept patients insured by Obamacare.
Something you will never hear in a speech by President Obama
Major hospitals in Chicago will no longer serve patients insured in Obamacare exchanges (except in true emergencies) ---
http://beta.hotair.com/archives/2016/10/24/chicago-hopenchange-major-hospitals-bail-obamacare-2017/?utm_source=hadaily&utm_medium=email&utm_campaign=nlNews Item Prior to November 8 Election of President Trump
Major Chicago Hospitals Not In 2017 Obamacare Marketplace Plans ---
https://www.wbez.org/shows/wbez-news/major-chicago-hospitals-not-in-2017-obamacare-marketplace-plans/f55d6c23-d9b1-452f-8c75-73635bd83d07Some of Chicago’s largest hospitals said they will not be part of any Cook County Affordable Care Act marketplace plans in 2017.
University of Chicago Medical Center and Rush University Medical Center both said they don’t plan to be in network for any Obamacare marketplace plans next year.
The change means patients with doctors at those hospitals will either need to find a plan off the marketplace, and lose Obamacare subsides, or find a new doctor.
Northwestern Memorial Hospital said it will also be out of the marketplace, but will have exceptions for some of its partner hospitals.
Continued in article
According to emergency room physicians Obamacare made it much worse for emergency rooms.
American College of Emergency Room Physicians
The Uninsured: Access to Medical Care Fact Sheet ---
http://newsroom.acep.org/fact_sheets?item=30032
"Accountability for ObamaCare: Democrats should pay a
political price for this historic failure," The Wall Street Journal, October
25, 2016 --- |
http://www.wsj.com/articles/accountability-for-obamacare-1477435661?mod=djemMER
ObamaCare has suddenly been injected back into the 2016 election debate, on the news of the law’s 25%-plus average premium increase for 2017. Even Donald Trump is talking about it. With only two weeks to go, this is a moment for voters to hold accountable the Democrats who imposed this debacle on the country over voter objections.
Next year’s enormous price increases are merely the latest expression of ObamaCare’s underlying problems, and the dysfunction is undermining the health security of Americans who lack employer coverage. A wave of major insurers have quit the exchanges, and those that are left have raised deductibles and copays and restricted choices of doctors and hospitals. The public is witnessing—and the unlucky are experiencing—the collapse of one progressive promise after another.
At every stage of the ObamaCare saga, liberals said not to worry. Sure, the law was unpopular when Democrats rammed it through Congress on a partisan vote in 2009-10, but voters would learn to love it once the subsidies started rolling. That didn’t happen, and in 2014 President Obama tried to buck up Democrats by saying that “five years from now” people will look back on the law as “a monumental achievement.” Two years later it’s worse.
Nothing could shake the liberal faith in their supposed landmark: Not the Healthcare.gov website fiasco of 2013, or the millions of individual health plans that were cancelled despite President Obama’s promise about keeping them. The left kept the faith as the entitlement subtracted from economic growth, hurt incomes and killed jobs. MIT economist Jonathan Gruber called the critics stupid, and Mr. Obama denigrates anyone who disagrees with him as illegitimate or politically motivated.
Now reality is confirming what the critics predicted. ObamaCare’s regulatory mix—benefit mandates, requiring insurers to sell coverage to all comers, and narrow ratings bands that limit how much premiums can vary by health status—was tried by several states in the 1980s and ’90s. Every one saw the same results that are now unspooling nationally: high and rising costs, low and declining enrollment, and less insurer and provider competition.
The Affordable Care Act was supposed to solve these predictable disruptions with subsidies and a mandate to buy insurance or pay a penalty. But most people don’t think ObamaCare plans provide value for the money, especially if they are non-subsidized.
So now the liberal line is that ObamaCare has a few problems, but don’t worry: The same geniuses who wrote the law know how to fix it. The Bernie Sanders-Elizabeth Warren left wants a new “public option,” higher subsidies, more price controls and even more intrusive regulatory control. Hillary Clinton has endorsed all of this.
“The Affordable Care Act has done what it was designed to do,” Mr. Obama declared last week in Miami, apparently meaning that the law has reduced the number of uninsured. But most of the coverage gains have come from dumping patients into Medicaid, a failing program that provides substandard care. Nominally private exchange plans increasingly resemble Medicaid too.
Mrs. Clinton may be horse-whispering Ms. Warren now, but ObamaCare’s failures aren’t likely to bring the U.S. closer to their single-payer nirvana any time soon. ObamaCare was the best Democrats could do when they had a 60-vote Senate supermajority and bought off interest groups like the insurers, hospitals, drug makers and American Medical Association.
The only way to break the ObamaCare status quo is if the public returns a Republican Congress to Washington. If Republicans can hold the Senate amid a Clinton victory, they’d be in a better position to negotiate solutions along the lines of the House GOP “Better Way” blueprint that would start to repair the individual market and create incentives for more choice and competition.
Take Wisconsin, where Democrat Russ Feingold cast the deciding 60th vote for ObamaCare and voters fired him for it in 2010. He’s back hoping voters forget. Evan Bayh, who also cast the deciding vote before retiring to become a superlobbyist, is back facing Indiana voters and Hoosiers can deliver a verdict.
In Arizona, premiums will rise a mind-boggling 116%, only two insurers are still selling plans, and John McCain has made ObamaCare a major theme. His opponent, Congresswoman Ann Kirkpatrick, calls ObamaCare her “proudest vote.” Katie McGinty likes to say Pennsylvanians should be “proud of ObamaCare,” though the commonwealth is slated for a 53% increase. A memo about ObamaCare pride month must have gone out from Democratic HQ.
Mr. Trump has missed a chance by not prosecuting a consistent case against ObamaCare, despite Mrs. Clinton’s past as the chief architect of its HillaryCare prototype in the 1990s. As that episode shows, the longstanding progressive goal has been to centralize political control over American health care.
Now voters are finally seeing what happens when the planners try to design a single health-care solution for a large and diverse country. Mr. Obama called ObamaCare “a starter home” in Miami. Republicans ought to campaign as the bulldozer.
From the CFO Journal's Morning Ledger on December 2, 2016
Obamacare’s bright spots and drawbacks
Here’s the good news: Thanks to the Affordable Care Act, or Obamacare, more Americans have access to health care than ever before, Leemore Dafny and Dr. Thomas Lee write for Harvard Business Review. The bad news? The care itself hasn’t improved much. Despite the hard work of dedicated providers, our health-care system remains chaotic, unreliable, inefficient and crushingly expensive.
Nation's Top Hospitals Refuse Obamacare-Insured Patients ---
http://www.newsmax.com/Newsfront/Obamacare-hospitals-plans-coverage/2013/11/01/id/534327/
Something you will never hear in a speech by President Obama
Major hospitals in Obama's home town of Chicago will no longer serve patients
insured in Obamacare exchanges (except in true emergencies) ---
http://beta.hotair.com/archives/2016/10/24/chicago-hopenchange-major-hospitals-bail-obamacare-2017/?utm_source=hadaily&utm_medium=email&utm_campaign=nl
News Item Prior to November 8 Election of President Trump
Major Chicago Hospitals Not In 2017 Obamacare Marketplace Plans ---
https://www.wbez.org/shows/wbez-news/major-chicago-hospitals-not-in-2017-obamacare-marketplace-plans/f55d6c23-d9b1-452f-8c75-73635bd83d07
Some of Chicago’s largest hospitals said they will not be part of any Cook County Affordable Care Act marketplace plans in 2017.
University of Chicago Medical Center and Rush University Medical Center both said they don’t plan to be in network for any Obamacare marketplace plans next year.
The change means patients with doctors at those hospitals will either need to find a plan off the marketplace, and lose Obamacare subsides, or find a new doctor.
Northwestern Memorial Hospital said it will also be out of the marketplace, but will have exceptions for some of its partner hospitals.
Continued in article
According to emergency room physicians Obamacare made it much worse for
emergency rooms.
American College of Emergency Room Physicians
The Uninsured: Access to Medical Care Fact Sheet ---
http://newsroom.acep.org/fact_sheets?item=30032
"Sen. Chuck Schumer: Obamacare
Focused 'On The Wrong Problem,' Ignores The Middle Class" by Avik Roy,
Forbes, November 26, 2014 ---
http://www.forbes.com/sites/theapothecary/2014/11/26/sen-chuck-schumer-obamacare-focused-on-the-wrong-problem-ignores-the-middle-class/
Despite the enduring unpopularity of Obamacare, Congressional Democrats have up to now stood by their health care law, allowing that “it’s not perfect” but that they are proud of their votes to pass it. That all changed on Tuesday, when the Senate’s third-highest-ranking Democrat—New York’s Chuck Schumer—declared that “we took [the public’s] mandate and put all our focus on the wrong problem—health care reform…When Democrats focused on health care, the average middle-class person thought, ‘The Democrats aren’t paying enough attention to me.’”
Sen. Schumer made his remarks at the National Press Club in Washington. “Democrats blew the opportunity the American people gave them…Now, the plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed,” Schumer maintained. “But it wasn’t the change we were hired to make. Americans were crying out for the end to the recession, for better wages and more jobs—not changes in health care.”
“This makes sense,” Schumer continued, “considering 85 percent of all Americans got their health care from either the government, Medicare, Medicaid, or their employer. And if health care costs were going up, it really did not affect them. The Affordable Care Act was aimed at the 36 million Americans who were not covered. It has been reported that only a third of the uninsured are even registered to vote…it made no political sense.”
The response from Obama Democrats was swift. Many, like Obama speechwriters Jon Lovett and Jon Favreau and NSC spokesman Tommy Vietor, took to Twitter. “Shorter Chuck Schumer,” said Vietor, “I wish Obama cared more about helping Democrats than sick people.
Medicaid Explodes New enrollments vastly exceed estimates, and
states are on the hook. ---
http://www.wsj.com/articles/medicaid-explodes-1479426939?mod=djemMER
On Donald Trump’s victory Republicans in Congress are primed for an ambitious agenda, and not a moment too soon. One immediate problem is ObamaCare’s expansion of Medicaid, which has seen enrollment at least twice as high as advertised.
Most of the insurance coverage gains from the law come from opening Medicaid eligibility beyond its original goal of helping the poor and disabled to include prime-age, able-bodied, childless adults. The Supreme Court made this expansion optional in 2012, and Governors claimed not joining would leave “free money” on the table because the feds would pick up 100% of the costs of new beneficiaries.
In a new report this week for the Foundation for Government Accountability, Jonathan Ingram and Nicholas Horton tracked down the original enrollment projections by actuaries in 24 states that expanded and have since disclosed at least a year of data on the results. Some 11.5 million people now belong to ObamaCare’s new class of able-bodied enrollees, or 110% higher than the projections.
Analysts in California expected only 910,000 people to sign up, but instead 3.84 million have, 322% off the projections. The situation is nearly as dire in New York, where enrollment is 276% higher than expected, and Illinois, which is up 90%. This liberal state triumvirate is particularly notable because they already ran generous welfare states long before ObamaCare.
Continued in article
Jensen Comment
President Obama baited the hook by claiming the Federal Government would pay for
Medicaid expansion. But the states that took the bait are now on the hook.
Medicaid is not the largest single expense item in most states, and the expense
that will go completely out of control (heavily due to fraud) will be the cost
of caring for older people where medical expenses are greatest, especially since
Medicaid foots sometimes years of all nursing home and medication costs.
"How to Fix the Scandal of Medicaid and the Poor," by Scott W. Atlas,
The Wall Street Journal, March 15, 2016 ---
http://www.wsj.com/articles/how-to-fix-the-scandal-of-medicaid-and-the-poor-1458080771?mod=djemMER
Many doctors won’t take the insurance, and the care patients do receive is inferior. Here’s a solution.
The two principal expenditures of the Affordable Care Act so far include $850 billion for insurance subsidies and a similar outlay for a massive Medicaid expansion. The truth is that Medicaid—a program costing $500 billion a year that rises to $890 billion in 2024—funnels low-income families into substandard coverage. Instead of providing a pathway to excellent health care for poor Americans, ObamaCare’s Medicaid expansion doubles down on their second-class health-care status.
Already 55% of doctors in major metropolitan areas refuse new Medicaid patients, according to the 2014 Merritt Hawkins annual survey. Even of those providers signed up with Medicaid, 56% of primary-care doctors and 43% of specialists are not available to new patients. Moreover, numerous studies have found that the quality of medical care is inferior under Medicaid, compared with private insurance. Lower quality means more in-hospital deaths, more complications from surgery, shorter survival after treatment, and longer hospital stays than similar patients with private insurance.
The two principal expenditures of the Affordable Care Act so far include $850 billion for insurance subsidies and a similar outlay for a massive Medicaid expansion. The truth is that Medicaid—a program costing $500 billion a year that rises to $890 billion in 2024—funnels low-income families into substandard coverage. Instead of providing a pathway to excellent health care for poor Americans, ObamaCare’s Medicaid expansion doubles down on their second-class health-care status.
Already 55% of doctors in major metropolitan areas refuse new Medicaid patients, according to the 2014 Merritt Hawkins annual survey. Even of those providers signed up with Medicaid, 56% of primary-care doctors and 43% of specialists are not available to new patients. Moreover, numerous studies have found that the quality of medical care is inferior under Medicaid, compared with private insurance. Lower quality means more in-hospital deaths, more complications from surgery, shorter survival after treatment, and longer hospital stays than similar patients with private insurance.
.
Legislation signed by President Bill Clinton in 1996 transformed the federal welfare program into a pathway to self-sufficiency. In the same way, Medicaid should be redesigned as a bridge toward affordable private insurance. First, the new Medicaid should include a private-insurance option with catastrophic coverage but few coverage mandates for all enrollees.Second, new Medicaid should establish and put initial funds into health savings accounts using part of the current federal dollars already going into Medicaid. This will empower beneficiaries and give them incentives to follow healthy lifestyles to protect those new assets. With these reforms, doctors and hospitals would receive payments from the same insurance as from non-Medicaid patients. Because health providers receive the same payments whether they treat Medicaid or non-Medicaid patients, the limited access and substandard treatment options under Medicaid would be eliminated.
To ensure availability of the same coverage to both Medicaid and non-Medicaid beneficiaries, federal funding would go only to eligible people in states that offer these same coverage choices to the entire state population. Federal money will be contingent on states meeting thresholds for the number of Medicaid enrollees moved into private coverage. Federal funds would go directly into beneficiary HSAs or to premium payments, rather than into state bureaucracies. States should want this new program because it will reduce the administrative costs of running a separate insurance program and, most important, provide access to quality health care for their residents.
Ultimately, traditional Medicaid would be eliminated as new enrollees move into private coverage. These reforms would change the purpose and culture of Medicaid agency offices from running government-administered plans to establishing HSAs and finding private insurance for beneficiaries.
Why focus on lower-cost, high-deductible health insurance coupled with HSAs? Published studies have shown that pairing HSAs with high-deductible coverage reduces health-care costs. Patient spending averages 15% lower in high-deductible plans, with even more savings when paired with HSAs—without any consequent increases in emergency visits or hospitalizations and without a harmful impact on low-income families. Secondarily, wellness programs that HSA holders more commonly use improve chronic illnesses, reduce health claims and save money.
Continued in article
Stanford University: Long-term care can
be ruinously expensive, and the odds of needing it are high. So why don’t
seniors buy insurance to cover it? ---
https://www.gsb.stanford.edu/insights/whats-behind-americas-elder-care-crisis?utm_source=Stanford+Business&utm_campaign=62b269bea9-Stanford-Business-Impact-Issue-101-11-27-2016&utm_medium=email&utm_term=0_0b5214e34b-62b269bea9-70265733&ct=t(Stanford-Business-Impact-Issue-101-11-27-2016)
Christopher Tonetti is an assistant professor of economics at Stanford Graduate School of Business. His coauthors on the papers “Long-Term Care Utility and Late-in-Life Saving” and “Late-in-Life Risks and the Under-Insurance Puzzle” are John Ameriks, Vanguard; Joseph Briggs, New York University; Andrew Caplin, New York University & NBER; and Matthew D. Shapiro, University of Michigan & NBER.. . .
What’s Wrong Today
The flaws in existing long term care insurance policies are many. One common gripe is that premiums are too high relative to benefits. But Tonetti’s model shows that demand for long-term care insurance isn’t very sensitive to price — increasing premiums by 30% over the actuarially fair price had little effect on purchases.
The bigger deterrent, surely, is that the policies one can buy today don’t actually eliminate risk. “Those earlier studies basically assumed we all have access to a state-contingent asset and choose not to buy it,” Tonetti says. “But these aren’t state-contingent assets at all. They work on a reimbursement model. You pay for the care yourself and then hope to get your money back.”
Stories abound of insurance companies denying claims or dragging out the process. “It can get adversarial,” Tonetti says, “and you might be in no shape to fight back or might be dying and have a short horizon.”
Short stays in a facility, the most common case, are not covered because of deductibles. Long stays, often needed for patients with cognitive decline — the most expensive case — are not covered because benefits end after one to five years. Within those bounds, there are limits on the services paid for and where they can be delivered. And, oh, your premiums might be raised at any time; fail to pay and you lose your coverage.
Future Potential
Tonetti says those flaws don’t entirely explain the under-insurance puzzle. When the better policy was explained to test subjects, not all those predicted to want it said they’d actually buy it. But that gap arose mainly among the wealthiest individuals, who can rely on their own resources.
For the majority of elderly Americans, the introduction of an improved form of long-term care insurance would offer a tremendous increase in quality of life, not to mention peace of mind. And by lightening the load on Medicaid, it would be a relief for state and federal finances as well.
That’s not to say it would be easy. These papers don’t analyze why the market appears to be failing, but fears of “adverse selection” are likely a factor; that’s when coverage is purchased mainly by people who expect to cash in on the benefits, making it unprofitable. But Tonetti and his colleagues have convincingly demonstrated that there’s an unmet demand for long-term care insurance — a big opportunity for any insurer who can figure it out.
Jensen Comment
One thing the article does not mention is a tactic taken by many, many folks
approaching possible long-term care (usually in nursing homes but sometimes at
home). The tactic is to plan ahead and push all the assets to the heirs before
long-term care is needed. Then the heirs support the old folks until if and when
those "impoverished" old folks now qualify for Medicaid to pay all the long-term
care bills. Their Medicare will not pay for long-term care but their Medicaid
will pay for all long-term care. A friend of mine insists this tactic is
perfectly legal. But if it's legal (I'm not entirely convinced) its certainly
not ethical to shield the savings of older folks from the expenses of their
long-term care.
Younger folks such as severely disabled young adults generally can be turned over to states to pay for their long-term care. This is all perfectly legal. And in my opinion it's ethical since these unfortunates generally do not have their own savings for such purposes. Decades ago parents usually had to pay for the long-term care of their disabled children, and some still do contribute to their long-term care. But this is less and less common.
In other nations like Canada and the United Kingdom long-term care expenses created crises in funding.
Nationalized
healthcare is not all it's cracked up to be
---
http://www.businessinsider.com/nationalized-healthcare-is-not-all-its-cracked-up-to-be-2016-9
. . .
Back home, though, Canadians seem far more critical of the system. If you follow the internal Canadian debate, you’ll hear the word “crisis.” In fact, many Canadian healthcare economists warn that their system is headed for a major collapse. The aging population has continued to stress an already fragile system. This is the same system that many proponents of the Affordable Care Act, or Obamacare, pointed to as a model.
Another model of national health care cited by fans of the ACA is the UK’s National Health Service (NHS). Like the Canadian system, there seems to be one attitude for export and another for domestic consumption. You may recall the odd tribute to the UK’s National Health Service (NHS) in the opening ceremony of the 2012 Olympics. The NHS was portrayed as a sea of Mary Poppins bliss. At home, though, Brits had reason to complain. The UK was rated as having the worst patient care and lowest cancer survival rates in the Western World.
The NHS is in even worse shape now, and complaints are growing louder. According to the committee that represents UK hospitals, the NHS is on the verge of collapse. The former health minister Paul Burstow warned of this outcome two years ago. At the time, increases in the NIH budget were limited to the rate of inflation. But that did not allow for the increased cost of a growing elderly population. The NIH effort to find £30 billion in “efficiency savings” was already putting enormous strains on the system.
When a healthcare system is overloaded, it’s not just the aged who suffer. A Lancashire man operated on himself when he was put on a long waitlist for a surgery that he badly needed. With waitlists growing, the Royal College of Surgeons reports that financially challenged clinical groups are denying services to patients who are obese or smoke. Often, delayed treatment will increase medical costs in the long run.
So it shouldn’t be surprising that the Affordable Care Act, which was inspired by the Canadian and British systems, is in deep trouble. Though I predicted it, it is worrisome when the act’s biggest supporters, including The New York Times, admit the program’s flaws.
The growing aged population is a huge financial burden
Obamacare doesn’t deal with the real source of rising healthcare costs: the increase in age-related diseases due to a growing elderly population. It is mathematically impossible to cut societal medical costs while at the same time providing adequate healthcare to a growing and increasingly expensive older population.
This is not just a problem with health care. Social Security and pension funds are running deficits, which will also worsen. Alan Greenspan, former chairman of the Federal Reserve, recently said that he has lost the optimism that he has long been known for. The reason is that “we have a 9 percent annual rate of increase in entitlements, which is mandated by law. It has got nothing to do with the economy. It has got to do with age and health and the like.”
Greenspan points out that politicians refuse to deal with the “third rail” of entitlements. I agree, but I think there’s a solution. Politicians claim that voters won’t accept delayed retirement. But the evidence shows that most people would like to work longer and save more to pay their own way. Zoya Financial reports that almost two thirds of Americans have to retire earlier than planned, largely due to problems with their own health or a spouse’s.
Anti-aging biotechnologies are in labs right now that could lengthen health spans and working careers. This would allow us to save our entitlement systems. But economists and politicians still have no clue about the biotechnological progress that has marked the start of the 21st century. This will change because it must… but I hope it happens soon
50% of health and social-care funding is spent on 4%
of people . . . About 25% of all hospital inpatient spending during a person’s
lifetime occurs in the final three months.
"The (British) National Health Care Service is a Mess,"
The
Economist, September 10, 2016, pp. 48-49 ---
http://www.economist.com/news/britain/21706563-nhs-mess-reformers-believe-new-models-health-care-many-pioneered
. . .
Like health-care systems around the world, the National Health Service (NHS) is struggling to provide good care at low cost for patients such as Mrs Evans (not her real name). Its business model has not kept up with the changing burden of disease. For as more people enter and live longer in their dotage, demand increases for two costly types of care. The first is looking after the dying. About 25% of all hospital inpatient spending during a person’s lifetime occurs in the final three months. The second is caring for those with more than one chronic condition. About 70% of NHS spending goes on long-term illnesses. More than half of over-70s have at least two and a quarter have at least three. In south Somerset 50% of health and social-care funding is spent on 4% of people.
. . .
If one fallacy about the NHS is that it is the envy of the world, as its devotees claim, another is that it is a single organisation. In fact it is a series of interlocking systems. Public health, hospitals, general practitioners (or GPs, the family doctors who provide basic care outside hospitals) and mental-health services all have separate funding and incentives. Social care, which includes old-folks’ homes and the like, is run by local councils, not the NHS
. . .
So the NHS must do more with what it already spends. A sign of inefficiency is the 6,000 patients in English hospitals who are ready to go home but not yet discharged, up from 4,000 in 2013. They cost the service hundreds of millions of pounds per year and obstruct others from treatment. The bed-blockers themselves are harmed, too. Elderly patients lose up to 5% of muscle strength for every day they are laid up in hospital. Some delays are the result of council cuts: about 400,000 fewer old people receive social care than in 2010, meaning that hospitals are sometimes used as expensive alternatives to care homes. But most are due to how hospitals are run.
. . .
On average, the framework made GPs some of the highest-paid family doctors in the world when it was introduced in 2004. But since then it has become less generous. GPs’ real-terms income has fallen by one-fifth. This, and poor planning, has led to a shortage of them. England needs 5,000 more in the next five years. The NHS is mulling a deal with Apollo, whereby the Indian health-care firm supplies enough doctors to fill the gap.
. . .
The move from “volume to value”—that is, from paying providers for the procedures they carry out to paying them for the outcomes they achieve—has helped to stem the cost of Medicare, the American health system for pensioners. The expansion of ACOs as part of Obamacare led to reduced mortality rates and savings for providers of about 1-2%. But Dan Northam Jones, a visiting fellow at Harvard, warns that the potential for savings is greater in systems like Medicare, where there is no cap on spending.
And yet ACOs reflect a growing belief that if you want radically to improve health care you have to change how you pay for it. They will not solve all the problems of the NHS, some of which are inherent in its taxpayer-funded model. But perhaps its business model may yet catch up with how illness is changing. The NHS should forget being the envy of the world, and instead learn from it.
On November 22, 2009 CBS Sixty Minutes aired a video featuring experts
(including physicians) explaining how the single largest drain on the Medicare
insurance fund is keeping dying people hopelessly alive who could otherwise be
allowed to die quicker and painlessly without artificially prolonging life on
ICU machines.
"The Cost of Dying," CBS Sixty Minutes Video, November 22, 2009
---
"Germany Is Exporting Its Grandmas (to Poland)," by Naomi, Kresge,
Bloomberg Business Week, September 26, 2013 ---
http://www.businessweek.com/articles/2013-09-26/germany-exports-its-seniors-to-nursing-homes-abroad
"Government Medicine vs. the Elderly: In Britain in 2007-08, 16.5% of
deaths came after 'terminal sedation," by Rupert Darwall,
The Wall Street
Journal, September 14, 2009 ---
http://online.wsj.com/article/SB10001424052970203917304574412680569936844.html?mod=djemEditorialPage
Rarely has the Atlantic seemed as wide as when America's health-care debate provoked a near unanimous response from British politicians boasting of the superiority of their country's National Health Service. Prime Minister Gordon Brown used Twitter to tell the world that the NHS can mean the difference between life and death. His wife added, "we love the NHS." Opposition leader David Cameron tweeted back that his plans to outspend Labour showed the Conservatives were more committed to the NHS than Labour.
This outbreak of NHS jingoism was brought to an abrupt halt by the Patients Association, an independent charity. In a report, the association presented a catalogue of end-of-life cases that demonstrated, in its words, "a consistent pattern of shocking standards of care." It provided details of what it described as "appalling treatment," which could be found across the NHS.
A few days later, a group of senior doctors and health-care experts wrote to a national newspaper expressing their concern about the Liverpool Care Pathway, a palliative program being rolled out across the NHS involving the withdrawal of fluids and nourishment for patients thought to be dying. Noting that in 2007-08, 16.5% of deaths in the U.K. came after "terminal sedation," their letter concluded with the chilling observation that experienced doctors know that sometimes "when all but essential drugs are stopped, 'dying' patients get better" if they are allowed to.
The usual justification for socialized health care is to provide access to quality health care for the poor and disadvantaged. But this function can be more efficiently performed through the benefits system and the payment of refundable tax credits.
The real justification for socialized medicine is left unstated: Because health-care resources are assumed to be fixed, those resources should be prioritized for those who can benefit most from medical treatment. Thus the NHS acts as Britain's national triage service, deciding who is most likely to respond best to treatment and allocating health care accordingly.
It should therefore come as no surprise that the NHS is institutionally ageist. The elderly have fewer years left to them; why then should they get health-care resources that would benefit a younger person more? An analysis by a senior U.K.-based health-care expert earlier this decade found that in the U.S. health-care spending per capita goes up steeply for the elderly, while the U.K. didn't show the same pattern. The U.K.'s pattern of health-care spending by age had more in common with the former Soviet bloc.
A scarcity assumption similar to the British mentality underlies President Barack Obama's proposed health-care overhaul. "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it," Mr. Obama claimed in his address to Congress last Wednesday, a situation that, he said, threatened America's economic competitiveness.
This assertion is seldom challenged. Yet what makes health care different from spending on, say, information technology—or any category of consumer service—such that spending on health care is uniquely bad for the American economy? Distortions like malpractice suits that lead to higher costs or the absence of consumer price consciousness do result in a misallocation of resources. That should be an argument for tackling those distortions. But if high health-care spending otherwise reflects the preferences of millions of consumers, why the fuss?
The case for ObamaCare, as with the NHS, rests on what might be termed the "lump of health care" fallacy. But in a market-based system triggering one person's contractual rights to health care does not invalidate someone else's health policy. Instead, increased demand for health care incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into a reality.
According to the 2002 Wanless report, used by Tony Blair's government to justify a large tax hike to fund the higher spending, the NHS is late to adopt and slow to diffuse new technology. Still, NHS spending more than doubled to £103 billion in 2009-10 from £40 billion in 1999-2000, equivalent to an average growth rate of over 7% a year after inflation.
In 1965, economist (and future Nobel laureate) James Buchanan observed of the 17-year old NHS that "hospital facilities are overcrowded, and long delays in securing treatment, save for strictly emergency cases, are universally noted." Forty-four years later, matters are little improved. The Wanless report found that of the five countries it looked at, the U.S. was the only one to be both an early adopter and rapid diffuser of new medical techniques. It is the world's principal engine driving medical advance. If the U.S. gets health-care reform wrong, the rest of the world will suffer too.
Mr. Darwall, a London-based strategist, is currently writing a book on the history of global warming, to be published by Quartet Books in Spring 2010.
Jensen Plea
If and when I become gaga please
sedate me to the max (meaning euthanize me)! I fear my wife, who is quite
religious, will not allow that to happen.
Obamacare Fraud is Rampant
Obama Administration Breaks Law to Enrich Health Insurers ---
by Betsy McCaughey
Creaters, February 24. 2016
https://www.creators.com/read/betsy-mccaughey/02/16/obama-administration-breaks-law-to-enrich-health-insurers
The Obama administration will tell any lie and break any law to prevent the president's signature health program from collapsing. Insurance companies, such as UnitedHealthcare and Aetna, are losing billions trying to sell Obamacare plans, and the risk is they'll drop out at the end of 2016. No insurance companies means no Obamacare. In 2014, the White House tried to avert that disaster by promising insurers a bailout funded with taxpayer dollars, but public outrage and quick action by Senator Marco Rubio put a stop to it. Now the administration is at it again.
Desperate to keep insurers on board, the administration scrambled to find another source of money. Unfortunately, a big part of that money pot belongs to the public. Disregarding that fact, the administration announced on Feb. 12 that the money will be handed out to insurers — a whopping $7.7 billion this year alone. That huge handout to the insurance industry violates the law.
This is money you and everyone else who already has insurance is forced to pay, called a reinsurance fee. You pay the fee whether you buy your own plan or get covered at work, even if your employer self-insures. You may be clueless about it, but the fee is buried in your premium or taken out of your compensation.
The language of section 1341 of the Affordable Care Act, which details what this money can be used for, is clear as a bell. Some of these annual fees — adding up to billions a year — belong to the public, not the insurance companies. The law states a fixed share "shall be deposited into the general fund of the Treasury of the United States and may not be used" to offset insurance companies' losses. But the administration gave all of it to the insurance companies last year, and got away with that heist. So they're trying it again.
Anyone in the corporate world who misused funds that way would be headed to prison. This rogue administration is going to any length — including running afoul of the law — to keep insurers hooked into Obamacare.
In the words of University of Houston law professor Seth Chandler, who tried to call attention to the crime several months ago, this is an illegal "diversion of funds to enrich insurers." Last year alone, Cross Blue Shield of Texas got $549 million of these reinsurance funds, while Anthem Blue Cross of California got $401 million.
How did this fly under the radar last year? Because no one — especially members of Congress — has read the law. Insurance companies weren't about to object to getting more money than the law allows. Plus, the announcements of these payments were buried in mind-numbing federal agency releases. The latest such disclosure came late on the Friday of a holiday weekend. The business press reported the announcement but didn't go back to read section 1341 of the law and find that the payouts are illegal.
Last week, a few health scholars took notice, including Doug Badger, senior fellow at the Galen Institute. He says the illegal maneuver is "designed to keep a sinking ship from hitting rock bottom."
Congress should step in immediately and exercise its oversight duties to stop this looting. The next payments to insurers are promised for March. No time to waste.
Obamacare was sold on lies: You can keep your health plan if you like it. And you can keep your doctor if you like your doctor. Then, once it was passed, the administration resorted to a long string of lawless executive actions to keep an unworkable scheme going, despite the damage being done to employers, doctors and consumers.
The administration's diversion of public funds to its insurance company cronies is just the latest defiance of the law. The president has illegally delayed the employer mandate repeatedly. He's handing out free Obamacare plans to illegal immigrants. Statutory deadlines are routinely ignored, and funds are slyly shifted from one program to another — the law be damned.
Another Obama
Lie Revealed
Revealed in Hillary Clinton's Long Delayed Email Release
"Hillary’s Dirty Little ObamaCare Secret: The White House was telling
her the opposite of what Obama said," by Gerald Herbert, The Wall Street
Journal, March 1, 2016 ---
http://www.wsj.com/articles/hillarys-dirty-little-obamacare-secret-1456877391?mod=djemMER
The State Department released the last batch of Hillary Clinton’s emails on Monday, and the exercise has been instructive about her recklessness with classified material. But as a side note, we ought to memorialize what President Obama’s aides were telling Mrs. Clinton about the Affordable Care Act, which was the opposite of what their boss was telling the public.
Despite her duties as top diplomat, Mrs. Clinton found time to follow ObamaCare’s progress in Congress, and she received regular updates from Neera Tanden, then a White House health staffer. Ms. Tanden is now president of the liberal Center for American Progress, Mrs. Clinton’s economic policy shop.
In an Oct. 19, 2009 email, Mrs. Clinton asked Ms. Tanden, “Are you worried about the lack of cost controls in the current bills?” Ms. Tanden replied that “the dirty little secret is that we don’t have a lot of good evidence on what works—in a way that Congress has any appetite to do. I mean, cost controls, as we all know, is [sic] attacked as rationing. So everyone likes to discuss this, including the Administration, but then on the other hand, says they won’t touch the benefits. Now there is a lot of fat in the system, but some of that excess is just too much care. Yet no one really wants care to be restricted.”
Not a month earlier, the President had promised Congress that the bill would save “hundreds of billions of dollars,” according to “Democratic and Republican experts.” In March 2010 he said that “we have now incorporated almost every single serious idea from across the political spectrum about how to contain the rising cost of health care.”
Ms. Tanden was telling Mrs. Clinton that the truth was closer to the reverse. She wrote that “the other problem” is that the de minimis cost-control problems that ObamaCare did include “need some time to incubate because we don’t have all the evidence we need. . . . We may have oversold what these bills will (or even can) do.” Critics at the time, including us, argued that White House claims about cost control were always a bill of goods. But we’d be curious to hear what ObamaCare architects like Peter Orszag think of Ms. Tanden’s private candor, or the credulous columnists they duped.
By the way, the Clinton-Tanden correspondence is heavily redacted for some reason, and its release was delayed almost a year for interagency review—though emails about health care shouldn’t compromise national security. Perhaps they also shared a between-us laugh about the other health-care deceptions the White House was getting away with.
Inspector General's report warns that billions in federal loans might not be
repaid.
"Obamacare’s Government-Backed Nonprofit Health Plans Are a Disaster—and
Could Cost Taxpayers Billions," by Peter Suderman, Reason Magazine,
July 31, 2015 ---
http://reason.com/blog/2015/07/31/obamacares-government-backed-nonprofit-h
The federal government shelled out $2.4 billion in loans to a series of non-profit health plans under Obamacare, but now they’re struggling to stay alive.
The plans, dubbed CO-OPs (Consumer Operated and Oriented Plans) were intended to increase competition in the insurance market and serve as a check on private insurers by providing an alternative that wasn’t focused on profit. They were a compromise measure intended to satisfy liberals who wanted the law to set up a fully government-run health insurance option.
As it turns out, Obamacare’s CO-OPs weren’t focused on profit—or, it seems, financial viability of any kind.
The CO-OPs have struggled to meet enrollment targets, with 13 of the 23 non-profit plans showing “considerably lower” enrollment than projected, according to a report by the Health and Human Services Inspector General. Finances were shaky all around with 21 of 23 plans incurring losses through the end of 2014, the report says.
This isn’t just a problem for the CO-OPs. It’s a problem for the taxpayers. The $2.4 billion in loans given to these startup plans were supposed to be repaid to the government with interest. Loans given to start the plans were supposed to be repaid in five years; “solvency” loans were supposed to be repaid in 15 years.
Continued in article
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
'The Unaffordable Care Act: Premiums are spiking around the country.
Obama is in denial," The Wall Street Journal, July 10, 2015 ---
http://www.wsj.com/articles/the-unaffordable-care-act-1436569086?tesla=y
The Affordable Care Act was supposed to make insurance, well, more affordable. But now hard results are starting to emerge: premium surges that often average 10% to 20% and spikes that sometimes run as high as 50% or 60% or more from coast to coast. Welcome to the new abnormal of ObamaCare.
This summer insurers must submit rates to state regulators for approval on the ObamaCare exchanges in 2016—and even liberals are shocked at the double-digit requests, or at least the honest liberals are. Under ObamaCare, year-over-year premium increases above 10% must also be justified to the Health and Human Services Department, and its data base lists about 650 such cases so far.
In a study across 45 states, the research outfit Health Pocket reports that mid-level Exclusive Provider Organization plans are 20% more expensive in 2016 on average. HMOs are 19% more expensive, and for all plan types the average is 14%.
President Obama dropped by Nashville last week to claim Tennessee as a state where “the law has worked better than we expected” and “actually ended up costing less than people expected,” so let’s test the reality of those claims. As a baseline, in 2015 premium increases for Tennessee plans ranged from 7.5% to 19.1%.
For 2016 BlueCross BlueShield of Tennessee—one of the state’s two major insurers—is requesting a 36.3% increase. One product line from Community Health Alliance Mutual is rising 32.8%, while another from Time Insurance Co. hits 46.9%. Offerings from Cigna, Humana and UnitedHealthcare range from 11% to 18%. If this means ObamaCare is working better than the President expected, then what, exactly, was he expecting?
Continued in article
Obama's Whoppers on the ACA ---
Click Here
http://townhall.com/columnists/donaldlambro/2015/07/08/obamas-whoppers-will-bite-him-in-the-end-and-the-democrats-too-in-2016-n2022375?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=
"Hospitals Expected More of a Boost
From Health Law Expansion of Medicaid hasn’t had the financial impact that was
anticipated," by Christian Weaver, The Wall Street Journal, June 3,
2015 ---
http://www.wsj.com/articles/hospitals-expected-more-of-a-boost-from-health-law-1433304242?KEYWORDS=Hospitals
The health law’s expansion of Medicaid in many states hasn’t benefited nonprofit hospitals in those states as expected, according to a new report by Moody’s Investors Service.
Hospitals in the mostly blue states that expanded Medicaid were largely expected to benefit from fewer unpaid bills and more paying customers, but that hasn’t generally translated into better operating margins or cash flow, Moody’s found.
Performance improved across the board—including in the mostly Republican-led states that opted out of the law’s Medicaid expansion—as the economy gained steam last year and unemployment declined.
In expansion states, hospitals’ unpaid bills fell 13% on average last year compared with 2013, the report found. But, their 2014 operating margins didn’t increase any more than hospitals in the 22 states that have sat out the expansion, the report shows.
“Clearly, reducing bad debt is positive, but it is not this silver bullet,” said Daniel Steingart, a Moody’s analyst and author of the report. He said the findings call into question “a narrative out there that Medicaid expansion has lowered bad debt and that is driving [financial] improvements at hospitals.”
Continued in article
Jensen Comment
When I lived in San Antonio, over $1,000 of my property tax billing went to the
Bexar County Hospital to cover charity medicine and bad debts of people who were
treated but did not pay for the treatments. As a rule there's at least one
hospital in larger cities, usually the largest non-profit hospital, that
receives local tax dollars to contribute toward the hospital's bad debts.
Obamacare's promise of relieving the burden of local taxpayers for charity medicine turned into another one of the lies. Indeed there are fewer bad debts due to expanded Medicaid coverage such that more Federal dollars are pouring into hospitals who accept Medicaid patients. However, the bad news is that Medicaid only covers (according to the article) about half the cost of treating Medicaid patients in hospitals. This leaves hospitals with tow choices. Provide lower-cost care or ask for more dollars from local taxpayers to cover the added losses of the expanded Medicaid coverage.
It turns out that states who refused to expand Medicaid coverage are better off for having refused.
MediCal is California's Version of Medicaid free medical services for poor people. MedicCal also has a price-fixing program that is preventing many doctors and hospitals from providing services to patients insured by MediCal. This is an example of where price fixing either results in either having no goods and services or inferiors goods and service.
"Medi-Cal a waiting game for many
low-income Californians," by Tracy Seipel, San Jose Mercury News, February
7, 2015 ---
http://www.mercurynews.com/health/ci_27481258/obamacare-medi-cal-waiting-game-many-low-income
Julie Moreno felt lucky to be among more than 2.7 million previously uninsured Californians to be added to Medi-Cal, the state's health care program for the poor.
Until she needed cataract surgery.
For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend's mother to have the procedure done elsewhere last February.
One year into the explosive, health law-induced growth of Medi-Cal, it appears one of the most alarming predictions of critics is coming true: The supply of doctors hasn't kept up with demand. One recent study suggests the number of primary care doctors in California per Medi-Cal patient is woefully below federal guidelines.
"If you're pregnant, you get help," Moreno said. "But if you're 49 and not pregnant, you have to wait for everything."
In fact, seven months after Moreno's surgery, her original surgeon's office called just to say they still couldn't fit her in.
At least 1.2 million Californians have signed up for a private insurance plan since enrollment began in October 2013 under the Affordable Care Act, better known as Obamacare. But it's Medi-Cal that has witnessed the largest growth -- 2.7 million since the controversial law opened the program up to many more recipients in January 2014.
By mid-2016, more than 12.2 million people -- nearly a third of all Californians -- will be on Medi-Cal, state health officials say.
Those officials continue to insist that the current delays to see a doctor and crowded emergency rooms are all part of to-be-expected growing pains. But many experts say the problems are so widespread they shouldn't be ignored.
"California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients," said Dr. Del Morris, president of the California Academy of Family Physicians, which represents many of the first-line doctors who treat Medi-Cal patients. "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"
Morris and other experts say the situation is about to get worse, in part because of Medi-Cal's health care reimbursement rates.
For years, the rates paid by Medi-Cal -- called Medicaid in the rest of the country -- have been among the nation's lowest. A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31. A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.
Even before the latest cuts, Medi-Cal doctors -- particularly specialists -- in California's rural areas often seemed nearly impossible to find. And the shortage of Medi-Cal physicians appears to be causing spikes in the number of Medi-Cal patients being treated in hospital emergency rooms around the state. Data from the Office of Statewide Health Planning and Development show that in the first three quarters of 2014, "treat and release" visits to emergency rooms by Medi-Cal patients jumped 30 percent from the same period the year before.
At least once a week at the MayView Community Health Center in Mountain View, the clinic is so swamped that it is forced to send Medi-Cal patients to hospital emergency rooms "because they cannot go anywhere else," clinic operations director Harsha Mehta said.
Since January 2014, Axis Community Health in Pleasanton has added about 1,700 new Medi-Cal patients to its five facilities that serve the Tri-Valley area, bringing the total to about 14,000. While 700 of those patients were already being treated at Axis before they enrolled in Medi-Cal, the overall jump in new patients is forcing Dr. Divya Raj, Axis' medical director, to hire more hard-to-find doctors.
A recent report by the California HealthCare Foundation that tried to determine if the state has enough doctors to handle the influx of Medi-Cal patients reinforces Raj's trepidation.
The report found the ratio of patients to full-time primary care doctors participating in Medi-Cal -- including family medicine physicians, general internists, pediatricians and ob/gyns -- was 35 to 49 physicians per 100,000 enrollees, well below the federal guidelines of 60 to 80.
"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."
Bait and Switch for Primary Care "Doctors"
Nationwide there was an enormous shortage of primary care doctors before
Obamacare. Obamacare greatly increased the demand for such doctors, thereby,
making the shortage much worse. This has led to nationwide bait and switch
primary care that is similar to three of the medical clinics in Littleton, New
Hampshire. Each clinic has one MD and one or more added "physicians assistants"
who are not medical doctors but can examine patients and prescribe common
medications.
The bait and switch part is that patients in each clinic are not allowed to see the MD at all or must wait much longer for an appointment to see the the MD. In the meantime they are encouraged to be examined by only the physicians assistant or to go to emergency rooms.
Another sad part of the bait and switch tactic is that many specialists such as those at the Dartmouth medical center will only see patients referred by an MD or osteopath. Without such referrals patients are not allowed to make appointments with such specialists such as dermatologists, psychiatrists, and surgeons.
One other clinic up here has a really lousy and uncaring foreign-trained MD and an osteopath. My primary care doctor is the osteopath. He seems pretty good to me, but then my medical needs are fairly simple and routine. Our Littleton Regional Hospital does have an outstanding emergency room, although it's not a trauma center and has to send a relatively large number of patients by helicopter to the Dartmouth medical center about 50 miles away.
Of course patients with serious problems have discovered how to get referrals. The go directly to emergency rooms and maybe wait the better part of a day to be examined. But they eventually leave with a referral to see a specialist provided that specialist will accept their insurance.
The huge problem in New Hampshire is that nearly half (slightly less this year) of the hospitals and specialists will not accept ACA insurance.
"How Obamacare Is Ruining Health Insurance," by John C. Goodman,
Forbes, February 11, 2015 ---
http://www.forbes.com/sites/johngoodman/2015/02/11/how-obamacare-is-ruining-health-insurance/
The health insurance market is changing. And the changes are not good. Even before there was Obamacare, most insurers most of the time had perverse incentives to attract the healthy and avoid the sick. But now that the Affordable Care Act has completely changed the nature of the market, the perverse incentives are worse than ever.
Writing in Sunday’s New York Times Elizabeth Rosenthal gives these examples:
- When Karen Pineman of Manhattan sought treatment for a broken ankle, her insurer told her that the nearest in-network doctor was in Stamford, Connecticut – in another state.
- Alison Chavez, a California breast cancer patient, was almost on the operating table when her surgery had to be cancelled because several of her doctors were leaving the insurer’s network.
- When the son of Alexis Gersten, a dentist in East Quogue New York, needed an ear, nose and throat specialist, the insurer told her the nearest one was in Albany – five hours away.
- When Andrea Greenberg, a New York lawyer, called an insurance company hotline with questions she found herself speaking to someone reading off a script in the Philippines.
- Aviva Starkman Williams, a California computer engineer, tried to determine whether the pediatrician doing her son’s 2-year-old checkup was in-network, the practice’s office manager “said he didn’t know because doctors came in and out of network all the time, likening the situation to players’ switching teams in the National Basketball Association.”
But aren’t these insurers worried that if they mistreat their customers, their enrollees will move to some other plan? Here’s the rarely told secret about health insurance in the Obamacare exchanges: insurers don’t care if heavy users of medical care go to some other plan. Getting rid of high-cost enrollees is actually good for the bottom line.
To appreciate how different health insurance has become, let’s compare it to the kind of casualty insurance people buy for their home or their cars.
Dennis Haysbert is the actor I remember best for playing the president of the United States in the Jack Bauer series, 24. You probably know him better as the spokesman for Allstate. In one commercial he is standing in front of a town that looks like it has been demolished by a tornado. “It took only two minutes for this town to be destroyed,” he says. And he ends by asking “Are you in good hands?”
The point of the commercial is self-evident. Casualty insurers know you don’t care about insurance until something bad happens. And the way they are pitching their products is: Once the bad thing happens, we are going to take care of you.
Virtually all casualty insurance advertisements carry this message, explicitly or implicitly. Nationwide used to run a commercial in which all kinds of catastrophes were caused by a Dennis-the-Menace type kid. In a State Farm ad, a baseball comes crashing through a living room window. Nationwide’s “Life comes at you fast” series features all kinds of misadventures. And of course, the Aflac commercials are all about unexpected mishaps.
The Case Against Obamacare: An eBook From Forbes
Don’t be fooled. The new health law has disrupted coverage for millions, and driven up costs for millions more.My favorite casualty insurer print ad is sponsored by Chubb. It features a man fishing in a small boat with his back turned to a catastrophe. He is about to go over what looks like Niagara Falls. Here’s the cutline: “Who insures you doesn’t matter. Until it does.”
Now let’s compare those messages to what we see in the health insurance exchange. Federal employees have been obtaining insurance in an exchange, similar to the Obamacare exchanges, for several decades. Every fall, during “open enrollment,” they select from among a dozen or so competing heath plans. In Washington, DC where the market is huge, insurers try to attract customers by running commercials on TV, in print and in other venues.
Continued in article
From the CFO Journal's Morning Ledger on December 9, 2014
Workers to bear burden of ACA cost increases ---
http://blogs.wsj.com/cfo/2014/12/08/workers-to-bear-burden-of-aca-cost-increases/?mod=djemCFO_h
Workers in the U.S. should expect health care to take a bigger bite out of their paychecks next year, CFO Journal’s Vipal Monga reports. According to Bank of America Merrill Lynch, finance chiefs at U.S. companies expect the Affordable Care Act to increase healthcare costs next year, and the majority expect to pass that along to their employees.
Jensen Comment
There were only supposed to be savings for workers under the ACA. What went
wrong?
"ObamaCare by the Numbers: Part 2," by John Cassidy, The New Yorker,
March 2010 ---
http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html
. . .
Does Santa Claus live after all? According to the C.B.O., between now and 2019 the net cost of insuring new enrollees in Medicaid and private insurance plans will be $788 billion, but other provisions in the legislation will generate revenues and cost savings of $933 billion. Subtract the first figure from the second and—voila!—you get $143 billion in deficit reduction.
The first objection to these figures is that the great bulk of the cost savings—more than $450 billion—comes from cuts in Medicare payments to doctors and other health-care providers. If you are vaguely familiar with Washington politics and the letters A.A.R.P. you might suspect that at least some of these cuts will fail to materialize. Unlike some hardened skeptics, I don’t think none of them will happen. One part of the reform involves reducing excessive payments that the Bush Administration agreed to when it set up the Medicare Advantage program in 2003. If Congress remains under Democratic control—a big if, admittedly—it will probably enact these changes. But that still leaves another $300 billion of Medicare savings to be found.
The second problem is accounting gimmickry. Acting in accordance with standard Washington practices, the C.B.O. counts as revenues more than $50 million in Social Security taxes and $70 billion in payments towards a new home-care program, which will eventually prove very costly, and it doesn’t count some $50 billion in discretionary spending. After excluding these pieces of trickery and the questionable Medicare cuts, Douglas Holtz-Eakin, a former head of the C.B.O., has calculated that the reform will actually raise the deficit by $562 billion in the first ten years. “The budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed,” he wrote in the Times. “So fantasy in, fantasy out.”
Holtz-Eakin advised John McCain in 2008, and he has a reputation as a straight shooter. I think the problems with the C.B.O.’s projections go even further than he suggests. If Holtz-Eakin’s figures turned out to be spot on, and over the next ten years health-care reform reduced the number of uninsured by thirty million at an annual cost of $56 billion, I would still regard it as a great success. In a $15 trillion economy—and, barring another recession, the U.S. economy should be that large in 2014—fifty or sixty billion dollars is a relatively small sum—about four tenths of one per cent of G.D.P., or about eight per cent of the 2011 Pentagon budget.
My two big worries about the reform are that it won’t capture nearly as many uninsured people as the official projections suggest, and that many businesses, once they realize the size of the handouts being offered for individual coverage, will wind down their group plans, shifting workers (and costs) onto the new government-subsidized plans. The legislation includes features designed to prevent both these things from happening, but I don’t think they will be effective.
Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.
Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)
If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”
So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.
The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.
Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)
In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead.
Even if the government tried to impose additional sanctions on such firms, I doubt it would work. The dollar sums involved are so large that firms would try to game the system, by, for example, shutting down, reincorporating under a different name, and hiring back their employees without coverage. They might not even need to go to such lengths. Firms that pay modest wages have high rates of turnover. By simply refusing to offer coverage to new employees, they could pretty quickly convert most of their employees into non-covered workers.
The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it. According to the C.B.O., somewhere between eight and nine million workers will lose their group coverage as a result of their employers refusing to offer it. That isn’t a trifling number. But the C.B.O. says it will be largely offset by an opposite effect in which employers that don’t currently provide health insurance begin to offer it in response to higher demand from their workers as a result of the individual mandate. In this way, some six to seven million people will obtain new group coverage, the C.B.O. says, so the overall impact of the changes will be minor.
Continued in article
"Senate Bill Sets a Plan to Regulate Premiums," by Robert Pear, The New York Times, April 20, 2010 --- http://www.nytimes.com/2010/04/21/health/policy/21healt
. . .
Grace-Marie Turner, president of the Galen Institute, a research center that advocates free-market health policies, said the Democrats’ proposal was unlikely to succeed in lowering insurance costs.
“Capping premiums without recognizing the forces that are driving up costs would be like tightening the lid on a pressure cooker while the heat is being turned up,” Mrs. Turner said.
Mrs. Feinstein said her bill would close what she described as “an enormous loophole” in the new law. And she said health insurance should be regulated like a public utility.
“Water and power are essential for life,” Mrs. Feinstein said. “So they are heavily regulated, and rate increases must be approved. Health insurance is also vital for life. It too should be strictly regulated so that people can afford this basic need.”
The 6 Biggest Whoppers In Gruber's ObamaCare Comic Book ---
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm
. . .
What the reviewers failed to mention is that the book is also chock-a-block with misinformation and outright falsehoods about the law Gruber helped construct — many of which Gruber himself exposed later on. Among the most glaring:
• Gruber claims that for individuals and small firms qualifying for a tax credit, "this bill will lower your health care costs." But Gruber would later go on to tell several states the opposite. One of them was Wisconsin, where he said fewer than 6% would see lower premiums, and 41% would get hit with hikes of 50% or more. Meanwhile, millions learned that Gruber's claim was a fantasy last year, when they confronted ObamaCare's sky-high premiums after seeing their existing plans canceled.
• Gruber declares that the law doesn't raise taxes on anyone "with incomes below $200,000 per year." Yet several of the dozens of tax hikes stuffed into the bill hit the middle class, or soon will. Americans for Tax Reform counted seven big ones.
• In the section on the Cadillac tax, which depicts Gruber tooling around in a Caddy, he claims this tax would apply "only to the top few percent of health insurance plans" and would hit more only if premiums climb faster than inflation.
But in videotaped comments, Gruber explains that the tax was purposely designed to start small and then eventually hit all employer plans, "essentially getting rid of the exclusion for employer-sponsored plans."
• Gruber emphatically declares that ObamaCare will cut the federal deficit by $1 trillion over its second decade because "the deficit-reducing effects of this legislation grow over time."
But all the Congressional Budget Office said was that a "rough outlook" for ObamaCare's second decade resulted in deficit cuts "in a broad range of around one-half percent of GDP." And that assumed the law was enacted exactly as written, and worked exactly as predicted, both of which have already failed to come true.
When the Government Accountability Office ran the numbers using more realistic scenarios, it found ObamaCare adding significantly to the long-term deficit. The CBO, meanwhile, has given up making even short-term forecasts of ObamaCare's impact on the deficit.
• Throughout the book, Gruber cites CBO projections of ObamaCare's effects on premiums and coverage, calling it "the best independent source for evaluating bills like the ACA." What he doesn't mention is that when the CBO developed its health care forecasting model in 2007, Gruber had a role in creating it. It even credits Gruber for his "helpful comments and feedback ... throughout the model's development."
And in a 2011 paper, Gruber himself said that his own health care model "mirrors the CBO approach to modeling health reform."
• Gruber says that if the law's many cost-control measures work as expected, "the ACA will end up solving our cost problem in the U.S." But earlier this year Gruber told the Washington Post that it was "misleading" to say ObamaCare will save money. "The law isn't designed to save money," he said. "It's designed to improve health, and that's going to cost money."
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
"Supreme Court Battle Brewing Over
Medicaid Fees," by Phil Galewitz, WebMD, January 12, 2015 ---
http://www.webmd.com/health-insurance/20150112/supreme-court-battle-brewing-over-medicaid-fees
Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection.
But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, she was finally able to get Nathaniel an appointment nearly a week later near their South Florida home. That was in 2005.
Last month, ruling in a lawsuit brought by the state’s pediatricians and patient advocacy groups, a federal district judge in Miami determined Nathaniel’s wait was “unreasonable” and that Florida’s Medicaid program was failing him and nearly 2 million other children by not paying enough money to doctors and dentists to ensure the kids have adequate access to care.
The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. In the past two decades, similar cases have been filed in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia– with many resulting in higher pay.
But while providers and patient advocates nationwide hailed the Florida decision, they are deeply worried about a U.S. Supreme Court case that they say could restrict their ability across the country to seek judicial relief from low Medicaid reimbursement rates.
The high court on Jan. 20 will hear a case from Idaho seeking to overturn a 2011 lower court order to increase payments to providers serving Medicaid enrollees with development disabilities. In the original case, five centers serving developmentally disabled adults and children argued that Idaho was unfairly keeping Medicaid reimbursement rates at 2006 levels despite studies showing that the cost of providing care had risen.
Idaho officials argue only the state and federal government should be able to set provider fees in Medicaid and all other “private parties,” including patients and providers, should not be able to use the court system to gain higher rates. Twenty-seven states and the Obama administration are supporting Idaho’s appeal, along with the National Governors Association
November 2014
The 6 Biggest Whoppers In Gruber's ObamaCare Comic Book ---
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm
. . .
What the reviewers failed to mention is that the book is also chock-a-block with misinformation and outright falsehoods about the law Gruber helped construct — many of which Gruber himself exposed later on. Among the most glaring:
• Gruber claims that for individuals and small firms qualifying for a tax credit, "this bill will lower your health care costs." But Gruber would later go on to tell several states the opposite. One of them was Wisconsin, where he said fewer than 6% would see lower premiums, and 41% would get hit with hikes of 50% or more. Meanwhile, millions learned that Gruber's claim was a fantasy last year, when they confronted ObamaCare's sky-high premiums after seeing their existing plans canceled.
• Gruber declares that the law doesn't raise taxes on anyone "with incomes below $200,000 per year." Yet several of the dozens of tax hikes stuffed into the bill hit the middle class, or soon will. Americans for Tax Reform counted seven big ones.
• In the section on the Cadillac tax, which depicts Gruber tooling around in a Caddy, he claims this tax would apply "only to the top few percent of health insurance plans" and would hit more only if premiums climb faster than inflation.
But in videotaped comments, Gruber explains that the tax was purposely designed to start small and then eventually hit all employer plans, "essentially getting rid of the exclusion for employer-sponsored plans."
• Gruber emphatically declares that ObamaCare will cut the federal deficit by $1 trillion over its second decade because "the deficit-reducing effects of this legislation grow over time."
But all the Congressional Budget Office said was that a "rough outlook" for ObamaCare's second decade resulted in deficit cuts "in a broad range of around one-half percent of GDP." And that assumed the law was enacted exactly as written, and worked exactly as predicted, both of which have already failed to come true.
When the Government Accountability Office ran the numbers using more realistic scenarios, it found ObamaCare adding significantly to the long-term deficit. The CBO, meanwhile, has given up making even short-term forecasts of ObamaCare's impact on the deficit.
• Throughout the book, Gruber cites CBO projections of ObamaCare's effects on premiums and coverage, calling it "the best independent source for evaluating bills like the ACA." What he doesn't mention is that when the CBO developed its health care forecasting model in 2007, Gruber had a role in creating it. It even credits Gruber for his "helpful comments and feedback ... throughout the model's development."
And in a 2011 paper, Gruber himself said that his own health care model "mirrors the CBO approach to modeling health reform."
• Gruber says that if the law's many cost-control measures work as expected, "the ACA will end up solving our cost problem in the U.S." But earlier this year Gruber told the Washington Post that it was "misleading" to say ObamaCare will save money. "The law isn't designed to save money," he said. "It's designed to improve health, and that's going to cost money."
November 13, 2014
Here are three crucial facts about the ACA that both the White House and the
media didn’t want you to know about ---
http://www.foxnews.com/opinion/2014/11/13/3-things-white-house-doesnt-want-to-know-about-obamacare-plus-3-things-coming/?cmpid=NL_opinion
1. HUGE DEFICITS AND NEW TAXES. According to the Congressional Budget Office, the latest projections for the net cost of ObamaCare over the next ten years are just over $1.4 trillion. Whereas President Obama promised in 2009 that it would cost less than $1 trillion over ten years. In order to partially pay for this, ObamaCare has added more than 20 new taxes totaling over $500 billion.2. BUREAUCRACY. Speaking of Orwellian politics, ObamaCare includes 159 new boards and agencies to restrict and govern your health care choices.
3. STILL MORE BUREAUCRACY. Dysfunctional state exchanges with high deductible policies, narrow doctor networks, including federally-run exchanges in 36 states which may not be allowable under the law (SCOTUS currently considering this case).Here are three new things coming up in 2015 that are highely controversial:
1. PENALTIES WILL RISE – INDIVIDUAL MANDATE. In 2014, people are facing a penalty of $95 per person or 1% of income.In 2015, the penalty will more than triple to $325 per person or 2% of income, whichever is higher.
If an American failed to get coverage this year, the penalty will be taken out of their tax refund in early 2015.
2. SERIOUS RATE HIKES FOR CHEAPER OBAMACARE PLANS. According to Investor’s Business Daily, the lowest cost bronze plan will increase an average of 7 % in many cases, the lowest cost silver plan by 9%, and the lowest priced catastrophic policy will climb 18 percent on average. Double digit rate hikes are anticipated in several southern and Midwestern states including Kansas, Iowa, Louisiana, North and South Carolina, Tennessee, Iowa, and Virginia.Subsidies will continue to be a huge part of the program. In 2014, subsidies provided ¾ of the premiums for the federally-run exchanges.
3. EMPLOYER MANDATE WILL TAKE EFFECT. After being delayed for a year, large businesses (100 or more employees in 2015, 50 or more in 2016) will be required to offer affordable (and subsidized) health plans to at least 70 percent of their full time employees or face a $2,000-$3,000 penalty per employee.This mandate will lead to fewer full time employees being hired.
Continued in article
"Audit found ineligible people on
Minnesota's public-health rolls," Brian Lambert, Minneapolis Post,
November 12, 2014 ---
http://www.minnpost.com/glean/2014/11/audit-found-ineligible-people-states-public-health-rolls
The AP story says, “Minnesota's legislative auditor says the state Department of Human Services has failed to adequately verify the eligibility of people who enroll in public health care programs through the state's health insurance exchange MNsure. In a report released Wednesday, the Office of the Legislative Auditor says it found many instances where department paid for Medical Assistance and MinnesotaCare benefits for people who weren't eligible because their incomes were too high or didn't qualify for other reasons. It says the department also charged incorrect MinnesotaCare premium rates.”
"Audit reveals half of people enrolled in
Illinois Medicaid program not eligible," by Craig Cheatham, KMOV
Television, November 4, 2013 ---
http://www.kmov.com/news/just-posted/Audit-reveals-half-of-people-enrolled-in-IL-Medicaid-program-not-eligible-230586321.html?utm_content=buffer824ba&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer
"Medicaid Spending Has Exploded, And It Will Keep Rising Faster Than Expected
"Medicaid Spending Has
Exploded, And It Will Keep Rising Faster Than Expected," by John R. Graham,
Daily Caller, November 12. 2014 ---
http://dailycaller.com/2014/11/12/medicaid-spending-has-exploded-and-it-will-keep-rising-faster-than-expected/
According to the Centers for Medicare & Medicaid Services (CMS), spending on Medicaid, the jointly funded state-federal welfare program that provides health benefits to low-income people, increased 6.7 percent in 2013 to $449.5 billion. And it will keep growing at a fast rate.
In 2014, total Medicaid spending is projected to grow 12.8 percent because Obamacare has added about 8 million dependents. A large minority of states have chosen to increase residents’ eligibility for Medicaid by expanding coverage to adults making up to 138 percent of the federal poverty level.
Unfortunately, more states are likely to expand this welfare program. This is expected to result in a massive increase in the number of Medicaid dependents: From 73 million in 2013 to 93 million in 2024. Medicaid spending is expected to grow by 6.7 percent in 2015, and 8.6 percent in 2016. For 2016 to 2023, spending growth is projected to be 6.8 percent per year on average.
This comprises a massive increase in welfare dependency and burden on taxpayers. Further, official estimates often low-ball actual experience. This is because it is hard to grapple with how clever states are at leveraging federal dollars.
The Office of the Inspector General of the U.S. Department of Health & Human Services has just released a report that summarizes a decade of research on how states game the system to increase spending beyond that which the federal government anticipated.
The incentive lies in Medicaid’s perverse financing merry-go-round. In a rich state like California, for example, the federal government (pre-Obamacare) spent 50 cents on the dollar for adult dependents. So, if California spent 50 cents, it automatically drew 50 cents from the U.S. Treasury. And most states had a bigger multiplier. Which state politician can resist a deal like that?
Continued in article
Jonathan Gruber --- http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29#Controversies
. . .
In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.[17][18][19] While he did disclose his HHS connections in an article for the New England Journal of Medicine, his oversight in doing this earlier was defended by Paul Krugman in The New York Times.[20]
One heavily-scrutinized part of the ACA reads that subsidies should be given to healthcare recipients who are enrolled "through an Exchange established by the State". Some have read this to mean that subsidies can be given only in states that have chosen to create their own healthcare exchanges, and do not use the federal exchange, while the Obama administration says that the wording applies to all states. This dispute is currently part of an ongoing series of lawsuits referred to collectively as King v. Burwell. In July 2014, two separate recordings of Gruber, both from January 2012, surfaced in which he seemed to contradict the administration's position.[5] In one, Gruber states, in response to an audience question, that "if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits",[21] while in the other he says, "if your governor doesn't set up an exchange, you're losing hundreds of millions of dollars of tax credits to be delivered to your citizens."[22] When these recordings emerged, Gruber called these statements mistaken, describing them as "just a speak-o — you know, like a typo".[21]
In November 2014, a series of four videos emerged of Gruber speaking at different events, from 2010 to 2013, about ways he felt the ACA was misleadingly crafted and marketed to get the bill passed; in several of these videos he specifically refers to American voters as ill-informed and "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage. Gruber said the bill's inherent "lack of transparency is a huge political advantage" in selling it.[23] The comments caused significant controversy.[24][25][26][27][28] In two subsequent videos, Gruber was shown talking about the decision (which he attributed to John Kerry) to have the bill tax insurance companies instead of patients, which he called fundamentally the same thing economically but more palatable politically. In one video, he stated that "the American people are too stupid to understand the difference" between the two approaches, while in the other he said that the switch worked due to "the lack of economic understanding of the American voter."[29] In another video, taken in 2010, Gruber expressed doubts that the ACA would significantly reduce health care costs, though he noted that lowering costs played a major part in the way the bill was promoted.[30]
"Yes, Jonathan Gruber Is An
Obamacare “Architect” The health law’s allies are trying to distance themselves
from the economist’s remarks about the deception involved in passing the law.
But they’re only proving him right," by Peter Suderman, Reason Magazine,
November 18, 2014 ---
http://reason.com/archives/2014/11/18/yes-jonathan-gruber-is-an-obamacare-arch
Jonathan Gruber --- http://en.wikipedia.org/wiki/Jonathan_Gruber_%28economist%29#Controversies
Obamacaregate Question
Who disclosed the embarrassing Johathan Gruber videos?
Vox is a liberal/progressive Website, and
this is a pretty good explanation of the Gruber embarrassment to date.
"The Jon Gruber controversy and what it means for Obamacare, explained,"
by Sarah Kliff, Vox, November 16, 2014 ---
http://www.vox.com/2014/11/13/7211279/obamacare-jon-gruber-controversy
. . .
4) Who keeps finding all these clips?
Rich Weinstein, a forty-something investment advisor whose insurance policy was canceled under Obamacare, has surfaced the last three videos. Dave Weigel has written a great profile of him, including this part where Weinstein describes how he got started:
"When Obama said 'If you like your plan, you can keep your plan, period'-frankly, I believed him," says Weinstein. "He very often speaks with qualifiers. When he said 'period,' there were no qualifiers. You can understand that when I lost my own plan, and the replacement cost twice as much, I wasn't happy."
So Weinstein, new plan in hand, started watching the news. "These people were showing up on the shows, calling themselves architects of the law," he recalls. "I saw David Cutler, Zeke Emanuel, Jonathan Gruber, people like that. I wondered if these guys had some type of paper trail. So I looked into what Dr. Cutler had said and written, and it was generally all about cost control. After I finished with Cutler, I went to Dr. Gruber. I assume I went through every video, every radio interview, every podcast. Every everything."
Continued in article
Jensen Comment
What are the biggest mistakes when the ACA was enacted?
Answer
In my opinion, apart from the technical things that need to be corrected such as
foisting patient bad debts (due to premium payment lapses) on doctors and
hospitals, the biggest mistake was the CBO's estimates of ACA costs, cost
estimates that are largely traceable to Johathan Gruber.
"Pelosi Claims Health Care Reform to Save $1.3 Trillion," by Matt Cover, CNS News,
March 26, 2010 ---
http://www.cnsnews.com/news/article/63373
According to the Congressional Budget Office,
(in 2014)
the latest projections for the net cost of ObamaCare over the next ten years are
just over $1.4 trillion.
http://www.foxnews.com/opinion/2014/11/13/3-things-white-house-doesnt-want-to-know-about-obamacare-plus-3-things-coming/?cmpid=NL_opinion
Jensen Comment
Doesn't that add up to a $2.7 trillion change in estimated costs in four years?
Another embarrassment is how RomneyCare in
Massachussets that preceded the ACA for the USA foisted RomneyCare costs on to
Federal taxpayers. Governor Romney (and Ted Kennedy's legacy) should be
embarrassed along with President Obama about Professor Gruber's revelations. ---
http://hotair.com/archives/2014/11/17/gruber-romneycare-just-a-way-to-rip-off-the-feds-for-400-million-a-year/
Obama personally asked me to help disguise unhelpful
Obamacare facts.
Jonathan Gruber ---
http://hotair.com/archives/2014/11/17/gruber-obama-personally-asked-me-to-help-disguise-unhelpful-obamacare-facts/
"Jonathan Gruber’s ‘Stupid’ Budget Tricks: His ObamaCare
candor shows how Congress routinely cons taxpayers," The Wall Street
Journal, November 14, 2014 ---
http://online.wsj.com/articles/jonathan-grubers-stupid-budget-tricks-1416009107?tesla=y&mod=djemMER_h&mg=reno64-wsj
As a rule, Americans don’t like to be called “stupid,” as Jonathan Gruber is discovering. Whatever his academic contempt for voters, the ObamaCare architect and Massachusetts Institute of Technology economist deserves the Presidential Medal of Freedom for his candor about the corruption of the federal budget process.
In his now-infamous talk at the University of Pennsylvania last year, Professor Gruber argued that the Affordable Care Act “would not have passed” had Democrats been honest about the income-redistribution policies embedded in its insurance regulations. But the more instructive moment is his admission that “this bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies.”
Mr. Gruber means the Congressional Budget Office, the institution responsible for putting “scores” or official price tags on legislation. He’s right that to pass ObamaCare Democrats perpetrated the rawest, most cynical abuse of the CBO since its creation in 1974.
In another clip from Mr. Gruber’s seemingly infinite video library, he discusses how he and Democrats wrote the law to game the CBO’s fiscal conventions and achieve goals that would otherwise be “politically impossible.” In still another, he explains that these ruses are “a sad statement about budget politics in the U.S., but there you have it.”
Yes you do. Such admissions aren’t revelations, since the truth has long been obvious to anyone curious enough to look. We and other critics wrote about ObamaCare’s budget gimmicks during the debate, and Rep. Paul Ryan exposed them at the 2010 “health summit.” President Obama changed the subject.
But rarely are liberal intellectuals as full frontal as Mr. Gruber about the accounting fraud ingrained in ObamaCare. Also notable are his do-what-you-gotta-do apologetics: “I’d rather have this law than not,” he says.
Recall five years ago. The White House wanted to pretend that the open-ended new entitlement would spend less than $1 trillion over 10 years and reduce the deficit too. Congress requires the budget gnomes to score bills as written, no matter how unrealistic the assumption or fake the promise. Democrats with the help of Mr. Gruber carefully designed the bill to exploit this built-in gullibility.
So they used a decade of taxes to fund merely six years of insurance subsidies. They made-believe that Medicare payments to hospitals will some day fall below Medicaid rates. A since-repealed program for long-term care front-loaded taxes but back-loaded spending, meant to gradually go broke by design. Remember the spectacle of Democrats waiting for the white smoke to come up from CBO and deliver the holy scripture verdict?
On the tape, Mr. Gruber also identifies a special liberal manipulation: CBO’s policy reversal to not count the individual mandate to buy insurance as an explicit component of the federal budget. In 1994, then CBO chief Robert Reischauer reasonably determined that if the government forces people to buy a product by law, then those transactions no longer belong to the private economy but to the U.S. balance sheet. The CBO’s face-melting cost estimate helped to kill HillaryCare.
The CBO director responsible for this switcheroo that moved much of ObamaCare’s real spending off the books was Peter Orszag, who went on to become Mr. Obama’s budget director. Mr. Orszag nonetheless assailed CBO during the debate for not giving him enough credit for the law’s phantom “savings.”
Then again, Mr. Gruber told a Holy Cross audience in 2010 that although ObamaCare “is 90% health insurance coverage and 10% about cost control, all you ever hear people talk about is cost control. How it’s going to lower the cost of health care, that’s all they talk about. Why? Because that’s what people want to hear about because a majority of Americans care about health-care costs.”
*** Both political parties for some reason treat the CBO with the same reverence the ancient Greeks reserved for the Delphic oracle, but Mr. Gruber’s honesty is another warning that the budget rules are rigged to expand government and hide the true cost of entitlements. CBO scores aren’t unambiguous facts but are guesses about the future, biased by the Keynesian assumptions and models its political masters in Congress instruct it to use.
Republicans who now run Congress can help taxpayers by appointing a new CBO director, as is their right as the majority. Current head Doug Elmendorf is a respected economist, and he often has a dry wit as he reminds Congressfolk that if they feed him garbage, he must give them garbage back. But if the GOP won’t abolish the institution, then they can find a replacement who is as candid as Mr. Gruber about the flaws and limitations of the CBO status quo. The Tax Foundation’s Steve Entin would be an inspired pick.
Democrats are now pretending they’ve never heard of Mr. Gruber, though they used to appeal to his authority when he still had some. His commentaries are no less valuable because he is now a political liability for Democrats.
"Academic Built Case for Mandate in
Health Care Law," by Catherine Rampell, The New York Times, March 28,
2012 ---
http://www.nytimes.com/2012/03/29/business/jonathan-gruber-health-cares-mr-mandate.html?pagewanted=all&_r=1&
After Massachusetts, California came calling. So did Connecticut, Delaware, Kansas, Minnesota, Oregon, Wisconsin and Wyoming.
They all wanted Jonathan Gruber, a numbers wizard at M.I.T., to help them figure out how to fix their health care systems, just as he had helped Mitt Romney overhaul health insurance when he was the Massachusetts governor.
Then came the call in 2008 from President-elect Obama’s transition team, the one that officially turned this stay-at-home economics professor into Mr. Mandate.
Mr. Gruber has spent decades modeling the intricacies of the health care ecosystem, which involves making predictions about how new laws will play out based on past experience and economic theory. It is his research that convinced the Obama administration that health care reform could not work without requiring everyone to buy insurance.
And it is his work that explains why President Obama has so much riding on the three days of United States Supreme Court hearings, which ended Wednesday, about the constitutionality of the mandate. Questioning by the court’s conservative justices has suggested deep skepticism about the mandate, setting off waves of worry among its backers — Mr. Gruber included.
“As soon as I started reading the dispatches my stomach started churning,” Mr. Gruber said of the arguments on Tuesday, while taking a break from quizzing his son for a biology test. “Losing the mandate means continuing with our unfair individual insurance markets in a world where employer-based insurance is rapidly disappearing.”
Mr. Gruber, 46, hates traveling without his wife and three children, so he is tracking the case from his home in Lexington, Mass. There he crunches numbers and advises other states on health care, in between headbanging at Van Halen concerts with his 15-year-old son and cuddling with the family’s eight parrots. (His wife, Andrea, volunteers at a bird rescue center.)
If the court rules against the mandate, Mr. Gruber says he believes the number of newly insured Americans could fall to eight million from the projected 32 million. He insists that without a mandate, the law will result in a terrible spiral: only relatively sick Americans will choose to get insurance, leading premium prices to rise and causing the healthier of even those sick people to drop their insurance, sending prices higher and higher.
Some other economists quibble, though, with Mr. Gruber’s pessimistic assessment.
“My general thought about the mandate is if insurance is affordable and accessible, most people will buy it anyway,” said David Cutler, an economist at Harvard and longtime collaborator of Mr. Gruber’s.
Others, like Paul Starr, a Princeton sociologist, say they believe Mr. Gruber’s work does not account for how hard it will be to enforce the mandate.
“There is this groupthink about how important the mandate is,” Mr. Starr says. “Most people don’t understand or won’t acknowledge how weak the enforcement mechanism is.”
Mr. Starr said he thought Mr. Gruber in particular was overstating the effectiveness of the mandate because “it’s his baby.”
That said, it is difficult for too many other experts to categorically refute Mr. Gruber’s work, since he has nearly cornered the market on the technical science behind these sorts of predictions. Other models exist — built by nonprofits like the RAND Corporation or private consultancies like the Lewin Group — but they all use Mr. Gruber’s work as a benchmark, according to Jean Abraham, a health economist at the University of Minnesota and former senior economist in both the Obama and George W. Bush administrations.
“He’s brought a level of science to an issue that would otherwise be just opinion,” Mr. Cutler says. “He’s really the only person who has been doing all this careful modeling for so long. He’s the only person you can go to for that kind of thing, which is why the White House reached out to him in the first place.”
Mr. Obama had made health care reform a cornerstone of his campaign, and wanted to announce a credible proposal quickly after taking office. But members of the Obama administration’s transition team said they had inherited an executive branch that had vastly underinvested in modeling research on health care, especially compared to the technical modeling that had been done in areas like tax policy.
“Creating a good model from scratch would have taken months, maybe years,” said Lawrence H. Summers, who was the director of President Obama’s National Economic Council and had advised Mr. Gruber on his dissertation when they were at Harvard.
Mr. Gruber had already spent years researching government mandates, starting with his 1991 dissertation about how mandated employer benefits cut into workers’ wages.
He also did similar analyses, on a broader range of public policies for the Treasury Department in the Clinton administration from 1997-98. He was recruited by Mr. Summers, who was then deputy secretary of Treasury.
Then in 2001, after returning to M.I.T., Mr. Gruber received an e-mail from Amy Lischko, who was then an assistant commissioner in the Massachusetts healthy policy department under then-Gov. Jane M. Swift, a Republican.
She was familiar with his work, and contracted him to model some potential ways that Massachusetts could expand health insurance coverage.
“He certainly wasn’t as well known then as he is now in the health care arena,” said Ms. Lischko, now a professor at Tufts University School of Medicine. “We couldn’t exactly kick the tires on these kinds of models back then, but we knew he had done work on simulations before.”
Mr. Gruber calls himself a “card-carrying Democrat.” He and his wife host a “great quadrennial Democratic victory party” whether or not the Democratic candidate wins, he said. But given his reputation and relatively rare expertise, he still ended up working for two Republican governors in Massachusetts.
When Mr. Romney succeeded Ms. Swift in 2003, he proposed using an individual mandate to help the state achieve universal health care coverage. Mr. Gruber was again brought in to analyze the idea, which he had not formally modeled before.
“Romney saw it as a traditional Republican moral issue of personal responsibility, getting rid of the free riders in the system, not as much of an economic issue,” Mr. Gruber said. “Not only were the Republicans for it, the liberals hated it. People forget that.”
Mr. Obama had vehemently opposed an individual mandate before his election in 2008.
After the Massachusetts plan passed in 2006, Arnold Schwarzenegger, then the Republican governor of California, invited Mr. Gruber to Sacramento to help model a similar proposal.
“That was awesome,” Mr. Gruber says, his eyes widening at the memory. “I got to see the sword from Conan the Barbarian.”
The California proposal fell apart, but soon Mr. Gruber had a little cottage industry helping states model potential health system changes. He also serves on the Massachusetts board that oversees the state’s new health care exchanges.
Along with these credentials, Mr. Gruber’s position as an adviser to the influential Congressional Budget Office also left him perfectly positioned to advise the White House on health reform.
“The most important arbiter of everything was the C.B.O.,” said Neera Tanden, who was a senior adviser for health reform at the Department of Health and Human Services.
The C.B.O.’s assessment of a bill’s efficacy and costs strongly influences political debate, but the office does not publicly reveal how it calculates those numbers.
“We knew the numbers he gave us would be close to where the C.B.O. was likely to come out,” Ms. Tanden said. She was right.
After Mr. Gruber helped the administration put together the basic principles of the proposal, the White House lent him to Capitol Hill to help Congressional staff members draft the specifics of the legislation.
This assignment primarily involved asking his graduate student researchers to tweak his model’s software code. It was also almost entirely conducted from his home office, while his children were at school and then after they had gone to bed.
“If I wanted to be in Washington, I’d have taken a job in Washington,” he said. “I wanted to be around for my family.”
Even though he was brought in by the White House, Congressional staff members from both parties trusted him because he was seen as an econometric wonk, not a political agent. But soon his very involvement with the bill caused questions about his objectivity to be raised in the news media.
During and after the bill’s slog through Congress, he frequently spoke with reporters and wrote opinion pieces supporting the Affordable Care Act but did not always mention his role in helping to devise it.
He says he regrets not being more upfront about his involvement with the administration. But he does not apologize for publicly advocating the legislation, and continuing to do so — including through a comic book he wrote to explain the law.
“Yes, I want the public to be informed by an objective expert,” he says. “But the thing is, I know more about this law than any other economist.”
The unintentional Obamacare Wrecking
Ball Professor from MIT
MIT economist Jonathan Gruber is one of the foremost architects of Obamacare,
having bragged that he "knows more about this law" than anyone else in his
field. He's also emerged as an unintentional one-man wrecking ball against
Obamacare, making public statements that have undermined the Obama
administration's legal and political defenses of the president's signature
domestic legacy.
http://www.townhallmail.com/zlzjrctbjjwkrbjbkbrptkgllfkllbftddpcqrwdbwmdms_wzvdnjvgdsn.html
The Astonishing Omission in the Wall
Street Journal's Story About Obamacare Enrollment
http://www.newrepublic.com/article/120268/wall-street-journal-article-latinos-obamacare-omits-medicaid
"Watch Obamacare Architect Jonathan
Gruber Explain Why "Lack of Transparency" Was Key to Passing the Health Care
Law," by Peter Suderman, Reason Magazine, November 10, 2014 ---
http://reason.com/blog/2014/11/10/watch-obamacare-architect-jonathan-grube
. . .
It's even harder to believe now that he has admitted that he thinks it's fine to mislead people if doing so bolsters the policy goals he favors. It's really quite telling, about the law and also about Gruber. Gruber may believe that American voters are stupid, but he was the one who was dumb enough to say all this on camera.
Jensen Comment
Condoning the misleading of the public for political
purposes by a scientist borders on fabrication of data and may be in violation
of his university's (MIT) academic integrity policy.
Similar issues arose in the allegations
against Phil Jones regarding integrity of his climate temperature recordings ---
http://en.wikipedia.org/wiki/Climatic_Research_Unit_email_controversy
Professor Jones stepped aside temporarily but was reinstated. Nevertheless these
and similar allegations badly damaged the public's confidence in climate change
data.
Jon Krosnick, professor of communication, political science and psychology at Stanford University, said scientists were overreacting. Referring to his own poll results of the American public, he said "It's another funny instance of scientists ignoring science." Krosnick found that "Very few professions enjoy the level of confidence from the public that scientists do, and those numbers haven't changed much in a decade. We don't see a lot of evidence that the general public in the United States is picking up on the (University of East Anglia) emails. It's too inside baseball."[139]
The Christian Science Monitor, in an article titled "Climate scientists exonerated in 'climategate' but public trust damaged," stated, "While public opinion had steadily moved away from belief in man-made global warming before the leaked CRU emails, that trend has only accelerated."[140] Paul Krugman, columnist for the New York Times, argued that this, along with all other incidents which called into question the scientific consensus on climate change, was "a fraud concocted by opponents of climate action, then bought into by many in the news media."[141] But UK journalist Fred Pearce called the slow response of climate scientists "a case study in how not to respond to a crisis" and "a public relations disaster".[142]
A. A. Leiserowitz, Director of the Yale University Project on Climate Change, and colleagues found in 2010 that:
Climategate had a significant effect on public beliefs in global warming and trust in scientists. The loss of trust in scientists, however, was primarily among individuals with a strongly individualistic worldview or politically conservative ideology. Nonetheless, Americans overall continue to trust scientists more than other sources of information about global warming.
In late 2011, Steven F. Hayward wrote that "Climategate did for the global warming controversy what the Pentagon Papers did for the Vietnam war 40 years ago: It changed the narrative decisively."[143] An editorial in Nature said that many in the media "were led by the nose, by those with a clear agenda, to a sizzling scandal that steadily defused as the true facts and context were made clear."
Jensen Comment
Professor Gruber's confession will similarly affect the public opinion of the
way Obamacare was foisted on the public. This is not a proud moment in science
or the life of a scientist and his university.
Also see ethics issues at
http://www.ethicssage.com/
Flackcheck Patterns of Deception ---
http://www.flackcheck.org/patterns-of-deception/affordable-care-act/?gclid=CMWP97rJhsICFWxk7AodCA8AqQ
Bob Jensen's threads on professors who
cheat ---
http://faculty.trinity.edu/rjensen/Plagiarism.htm#ProfessorsWhoPlagiarize
From the CFO Journal's Morning Ledger on November 6, 2014
Health insurers woo consumers in crowded market
http://online.wsj.com/articles/health-insurance-deadline-prompts-marketing-blitz-to-drum-up-business-1415202655?mod=djemCFO_h
Health insurers are unleashing a blizzard of ads, letters, live events and other efforts to reach consumers, as the industry ramps up for the reopening of the health law’s marketplaces on Nov. 15. Meanwhile, small-business owners test-driving the federal government’s new online health-insurance exchange report a mixed experience with the site ahead of its planned opening in 10 days.
Jensen Comment
Health insurance is currently a very good business for companies, because bad
debts from people who do not pay contracted premiums are passed on to the
doctors and hospitals after 30 days. In any case Obamacare promises guaranteed
profits for insurance companies at taxpayer expense if necessary. This is not
capitalism since one of the tenants of capitalism is that businesses take risks
risks of losses and failure.
It's the doctors and hospitals that take the financial risks. In New Hampshire nearly half the hospitals refuse to admit patients with ACA insurance except in dire emergencies. Many doctors are turning patients away unless they have something other than ACA medical insurance.
Another good thing for insurers is that the deductibles have become so huge (40% to 60%) that insured people put off getting medical care until absolutely necessary --- thereby greatly reducing the number of claims to be processed and paid.
My point is that just to say that more people now have ACA health insurance is not saying a whole lot about the quality of health care that this insurance is buying. There will probably be gridlock for years in Washington DC for any attempts to bring quality health care to all citizens of the USA. I favor national health insurance, although national health insurance plans in most non-OPEC nations like Sweden, Denmark, and the UK are doing badly these days. I consider Canada to be an OPEC nation. Germany is doing better because it allows people to take on supplemental health insurance using their own savings.
The USA is now an one of the world's largest oil producers, but gridlock politics have all but destroyed possibilities for great health care for all citizens. It's one of the best nations for health care for people who can afford to pay for the services, including those lucky enough to be on Medicaid or Medicare.
A long-delayed correction of a lie
"You Might Lose Your Doctor Under Obamacare," WebMd, March 14,
2014 ---
http://hotair.com/archives/2014/03/14/great-news-80-of-employers-have-or-may-raise-deductibles-thanks-to-obamacare/
Voters in November might be ready to show Democrats what they think about removing choice and hiking costs, as well as their arrogance in determining that a few politicians in Washington know better about their choices than they do. Unfortunately, Barack Obama doesn’t appear to have figured out this problem. In an interview with WebMD, Obama finally acknowledged that, contra his promise, people might not be able to keep the doctors they liked, but that they probably shouldn’t have liked those doctors in the first place.
Jensen Comment
Why won't he still admit the truth. Many of those doctors that "they liked" tend
to be so good that they get more than enough business without working for
medical clinics and
Here in New Hampshire 10 of the 26 hospitals and many of the best physicians in the state refuse to go on network. One of the main reasons is that patients in default on their health exchange premiums must be treated for 90 days with physicians and hospitals bearing the treatment costs for the last 60 of those 90 days. God forbid that the fat-cat insurance companies or the Federal government take the risks of paying for the free care during those 60-days.
Questions
Was President Obama correct in promising that the ACA insurance would transfer
Medicaid patients from ER rooms to ACA networked physicians?
How does the ACA expansion of Medicaid greatly increase the moral hazard of new Medicare patients?
One of the naive promises made by President Obama was that uninsured people previously seeking free care in Emergency Rooms (ER) would relieve the ER rooms for all the new Medicaid patients who could now have access to network physicians with their new free medical care and medication insurance policies. This was naive because he should have known that previous Medicaid patients preferred ER rooms even when they had freeMedicaid insurance. He should have known that when Oregon expanded the number of people on Medicaid that demand for ER services increased by 40%.
People receiving free medical care and medications are inclined to favor ER services even when they can have care from network physicians. Reasons are complicated especially when walk-in medical clinics are available. One reason is that walk-in clinics serving Medicaid patients are not usually as close by as hospitals with ER services. The physicians in the ER facilities are likely to not only be MDs, they are sometimes better MDs that the staff of walk-in medical clinics who often hire newly graduated MDs still in residency or physicians assistants. In other words, if you want the best physicians the odds are usually better for ER rooms than networked ACA physicians and walk-in clinics.
When walk-in clinics are not convenient, getting an appointment with a networked physician may take weeks or even months. Top physicians are available 24/7 for emergency patients and non-emergency Medicaid patients. Insured patients not on Medicaid may be discouraged by co-pays of expensive ER services. But Medicaid patients never have to worry about co-payments.
Last night CBS News reported that ER use expanded by 40% due to new Medicaid patients.
Giving poor people health insurance, the belief was, would decrease their dependence on hospital emergency rooms by providing them access to more appropriate, lower-cost primary care.
But a study published in the journal Science on Thursday finds that's not the case. When you give people Medicaid, it seems they use both more primary care and more emergency room services.
"Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations," says Amy Finkelstein, an economics professor at MIT and one of the authors of the study. "Including visits for conditions that may be most readily treatable in primary care settings."
In other words, people are going to the emergency department for things that aren't emergencies. This is exactly what policymakers hoped to avoid by giving people health insurance – including the huge increase in Medicaid coverage coming as part of the Affordable Care Act.
And the increase in ER use found in the study was significant – "about 40 percent," Finkelstein said.
This would be a good place to point out this is not just any study. It is the third major paper from something called the Oregon Health Insurance Experiment, which Finkelstein heads along with Katherine Baicker from the Harvard School of Public Health.
The experiment was a rare opportunity to create a randomized controlled experiment – the gold standard of scientific research. It came about almost by accident, thanks to Oregon's decision in 2008 to expand its Medicaid program via a lottery.
The result, said Finkelstein, was that the groups of people with or without insurance were identical, "except for the fact that some have insurance and some don't. You've literally randomized the allocation of insurance coverage."
And that gave researchers the ability to compare the effects of having health insurance — in this case, Medicaid.
The first paper from the research team, published in 2011, was mostly positive. It found that people who got Medicaid coverage were more likely to use health services in general, less likely to suffer from depression, and less likely to suffer financial problems related to medical bills than those who remained uninsured.
The results in the second paper, published last spring, were more equivocal. Researchers found no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes.
It's not clear that the emergency room results will translate nationwide: The study only lasted 18 months and the study population is both more while and more urban than the rest of the nation.
But that's not stopping critics of Medicaid expansion.
"When you make ER care free to people, they consume more of it. They consume 40 percent more of it," says Michael Cannon, head of health policy for the libertarian Cato Institute. "Even as they're consuming more preventive care. And so one of the main arguments for how Obamacare was going to reduce health care costs is just flat out false."
Cannon says the study will likely further hurt President Obama's credibility for vowing that expanding Medicaid would help get people out of emergency rooms. But what's likely to bother the administration even more, he says, is what it may do to the half of the states that have yet to adopt the Medicaid expansion.
"This study is going to make it less likely that the 25 states that decided not to expand Medicaid are going to change their minds and decide to expand Medicaid," Cannon predicts.
But this study doesn't come as much of a surprise to those people who actually run Medicaid programs around the country.
"This is not something that is unexpected and not something that we're not prepared for," says Kathleen Nolan. She's director of state policy and programs for the National Association of Medicaid Directors.
Continued in article
Jensen Comment
The majority of new Medicaid patients will be poor, although it is possible for
millionaires to now qualify for Medicaid with devious financial planning such as
low income students having million dollar trust funds. The poor patients have
incentives to game the ER services for prescription pain medicine. With one
network physician or clinic, there will be records as to when prescriptions can
be renewed. Given the Administration's track record for implementing databases,
I strongly doubt that a Medicaid patient intent upon selling prescription pain
killers can be prevented by traveling around to different hospital ER service
for prescriptions that would not be granted if the ER physician was aware of the
last time a Medicaid patient received such a prescription in another hospital
and another and another.
I'm not certain how well pharmacies share prescription data or even if privacy laws even allow CVC and Walgreen and Wal-mart to even share a person's prescription data without receiving permission from the patient.
The moral hazard is greater with poor people in need of selling their pills like they sell food stamps.
Can prescription data be shared between different corporations without patient consent?
And then there's the problem of granting Medicaid to people who do not qualify for Medicaid. For example, an audit in Illinois revealed that half the people on Medicaid did not qualify for Medicaid. This appears to be yet another entitlement going crazy at taxpayer expense.
Bob Jensen's health care messaging updates --- http://faculty.trinity.edu/rjensen/Health.htm
The Lies and Deceptions
Americans stubbornly resist this landmark
legislation in part because virtually every major claim about its benefits is
turning out to be false—and people recoil when misled.
Karl Rove, The Wall Street Journal, September 30, 2010 ---
http://online.wsj.com/article/SB10001424052748704116004575522073624475054.html?mod=djemEditorialPage_t
"Obamacare: Silence of the Insurers," by Jonah Goldberg, Townhall,
December 18, 2013 ---
http://townhall.com/columnists/jonahgoldberg/2013/12/18/obamacare-silence-of-the-insurers-n1764535?utm_source=thdaily&utm_medium=email&utm_campaign=nl
When will the insurers revolt?
It's a question that's popping up more and more. On the surface, the question answers itself. We're talking about pinstriped insurance company executives, not Hells Angels. One doesn't want to paint with too broad a brush, but if you were going to guess which vocations lend themselves least to revolutionary zeal, actuaries rank slightly behind embalmers.
Still, it's hard not to wonder how much more these people are willing to take. Even an obedient dog will bite if you kick it enough. Since Obamacare's passage, the administration has constantly moved the goalposts on the industry. For instance, when the small-business mandate proved problematic in an election year, the administration delayed it, putting its partisan political needs ahead of its own policy and the needs of the industry.
But the insurers kept their eyes on the prize: huge guaranteed profits stemming from the diktat of the health insurance mandate. When asked how he silenced opponents in the health industry during his successful effort to socialize medicine, Aneurin Bevan, creator of the British National Health Service, responded, "I stuffed their mouths with gold."
Hence, the insurers were ready on Oct. 1. They rejiggered their industry. They sent out millions of cancellation letters to customers whose plans no longer qualified under the new standards set by the Affordable Care Act. They told their customers to go to the exchanges to get their new plans.
But because President Obama promised Americans "if you like your health care plan, you can keep it," (PolitiFact's "Lie of the Year"), those cancellations became a political problem of Obama's own making.
In response, the president blamed it on the insurance companies or "bad apple" insurers. White House spokesman Jay Carney insisted that it was the insurance companies that unilaterally decided not to grandfather existing plans. (The Washington Post's "Fact Checker" columnist, Glenn Kessler, gave this claim "Three Pinocchios.")
Then, just last week, Health and Human Services Secretary Kathleen Sebelius announced that she was "urging" insurers to ignore both their contracts and the law and simply cover people on the honor system -- as if they were enrolled and paid up. She also wants doctors and hospitals to take patients, regardless of whether they are in a patients' insurance network or even if the patient is properly insured at all. Just go ahead and extend the deadline for paying, she urged insurers; we'll work out the paperwork later.
Of course, urging isn't forcing. But as Avik Roy of Forbes notes, the difference is subtle. Also last week, HHS also announced last week that it will consider compliance with its suggestions when determining which plans to allow on the exchanges next year. A request from HHS is like being asked a "favor" by the Godfather; compliance is less than voluntary.
The irony, as Christopher DeMuth recently noted in the Weekly Standard, is that if the architects of Obamacare had their way, the insurers would have been in even worse shape today. The original plan was for a "public option" that would have, over time, undercut the private insurance market to the point where single-payer seemed like the only rational way to go. If it weren't for then-Sen. Joe Lieberman's insistence that the provision be scrapped, DeMuth writes, "Obamacare's troubles would today be leading smoothly to the expansion of direct federal health insurance to pick up millions of canceled policies and undercut rate increases on terms no private firm could match."
In other words, the insurers knew the administration never had their best interests at heart but got in bed with it anyway.
Continued in article
Jensen Comment
Until recently the enthusiasm of medical insurance companies was understandable
since the the losses for deductible portions of contracts were passed on mostly
to patients themselves and possibly their doctors. Most medical service bad
debts of for default of premium payments were passed on to hospitals and
doctors.
Also the big and prosperous insurance companies were allowed to opt out of participating in the more risky health insurance exchanges. Most did opt out such that the government had to make loans for new exchange companies to to become insurers for individuals not covered by their employers. These exchanges are poorly capitalized, and many will probably have to be bailed out by the government if and when they encounter insolvency.
To get more heavily capitalized insurance companies to participate would require higher premium rates and more protection against bad debt losses. But this in turn would raise premiums dramatically and be counter to the whole purpose of the Affordable Care Act --- to get more people insured and using more preventative care options. High premiums and low deductibles could destroy the Affordable Care Act by making more rather than fewer people insured.
The silence of the media on astute health care providers is more
problematic.
Many of the biggest and best hospitals like the Andersen Cancer Center will not
serve patients covered by the exchanges. Over 70% of California's physicians
will not serve patients covered by the exchanges (except in the case where
emergency treatment is called for).
Has any media source complained that with proper investment planning very wealthy people, especially college students on trust funds, may get free Medicaid medical care and medications.
Jensen Question
I asked the following question on the Turbo Tax Forum Regarding the
Affordable Care Act
Questions:
Question
I'm told that only income, not wealth, will be the deciding factor on
eligibility for Medicaid beginning in 2014.
If I'm a full time student having zero income and $10 million trust fund of
stock paying no dividends, will I be eligible for Medicaid?
A Turbo Tax expert says that wealth may still be a criterion in the states that rejected the Medicaid expansion. Having valuable assets is no longer a criterion in those states that yielded to Whitehouse pressure and temporary funding to expand Medicaid roles.
There are 24 states who are not expanding Medicaid and may, therefore,
still deny Medicaid to millionaires. The other 26 states may now grant free
health care to millionaires who strategically lock in their wealth for long-term
growth and negligible current income ---
https://www.statereforum.org/tracking-health-coverage-enrollment-by-state
"What 2014 means for Obamacare," by Sarah Kliff, The Washington
Post, January 1, 2013 ---
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/01/what-2014-means-for-obamacare/
. . .
The next Obamacare fight is going to be about access.
After three months of enrollment, January will be the first month when shoppers can see what they purchased. We know that the plans for sale on the marketplace tend to have relatively limited networks, as insurers restricted doctor access to hold down premium prices. New subscribers could find that a doctor they want isn't in network, and get frustrated. Co-payments may seem alarmingly high -- a byproduct of keeping premiums low. While the health-care system probably has the capacity to absorb a few million new insurance subscribers (for a variety of reasons explored here) there is still room for issues about access to specific doctors and the price tag that comes along with trips to the doctor's office.Continued in article
Jensen Comment
While the new Medicaid patients will probably flood the hospital ERs instead of
seeking out network physicians, the patients on plans requiring co-payments and
deductibles will probably seek out physicians on their network plans. Hospital
ERs tend to charge large co-payments which of course do not matter to Medicaid
patients since they do not have to pay any co-payments.
In some instances physicians who are suing the ACA network insurers after
being dropped by the networks
",MDs sue ObamaCare insurer over dropped doctors" by Geoff Earle, Fox
News, December 28, 2013 ---
http://nypost.com/2013/12/28/mds-sue-obamacare-insurer-over-dropped-doctors/
A group of New York doctors is suing insurance giant UnitedHealthcare, charging that it booted doctors from its network to avoid cost hikes imposed by ObamaCare.
The company’s decision to kick more than 2,000 docs from its Medicare Advantage network threatens to harm elderly and disabled patients, according to the filing in Brooklyn federal court.
“By terminating numerous physicians from the . . . network, United seeks to stem financial losses occasioned by reduced federal payments under the Affordable Care Act,” the suit launched by the Medical Society of the State of New York claims.
“This, of course, comes at the expense of physicians,” the suit continues, arguing that the company violated doctors’ contracts by failing to give sufficient notice, among other things.
Tugging at the heartstrings, the suit specifically mentions elderly and disabled patients “who must now either find new physicians (including traveling farther distances to find a participating . . . provider), switch plans to continue treatment with the terminated physicians, or pay significant additional out-of-pocket costs to continue treatment with an ‘out-of-network’ provider.”
It accuses United of “shifting the financial burdens imposed by the Affordable Care Act from itself, a multibillion-dollar company,” to providers and patients.
Medical Society President Sam Unterricht told The Post the company’s decision was unfair to patients, since they had to choose a new plan under Medicare Advantage, a private alternative to traditional Medicare, by Dec. 7, when company Web sites still showed doctors who were being kicked out of the network at the start of the new year.
“For some people who are medically fragile it can really be dangerous. There can be gaps in care,” he said.
Unterricht said reduced Medicare Advantage payments to physicians are being used as a cost-saving measure to fund ObamaCare. He said docs would get paid 20 percent or even 40 percent less per patient.
“A lot of doctors are not going to be able to accept that and really give good medical care at that kind of a price,” he said.
Continued in article
Jensen Comment
This is a reversal of the stories we are hearing about physicians boycotting the
ACA networks.
We are seeing a bit about this up here. In their separate offices in our Littleton Regional Hospital three different medical network groups each dropped one of its MDs. Interestingly, all three of the dropped physicians at one time or another been general practitioners for my wife or me. The dropped MDs were all women MDs who were replaced by new and much cheaper Physician Assistants who are permitted, at least up here, to examine patients like a physician and write prescriptions.
One of the MDs, Dr. Virginia Jeffryes, after facing the huge expense of starting a new practice, was hired back by her network group but now has to commute to Whitefield. Dr. Kathleen Smith and Dr. Robin Hallquist are incurring the expenses of commencing new practices in Littlleton and Twin Mountain respectively. The startup expenses include renting office space, hiring medical and administrative staff, buying computers and other equipment,, going it alone for malpractice insurance premiums. Plus there is an enormous amount of red tape involved in getting permission to bill third parties like Medicare and Worker Comp.
I firmly believe these quality physicians were dropped by their respective medical network groups and replaced by Physician Assistants (PAs) and/or Osteopaths to save money. That, however, is only my opinion since I have no inside tracks to the accounting records.
One of the network groups retained a cheap and uncaring MD trained in another country. She needs and attitude adjustment. I'm told by a neighbor who works in the hospital that her patients are continually asking for another "doctor" be it a PA or an Osteopath.
Why didn't the group fire the lousy MD and retain the high quality MD? That's a no-brainer question for a managerial accounting student.
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
Deloitte's Map of the Number of Healthcare Exchanges Estimated Per State ---
http://www.deloitte.com/assets/Dcom-UnitedStates/Local
Assets/Documents/Health Plans/us_hp_hix_IndividualMarketCompetition_81313.pdf
For example, New Hampshire and West Virginia have one whereas Texas has 11,
Wisconsin has 13, and New York has 16.
Each carrier does have multiple plans that vary largely on the size of the
deductibles with bronze plans having 40% deductibles and silver having 30%
deductibles. Prices vary in different states. Prices also vary with age and smoking.
There are differences even among states who are not providing their own
exchanges. Currently there are 26 states who rely on Federally provided
exchanges ---
https://www.statereforum.org/where-states-stand-on-exchanges
Why does Maine have only two exchanges while Texas has 11 exchanges?
How to Mislead With Statistics and Graphs
Question
If you were teaching statistics how could you use the following article to
illustrate how to mislead with statistics?
"Obamacare Prices: Competition Lacking in Some Exchanges," by John
Tozzi, Bloomberg Businessweek, December 19. 2013 ---
http://www.businessweek.com/articles/2013-12-19/obamacare-prices-competition-lacking-in-some-exchanges?campaign_id=DN122313
The drafters of the Affordable Care Act imagined vibrant marketplaces that would give consumers options from many insurers. So far, competition is limited: 40 percent of Americans live in counties with three or fewer companies selling Obamacare policies, leaving them more wireless carriers to choose from than health plans.
Jensen Comment
No matter how much we preach that correlation is not causation, journalists,
students, and even professors fall into the same old trap of not digging deeper
for causes rather than implying that correlation is synonymous with causation.
Yes premiums do seem to be correlated with competition. But how much is the competition really affecting price relative to underlying causal factors that affect such things as companies refusing to enter the competition?
Insurance companies themselves are not very forthcoming about why they avoid certain markets other than providing vague statements about those markets not being profitable. The bottom line is that I don't know why there is so little medical insurance competition in some parts of the country relative to other parts of the USA. But I would not be so naive to imply that lack of competition is a causal factor. Where there's lack of competition there are most likely either underlying barriers to entry or other causal factors that make medical insurance less profitable in those areas. Charging higher prices for insurance in those markets is a result of whatever factors are driving potential competitors out of those markets.
A skilled analyst would probe deeper as to why there is so little competition in come counties and states.
December 24 reply from the TurboTax Forum
Hello rjensen,
SweetieJean commented on an answer to your question: Why does the number of exchanges vary so greatly. For example, New Hampshire and West Virginia have only one exchange whereas New York has 16 exchanges and Texas has 11 exchanges?
Saw a recent article about someone who had only 1 insurance in their Exchange, but their across the street neighbor (who lived in a different zip code) had 15. In very rural areas (NH, WV), there isn't enough of a customer population for most insurance companies to make a profit.
To view the comment, click (or copy and paste in your browser) the link below:https://ttlc.intuit.com/replies/3351534
I never knew about ACA consumer add-on taxes until this was reported today by
CBS News
"As Obamacare Deadline Looms, Insurance Companies Pile On The Taxes,"
CBS News, December 26, 2013 ---
http://newyork.cbslocal.com/
. . .
And there’s more: most insurance companies don’t tell you about the taxes they add to their premiums. The numbers will vary, but one subscriber said their tax amount is $23.14 a month, or nearly $278 annually.;
Other add-ons include:
* A 2 percent premium tax on every health plan.
* A user fee of 3.5 percent to sell through the online marketplace.
* A $2-per-policy fee.
Nonetheless, supporters of the Affordable Care Act claim the neediest will get the best coverage.
“People who make a little more will pay more; people who make a little less will pay less,” Arevalo said.
Critics say most insurers don’t specifically post taxes on invoices, and some question how, in the case Brennan showed earlier, Alabama Blue Cross-Blue Shield was able to be so specific.
Watch the video
Surely Chuck you cannot argue that having premiums and choices of plans vary
so drastically across zip codes is fair.
"COST, NUMBER OF HEALTH CARE PLANS VARY WIDELY BY COUNTY," USA Today
---
http://www.usatoday.com/story/news/nation/2013/11/21/affordability-obamacare-plans-varies-state-county/3641821/
Look at the maps!
The variable premiums and deductibles that were somewhat unfair by zip codes
before the ACA have exacerbated those and are increasingly unaffordable in some
zip codes. The USA Today (December emphasizes this ---
"Lack aid? Many counties have only pricey plans," by Jayne O'Donnell,
USA Today, December 26, 2013 ---
http://www.usatoday.com/story/news/nation/2013/12/25/affordability-healthcaregov-plans-usa-counties/4165513/
More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that's affordable — by the government's own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.
Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.
More than a third don't offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.
Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.
The USA TODAY analysis looked at whether premiums for the least expensive plan in any of the metal levels was more than 8% of household income. That's similar to the affordability test used by the federal government to determine whether premiums are so expensive consumers aren't required to buy plans under the Affordable Care Act.
The number of people who earn close to the subsidy cutoff and are priced out of affordable coverage may be a small slice of the estimated 4.4 million people buying their own insurance and ineligible for subsidies. But the analysis clearly shows how the sticker shock hitting many in the middle class, including the self-employed and early retirees, isn't just a perception problem. The lack of counties with affordable plans means many middle-class people will either opt out of insurance or pay too much to buy it.
The prices of exchange plans have shocked many shoppers, especially those who had plans canceled because they did not meet the ACA coverage requirements. But experts are not surprised.
"The ACA was not designed to reduce costs or, the law's name notwithstanding, to make health insurance coverage affordable for the vast majority of Americans," says health care consultant Kip Piper, a former government and insurance industry official. "The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace."
Along with underscoring how high rates are in many places, the analysis could portend more problems for the health law's troubled rollout. The Congressional Budget Office projected 7 million people would sign up for the law by the end of 2014 and enrollment is already falling several million short of that goal. Insurers need a lot of relatively healthy people to sign up for insurance to make up for the higher cost of insuring the less healthy. Highly subsidized lower-income consumers who haven't had insurance before often weren't getting regular doctors' visits. If many of those making about $50,000 for an individual or about $62,000 in household income for a couple opt out of the new health care system, it will deprive it of some of the counterbalancing effect needed.
Still, about 95% of consumers live in states where the average premiums are below earlier estimates, says Department of Health and Human Services spokeswoman Joanne Peters.
"The new Marketplace is night and day from what consumers faced in the individual market before the health care law, where they could see unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they can even get coverage without being denied for a pre-existing condition," says Peters.
Many ACA-compliant plans will cover prescription drugs, routine care for chronic conditions and primary care visits even before deductibles are met, Peters notes.
But those aren't the plans that are affordable to many middle-class individuals buying insurance. In many cases, catastrophic plans — which USA TODAY excluded from its analysis — may be all that's left for consumers on the exchanges. These high-deductible plans are generally only available for consumers under 30, who are least likely to need to use them, but they can also be purchased by people who don't have other affordable options available in their area. These plans generally require consumers to pay all of their medical costs up to a certain amount — often $6,000 or more — although preventive benefits such as physicals have to be covered under the new law.
President Obama said last week that people whose plans were canceled and think the options on the exchanges are too expensive aren't required to buy insurance or can buy a catastrophic plan through what's known as a "hardship exemption." But most people actually do want insurance, says financial counselor and author Karen McCall.
"Every one of those people, if they have any consciousness and aren't totally self-medicating, would prefer to have insurance," says McCall, author of the book Financial Recovery. "You could go a year and not get any benefit of health insurance, but there is a deep emotional need to know that we have proper insurance."
State and federal exchange officials approve the rates health insurers can offer, and plans are then subsidized to levels that make them affordable for those below 400% of the poverty level. Karen Pollitz, a senior fellow at the Kaiser Family Foundation, acknowledges that catastrophic and even bronze plans would be very difficult for many 40 or 50-something consumers to afford with their $5,000-$6,000 annual deductibles.
"Most people don't have that kind of money in the bank, and I think it's going to create problems for people," Pollitz says.
Although premiums are unaffordable in many places now, protections in the law will prevent the massive jumps in premiums that characterized the individual insurance market before the ACA, she says.
Individual policies before had only the "optics of affordability and no dependability," Pollitz says. "What good is protection if it doesn't work when you need it?"
More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that's affordable — by the government's own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.
Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.
More than a third don't offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.
Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.
Jensen Comment
If we are going to have affordable health care for all then the premiums should be affordable by all and not my some zip codes suffer much more than people living in other zip codes.
Jensen Comment
The problem is that the ACA is just not sustainable unless drastic changes are
made. The ACA assumed that wealthier and healthier people were going to pay for
almost all the expansion of free Medicaid medical care and subsidized premiums.
But the prices that were set are just not affordable to too many people and in
order to have medical plans other people are opting for high deductibles that
they will not be able to pay in times of expensive medical care needs.
Furthermore, the pricings are too variable and unfair across all the counties of
the USA.
The ACA is just not sustainable. It should have been a national health plan from the beginning. Turning it into a national health plan in the future will be an enormous shock to the slowly expanding economy and a disaster to the entitlements disaster.
But I don't really care all that much. I will be dead before the enormous
disasters hit.
I just hate the fraud and unfairness that the ACA is exacerbating. It turns out
that the preconditions problem for uninsured people was not all that great a
problem that could have been solved much more cheaply. The majority of the the
problem with uninsured people was that they either could not afford or did not
want to afford medical insurance that is now ever more costly to many of these
same peopl
"Obama's Mental Health Solution Falls Flat," by Nicole Bailey,
Townhall, December 2, 2013 ---
http://townhall.com/tipsheet/nicolebailey/2013/12/12/obamas-mental-health-solution-falls-flat-n1761910?utm_source=thdailypm&utm_medium=email&utm_campaign=nl_pm
. . .
The Obama administration has expanded mental health care coverage, but the latest research shows that psychiatrists often do not accept insurance at all. When only 43% of psychiatrists accept Medicaid, it is difficult to see how expanded coverage will help mental health patients.
Psychiatrists accept medical insurance less frequently than other specialists across the board, according to the study published in JAMA Psychiatry by researchers from three separate medical schools:
- 55.3% of psychiatrists accepted medical insurance in general, compared to 88.7% of other physicians
- 54.8% of psychiatrists accepted Medicare, compared to 86.1% of other physicians
- 43.1% of psychiatrists accepted Medicaid, compared to 73.0% of other physicians
The mainline media seems to avoid the greatest concerns of the Affordable Care Act --- concerns about making hospitals and doctors absorb most of the costs of medical care during the 90-day premium default grace period and the cost of serving patients who afterwards renege on paying the deductible portions that they agreed to pay to get lower premium plans.
The USA now has a dual health care program --- the highest quality health care in the world for the wealthy on Cadillac medical insurance plans and inferior quality health care in the chaos of the Affordable Care Act that will force soaring inflation in health care provider pricings. Your local Congressional representative is signing up for a Cadillac plan paid for by taxpayers.
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
the Affordable Care Act: Limits Placed Upon Choosing Your Own Doctor and Hospital
Jensen Comment
The media along with President Obama led us to believe that medical insurance
plans were going to vary only be the amount of the deductibles and age of the
applicant. We are now learning more about differences in medical networks of
hospitals and doctors. The President kept insisting that we could keep our
present doctors. Technically that was not a lie, but what was left unsaid is
that to literally keep your favored doctors and hospitals you may have to opt
for the more expensive Cadillac plans having "broader network coverage "of
physicians and selective hospitals that opted out of serving the lower-priced
limited network plans.
Dr. Ezekiel Emanuel --- http://en.wikipedia.org/wiki/Ezekiel_Emanuel
"ObamaCare in Translation Ezekial Emanuel explains what the President really
meant about your doctor," The Wall Street Journal, December 8, 2013 ---
http://online.wsj.com/news/articles/SB10001424052702304014504579246552456954872?mod=djemEditorialPage_h
. . .
Mr. Wallace: "It's a simple yes or no question. Didn't he say if you like your doctor, you can keep your doctor?"
Dr. Emanuel: "Yes. But look, if you want to pay more for an insurance company that covers your doctor, you can do that. This is a matter of choice. We know in all sorts of places you pay more for certain—for a wider range of choices or wider range of benefits. The issue isn't the selective networks. People keep saying, 'Oh, the problem is you're going to have a selective network.'"
Mr. Wallace: "Well, if you lose your doctor or lose your hospital—"
Dr. Emanuel: "Let me just say something. People are going to have a choice as to whether they want to pay a certain amount for a selective network or pay more for a broader network."
Mr. Wallace: "Which means your premiums would probably go up."
Dr. Emanuel: "They get that choice. That's a choice you've always made."
It's nice to hear a central planner embrace choice, except this needs translating too. The truth is that you may be able to pay more to keep your doctor, but only after you choose one of ObamaCare's preferred plans that already costs you more than your old plan that ObamaCare forced you to give up.
Jensen Comment
What Dr. Emanuel failed to mention is that the "broader expensive network" plans
are Cadillac plans for which employers lose their tax deductions.
The Cadillac Tax: A Game Changer for U.S. Health Care: Can you
explain this tax to your students?
Do you understand the Cadillac Tax provision of the Affordable Healthcare Act
that will have a monumental 2018 impact on healthcare coverage of employees who
are now covered by employer plans --- plans now costing the government over $250
billion per year? But not for long!
Do you understand the Cadillac Tax provision?
Me neither. As Nancy Pelosi said years ago, Congress passed the ACA before
anybody in the USA had a chance to study all the surprises in this the enormous
bill.
If you're covered presently on your employer's plan you should most certainly learn about the Cadillac Tax provision that kicks in in 2018.
"The Cadillac Tax: A Game Changer for U.S. Health Care." by Jonathan
Gruber (MIT), Harvard Business Review Blog, November 15. 2013 ---
http://blogs.hbr.org/2013/11/the-cadillac-tax-a-game-changer-for-u-s-health-care/
Jensen Comment
Non-profit organizations, especially labor unions, for whom Cadillac plans are
especially popular will be allowed to keep their plans without penalty since tax
deductions are not of concern to them.
Having preferred networks of doctors and hospitals is not unheard of in national health care plans. Germany, for example, has both public health insurance plus premium coverage with private insurance. Cuba notoriously has bourgeoisie plans for members of the Communist Party and the wealthy versus proletariat plans for the poor people.
If you Congressional representative brags about signing up for Obamacare ask if he or she has a Cadillac Obamacare plan that lets them choose their own doctors and hospitals.
President Obama's Blatant Political Payoff: Unions Get Tax-Free
Cadillac Health Plans Unlike the Rest of the USA
Oops Some Selected Corporations Get Breaks as Well
"Unions Get Big ObamaCare Christmas Present As Other Self-Insured Groups Get
Scrooged," by Larry Bell, Forbes, December 22, 2013 ---
http://www.forbes.com/sites/larrybell/2013/12/22/unions-get-big-obamacare-christmas-present-as-other-self-insured-groups-get-scrooged/
As a presumed constitutional scholar, Barack Obama should know that while a president has authority to check the Legislative Branch by recommending legislation to be passed by Congress, or through presidential veto, he or she cannot legislate through executive fiat or pick which parts of the law to comply with or decline. Article 2, Section 3, Clause 5 of our Constitution requires that the president “…shall take care that the Laws be carefully executed.” It doesn’t limit those laws or encapsulated provisions to the particular ones that he or she likes.
Speaking before the House Judiciary Committee on December 3, Professor Jonathan Turley of George Washington University observed that the president isn’t taking that “Laws be faithfully executed” oath very seriously, particularly with regard to his signature Affordable Care Act (aka.“ObamaCare”).
Although Turley had voted for Obama and professes to agree with him on health care and other issues, he warned that his power grabs are causing “the most serious constitutional crisis in my lifetime.”
The White House Earns Its Union Label
In addition to delaying and rewriting key ACA provisions and carving out a special subsidy for members of Congress, Obama’s latest constitutional violation will exempt unions from a fee the law imposes upon all large group health plans. That provision which appears in Section 1341 (b)(1)(A) establishes a reinsurance program to compensate insurers on exchanges in the individual market if they are hit with higher than expected costs to cover those with pre-existing conditions. This will come from insurers and self-insured employers who pay in proportion to the number of people they cover. The target is to raise $25 billion during 2014, amounting to $63 per covered employee. The union exemption would kick in for 2015 and 2016.
As reported in a Wall Street Journal editorial, “The unions hate this reinsurance transfer because it takes from their members in the form of higher premiums and gives to people on the exchanges.”
The union exemption deal will require that insurers who aren’t fully reimbursed by fees along with non-exempted self-insured employers will have to pay more to make up the shortfall. How will they make that up? How else but by passing on higher costs to their customers? The Department of Health and Human Services has confirmed that the fee for other non-exempt plans will be higher as a result.
Responding to union pressure, an exemption buried on page 72,340 of the December 2 Federal Register states: “Our continued study of this issue leads us to believe that this provision may reasonably be interpreted in one of two ways – it may be interpreted to mean that self-insured, self- administered plans must make reinsurance contributions, or it may be interpreted to mean that such plans are excluded from the obligation…upon further consideration of the issue, we believe the statutory language can reasonably be read…”
Yet as Betsy McCaughey points out in an Investor’s Business Daily piece, while Taft-Hartley plans self -insure and self-administer, the weasel-wording is a ruse. She writes: “That’s a lie. The ACA’s reinsurance provision doesn’t use the word ‘self-insured’ or distinguish between plans that pay their own claims and plans that hire administrators.”
Here, “self-insured” refers to a business which pays directly for its workers’ policy costs and hires an insurer as a third-party administrator to process claims and manage care. “Self-administered” plans go one step farther and manage their benefits in-house. As the Wall Street Journal observes, other than collectively-bargained Taft-Hartley plans, “Almost no business in the real world still follows this old –fashioned practice”. Such insurance covers about 20 million union members, and about four out of five Taft-Hartley trusts.
Eleven Republican senators who see the exemption as blatant congressional circumvention and cronyism by the Obama administration to curry favor with political allies have introduced a bill called the “Union Tax Fairness Act” (S. 1724) to block it. Included are U.S. Senators Orrin Hatch (R-UT), John Thune (R-SD), Lamar Alexander (R-Tenn.), James Inhofe (R-OK), David Vitter (R-LA), Mike Enzi (R-WY), Ron Johnson (R-WS), John Barrasso (R-WY), Tim Scott (R-SC), Saxby Chambliss (R-GA), and Tom Coburn (R-OK).
Senator Hatch commented: “Since the overwhelming majority of self-administered health insurance plans are run by unions, let’s call this what it is: a political payback by the administration to its union friends for backing this disastrous law. But the fact is, the White House doesn’t have the authority to change the law on its own and, as this bill makes clear, any attempt at a Big Labor carve-out from ObamaCare must be approved by Congress.”
Senator Thune said: “Unions should not be granted a special exemption from ObamaCare’s reinsurance tax just because the president fears further union backlash on his signature law. These unions agreed to pay this tax when they endorsed ObamaCare, but now that they are finding out what the law means for them and their plans, they want out. Rather than granting special backroom deals to political allies, the administration should support fairness for all by permanently delaying the law for every American.”
Senator Alexander added: “The Obama administration should not reward its labor union friends and allies who helped pass the health care law by giving them a carve-out from the law’s worst provisions. This hefty reinsurance fee is one of the many job-killing taxes that helped pay for the passage of the law – the administration should be embarrassed that it would consider exempting their union cronies without providing similar relief to our nation’s employers and faith-based and charitable organizations.”
The unions weren’t the only cronies to get a special ObamaCare break. Insurers who went along with ACA from the beginning in order to expand markets from previously uninsured populations on the taxpayer dole didn’t want any of that same medicine for themselves.
Ten giant health insurance companies, including Blue Cross/Blue Shield, Cigna and Aetna, went to the White House and received waivers allowing them to impose yearly cap limits on health coverage they provide to their own employees. Under ObamaCare, companies which aren’t exempt are required to phase out caps on annual health care benefits by 2014.
Cigna Corp., the largest waiver exemption beneficiary, was allowed to cap benefits for its 265,000 employees. This exception was granted just slightly less than one month before its CEO David M. Cordani told attendees at a November 9, 2010 Reuters Health Summit: “I don’t think it’s in our society’s best interest to expend energy in repealing the law.”
Aetna was granted a waiver on October 1, 2010 allowing it to cap benefits for its 209,423 enrollees. The company’s CEO Mark Bertolini had previously expressed mixed feelings about the legislation. Writing in a March 2010 Op/Ed which appeared in the Hartford Courant shortly after it became law, he said: “When fully implemented, the new law will have a major effect on the market…Individuals and small employers will have more options and choices. The private sector will do what it does best: innovate to solve problems,”
The BCS Insurance Group which notes on their website “We are the premier source for insurance and reinsurance for Blue Cross and Blue Shield plans” received an ObamaCare waiver for its 115,000 enrollees. In fact three divisions of Blue Cross/Blue Shield reportedly received waivers. They include Excellus Blue Cross/Blue Shield (18,860 enrollees), Blue Cross/Blue/Shield of Tennessee (20,205 enrollees), and Mountain State Blue Cross/Blue Shield with 270 enrollees.
HHS waivers from oversight rules were granted to “Medigap” policy providers which exempts them from releasing and explaining health care payment rate increases. According to the Daily Caller, AARP, the largest of these, advocated for ObamaCare to include an attack on their biggest competitor, Medicare Advantage.
AARP was a driving force behind getting ObamaCare through Congress. They conducted a $121 million advertising campaign to push it, plus spent millions more lobbying for it on Capitol Hill. After President Obama called for $313 billion in Medicare cuts to fund his signature program, Medicare Advantage took the big hit.
Broken Premises
Don’t forget that ObamaCare would have encountered the same forgotten fate as HillaryCare had it not been for the support of big unions and insurers. Perhaps recall those throngs of United Federation of Teachers (UFT) and Service Employee International Union (SEIU) members picketing the Supreme Court in favor of its approval carrying signs that read “Protect Working Families, Protect the Law”.
And they already received gratitude. Immediately after the provisions took effect, unions requested and were granted 1,231 waivers exempting 543,812 of their employees compared with only 69, 813 non-union worker exemptions.
Continued in article
Jensen Comment
With most of the millions of signing up "affordable health care" getting free
medical care under the expanded Medicaid programs or premiums subsidized by the
government, it shouldn't end up as a surprise who will really pay for medical
care in the future. That's becoming a no-brainer. Even clever millionaires such
as students with trust funds are now eligible for free Medicaid health care.
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
How to Lie With Naive Politically Correct Estimates
"Affordable Care Act: 17 Million Can Get Subsidies," by Mary Agnes
Carey, WebMD News from Kaiser Health News, November 5, 2013 ---
http://www.webmd.com/health-insurance/20131105/17-million-people-eligible-for-premium-subsidies-study-finds
Jensen Comment
Fraud is inevitable and cannot be prevented when it comes to giving out
subsidies to to insured that are not legally entitled to such subsidies.
Firstly, there's the $2 trillion underground economy where people are receiving
income that even the IRS cannot detect --- those folks who work for unreported
cash earnings. We're talking about millions of people who do not report any
income to the IRS or greatly under report their incomes ---
http://www.cs.trinity.edu/~rjensen/temp/TaxNoTax.htm
Secondly, the 17 million reported above does not jive with the estimated
49.5% (of 130 million) of taxpayers who file tax returns but do not pay any
income taxes. Some of them have incomes offset by credits such as credits for
dependents, but its likely that the nearly all of 50% of taxpayers who pay no
qualify, at least on paper, for subsidies ---
http://www.cs.trinity.edu/~rjensen/temp/TaxNoTax.htm
Most of those making more than $100,000 pay some income taxes. Bloomberg reports that 98% of those that pay no income taxes have less than $100,000 in earnings. Most are availing themselves of recent tax breaks such as energy credits, tax breaks from employer contributions to medical insurance, increased tax breaks for dependents, and deferred tax breaks such as breaks professors get for employer contributions to TIAA-CREF.
Watch the April 3, 2012 Bloomberg Video ---
http://www.bloomberg.com/video/89503501/
A family of four making less than $98,000 qualifies for a health insurance subsidy from the government.
Hence I think the 17 million estimate is wildly inaccurate unless tens of millions of those eligible for subsidies simply go uninsured because they cannot afford the deductibles even if the premiums with subsidies are affordable.
One added qualifier is the huge unknown (at least to me) number of Medicaid and Medicare recipients who are scoped out of the Affordable Health Care Act. Those on Medicaid do not pay income taxes. Most of those on Medicare do pay income taxes such that the sources of error in estimating the number of others who will actually claim subsidies under the Affordable Health Care Act is probably impossible to estimate within a 10 million range of error or more.
The enormous source of error that cannot be eliminated is that $2 trillion underground cash-only economy that takes place under the noses of the IRS enforcers of taxes.
"NBC News: "Obama Administration knew millions could not keep their health
insurance," by Bob Beauprez, Townhall, October 30, 2013 ---
http://finance.townhall.com/columnists/bobbeauprez/2013/10/30/nbc-news-obama-administration-knew-millions-could-not-keep-their-health-insurance-n1733175
When Obama repeatedly made the claim – "If you like your health plan; you can keep your health plan" – objective observers knew it wasn't so. This morning, the media is buzzing with evidence that Obama knew it was a lie, but deliberately kept spinning the same phony claim for years.
The shock in all this is not that Obama was lying; he has a well established record of that. It's that somebody has uncovered the evidence; the smoking gun. The following is the NBC News account of the mess du jour for the White House and ObamaCare.
Our sources deeply involved in the Affordable Care Act tell NBC NEWS that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.”
None of this should come as a shock to the Obama administration….
Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”
That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.
Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”
Continued in article
"5 Lies the Democrats Told To
Sell Obamacare," by John Hawkins, Townhall, June 4, 2013 ---
Click Here
http://townhall.com/columnists/johnhawkins/2013/06/04/5-lies-the-democrats-told-to-sell-obamacare-n1612356?utm_source=thdaily&utm_medium=email&utm_campaign=nl
. . .
It sounded great.
Of course, it also sounds great when a Nigerian prince offers to give you millions of dollars to help him get money into the United States. Unfortunately, those Nigerian princes with the funny names won't make you any richer, just as Presidents with funny names won't improve your health care. They'll just tell you lies like these.
1) Obamacare will cut the cost of your health care. If only. When Obamacare goes into effect next year, many Americans can expect STEEP increases in the cost of health care.
President Obama (promised)...that the cost of insurance would go down “by $2,500 per family per year.” ...In fact, the average 25 and 40-year-old will pay double under Obamacare what they would need to pay today, based on rates posted at eHealthInsurance.com (NASDAQ:EHTH). More specifically, for the typical 25-year-old male non-smoker, the average Obamacare “bronze” exchange plan in California will cost between 64 and 117 percent more than the cheapest five plans on eHealth. For 40-year-old male non-smokers, it’s between 73 and 146 percent more.2) Obamacare will not increase the deficit. Calling for a massive new government program to cut costs is sort of like moving to Death Valley for the reduced air conditioning bills. Alas, it's not so.
Obamacare will increase the long-term federal deficit by $6.2 trillion, according to a Government Accountability Office (GAO) report released today.Senator Jeff Sessions (R., Ala.), who requested the report, revealed the findings this morning at a Senate Budget Committee hearing. The report, he said, “confirms everything critics and Republicans were saying about the faults of this bill,” and “dramatically proves that the promises made assuring the nation that the largest new entitlement program in history would not add one dime to the deficit were false.”
President Obama and other Democrats attempted to win support for the health-care bill by touting it as a fiscally responsible enterprise. “I will not sign a plan that adds one dime to our deficits — either now or in the future,” Obama told a joint-session of Congress in September 2009. “I will not sign it if it adds one dime to the deficit, now or in the future, period.”
You mean Obama lied to us AGAIN? Who would have ever guessed?
3) "If you like your doctor, you will be able to keep your doctor. Period." Soon, many Americans will be happy if they can find A DOCTOR, much less THEIR DOCTOR.
Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.
The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.
Even if doctors do not quit their jobs over the ruling, America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.
What good is health care, even the bad health care we'll get through Obamacare, if you can't find a doctor to see you when you're sick?
4) Obamacare will create jobs. That would be true if you added "...at the IRS" to the end of it, but companies have already begun to move millions of workers from full to part time to avoid punitive new costs under Obamacare.
Retailers are cutting worker hours at a rate not seen in more than three decades — a sudden shift that can only be explained by the onset of ObamaCare’s employer mandates.
Nonsupervisory employees logged an average 30.0 hours per week in April, the shortest retail workweek since early 2010, Labor Department data out Friday show.
…This reversal doesn’t appear related to the economy, which has been consistently mediocre. Instead, all evidence points to the coming launch of ObamaCare, which the retail industry has warned would cause just such a result.
...One way for employers to minimize the costs of providing “affordable” coverage to modest-wage workers is to shift more work to part-time, defined as less than 30 hours per week under ObamaCare.
So not only are they going to get crummy health care, they're getting their hours cut back, too. Thanks, Obama!
5) If you like your health care plan, you'll be able to keep it. According to Obama, even though the government is about to come crashing into the health care market like a Blue Whale bellyflopping into a pond, it isn't going to have any impact at all on the insurance companies that were already swimming along. Why, if you like your own insurance, then there is nothing to worry about because you can keep it.
Yet, just last week Fox News reported,
New health insurance rules under ObamaCare could lead to a host of personal insurance plans being canceled as early as this fall, a scenario expected to cause consumer confusion.
Under the federal overhaul, those policies that cannot meet new insurance plan standards may be discontinued. This means individuals, and some small businesses, that rely on those plans will have to find new ones.
The goal is to ensure that most insurance policies offer a basic set of coverage, as part of the Obama administration's plan to cover most of the nation's 50 million uninsured.
Yet it also seems to run afoul of one of the president's best-known promises on the law: "If you like your health care plan, you'll be able to keep your health care plan."
In fact, state insurance commissioners largely are giving insurers the option of canceling existing plans or changing them to comply with new federal requirements. Large employer plans that cover most workers and their families are unlikely to be affected.
The National Association of Insurance Commissioners says it is hearing that many carriers will cancel policies and issue new ones because administratively that is easier than changing existing plans.
..."You're going to be forcibly upgraded," said Bob Laszewski, a health care industry consultant. "It's like showing up at the airline counter and being told, 'You have no choice, $300 please. You're getting a first-class ticket, why are you complaining?'"
On a personal note, as someone who buys his own insurance, the cost of my policy has gone up $50 a month since Obamacare passed and I expect it to be cancelled this fall, but I guess it's a small price to pay for us little people if it allows Barack Obama to feel like he finally accomplished something "historic."
Obamacare hasn't fully taken effect yet, but when it does, it's only going to get worse. Everything from death panels to unimaginably long waits for surgeries to bureaucrats denying effective, relatively common, currently in use treatments because they are "too expensive" are all coming down the pike. Obamacare is too much of a disaster to truly fix; so the best thing we can do right now is let this nightmare become reality, let people see how bad it is and then insist on a repeal or bust. Either the Democrats live with the disaster they've inflicted on the American people at the ballot box long term or they do the right thing and allow us to repeal this monstrosity before it does even more damage to our country.
Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm
"ObamaCare's Troubles Are Only Beginning: Be prepared for
eligibility, payment and information protection debacles—and longer waits for
care," by Michael J. Boskin, The Journal of Accountancy, December
15, 2013 ---
http://online.wsj.com/news/articles/SB10001424052702304403804579260603531505102?mod=djemEditorialPage_h
The White House is claiming that the Healthcare.gov website is mostly fixed, that the millions of Americans whose health plans were canceled thanks to government rules may be able to keep them for another year, and that in any event these people will get better plans through ObamaCare exchanges. Whatever the truth of these assertions, those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond. Here's why:
The "sticker shock" that many buyers of new, ACA-compliant health plans have experienced—with premiums 30% higher, or more, than their previous coverage—has only begun. The costs borne by individuals will be even more obvious next year as more people start having to pay higher deductibles and copays.
If, as many predict, too few healthy young people sign up for insurance that is overpriced in order to subsidize older, sicker people, the insurance market will unravel in a "death spiral" of ever-higher premiums and fewer signups. The government, through taxpayer-funded "risk corridors," is on the hook for billions of dollars of potential insurance-company losses. This will be about as politically popular as bank bailouts.
The "I can't keep my doctor" shock will also hit more and more people in coming months. To keep prices to consumers as low as possible—given cost pressures generated by the government's rules, controls and coverage mandates—insurance companies in many cases are offering plans that have very restrictive networks, with lower-cost providers that exclude some of the best physicians and hospitals.
Next year, millions must choose among unfamiliar physicians and hospitals, or paying more for preferred providers who are not part of their insurance network. Some health outcomes will deteriorate from a less familiar doctor-patient relationship.
More IT failures are likely. People looking for health plans on ObamaCare exchanges may be able to fill out their applications with more ease. But the far more complex back-office side of the website—where the information in their application is checked against government databases to determine the premium subsidies and prices they will be charged, and where the applications are forwarded to insurance companies—is still under construction. Be prepared for eligibility, coverage gap, billing, claims, insurer payment and patient information-protection debacles.
The next shock will come when the scores of millions outside the individual market—people who are covered by employers, in union plans, or on Medicare and Medicaid—experience the downsides of ObamaCare. There will be longer waits for hospital visits, doctors' appointments and specialist treatment, as more people crowd fewer providers.
Those with means can respond to the government-driven waiting lines by making side payments to providers or seeking care through doctors who do not participate in insurance plans. But this will be difficult for most people.
Next, the Congressional Budget Office's estimated 25% expansion of Medicaid under ObamaCare will exert pressure on state Medicaid spending (although the pressure will be delayed for a few years by federal subsidies). This pressure on state budgets means less money on education and transportation, and higher state taxes.
The "Cadillac tax" on health plans to help pay for ObamaCare starts four years from this Jan. 1. It will fall heavily on unions whose plans are expensive due to generous health benefits.
In the nearer term, a political iceberg looms next year. Insurance companies usually submit proposed pricing to regulators in the summer, and the open enrollment period begins in the fall for plans starting Jan. 1. Businesses of all sizes that currently provide health care will have to offer ObamaCare's expensive, mandated benefits, or drop their plans and—except the smallest firms—pay a fine. Tens of millions of Americans with employer-provided health plans risk paying more for less, and losing their policies and doctors to more restrictive networks. The administration is desperately trying to delay employer-plan problems beyond the 2014 election to avoid this shock.
Meanwhile, ObamaCare will lead to more part-time workers in some industries, as hours are cut back to conform to arbitrary definitions in the law of what constitutes full-time employment. Many small businesses will be cautious about hiring more than 50 full-time employees, which would subject them to the law's employer insurance mandate.
On the supply side, medicine will become a far less attractive career for talented young people. More doctors will restrict practice or retire early rather than accept lower incomes and work conditions they did not anticipate. Already, many practices are closed to Medicaid recipients, some also to Medicare. The pace of innovation in drugs, medical devices and delivery is expected to slow significantly, as higher taxes and even rationing set in.
The repeated assertions by the law's supporters that nobody but the rich would be worse off was based on a beyond-implausible claim that one could expand by millions the number of people with health insurance, lower health-care costs without rationing, and improve quality. The reality is that any squeezing of insurance-company profits, or reduction in uncompensated emergency-room care amounts to a tiny fraction of the trillions of dollars extracted from those people overpaying for insurance, or redistributed from taxpayers.
The Affordable Care Act's disastrous debut sent the president's approval ratings into a tailspin and congressional Democrats in competitive districts fleeing for cover. If the law's continuing unpopularity enables Republicans to regain the Senate in 2014, the president will be forced to veto repeated attempts to repeal the law or to negotiate major changes.
It is exceptionally difficult -- for all practical
purposes, impossible," writes Eberstadt, "for a medical professional to disprove
a patient's claim that he or she is suffering from sad feelings or back pain. In
other words, many people are gaming or defrauding the system. This includes not
only disability recipients but health care professionals, lawyers and others who
run ads promising to get you disability benefits. Between 1996 and 2011, the
private sector generated 8.8 million new jobs, and 4.1 million people entered
the disability rolls.
Michael Barone, "Men Find
Careers in Collecting Disability," ---
Click Here
http://townhall.com/columnists/michaelbarone/2012/12/03/men_find_careers_in_collecting_disability?utm_source=thdaily&utm_medium=email&utm_campaign=nl
Jensen Comment
Even after one or more spine surgeries it is virtually impossible to determine
whether remaining pain is real or faked. I can claim first hand that after 15
spine surgeries and metal rods from neck to hip that my wife's suffering is
real. However, I know of at least two instances where the disability careers are
faked in order to get monthly lifetime disability payments and access to
Medicare long prior to age 65. This seems to be one of the unsolvable problems
in society that becomes even more problematic when a disability career is easier
to enter than a job-like career.
Two Ivy League Professors Slugging It Out in a Political Arena
Harvard History Professor Niall Ferguson ---
http://en.wikipedia.org/wiki/Niall_Ferguson
Princeton Economics Professor Paul Krugman ---
http://en.wikipedia.org/wiki/Paul_Krugman
"Kinds Of Wrong," by Paul Krugman, The New York Times, August
21, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/21/kinds-of-wrong/
Looking at the comments on my Niall Ferguson takedown (see Ezra Klein, Matthew O’Brien, James Fallows, and Noah Smith for more), I found my memory jogged about a point I’ve been meaning to make about the nature of error in economics.
It seems to me that when readers declare that some piece of economics commentary is “wrong”, they often confuse three different notions of wrongness, which are neither intellectually nor morally equivalent.
First, there’s the ordinary business of expressing a view about the economy that the reader disagrees with – e.g., “Krugman is wrong, because the government can’t create jobs”; or, if you prefer, “Casey Mulligan is wrong, because we’re suffering from demand problems, not supply problems.” Obviously it’s OK to say things like this, and sometimes the criticism is correct. (I’m not wrong, but Mulligan is!) But equally obviously, there’s nothing, er, wrong about being wrong in this sense: people will disagree, and that’s legitimate.
Second, and much less legitimate, is the kind of wrongness that involves making assertions that are logically or empirically indefensible. I’d put the Cochrane/Fama claims that government spending can’t increase demand as a matter of accounting in this category; this is a basic conceptual error, which goes beyond mere difference of opinion. And economists who are wrong in this sense should pay a professional price.
That said, I don’t think it’s realistic to expect the news media to be very effective at policing this kind of wrongness. If professors with impressive-sounding credentials spout nonsense, it’s asking too much of a newspaper or magazine serving the broader public to make the judgment that they actually have no idea what they’re talking about.
Matters are quite different when it comes to the third kind of wrongness: making or insinuating false claims about readily checkable facts. The case in point, of course, is Ferguson’s attempt to mislead readers into believing that the CBO had concluded that Obamacare increases the deficit. This was unethical on his part – but Newsweek is also at fault, because this is the sort of thing it could and should have refused to publish.
Now, I don’t expect a publication that responds to daily or weekly news to do New Yorker-style fact checking. But it should demand that anyone who writes for it document all of his or her factual assertions – and an editor should check that documentation to see that it actually matches what the writer says.
Continued in article
"Unethical Commentary, Newsweek Edition," by Paul Krugman,
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/
¶There are multiple errors and misrepresentations in Niall Ferguson’s cover story in Newsweek — I guess they don’t do fact-checking — but this is the one that jumped out at me. Ferguson says:
¶The president pledged that health-care reform would not add a cent to the deficit. But the CBO and the Joint Committee on Taxation now estimate that the insurance-coverage provisions of the ACA will have a net cost of close to $1.2 trillion over the 2012–22 period.
¶Readers are no doubt meant to interpret this as saying that CBO found that the Act will increase the deficit. But anyone who actually read, or even skimmed, the CBO report (pdf) knows that it found that the ACA would reduce, not increase, the deficit — because the insurance subsidies were fully paid for.
¶Now, people on the right like to argue that the CBO was wrong. But that’s not the argument Ferguson is making — he is deliberately misleading readers, conveying the impression that the CBO had actually rejected Obama’s claim that health reform is deficit-neutral, when in fact the opposite is true.
¶More than that: by its very nature, health reform that expands coverage requires that lower-income families receive subsidies to make coverage affordable. So of course reform comes with a positive number for subsidies — finding that this number is indeed positive says nothing at all about the impact on the deficit unless you ask whether and how the subsidies are paid for. Ferguson has to know this (unless he’s completely ignorant about the whole subject, which I guess has to be considered as a possibility). But he goes for the cheap shot anyway.
¶Continued in article
Jensen Comment
The CBO assumes that the requirement (just upheld by a Supreme Court decision)
that all people in the United States have health insurance or otherwise will
have health insurance premiums deducted from their tax refunds that will fund
the added cost of covering current poor people needing subsidies for health
insurance coverage. This is what Krugman means above when he assumes "the
insurance subsidies are fully paid for." This is why the Affordable Health Care
Act (ACA) tried to get states to raise the number of people receiving state
subsidies for Medicaid. About half the states, however, are refusing to along
with the expanded coverage under Medicaid. This means that more higher-end low
income people will depend on the ACA "subsidies" instead of Medicaid coverage
from federal and state Medicaid funding.
It seems to be a matter of semantics whether these tax return add-ons are a tax or not, but Krugman (probably rightfully) ignores this matter of semantics. But since about half the taxpayers in the U.S. pay no income taxes and over 90% of them are below the median in earnings it's not clear whether enough insurance premiums expected to be collected will really be collected. The CBO may have been planning on an economic recovery that perhaps will never materialize in this new era of global competition with Asia. The CBO expectations of lower unemployment may not materialize (currently there are nearly 13 million unemployed people not counting the many who've simply given up looking for work or received fraudulent Social Security lifetime disability awards). The required subsidies in reality may greatly exceed the added premiums "tax" collected. But nobody, including the CBO, knows what deficits will become.
Also it's not at all clear that the CBO correctly estimated health care claims given the double-digit inflation in the cost of medical services. This is the real Achilles Heel of the Affordable Health Care Act. The costs of actually providing the promised services in the future may greatly exceed expectations.
What may be more subject to dispute is how accurate the CBO is on estimating future costs of bringing on people who have prior conditions that prevent them from currently being able to obtain health care coverage. I'm definitely in favor of providing affordable coverage to these people with prior conditions. But I think the eventual coverage costs will exceed CBO estimates since many of them need high-cost organ transplants and other very expensive medical services.
Professor Krugman has a very loyal crowd of liberal followers who seldom
disagree with his liberal politics.
The comment of NS
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/
I am very surprised by the hysterical reaction of many readers to Krugman's comment. The point of the argument is what the HBO report says. Does Ferguson lie about the HBO report in his Newsweek article? Either Ferguson or Krugman is correct. I would expect readers disagreeing with Krugman to provide quotations from the HBO report showing that he is wrong and that Ferguson is right.
Instead of that I see a lot of ideological delirium in too many of the comments.
NS, Paris, France
Comment of Laurie Wick
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/
I cancelled my subscription to Newsweek today. I do not need this kind of uninformed blather in my home. If I feel the need to read/hear totally unfactual, biased reporting, I can just turn on FOX news at any hour of the day or night. Which I will never do.
Laurie Wick
Jensen Comment
Actually, since Tina Brown became editor, Newsweek became a liberal feminist magazine. Niall Ferguson's column is only there for tokenism. The Ferguson cover story is most likely a desperate attempt to recover the millions of conservative subscribers who've defected since Tina Brown took over. One of the recent cover's of Newsweek accuses Candidate Romney of "being a Wimp." Are you sure you want to cancel Newsweek Laurie?
The Comment of J. Philip
The New York Times, August 19, 2012 ---
http://krugman.blogs.nytimes.com/2012/08/19/unethical-commentary-newsweek-edition/
FTA: "health reform that expands coverage requires that lower-income families receive subsidies to make coverage affordable. "
And, exactly,. Mr. Krugman, where do you think those subsidies are gonna come from? You can continue to carry Obama's water that's what you get paid to do, but the rest of us know a TAX when we see one.
J. Phillip
Closing Jensen Comment
I wish the Democrats had rammed a national health care plan down our throats in
that short window of time 2008-2010 when they controlled the entire executive
and legislative branches of the federal government. Instead we ended up with a
bastardized public-private ACA that pleases neither the left nor the right. I am
inclined to believe that the ACA will always have insurance premiums falling way
short of costs of delivering medical services. Whether or not this adds to the
deficit is simply a matter of accounting gimmicks the familiar governmental
accounting shell game ---
http://faculty.trinity.edu/rjensen/Theory02.htm#GovernmentalAccounting
Bob Jensen's threads on the ACA are at
http://faculty.trinity.edu/rjensen/Health.htm
Paul Ryan on the Affordable Health Care Act ---
http://www.youtube.com/watch?
The larger reality is that Medicare cannot and will
not continue as it is, as the President used to admit. A sampler of his rhetoric
from the town-hall summer of 2009: "Mark my words," he declared in Grand
Junction, Colorado, "Medicare in about eight to nine years goes into the red. .
. . It is going broke." He added in Portsmouth, New Hampshire, that "What is
truly scary—what is truly risky—is if we do nothing" because Medicare is
"unsustainable" and "running out of money." In Belgrade, Montana, he said the
program must be reformed "to be there for the next generation, not just for this
generation."What he rarely mentions is how he plans to fix
Medicare under ObamaCare. First the government will do things like arbitrarily
commanding providers to deliver the exact same benefits except for $716 billion
less. When that doesn't work, as it surely won't, the feds will take control of
the case-by-case decisions currently made between patients and doctors and
substitute the judgment of technocrats. (See what's already happening in
Massachusetts, "RomneyCare 2.0," August 6.)
"The Mediscare Boomerang," The Wall Street Journal, August 16, 2012 ---
http://professional.wsj.com/article/SB10000872396390444772404577587464183295348.html?mod=djemEditorialPage_t&mg=reno64-wsj
It's Unethical as it Gets in the Whitehouse
"Axelrod's ObamaCare Dollars Emails suggest the White House pushed business
to the presidential adviser's former firm to sell the health-care law," by
Kimberly A. Strassel, The Wall Street Journal, June 21, 2012 ---
http://professional.wsj.com/article/SB10001424052702304765304577480871706139792.html?mod=djemEditorialPage_t&mg=reno-wsj
Rewind to 2009. The fight over ObamaCare is raging, and a few news outlets report that something looks ethically rotten in the White House. An outside group funded by industry is paying the former firm of senior presidential adviser David Axelrod to run ads in favor of the bill. That firm, AKPD Message and Media, still owes Mr. Axelrod money and employs his son.
The story quickly died, but emails recently released by the House Energy and Commerce Committee ought to resurrect it. The emails suggest the White House was intimately involved both in creating this lobby and hiring Mr. Axelrod's firm—which is as big an ethical no-no as it gets.
Mr. Axelrod—who left the White House last year—started AKPD in 1985. The firm earned millions helping run Barack Obama's 2008 campaign. Mr. Axelrod moved to the White House in 2009 and agreed to have AKPD buy him out for $2 million. But AKPD chose to pay Mr. Axelrod in annual installments—even as he worked in the West Wing. This agreement somehow passed muster with the Office of Government Ethics, though the situation at the very least should have walled off AKPD from working on White-House priorities.
It didn't. The White House and industry were working hand-in-glove to pass ObamaCare in 2009, and among the vehicles supplying ad support was an outfit named Healthy Economy Now (HEN). News stories at the time described this as a "coalition" that included the Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association, and labor groups—suggesting these entities had started and controlled it.
House emails show HEN was in fact born at an April 15, 2009 meeting arranged by then-White House aide Jim Messina and a chief of staff for Democratic Sen. Max Baucus. The two politicos met at the Democratic Senatorial Campaign Committee (DSCC) and invited representatives of business and labor.
A Service Employees International Union attendee sent an email to colleagues noting she'd been invited by the Baucus staffer, explaining: "Also present was Jim Messina. . . . They basically want to see adds linking HC reform to the economy. . . . there were not a lot of details, but we were told that we wd be getting a phone call. well that call came today."
The call was from Nick Baldick, a Democratic consultant who had worked on the Obama campaign and for the DSCC. Mr. Baldick started HEN. The only job of PhRMA and others was to fund it.
Meanwhile, Mr. Axelrod's old firm was hired to run the ads promoting ObamaCare. At the time, a HEN spokesman said HEN had done the hiring. But the emails suggest otherwise. In email after email, the contributors to HEN refer to four men as the "White House" team running health care. They included John Del Cecato and Larry Grisolano (partners at AKPD), as well as Andy Grossman (who once ran the DSCC) and Erik Smith, who had been a paid adviser to the Obama presidential campaign.
In one email, PhRMA consultant Steve McMahon calls these four the "WH-designated folks." He explains to colleagues that Messrs. Grossman, Grisolano and Del Cecato "are very close to Axelrod," and that "they have been put in charge of the campaign to pass health reform." Ron Pollack, whose Families USA was part of the HEN coalition, explained to colleagues that "the team that is working with the White House on health-care reform. . . . [Grossman, Smith, Del Cecato, Grisolano] . . . would like to get together with us." This would provide "guidance from the White House about their messaging."
According to White House visitor logs, Mr. Smith had 28 appointments scheduled between May and August—17 made through Mr. Messina or his assistant. Mr. Grossman appears in the logs at least 19 times. Messrs. Del Cecato and Grisolano of AKPD also visited in the spring and summer, at least twice with Mr. Axelrod, who was deep in the health-care fight.
A 2009 PhRMA memo also makes clear that AKPD had been chosen before PhRMA joined HEN. It's also clear that some contributors didn't like the conflict of interest. When, in July 2009, a media outlet prepared to report AKPD's hiring, a PhRMA participant said: "This is a big problem." Mr. Baldick advises: "just say, AKPD is not working for PhRMA." AKPD and another firm, GMMB, would handle $12 million in ad business from HEN and work for a successor 501(c)4.
A basic rule of White House ethics is to avoid even the appearance of self-dealing or nepotism. If Mr. Axelrod or his West Wing chums pushed political business toward Mr. Axelrod's former firm, they contributed to his son's salary as well as to the ability of the firm to pay Mr. Axelrod what it still owed him. Could you imagine the press frenzy if Karl Rove had dome the same after he joined the White House?
Continued in article
"Study: Obama's Health Care Law Would Raise Deficit," SmartPros,
April 10, 2012 ---
http://accounting.smartpros.com/x73682.xml
Reigniting a debate about the bottom line for President Barack Obama's health care law, a leading conservative economist estimates in a study to be released Tuesday that the overhaul will add at least $340 billion to the deficit, not reduce it.
Charles Blahous, who serves as public trustee overseeing Medicare and Social Security finances, also suggested that federal accounting practices have obscured the true fiscal impact of the legislation, the fate of which is now in the hands of the Supreme Court.
Officially, the health care law is still projected to help reduce government red ink. The Congressional Budget Office, the government's nonpartisan fiscal umpire, said in an estimate last year that repealing the law actually would increase deficits by $210 billion from 2012 to 2021.
The CBO, however, has not updated that projection. If $210 billion sounds like a big cushion, it's not. The government has recently been running annual deficits in the $1 trillion range.
The White house dismissed the study in a statement late Monday. Presidential assistant Jeanne Lambrew called the study "new math (that) fits the old pattern of mischaracterizations" about the health care law.
Blahous, in his 52-page analysis released by George Mason University's Mercatus Center, said, "Taken as a whole, the enactment of the (health care law) has substantially worsened a dire federal fiscal outlook.
"The (law) both increases a federal commitment to health care spending that was already unsustainable under prior law and would exacerbate projected federal deficits relative to prior law," Blahous said.
The law expands health insurance coverage to more than 30 million people now uninsured, paying for it with a mix of Medicare cuts and new taxes and fees.
Blahous cited a number of factors for his conclusion:
- The health care's law deficit cushion has been reduced by more than $80 billion because of the administration's decision not to move forward with a new long-term care insurance program that was part of the legislation. The Community Living Assistance Services and Supports program raised money in the short term, but would have turned into a fiscal drain over the years.
- The cost of health insurance subsidies for millions of low-income and middle-class uninsured people could turn out to be higher than forecast, particularly if employers scale back their own coverage.
- Various cost-control measures, including a tax on high-end insurance plans that doesn't kick in until 2018, could deliver less than expected.
The decision to use Medicare cuts to finance the expansion of coverage for the uninsured will only make matters worse, Blahous said. The money from the Medicare savings will have been spent, and lawmakers will have to find additional cuts or revenues to forestall that program's insolvency.
Under federal accounting rules, the Medicare cuts are also credited as savings to that program's trust fund. But the CBO and Medicare's own economic estimators already said the government can't spend the same money twice.
Continued in article
Freakonomics
"Here’s Why Health Care Costs Are Outpacing Health Care Efficacy," by
Stephen J. Dubner, Freakonomics.com, April 18, 2011 ---
http://www.freakonomics.com/2011/04/18/heres-why-health-care-costs-are-outpacing-health-care-efficacy/
In a new working paper called “Technology Growth and Expenditure Growth in Health Care” (abstract here, PDF here), Amitabh Chandra and Jonathan S. Skinner offer an explanation:
In the United States, health care technology has contributed to rising survival rates, yet health care spending relative to GDP has also grown more rapidly than in any other country. We develop a model of patient demand and supplier behavior to explain these parallel trends in technology growth and cost growth. We show that health care productivity depends on the heterogeneity of treatment effects across patients, the shape of the health production function, and the cost structure of procedures such as MRIs with high fixed costs and low marginal costs. The model implies a typology of medical technology productivity: (I) highly cost-effective “home run” innovations with little chance of overuse, such as anti-retroviral therapy for HIV, (II) treatments highly effective for some but not for all (e.g. stents), and (III) “gray area” treatments with uncertain clinical value such as ICU days among chronically ill patients. Not surprisingly, countries adopting Category I and effective Category II treatments gain the greatest health improvements, while countries adopting ineffective Category II and Category III treatments experience the most rapid cost growth. Ultimately, economic and political resistance in the U.S. to ever-rising tax rates will likely slow cost growth, with uncertain effects on technology growth.
This paper strikes me as sensible, explanatory, and non-ideological to the max. It would be nifty if the people who work in Washington read it, and thought about it, and maybe even acted on it. (And it would be nifty if the Knicks beat the Celtics too, but I’m not holding my breath for either outcome …)
Here’s a very good paragraph from the paper:
The science section of a U.S. newspaper routinely features articles on new surgical and pharmaceutical treatments for cancer, obesity, aging, and cardiovascular diseases, with rosy predictions of expanded longevity and improved health functioning (Wade, 2009). The business section, on the other hand, features gloomy reports of galloping health insurance premiums (Claxton et al., 2010), declining insurance coverage, and unsustainable Medicare and Medicaid growth leading to higher taxes (Leonhardt, 2009) and downgraded U.S. debt (Stein, 2006). Not surprisingly, there is some ambiguity as to whether these two trends, in outcomes and in expenditures, are a cause for celebration or concern.
And the authors offer good specific examples of what they built their argument on, noting the …
Continued in article
"The Truth About Health Care Reform and the Economy: Separating economic fact from economic myth," by Veronique de Rugy, Reason Magazine, April 15, 2011 --- http://reason.com/archives/2011/04/15/the-truth-about-health-care-re
Myth 1: Health care reform will reduce the deficit.
Fact 1: Health care reform will increase the deficit.
The Patient Protection and Affordable Care Act includes many provisions that have nothing to do with health care: the CLASS act, a student loan overhaul, and many new taxes. These provisions don't change the health care system. They just raise money to pay for the new law. Strip them away and the law’s actual health care provisions don't lower the deficit—they increase it!
The chart below uses data from Congressional Budget Office (CBO) to clarify the fiscal consequences of health care reform.
. . .
As you can see, from 2012 to 2021, the Congressional Budget Office estimates that the health care act will reduce deficits by $210 billion (note that this estimate differs from the widely cited $143 billion figure used during the lead-up to the passage of the act). During this same time period, however, the actual health care reform provisions of the law will increase deficits by $464 billion.
Of course, one should not evaluate the health care legislation on its fiscal impacts alone. In theory we should get some fiscal benefits. But the key question is how they net out. Still, no matter what you think about the benefits of the health care legislation, it is incorrect to claim that health care reform will save money. It won’t.
Myth 2: The U.S. health care system is a free-market system.
Fact 2: Roughly half of all U.S. health care is currently paid for by the government.
. . .
Even in the absence of the health care reform law, government programs including Medicare and Medicaid already fund almost half of American health care. Roughly a third of the remaining expenditures are funded by private insurers—mainly through subsidized and highly regulated employee plans. Not exactly a free market.
As this chart shows, state and federal entities make up over half of the health insurance market. Of course, the Patient Protection and Affordable Care Act will only increase the share of government involvement in the health care market.
Myth 3: Medicare spending increases life expectancy for seniors. Reductions in Medicare spending will therefore reduce their life expectancy.
Fact 3: Increases in life expectancy for seniors are due to increased access to health care, not to Medicare.
While Medicare spending has certainly decreased seniors’ out of pocket health care expenses (by 1970, Medicare reduced out of pocket expenses by an estimated 40 percent relative to pre-Medicare levels), the program’s effect on mortality is much less clear.
. . .
Continued in article
"Mayberry OMG: Those false ads cost taxpayers $3.5 million,"
The Wall Street Journal, March 25, 2011 ---
|http://online.wsj.com/article/SB10001424052748704604704576220640964310506.html#mod=djemEditorialPage_t
President Obama met with the winner of the "save award" in the Oval Office the other day, the contest for federal employees who find ways to make government more efficient. Trudy Givens, of Portage, Wisconsin, suggested that the feds stop mailing out paper copies of the Federal Register (available online since 1994) to the provinces. Her good idea will cut about $4 million a year in printing and postage.
We don't work for the government, but here's our "save" suggestion: How about not spending some $3.5 million to deceptively promote ObamaCare?
It turns out it cost the Health and Human Services Department $2.78 million to buy airtime for three cable TV ads last year, featuring Andy Griffith praising the new entitlement. The "Matlock" eminence rendered his services pro bono, but Porter Novelli didn't. The media consulting firm racked up 668 billable hours and earned $404,384.40 producing the spots, according to documents released by the outside GOP advocacy group Crossroads GPS through the Freedom of Information Act.
At least Porter Novelli didn't charge taxpayers for fact-checking. Among Mr. Griffith's many deceptive claims, he tells his fellow seniors that their Medicare benefits won't change (they will, most immediately in Medicare Advantage) and that ObamaCare strengthens the program's finances (it doesn't, according to the chief Medicare actuary). Lovable ol' Andy of Mayberry then says "that new health-care law sure sounds good" to him, in a transparent bid to win over senior voters in advance of the 2010 election.
The next time the President wants to run misleading ads ahead of an election, he might hit up the Democratic Party or use his bully pulpit, rather than passing the bill to taxpayers. Meantime, an Administration functionary says in a new promotional Web video for the save award—how much did that one cost to produce?—that "Something that seems relatively small if replicated over the full length of the federal government can really result in substantial savings."
How about we go one better and save several trillion dollars by repealing a health-care bill that Americans still hate despite Sheriff Andy's endorsement?
"PolitiFiction True 'lies' about ObamaCare," The Wall Street
Journal, December 23, 2010 ---
http://online.wsj.com/article/SB10001424052748703886904576031630593433102.html?mod=djemEditorialPage_t
So the watchdog news outfit called PolitiFact has decided that its "lie of the year" is the phrase "a government takeover of health care." Ordinarily, lies need verbs and we'd leave the media criticism to others, but the White House has decided that PolitiFact's writ should be heard across the land and those words forever banished to describe ObamaCare.
"We have concluded it is inaccurate to call the plan a government takeover," the editors of PolitiFact announce portentously. "'Government takeover' conjures a European approach where the government owns the hospitals and the doctors are public employees," whereas ObamaCare "is, at its heart, a system that relies on private companies and the free market." PolitiFact makes it sound as if ObamaCare were drawn up by President Friedrich Hayek, with amendments from House Speaker Ayn Rand.
This purported debunking persuaded Stephanie Cutter, a special assistant to the President. If "opponents of reform haven't been shy about making claims that are at odds with the facts," she wrote on the White House blog, "one piece of misinformation always stood out: the bogus claim . . ." We'll spare you the rest.
PolitiFact's decree is part of a larger journalistic trend that seeks to recast all political debates as matters of lies, misinformation and "facts," rather than differences of world view or principles. PolitiFact wants to define for everyone else what qualifies as a "fact," though in political debates the facts are often legitimately in dispute.
For instance, everyone can probably agree that Medicare's 75-year unfunded liability is somewhere around $30.8 trillion. But that's different from a qualitative judgment, such as the wisdom of a new health-care entitlement that was sold politically as a way to reduce entitlement spending. But anyway, let's try to parse PolitiFact's ObamaCare reasoning.
Evidently, it doesn't count as a government takeover unless the means of production are confiscated. "The government will not seize control of hospitals or nationalize doctors," the editors write, and while "it's true that the law does significantly increase government regulation of health insurers," they'll still be nominally private too.
In fact—if we may use that term without PolitiFact's seal of approval—at the heart of ObamaCare is a vast expansion of federal control over how U.S. health care is financed, and thus delivered. The regulations that PolitiFact waves off are designed to convert insurers into government contractors in the business of fulfilling political demands, with enormous implications for the future of U.S. medicine. All citizens will be required to pay into this system, regardless of their individual needs or preferences. Sounds like a government takeover to us.
PolitiFact is run by the St. Petersburg Times and has marketed itself to other news organizations on the pretense of impartiality. Like other "fact checking" enterprises, its animating conceit is that opinions are what ideologues have, when in reality PolitiFact's curators also have political views and values that influence their judgments about facts and who is right in any debate.
In this case, they even claim that the government takeover slogan "played an important role in shaping public opinion about the health-care plan and was a significant factor in the Democrats' shellacking in the November elections." In other words, voters turned so strongly against Democrats because Republicans "lied," and not because of, oh, anything the Democrats did while they were running Congress. Is that a "fact" or a political judgment? Just asking.
As long as the press corps is nominating "lies of the year," ours goes to the formal legislative title of ObamaCare, the Patient Protection and Affordable Care Act. For a bill that in reality will raise health costs and reduce patient choice, the name recalls Mary McCarthy's famous line about every word being a lie, including "the" and "and."
"Bachmann Exposes $105 Billion Secret," by Phyllis Schlaffy,
Townhall, March 15, 2011 ---
http://townhall.com/columnists/phyllisschlafly/2011/03/15/bachmann_exposes_$105_billion_secret
When ObamaCare was passed by the Senate on Christmas Eve of 2009, senators had less than 72 hours to compare a 383-page package of amendments to the 2,074-page bill. Public outrage over backroom deals (such as the Cornhusker Kickback and the Louisiana Purchase) led to the election of Scott Brown in Massachusetts.
Democrats then cooked up a plan to link the now-2,409-page Senate-passed ObamaCare bill to dozens of amendments contained in a separate 150-page Budget Reconciliation bill that could pass both houses by a simple majority. That's when then-Speaker Nancy Pelosi famously told the then-Democratic majority, "We have to pass the bill so that you can find out what is in it."
When President Obama signed ObamaCare into law, that set in motion a series of funding triggers and money transfers that add up to $105,464,000,000 in pre-authorized appropriations that are scheduled to be paid up through FY2019. In laymen's language, that means writing postdated checks that are guaranteed to be paid out over the next eight years.
This money was divided into dozens of smaller amounts so the big total would not be apparent. For example, Section 2953 of ObamaCare included a pre-funded appropriation of $75 million a year for five years to "educate adolescents" in "adult preparation subjects" such as "stress management" and "the development of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects."
Section 4101(a) of ObamaCare prefunded $200 million a year over four years for the construction of school-based health centers. In Section 4002, a total of $17,750,000,000 will be deposited over 10 years to a discretionary account controlled by the HHS secretary (currently Kathleen Sebelius), who may spend that money "to provide for expanded and sustained national investment in prevention" and to "help restrain the rate of growth in private and public sector health care costs."
Continued in article
White did President Obama turn down IBM's offer to, for free, to detect
medical fraud?
Video: Did White House Snub Fraud Fighter?
http://news.yahoo.com/video/politics-15749652/did-white-house-snub-fraud-fighter-22352314
Is Medicare a "Medicare is a good example of a government program that is highly efficient?"
-----Original Message-----
From: AECM, Accounting Education using Computers and Multimedia [mailto:AECM@LISTSERV.LOYOLA.EDU] On Behalf Of Peters, James M Sent: Thursday, September 23, 2010 10:37 AM
To: AECM@LISTSERV.LOYOLA.EDU
Subject: Re: accounting basicsI think it is time to push back against all this anti-government rhetoric that just isn't based on observed evidence. Whether goverments work best or markets work best is a function of the task to be performed and the nature of the product. Governments have proven they can provide better health insurance and health care than the private sector. Medicare is a good example of a goverment program that is highly efficient and spends 97% of your tax dollars on health care while private sector firms spend only 70% to 75% of your premium dollars on health care. Some firms reach 80%, but they are the exception. Government run hospitals in the US are now rated as among the best, if not the best in the nation. The Veterans Hospitals have better records of treatment success and lower costs that the vast majority of private hospitals.
Market advocates seem to forget free market theory. Free markets only work when certain, rather restrictive conditions are met. Among the most frequently violated are equal power and knowledge among all market participants. Even Adam Smith in the Wealth of Nations advocated a strong role for governments in keeping markets free. When conditions are right, markets work brilliantly. However, (a rhetorical question) how many market in the industrialize world really meet the conditions of truly free markets? My answer is very few.
Governments do some things much better than markets. The key is recognizing the market conditions that lead to government advantage and letting governments handle those areas. Auditing is a prime candidate for government intervention because of no auditor can truly be objective when they are being paid by the client. The markets cannot function properly in auditing because the true customer, the general public, isn't a party to the transaction. Audits aren't just for the current owners, they are for perpsective owners as well, which means the general public. The general public needs to be represented at the table when auditors are hired.
The other key is to recognize that governments fail when people fail to be informed voters. All governments, like all markets, are not made equal. Some work better than others. In democracies, the effectiveness of the government is a function of the involvement and knowledge of the electorate. Thus, we are all responsible for our own government's success and failures. The fact that America seems to have a disfunctional government right now is that we have a disfunctional electorate that seems to enjoy mindless shouting matches over informed policy dialog. Other nations don't suffer from this disease.
Let's all join John Stewart in Washington DC for the "Return Sanity to America" rally. It is a start to building a government that can live up to its potential.
Jim
September 23, 2010 reply from Bob Jensen
Hi Jim,
If this is your idea of "observed evidence" then I've no hope for you in the academy. For one thing a good academic would be more precise about definitions like “better health care.” For example, some other nations come out “better” in infant mortality because they throw away very premature small babies and don’t count them into survival rates. What does “better” mean in terms of who invents the latest and greatest medications to fight cancer?
Medicare, for example, is one of the least-efficient government programs that arguably has the worst internal accounting controls of all other government programs except, possibly, the defense program. An "efficient" program would have stellar internal controls preventing fraud and error.
President Obama repeatedly asserts that "Medicare and Medicaid are largest deficit drivers" ---
http://www.politifact.com/truth-o-meter/statements/2009/jun/25/barack-obama/obama-says-medicare-and-medicaid-are-largest-defic/And Medicare is not a very good example of "government" efficiency since the private sector delivers virtually all the medical services. The Medicare service providers are notoriously inefficient by prescribing billions of dollars in unneeded services, medications, non-existent medical equipment, and lifetime disability benefits to crooks that are not disabled.
I don't care to continue on in the AECM with debates over extreme political dogma since this is truly outside what subscribers expect from the AECM. They wanted to learn more about the PwC re-branding and the future of auditing/assurance services. I doubt that they want to hear a rant about joining a Glenn Beck-bashing by Jon Stewart in Washington DC. Most of us do not support the extremes of Beck or Stewart and certainly do not want the AECM to be a rallying call for either extreme. That is not in the mission of the AECM.
Also I see no need to censor the other subscribers of the AECM if they happen to disagree with Jim Peterson’s political dogma. Even if I were a Glenn Beck supporter (which I’m not) I would not urge AECM subscribers to join me in Beck’s big Washington DC rally (where you would never find me).
It’s a free country, and I suspect you will be among the Glenn Beck bashers at Jon Stewart’s rally for liberals. But I don’t think you should plead with AECM subscribers to join you in this political burning of Beck’s books.
Bob Jensen
In 2009 President Barack Obama is engineering a universal health care bill by appealing to the with blatant and deceitful estimates of costs in a muddled up system of inclusions of social services that are only remotely linked to health care (such as marriage counseling).
Note that I’m not in favor of repealing the recent legislation. But I am in favor of adding a public option so long as taxation and insurance premiums are added to fully cover the annual costs of health insurance. And let's stop the BS on the left and on the right side of this debate.
Some of the blatant lies are as follows:
Fuzzy CBO Accounting Tricks
"ObamaCare by the Numbers: Part 2," by John Cassidy, The New Yorker,
March 2010 ---
http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html
This is a long and somewhat involved followup to my previous post on ObamaCare. . For those of you with O.A.D.D. (online attention-deficit disorder), I’ve provided an express and local version.
EXPRESS:
The official projections for health-care reform, which show it greatly reducing the number of uninsured and also reducing the budget deficit, are simply not credible. There are three basic issues.
The cost and revenue projections rely on unrealistic assumptions and accounting tricks. If you make some adjustments for these, the cost of the plan is much higher.
The so-called “individual mandate” isn’t really a mandate at all. Under the new system, many young and healthy people will still have a strong incentive to go uninsured.
Once the reforms are up and running, some employers will have a big incentive to end their group coverage plans and dump their employees onto the taxpayer-subsidized individual plans, greatly adding to their cost.
LOCAL:
For future reference (or possibly to roll up and beat myself over the head with in my dotage) I have filed away a copy the latest analysis (pdf) of health-care reform from the Congressional Budget Office. By 2019, it says, the bills passed by the House and Senate will have cut the number of uninsured Americans by thirty-two million, raised the percentage of people with some form of health-care coverage from eighty-three per cent to ninety-four per cent, and reduced the federal deficit by a cumulative $143 billion. If all of these predictions turn out to be accurate, ObamaCare will go down as one of the most successful and least costly government initiatives in history. At no net cost to the taxpayer, it will have filled a gaping hole in the social safety net and solved a problem that has frustrated policymakers for decades.
Does Santa Claus live after all? According to the C.B.O., between now and 2019 the net cost of insuring new enrollees in Medicaid and private insurance plans will be $788 billion, but other provisions in the legislation will generate revenues and cost savings of $933 billion. Subtract the first figure from the second and—voila!—you get $143 billion in deficit reduction.
The first objection to these figures is that the great bulk of the cost savings—more than $450 billion—comes from cuts in Medicare payments to doctors and other health-care providers. If you are vaguely familiar with Washington politics and the letters A.A.R.P. you might suspect that at least some of these cuts will fail to materialize. Unlike some hardened skeptics, I don’t think none of them will happen. One part of the reform involves reducing excessive payments that the Bush Administration agreed to when it set up the Medicare Advantage program in 2003. If Congress remains under Democratic control—a big if, admittedly—it will probably enact these changes. But that still leaves another $300 billion of Medicare savings to be found.
The second problem is accounting gimmickry. Acting in accordance with standard Washington practices, the C.B.O. counts as revenues more than $50 million in Social Security taxes and $70 billion in payments towards a new home-care program, which will eventually prove very costly, and it doesn’t count some $50 billion in discretionary spending. After excluding these pieces of trickery and the questionable Medicare cuts, Douglas Holtz-Eakin, a former head of the C.B.O., has calculated that the reform will actually raise the deficit by $562 billion in the first ten years. “The budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed,” he wrote in the Times. “So fantasy in, fantasy out.”
Holtz-Eakin advised John McCain in 2008, and he has a reputation as a straight shooter. I think the problems with the C.B.O.’s projections go even further than he suggests. If Holtz-Eakin’s figures turned out to be spot on, and over the next ten years health-care reform reduced the number of uninsured by thirty million at an annual cost of $56 billion, I would still regard it as a great success. In a $15 trillion economy—and, barring another recession, the U.S. economy should be that large in 2014—fifty or sixty billion dollars is a relatively small sum—about four tenths of one per cent of G.D.P., or about eight per cent of the 2011 Pentagon budget.
My two big worries about the reform are that it won’t capture nearly as many uninsured people as the official projections suggest, and that many businesses, once they realize the size of the handouts being offered for individual coverage, will wind down their group plans, shifting workers (and costs) onto the new government-subsidized plans. The legislation includes features designed to prevent both these things from happening, but I don’t think they will be effective.
Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.
Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)
If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”
So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.
The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.
Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)
In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead.
Even if the government tried to impose additional sanctions on such firms, I doubt it would work. The dollar sums involved are so large that firms would try to game the system, by, for example, shutting down, reincorporating under a different name, and hiring back their employees without coverage. They might not even need to go to such lengths. Firms that pay modest wages have high rates of turnover. By simply refusing to offer coverage to new employees, they could pretty quickly convert most of their employees into non-covered workers.
The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it. According to the C.B.O., somewhere between eight and nine million workers will lose their group coverage as a result of their employers refusing to offer it. That isn’t a trifling number. But the C.B.O. says it will be largely offset by an opposite effect in which employers that don’t currently provide health insurance begin to offer it in response to higher demand from their workers as a result of the individual mandate. In this way, some six to seven million people will obtain new group coverage, the C.B.O. says, so the overall impact of the changes will be minor.
The C.B.O.’s analysis can’t be dismissed out of hand, but it is surely a best-case scenario. Again, I come back to where I started: the scale of the subsidies on offer for low and moderately priced workers. If economics has anything to say as a subject, it is that you can’t offer people or firms large financial rewards for doing something—in this case, dropping their group coverage—and not expect them to do it in large numbers. On this issue, I find myself in agreement with Tyler Cowen and other conservative economists. Over time, the “firewall” between the existing system of employer-provided group insurance and taxpayer-subsidized individual insurance is likely to break down, with more and more workers being shunted over to the public teat.
At that point, if it comes, politicians of both parties will be back close to where they began: searching for health-care reform that provides adequate coverage for all at a cost the country can afford. What would such a system look like? That is a topic for another post, but I don’t think it would look much like Romney-ObamaCare.
On a quiet Friday afternoon this summer, the central justification for President Obama’s health-care overhaul died a quiet death. On that day, a bipartisan coalition in Congress reversed the scheduled Medicare cuts to physician payments, ensuring that, over the next decade, the White House’s reforms will cost many billions more than advertised. After over a year of debate and lofty rhetoric, the reality is this: the president’s goal of “bending” the health-care cost curve has unraveled in just a few months.
The president and his supporters argued that we need ObamaCare in order to tame the federal budget deficit. When he signed the bill into law, the president touted the importance of the legislation in reducing long-term deficits. Democrats cited Congressional Budget Office scoring showing that the health legislation would reduce the deficit over ten years to the tune of roughly $130 billion. But that was back in March.
In May, the CBO released its quantitative analysis showing that discretionary spending not accounted for in the previous scores would cost $115 billion. The CBO director himself expressed significant doubts about potential deficit reduction. Speaking to the Institute of Medicine, he said: “Rising health costs will put tremendous pressure on the federal budget during the next few decades and beyond. In CBO’s judgment, the health legislation enacted earlier this year does not substantially diminish that pressure.”
That brings us to the quiet Friday afternoon of June 25. By cancelling scheduled Medicare cuts, the president and his Congressional allies have made the fiscal problem even worse: Not only do those fiscal problems remain, but White House reforms meant to address them will push net federal-government health expenditures further into the red. Any notion of fiscal balance has been lost.
Yet cancelling these scheduled Medicare cuts is nothing new. Time and again, Republican and Democratic leaderships in Congress have haphazardly voted to undo scheduled cuts.
Congress reversed planned Medicare physician cuts in 1999—and 2004, 2005, 2006, and 2008. In fact, since 1997, when members of both parties agreed to automatic cuts if spending rose faster than population and economic growth, the program has been cut just once, in 2002. Maybe it’s the pressure of the doctors’ lobby. Maybe it’s the seniors’ lobby. Maybe it’s both.
And this Democratic Congress has been no better. In fact, just months after passing Obama’s health-reform legislation, Democrats vigorously and successfully pushed to postpone the Medicare cut until November (they had previously voted to delay it from April to June 2010).
More worrisome is this: in liberal circles, it’s popular to argue that Congressional efforts to control Medicare costs under the Sustainable Growth Rate (SGR) formula have been overly successful. James R. Horney and Paul N. Van de Water make exactly this point in a publication for the liberal Center on Budget and Policy Priorities. They write: “Even though Congress did not allow the full cuts required under the SGR formula to take effect, it has still cut the physician reimbursement rate substantially – at its current level, the reimbursement rate in 2010 will be 17 percent below the rate for 2001, adjusted for inflation.” Picking up on this point, Paul Krugman recently argued that Medicare has been historically very successful at reigning in costs. But praising Medicare cost containment in a time of heavy health-care cost inflation is like praising Lehman Brothers for making good investments in Latin America when the market for subprime mortgages was imploding.
Let’s put this in perspective: health inflation was 3.4 percent last year, just over double the basic inflation rate. Tellingly, the worst cost increases were experienced by Medicare (costs were up 8.6 percent), and Medicaid (9.9 percent).
Unfortunately, the White House and Congress squandered a great opportunity to bend the cost curve downwards, opting instead for the status quo. The quiet congressional vote in June shows how far the administration has strayed from its reform rhetoric. If we are ever to reign in health care spending, we need leaders who will make tough choices and tough cuts. Their rhetoric must become reality.
"What Difference Has RomneyCare Made?" by John C. Goodman,
Townhall, July 9, 2011 ---
http://townhall.com/columnists/johncgoodman/2011/07/09/what_difference_has_romneycare_made
. . .
On paper, it looks as though the state has made major progress in insuring the uninsured. From 6.4% of the population in 2006, the uninsured hover around 2% today. However, one study found that nearly all of the newly insured are either on Medicaid, in a state-subsidized plan or in an employer subsidized plan. Only 7% of the newly insured, or about 30,000 people, are directly paying their own way. It’s relatively easy to get people to sign up for insurance when coverage is free or almost free. And it’s not very expensive if you pay for the subsidies using money you would have spent anyway on free care for those who can’t pay their medical bills.
But aside from moving money from one bucket to another, have any real problems been solved? The evidence isn’t positive.
There are three major problems in health care all over the world: cost, quality and access. Since nothing in the Massachusetts reform addressed the problems of rising costs and less than adequate quality, those problems have remained more or less unchanged. What about access to care? Surely, newly insured people have more options in the medical marketplace.
The trouble is that almost all of the newly insured are in health plans that pay doctors and hospitals a lot less than what private insurance pays. Like other places around the country, Massachusetts Medicaid (called MassHealth) pays providers so little that patients often turn to hospital emergency rooms and community health centers for their care when they can’t find doctors who will see them. People in the newly subsidized private insurance plans aren’t faring much better because these plans pay only slightly more than what Medicaid pays.
The only solid analysis of what has actually happened to patients at this point is a study by Sharon Long and Paul Masi published in the journal Health Affairs. According to the study:
• There has been no significant change in the number of Massachusetts patients seeking care in hospital emergency rooms since the reform was implemented, and there has actually been an increase in emergency room use by people with incomes below 300% of the poverty level.
• There has been an increase in doctor visits but no change in visits to specialists and an actual decrease in “medical tests, treatment and follow up care,” which I assume is care for the chronically ill.
• There has been no change in the percent of the population reporting a failure to “get needed care for any reason within the past 12 months” and remarkably that includes one-third of those with incomes below 300% of the poverty level.
The problem with counting up doctor visits is that a visit is not always a visit. Nationally, in the state children’s health insurance program (CHIP) doctors have responded to an increase in the demand for their services by scheduling more appointments, but spending less time with patients. Also, you would think that the Massachusetts reform would shift health care resources from the general population to those with less income. But there is no evidence that has happened. On measures of access, the gap between the poor plus the near poor and everyone else appears not to have changed at all!
Ask yourself why you care whether other people have health insurance? The most likely reason is that you want people to have access to health care. But lack of access to care is a huge problem in Massachusetts right now. As I previously reported more than half of all family doctors and more than half of all internists are not accepting new patients. The wait is more than a month before a new patient is able to see a family doctor, and the wait to see an internist averages 48 days. The average wait in Boston to see a family doctor is more than two months.
What I am now reporting will be different than what you may have read in the newspapers or at other health blogs. MIT Professor Jon Gruber calls Massachusetts an unqualified success, citing some of the very same studies I am citing. But since Gruber was one of the architects of the Massachusetts health reform, this is like a student grading his own exam.
What about elevating the Massachusetts reforms to the national level in the form of ObamaCare? As I have previously reported, ObamaCare is likely to result in less access to care for our most vulnerable populations: the disabled and the elderly on Medicare, the poor on Medicaid and the near poor in newly subsidized private insurance. But that is only the beginning.
ObamaCare threatens a federal takeover of the practice of medicine. It threatens to cost millions of people their jobs. It threatens to cause a wasteful restructuring of American industry in a way that will make us less efficient and less competitive in the international marketplace. It will cause millions to lose their employer sponsored insurance. And it threatens to create health plans with perverse incentives to underprovide care to the patients most in need of the miracles of modern medical science.
ObamaCare will be anything but benign.
"The Massachusetts Health-Care 'Train Wreck': The future of
ObamaCare is unfolding here: runaway spending, price controls, even limits on
care and medical licensing," by Joseph Rago, The Wall Street Journal,
July 7, 2010 ---
http://online.wsj.com/article/SB10001424052748704324304575306861120760580.html?mod=djemEditorialPage_t
.
President Obama said earlier this year that the health-care bill that Congress passed three months ago is "essentially identical" to the Massachusetts universal coverage plan that then-Gov. Mitt Romney signed into law in 2006. No one but Mr. Romney disagrees.
As events are now unfolding, the Massachusetts plan couldn't be a more damning indictment of ObamaCare. The state's universal health-care prototype is growing more dysfunctional by the day, which is the inevitable result of a health system dominated by politics.
In the first good news in months, a state appeals board has reversed some of the price controls on the insurance industry that Gov. Deval Patrick imposed earlier this year. Late last month, the panel ruled that the action had no legal basis and ignored "economic realties."
In April, Mr. Patrick's insurance commissioner had rejected 235 of 274 premium increases state insurers had submitted for approval for individuals and small businesses. The carriers said these increases were necessary to cover their expected claims over the coming year, as underlying state health costs continue to rise at 8% annually. By inventing an arbitrary rate cap, the administration was in effect ordering the carriers to sell their products at a loss.
Mr. Patrick has promised to appeal the panel's decision and find some other reason to cap rates. Yet a raft of internal documents recently leaked to the press shows this squeeze play was opposed even within his own administration.
In an April message to his staff, Robert Dynan, a career insurance commissioner responsible for ensuring the solvency of state carriers, wrote that his superiors "implemented artificial price caps on HMO rates. The rates, by design, have no actuarial support. This action was taken against my objections and without including me in the conversation."
Mr. Dynan added that "The current course . . . has the potential for catastrophic consequences including irreversible damage to our non-profit health care system" and that "there most likely will be a train wreck (or perhaps several train wrecks)."
Sure enough, the five major state insurers have so far collectively lost $116 million due to the rate cap. Three of them are now under administrative oversight because of concerns about their financial viability. Perhaps Mr. Patrick felt he could be so reckless because health-care demagoguery is the strategy for his fall re-election bid against a former insurance CEO.
The deeper problem is that price controls seem to be the only way the political class can salvage a program that was supposed to reduce spending and manifestly has not. Massachusetts now has the highest average premiums in the nation.
In a new paper, Stanford economists John Cogan and Dan Kessler and Glenn Hubbard of Columbia find that the Massachusetts plan increased private employer-sponsored premiums by about 6%. Another study released last week by the state found that the number of people gaming the "individual mandate"—buying insurance only when they are about to incur major medical costs, then dumping coverage—has quadrupled since 2006. State regulators estimate that this amounts to a de facto 1% tax on insurance premiums for everyone else in the individual market and recommend a limited enrollment period to discourage such abuses. (This will be illegal under ObamaCare.)
Liberals write off such consequences as unimportant under the revisionist history that the plan was never meant to reduce costs but only to cover the uninsured. Yet Mr. Romney wrote in these pages shortly after his plan became law that every resident "will soon have affordable health insurance and the costs of health care will be reduced."
One junior senator from Illinois agreed. In a February 2006 interview on NBC, Mr. Obama praised the "bold initiative" in Massachusetts, arguing that it would "reduce costs and expand coverage." A Romney spokesman said at the time that "It's gratifying that national figures from both sides of the aisle recognize the potential of this plan to transform our health-care system."
An entitlement sold as a way to reduce costs was bound to fundamentally change the system. The larger question—for Massachusetts, and now for the nation—is whether that was really the plan all along.
"If you're going to do health-care cost containment, it has to be stealth," said Jon Kingsdale, speaking at a conference sponsored by the New Republic magazine last October. "It has to be unsuspected by any of the key players to actually have an effect." Mr. Kingsdale is the former director of the Massachusetts "connector," the beta version of ObamaCare's insurance "exchanges," and is now widely expected to serve as an ObamaCare regulator.
He went on to explain that universal coverage was "fundamentally a political strategy question"—a way of finding a "significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less.' And that's the challenge, how to do it. It's like we're waiting for a chain reaction but there's no catalyst, there's nothing to start it."
In other words, health reform was a classic bait and switch: Sell a virtually unrepealable entitlement on utterly unrealistic premises and then the political class will eventually be forced to control spending. The likes of Mr. Kingsdale would say cost control is only a matter of technocratic judgement, but the raw dirigisme of Mr. Patrick's price controls is a better indicator of what happens when health care is in the custody of elected officials rather than a market.
Naturally, Mr. Patrick wants to export the rate review beyond the insurers to hospitals, physician groups and specialty providers—presumably to set medical prices as well as insurance prices. Last month, his administration also announced it would use the existing state "determination of need" process to restrict the diffusion of expensive medical technologies like MRI machines and linear accelerator radiation therapy.
Meanwhile, Richard Moore, a state senator from Uxbridge and an architect of the 2006 plan, has introduced a new bill that will make physician participation in government health programs a condition of medical licensure. This would essentially convert all Massachusetts doctors into public employees.
All of this is merely a prelude to far more aggressive restructuring of the state's health-care markets—and a preview of what awaits the rest of the country.
"Your Health Care Costs, Going Higher," by Carrie Lukas,
Townhall, June 1, 2010 ---
http://townhall.com/columnists/CarrieLukas/2010/06/01/your_health_care_costs,_going_higher
How much will the new health care law cost? That was a matter of particular dispute during the debate of the Patient Protection and Affordability Act. The bill's authors monkeyed around with the numbers, delaying some benefits, creating new revenue raisers, and pushing off known, needed reforms, so that the Congressional Budget Office (CBO) could come up with a score below the $900 billion target.
Only the most naïve failed to recognize that those numbers were meaningless: Ultimately, they would have no relationship to how much the legislation would add to taxpayers' burdens and bloat the federal budget. CBO has since been revising its estimates upward: Another $115 billion for additional administrative costs associated with the new law. In addition, Congress now struggles to pass a change to the Medicare reimbursement rates, which will cost $23 billion just to patch the problem over for two years.
Taxpayers must be warned that these are just the first of many upward revisions by CBO. As Congressman Paul Ryan pointed out during the health care debate, the CBO score was based on ten years of increased taxes and Medicare cuts, and only six years of benefits. Former CBO Director Douglas Holtz-Eakin just released his own analysis of the law and found that, far from reducing the deficit as the President and Congressional proponents promised, the law will add more than $500 billion to the deficit during the first ten years and another $1.4 trillion in the decade after that.
Yet the program's cost for taxpayers are just a small part of the costs that will be borne by American citizens. Speaker Pelosi explained that only when the bill passed would Americans know what's in it, and she was right. Since the bill became law it's consequences for businesses and the medical system is becoming more obvious. Several large companies reported that they would suffer multi-million dollar losses due to the law's new taxes. Companies are also noting the incentives created by the law to drop insurance coverage for their employees. As Holtz-Eakin wrote: “Caterpillar recently noted that it could save 70 percent on health care costs by dropping coverage and paying the penalties; AT&T's $2.4 billion cost of coverage would drop to just $600 million for penalties.” Altogether, Holtz-Eakin estimates that as many as 35 million Americans could lose their employer-sponsored health insurance.
So much for being able to keep your insurance. Americans are also learning how other provisions will drive up insurance costs. This year, “children” up to the age of twenty-six will become eligible for their parents' health insurance policy. Analysts estimate that this change will increase the cost of all family policies by about one percent.
One percent itself isn't a big deal, but it's a reminder of the relationship between mandated benefits and price. The federal government will soon foist numerous new mandates upon insurance companies: free preventive care services, an end to benefit caps, limits on price differentials for those with pre-existing conditions, and many more to come. Far from freebies, these are expensive benefits and their costs will be spread around the insured population, driving premium prices up.
The law also gives government new powers to dictate how much insurance companies operate. As a result, insurance companies will have to find new ways to make ends meet, such as by reducing payments to doctors. And those doctors will also find ways to trim back costs, by consolidating practices to reduce overhead and taking on fewer patients.
Americans need not wait for the federal law to fully take effect to understand what's in store. They can also look to Massachusetts, where a similar health care law is already in force. Health care policy expert Grace Marie Turner recently reviewed the problems that plague Massachusetts. Health care costs for a family of four in the Bay State are the highest in the nation, with per capita health care spending 27% higher than the rest of the nation. The increased demand for medical services has created a shortage of doctors, making it difficult to get an appointment and creating long wait times. Ironically this has led to increased use of emergency rooms, a problem that greater insurance coverage was supposed to solve. Insurance companies need to raise rates to cover additional expenses, but the Governor is threatening to cap rate hikes, which will leave private insurers operating at a loss. How long is that sustainable?
The debate about how much this new health care law will cost Americans is far from over. Undoubtedly, as more of the law is implemented, we will learn more about its many hidden costs and consequences. But one thing is for sure, this new law will cost more, and like much, much more than the law's proponents promised.
There are lies and then there are damn
lies
"Pelosi Claims Health Care Reform to Save $1.3 Trillion; No Mention in CBO
Estimate," by Matt Cover, CNS News, March 26, 2010 ---
http://www.cnsnews.com/news/article/63373
House Speaker Nancy Pelosi (D-Calif.) said that the health care reform package the House passed on March 21 would ultimately save the country $1.3 trillion over the next 20 years. That claim, however, was not made by the Congressional Budget Office (CBO) in its cost estimate of the bill.
Pelosi, speaking to reporters at her weekly Capitol Hill press conference on Thursday, said that one of the most important reasons for passing the legislation was that it would save the government so much money.
“[O]ne of the main reasons to do the bill was that it saves the taxpayers $1.3 trillion — $1.3 trillion — over the life of the bill and the 10 years beyond,” she said.
However, no such figure appears in the Congressional Budget Office’s estimate of the package President Obama signed into law Tuesday.
According to a CBO letter sent to Pelosi on March 20, the day before that House passed the bill, the health reform bill and an accompanying package of amendments is expected to reduce the deficit by $143 billion over the 2010-2019 time period.
For the following decade, the CBO does not attempt to quantify the bill’s possible effects on the budget because, as it says, there are simply too many unknown factors for any estimate to be accurate.
“CBO has developed a rough outlook for the decade following the 2010–2019 period by grouping the elements of the legislation into broad categories and (together with JCT) assessing the rate at which the budgetary impact of each of those broad categories is likely to increase over time,” the report says.
The CBO did give a broad range that the package might reduce the deficit, saying that if Congress did not modify the law over the next 20 years, it could reduce the deficit “during that decade in a broad range between one quarter percent and one-half percent of gross domestic product (GDP).”
The CBO said that any estimates beyond 20 years were unreasonable, and declined to give any in their letter to Pelosi.
“CBO has not extrapolated estimates further into the future because the uncertainties surrounding them are magnified even more.”
While some press accounts attributed Pelosi’s figure to internal calculations based on the CBO’s 20-year projections, CNSNews.com could not confirm this despite repeated requests to the Speaker’s office asking to name the source of the figure.
In addition, in a March 19 letter to Rep. Paul Ryan (R-Wisc.) the CBO explained that the health care bill will begin adding to the deficit the moment congressional Democrats change the payment system Medicare uses to pay doctors.
Known as the “Doc Fix,” the change was removed from earlier versions of the bill in order to make it appear deficit- friendly. However, if Democrats go ahead with the changes as expected, the CBO explained that the deficit will rise by nearly $60 billion.
"CBO estimates that enacting H.R. 3961 [Doc Fix], by itself, would cost about $208 billion over the 2010–2019 period," the CBO informed Ryan. "CBO estimates that enacting H.R. 3961 together with those two bills [health care and a companion package of amendments] would add $59 billion to budget deficits over the 2010–2019 period."
"Signed, sealed, delivered," The Economist, March 27, 2010, Page 31 ---
http://www.economist.com/world/united-states/displaystory.cfm?story_id=15769767"SignThe first big idea that he stresses is the creation of a new agency to spearhead innovation and scale up any of the many pilot schemes contained in the bills that manage to reform delivery or payment systems. It is true that the reform effort began with earnest intent to “bend the cost curve”. Alas, explains Mark McClellan of the Brookings Institution, the most meaningful proposals have since been watered down or delayed.
The second lever of change that Mr Orszag says is underappreciated is an excise tax introduced on the most expensive (or “Cadillac”) insurance plans. Most economists like this idea, as it is likely to discourage excessive consumption of health care. Unfortunately, because of political pressure from labour unions and other groups, the Cadillac tax has been diluted, and delayed until 2018. Sceptics wonder if a future Congress will really implement this tax when the time comes. Mr Orszag is right that, if implemented, this provision will represent an important lever of cost control. But it’s a big “if”.
"What You Get With Free Health Care," by Janice Shaw Crouse, Townhall, March 29, 2010 ---
http://townhall.com/columnists/JaniceShawCrouse/2010/03/29/what_you_get_with_free_health_careOne of the prime arguments used to sell ObamaCare was that it would reverse the financial crisis and save the country a gazillion dollars — with benefits beginning in its first year. Sadly, somebody’s arm got twisted to produce Congressional Budget Office (CBO) figures — nicely timed for the House vote — to supposedly back up the Democrats’ arguments. Nobody seemed to understand that the CBO figures were just estimates. Yet, as they say, the devil is in the details. The CBO details clearly indicate that having the government’s role expanded to provide universal coverage will significantly increase costs, as well as premiums and taxes. Worse, the CBO notes that most of the current costs of the U.S. world-class health care are from providing new, cutting-edge treatments and ever-expanding medical technologies. They add, “Given the central role of medical technology in cost growth, reducing or slowing spending over the long term would probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application.”
How’s that for dispelling the claims that quality will remain high, rationing won’t happen, and technology will continue to expand while costs go down? The real life record of government control is a long way from matching the soaring rhetoric that has dominated the media coverage of the health care debate. Further, in those countries where massive government intervention has replaced free market enterprise, the reality is far short of the utopian promises and the policies that have been spun out so recklessly and misleadingly. Price controls, inevitably, limit innovation. If that happens to medical research and technological advancement, the results will be disastrous.
Continued in article
Note that I’m not in favor of repealing the recent legislation. But I am in favor of adding a public option so long as taxation and insurance premiums are added to fully cover the annual costs of health insurance. And let's stop the BS on the left and on the right side of this debate.
Fuzzy CBO Accounting Tricks
"ObamaCare by the Numbers: Part 2," by John Cassidy,
The New Yorker,
March 2010 ---
http://www.newyorker.com/online/blogs/johncassidy/2010/03/obamacare-by-the-numbers-part-2.html
This is a long and somewhat involved followup to my previous post on ObamaCare. . For those of you with O.A.D.D. (online attention-deficit disorder), I’ve provided an express and local version.
EXPRESS:
The official projections for health-care reform, which show it greatly reducing the number of uninsured and also reducing the budget deficit, are simply not credible. There are three basic issues.
The cost and revenue projections rely on unrealistic assumptions and accounting tricks. If you make some adjustments for these, the cost of the plan is much higher.
The so-called “individual mandate” isn’t really a mandate at all. Under the new system, many young and healthy people will still have a strong incentive to go uninsured.
Once the reforms are up and running, some employers will have a big incentive to end their group coverage plans and dump their employees onto the taxpayer-subsidized individual plans, greatly adding to their cost.
LOCAL:
For future reference (or possibly to roll up and beat myself over the head with in my dotage) I have filed away a copy the latest analysis (pdf) of health-care reform from the Congressional Budget Office. By 2019, it says, the bills passed by the House and Senate will have cut the number of uninsured Americans by thirty-two million, raised the percentage of people with some form of health-care coverage from eighty-three per cent to ninety-four per cent, and reduced the federal deficit by a cumulative $143 billion. If all of these predictions turn out to be accurate, ObamaCare will go down as one of the most successful and least costly government initiatives in history. At no net cost to the taxpayer, it will have filled a gaping hole in the social safety net and solved a problem that has frustrated policymakers for decades.
Does Santa Claus live after all? According to the C.B.O., between now and 2019 the net cost of insuring new enrollees in Medicaid and private insurance plans will be $788 billion, but other provisions in the legislation will generate revenues and cost savings of $933 billion. Subtract the first figure from the second and—voila!—you get $143 billion in deficit reduction.
The first objection to these figures is that the great bulk of the cost savings—more than $450 billion—comes from cuts in Medicare payments to doctors and other health-care providers. If you are vaguely familiar with Washington politics and the letters A.A.R.P. you might suspect that at least some of these cuts will fail to materialize. Unlike some hardened skeptics, I don’t think none of them will happen. One part of the reform involves reducing excessive payments that the Bush Administration agreed to when it set up the Medicare Advantage program in 2003. If Congress remains under Democratic control—a big if, admittedly—it will probably enact these changes. But that still leaves another $300 billion of Medicare savings to be found.
The second problem is accounting gimmickry. Acting in accordance with standard Washington practices, the C.B.O. counts as revenues more than $50 million in Social Security taxes and $70 billion in payments towards a new home-care program, which will eventually prove very costly, and it doesn’t count some $50 billion in discretionary spending. After excluding these pieces of trickery and the questionable Medicare cuts, Douglas Holtz-Eakin, a former head of the C.B.O., has calculated that the reform will actually raise the deficit by $562 billion in the first ten years. “The budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed,” he wrote in the Times. “So fantasy in, fantasy out.”
Holtz-Eakin advised John McCain in 2008, and he has a reputation as a straight shooter. I think the problems with the C.B.O.’s projections go even further than he suggests. If Holtz-Eakin’s figures turned out to be spot on, and over the next ten years health-care reform reduced the number of uninsured by thirty million at an annual cost of $56 billion, I would still regard it as a great success. In a $15 trillion economy—and, barring another recession, the U.S. economy should be that large in 2014—fifty or sixty billion dollars is a relatively small sum—about four tenths of one per cent of G.D.P., or about eight per cent of the 2011 Pentagon budget.
My two big worries about the reform are that it won’t capture nearly as many uninsured people as the official projections suggest, and that many businesses, once they realize the size of the handouts being offered for individual coverage, will wind down their group plans, shifting workers (and costs) onto the new government-subsidized plans. The legislation includes features designed to prevent both these things from happening, but I don’t think they will be effective.
Consider the so-called “individual mandate.” As a strict matter of law, all non-elderly Americans who earn more than the poverty line will be obliged to obtain some form of health coverage. If they don’t, in 2016 and beyond, they could face a fine of about $700 or 2.5 per cent of their income—whichever is the most. Two issues immediately arise.
Even if the fines are vigorously enforced, many people may choose to pay them and stay uninsured. Consider a healthy single man of thirty-five who earns $35,000 a year. Under the new system, he would have a choice of enrolling in a subsidized plan at an annual cost of $2,700 or paying a fine of $875. It may well make sense for him to pay the fine, take his chances, and report to the local emergency room if he gets really sick. (E.R.s will still be legally obliged to treat all comers.) If this sort of thing happens often, as well it could, the new insurance exchanges will be deprived of exactly the sort of healthy young people they need in order to bring down prices. (Healthy people improve the risk pool.)
If the rules aren’t properly enforced, the problem will be even worse. And that is precisely what is likely to happen. The I.R.S. will have the administrative responsibility of imposing penalties on people who can’t demonstrate that they have coverage, but it won’t have the legal authority to force people to pay the fines. “What happens if you don’t buy insurance and you don’t pay the penalty?” Ezra Klein, the Washington Post’s industrious and well-informed blogger, asks. “Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.”
So, the individual mandate is a bit of a sham. Generous subsidies will be available for sick people and families with children who really need medical care to buy individual coverage, but healthy single people between the ages of twenty-six and forty, say, will still have a financial incentive to remain outside the system until they get ill, at which point they can sign up for coverage. Consequently, the number of uninsured won’t fall as much as expected, and neither will prices. Without a proper individual mandate, the idea of universality goes out the window, and so does much of the economic reasoning behind the bill.
The question of what impact the reforms will have on existing insurance plans has received even less analysis. According to President Obama, if you have coverage you like you can keep it, and that’s that. For the majority of workers, this will undoubtedly be true, at least in the short term, but in some parts of the economy, particularly industries that pay low and moderate wages, the presence of such generous subsidies for individual coverage is bound to affect behavior eventually. To suggest this won’t happen is to say economic incentives don’t matter.
Take a medium-sized firm that employs a hundred people earning $40,000 each—a private security firm based in Atlanta, say—and currently offers them health-care insurance worth $10,000 a year, of which the employees pay $2,500. This employer’s annual health-care costs are $750,000 (a hundred times $7,500). In the reformed system, the firm’s workers, if they didn’t have insurance, would be eligible for generous subsidies to buy private insurance. For example, a married forty-year-old security guard whose wife stayed home to raise two kids could enroll in a non-group plan for less than $1,400 a year, according to the Kaiser Health Reform Subsidy Calculator. (The subsidy from the government would be $8,058.)
In a situation like this, the firm has a strong financial incentive to junk its group coverage and dump its workers onto the taxpayer-subsidized plan. Under the new law, firms with more than fifty workers that don’t offer coverage would have to pay an annual fine of $2,000 for every worker they employ, excepting the first thirty. In this case, the security firm would incur a fine of $140,000 (seventy times two), but it would save $610,000 a year on health-care costs. If you owned this firm, what would you do? Unless you are unusually public spirited, you would take advantage of the free money that the government is giving out. Since your employees would see their own health-care contributions fall by more than $1,100 a year, or almost half, they would be unlikely to complain. And even if they did, you would be saving so much money you afford to buy their agreement with a pay raise of, say, $2,000 a year, and still come out well ahead.
Even if the government tried to impose additional sanctions on such firms, I doubt it would work. The dollar sums involved are so large that firms would try to game the system, by, for example, shutting down, reincorporating under a different name, and hiring back their employees without coverage. They might not even need to go to such lengths. Firms that pay modest wages have high rates of turnover. By simply refusing to offer coverage to new employees, they could pretty quickly convert most of their employees into non-covered workers.
The designers of health-care reform and the C.B.O. are aware of this problem, but, in my view, they have greatly underestimated it. According to the C.B.O., somewhere between eight and nine million workers will lose their group coverage as a result of their employers refusing to offer it. That isn’t a trifling number. But the C.B.O. says it will be largely offset by an opposite effect in which employers that don’t currently provide health insurance begin to offer it in response to higher demand from their workers as a result of the individual mandate. In this way, some six to seven million people will obtain new group coverage, the C.B.O. says, so the overall impact of the changes will be minor.
The C.B.O.’s analysis can’t be dismissed out of hand, but it is surely a best-case scenario. Again, I come back to where I started: the scale of the subsidies on offer for low and moderately priced workers. If economics has anything to say as a subject, it is that you can’t offer people or firms large financial rewards for doing something—in this case, dropping their group coverage—and not expect them to do it in large numbers. On this issue, I find myself in agreement with Tyler Cowen and other conservative economists. Over time, the “firewall” between the existing system of employer-provided group insurance and taxpayer-subsidized individual insurance is likely to break down, with more and more workers being shunted over to the public teat.
At that point, if it comes, politicians of both parties will be back close to where they began: searching for health-care reform that provides adequate coverage for all at a cost the country can afford. What would such a system look like? That is a topic for another post, but I don’t think it would look much like Romney-ObamaCare.
"Premiums Will Decrease 3000% So You Should Get A Raise When
H'care Is Passed"
Barach Obama ---
http://www.youtube.com/watch?v=lUd-slJc-GY&feature=player_embedded
"Obamacare: Cooked Books You Can Believe In," by Deeroy Murdock,
National Review, March 11, 2010 ---
http://article.nationalreview.com/427508/obamacare-cooked-books-you-can-believe-in/deroy-murdock?page=1
The non-partisan Congressional Budget Office likewise warned last December 23 that Obamacare’s putative savings “would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. . . . To describe the full amount of [Hospital Insurance] trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government’s fiscal position.”
Consequently, Sen. Jeff Sessions (R., Ala.) predicts: “Taxpayers will be left holding billions in debt bonds to the Medicare Trust Fund that must be repaid.”
The Senate’s Obamacare bill would take $52 billion in anticipated Social Security revenues and divert them to offset Obamacare’s overall net cost. But wait: Those who have been promised future Social Security payments expect that $52 billion to be available to prevent their pension checks from bouncing. These $104 billion in political pledges cost only $52 billion.
This bill also includes something called Community Living Services and Support. This “CLASS Act” would offer long-term-care insurance with premiums invoiced immediately, but with benefits commencing in 2016. In the interim, the CBO expects a $72 billion surplus to accumulate. Congressional Democrats already have dedicated that sum to counterbalance and thus lower Obamacare’s perceived cost. But the Treasury needs that same $72 billion to finance the CLASS Act’s medical services. So, which is it?
Senate Budget Committee Chairman Kent Conrad (D., N.D.) described this scam in the Washington Post as “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.”
Continued in article
In his speech Wednesday (March
3, 2010) , demanding an "up or down" vote, the president
seemed convinced and committed—but nothing he said sounded true. His bill will
"bring down the cost of health care for millions," it is "fully paid for," it
will lower the long term deficit by a trillion dollars.
"What a Disaster Looks Like: ObamaCare will have been a colossal waste
of time—if we're lucky," by Peggy Noonan, The Wall Street Journal, March 4,
2010 ---
http://online.wsj.com/article/SB10001424052748704187204575101742162779612.html?mod=djemEditorialPage_t
All this contributes to a second problem, which is a growing credibility gap. In his speech Wednesday, demanding an "up or down" vote, the president seemed convinced and committed—but nothing he said sounded true. His bill will "bring down the cost of health care for millions," it is "fully paid for," it will lower the long term deficit by a trillion dollars.
Does anyone believe this? Does anyone who knows the ways of government, the compulsions of Congress, and how history has played out in the past, believe this? Even a little? Rep. Bart Stupak said Thursday that he and several of his fellow Democrats won't vote for the Senate version of the bill because it says right there on page 2,069 that the federal government would directly subsidize abortions. The bill's proponents say this isn't so. It would be a relief to have a president who could weigh in believably and make clear what his own bill says. But he seems to devote more words to obscuring than clarifying.
Continued in article
"Congressional Budget Office Says Dems Are Using Accounting Trick To Claim Medicare 'Savings'," by Megan McArdle, Business Insider, December 23, 2009 --- http://www.businessinsider.com/congressional-budget-office-says-dems-are-using-accounting-trick-to-claim-healthcare-savings-2009-12
"This bill will strengthen Medicare and extend the life of the program." -
President Barack Obama, after the Senate health care bill secured 60 votes.It's from the Wonk Room blog at the Center for American Progress, and as you can see, it puts this claim up there front and central. As you can see from the quote above, it's not just an error made by one pundit. As I recall, the claim was made more than once during the Senate debate, and of course, by our president in selling the bill. The graphic was very widely distributed.
Unfortunately, the CBO finally got around to ruling on this question, and no, this is not actually going to fix the Medicare budget problem; it's an artifact of the way the government accounting is done.
The explanation is a little complicated, and I'm not sure how many of you want to go through it, but I'll try my hand at a reasonably succinct explanation. Basically, Medicare, like Social Security, has a "trust fund" (actually, more than one), which is supposed to fund it until the trust fund is exhausted in 2019. The "trust fund" does not exist in any meaningful sense, because its "assets" consist of claims on the general fund, i.e. all the rest of the tax money. As Medicare goes into deficit, it trades in those assets to cover its funding gap, which means the general fund has to find the money to pay off the special bonds by either raising taxes, cutting other spending, or borrowing more money. After the trust fund is exhausted, the general fund has to find the money to pay for the Medicare deficit by either . . . raising taxes, cutting other spending, or borrowing more money. The difference to taxpayers is nil.
Technically, when you cut Medicare spending, that money shows up as an increase in the Medicare trust fund, rather than some other possible accounting entry. But the effect on the unified budget is the same: the money saved by cutting Medicare is spent on other stuff. Whether Medicare is "calling bonds" or "demanding money to cover its deficit", we still have to find exactly as much money to pay for Medicare as we did before. Which is a lot of money. One of the reasons the projected deficits for the rest of the decade are so big is that the cost of Medicare is outstripping the revenue raised by its payroll tax, and so we have to shovel in more and more money from the general fund.
You can dedicate that money to paying for Medicare--but then you have to introduce a corresponding future liability on the general fund, in the amount of the Medicare savings. That would mean that this bill would increase the deficit by hundreds of billions of dollars, rather than reducing it.
Or as the CBO says:
The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund. Unified budget accounting shows that the majority of the HI trust fund savings would be used to pay for other spending under the PPACA and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits. To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position.
It's a little disappointing, really. At the rate that Democratic politicians were generating ever-more-spectacular budget savings from the same old set of health care proposals, I had expected our looming fiscal problems to be permanently resolved by this time next week.
From TheAtlantic - shaping the national debate on the most critical issues of our times, from politics, business, and the economy, to technology, arts, and culture.
Lie: Billions will be saved from new Medicare billing efficiencies and
fraud prevention
Never ending fraud in Medicare billings:
Unaudited overpayments, unqualified items, and criminal vendors
One spending sinkhole can be traced to large
medical-equipment suppliers, device makers, and pharmaceutical companies, which
government auditors and industry veterans describe as a recalcitrant bunch.
Medical manufacturers know public agencies generally pay first and ask questions
later—if ever. Medicare receives 4.4 million claims
daily; fewer than 3% are reviewed before being paid within the legally required
30 days.
"A Hole in Health-Care Reform: Overbilling by medical-equipment suppliers,
device makers, and drug companies has cost taxpayers billions.
New legislation will do little to stem the tide,"
by Chad Terhune, Business Week, December 10, 2009 ---
http://www.businessweek.com/magazine/content/09_51/b4160046945722.htm?link_position=link3
President Barack Obama and his Democratic allies on Capitol Hill say that a vast expansion of health coverage can be funded by squeezing out waste and fraud rather than cutting benefits. Whether that turns out to be true may help determine the success of the sweeping reform package being debated by Congress. Slashing costs is no easy task, and stopping fraud is even tougher. No less than $47 billion in Medicare spending went to dubious claims in the year ended Sept. 30, according to the U.S. Health & Human Services Dept. That's 10.7% of the $440 billion program that subsidizes care for the elderly. Medicaid, the government program for the poor, lets billions trickle away at roughly the same rate. The $10 million annual increase that Congress is allocating to fight fraud may not be enough to do the trick.
One spending sinkhole can be traced to large medical-equipment suppliers, device makers, and pharmaceutical companies, which government auditors and industry veterans describe as a recalcitrant bunch. Medical manufacturers know public agencies generally pay first and ask questions later—if ever. Medicare receives 4.4 million claims daily; fewer than 3% are reviewed before being paid within the legally required 30 days.
One way to get a sense of the scale of the seepage—and the challenge facing the Administration—is to look at whistleblower lawsuits filed under the federal False Claims Act. That law allows company employees to sue on behalf of the government to recover improperly claimed federal funds.
A suit filed by William A. Thomas, a former senior sales manager at Siemens Medical Solutions USA, one of the nation's largest medical suppliers and a unit of German engineering giant Siemens (SI), offers a case study in the difficulty of containing costs. Thomas, a 15-year Siemens Medical veteran, alleges in federal court in Philadelphia that for years the company overbilled the Veterans Affairs Dept. and other government agencies by hundreds of millions of dollars for MRI and CT scan machines and other expensive equipment. These high-tech systems—used to examine everything from damaged knees to suspected cancers—cost $500,000 to $3 million apiece, sometimes more. Thomas, who retired from Siemens in 2008, claims that with no justification other than larger profits, his former employer charged its government customers far more than private-sector buyers for the same equipment.
"Billions and billions could be saved with the right government regulation and oversight applied to health care," Thomas, 56, says in an interview. "But I think corporations will continue running circles around the federal government."
In court filings, Siemens has denied any wrongdoing and has sought to have the Thomas suit dismissed. A company spokesman, Lance Longwell, declined to elaborate for this article, citing the litigation.
The Thomas suit illustrates some of the vagaries of False Claims Act cases, hundreds of which are filed every year against government contractors in a range of industries. As the plaintiff, Thomas stands to pocket up to 30% of any court recovery, with the rest going to the Treasury. The Justice Dept., which can intervene in such suits to help steer them, announced last year that it will stay out of the case against Siemens for now. Yet Thomas' allegations have helped drive a parallel criminal investigation of Siemens' equipment marketing practices by the Defense Dept. and the U.S. Attorney's Office in Philadelphia.
In April federal investigators searched for records at the headquarters of Siemens Medical in Malvern, Pa., a suburb of Philadelphia. Ed Bradley, special agent-in-charge of the Defense Criminal Investigative Service, confirmed that the investigation is continuing but declined to comment further.
Longwell, the Siemens Medical spokesman, says the company is cooperating with criminal investigators. In March, just weeks before the search of its offices, Siemens won a new $267 million contract to provide radiology equipment to the U.S.
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Ontario. The world's most highly skilled workforce.
Jensen Comment
The GAO has declared that many huge sink holes for fraud and waste are
unauditable --- the Pentagon, the IRS, Medicare, and the list goes on and on.
But the Congress that funds these programs is manipulated by special interest
groups who do not want these audits. The new sink hole on the block is almost
anything green.
What is happening to America?
Sadly, Medicare patients in Texas may once again be turned away by their doctors under the pending 2009 House version of Obamacare:
The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):
Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.
Unfortunately, it appears that under Obamacare, Texas will once again have to return to lawyer-ambulance-chasing days of old and revise its Constitution that presently limits attorneys' fees and imposes caps on damages. A former colleague at Trinity University on November 5, 2009 explained in a private message some of the reasonable details of the current Texas restrictions on damages in Texas (sounds reasonable to me and is more generous to patients and lawyers than Canada's really tight restrictions):
It is not true (under the revised Texas Constitution) that those who have been harmed by a physician’s malfeasance will not have their day in a Texas court. They will be able to claim real damages (economic - loss of income and medical costs) as well as punitive and pain and suffering damages – the difference is that some types of damages (non-economic) will be capped. What most of us don’t understand, is that the fear of these huge punitive damages causes physicians to practice defensive medicine – ordering more tests, ordering procedures just to make certain that they’re not missing anything. All these tests and procedures would be great and expected if they in themselves did not pose a risk to the patient, but many of them do. So, physicians must constantly balance their certainty of their diagnosis against the risk to the patient of additional tests. When we add huge punitive damages, we tip the scales in favor of more tests and procedures, which may, in fact, be more risky for the patient. And, in the end the burden for million dollar awards is borne by us all not just the physicians.
Since it is difficult to undo the health damage that has occurred, oversight of the physician is at the heart of the matter. There are ways to insure quality, standard-of-care medical practice outside of expensive court proceedings. So in addition to tort reform, the focus should equally be on systems of accountability for physicians.I think it is an outright lie that Obamacare will not cause many medical specialists to turn their backs on Medicare patients for much the same reason that Erika was turned away by a surgeon from the South Texas Spinal Clinic after having two of his surgeries. It will be amazing that any highly specialized neurosurgeon will accept the losses of treating Medicare patients.
The sad part is that Obamacare will reduce fees allowed to be charged to Medicare patients while at the same time greatly increase the cost of malpractice insurance for physicians treating those patients.
Canadian Malpractice Insurance Takes Profit Out Of
Coverage," by Jane Akre, Injury Board, July 28, 2009 ---
Click Here
The St. Petersburg Times takes a look at the cost of insurance in Canada for health care providers.
A neurosurgeon in Miami pays about $237,000 for medical malpractice insurance. The same professional in Toronto pays about $29,200, reports Susan Taylor Martin.
A Canadian orthopedic surgeon pays just over $10,000 for coverage that costs a Miami physician $140,000. An obstetrician in Canada pays $36,353 for insurance, while a Tampa Bay obstetrician pays $98,000 for medical malpractice insurance.
For those of you interested in Erika's saga with spine surgeries, you can
read about more of the details at
http://faculty.trinity.edu/rjensen/Erika2007.htm
She has a metal rack on her spine that extends from her neck to her hips.
Surgeons broke her back in three places before attaching the rods and screws, In
spite of the rack she can bend over while standing and pick a paper towel up
from the floor.
"The Cost of Health Care Reform,"
by Michael Tanner, Townhall, November 7, 2009 ---
http://townhall.com/columnists/MichaelTanner/2009/11/07/the_cost_of_health_care_reform
The Democratic leadership simply shifted some of the bill's cost to other bills. For example, for purposes of the health care bill, the Democrats assume that a currently scheduled 21 percent cut in Medicare reimbursements will take affect next year. However, at the same time, they have introduced a separate bill repealing those cuts at a cost of $250 billion, so that cost isn't technically part of health care reform. And your household budget would look so much better if you didn't have to pay your mortgage and car payment. (The Senate just tried to do something similar, only to have the cynical ploy rejected 53-47, with 13 Democrats refusing to play along.)
If you count that cost honestly, the bill's cost rises to nearly $1.3 trillion. And that still understates the bill's cost.
The CBO provides ten year projections of a bill's cost, between 2010 and 2019 in this case. But most provisions of the health bill don't take effect until 2014. So the "10-year" cost projection only includes six years of the bill. Again, consider your household budget. Wouldn't it be great if you could count a whole month's income, but only two weeks expenditures? If we look at the bill more honestly over the first 10 years that the programs are actually in existence, say from 2014 to 2024, it would actually cost more than $2.3 trillion. And, this doesn't include approximately $200 billion in additional spending for public health programs, a reinsurance program for retiree health care, and new preventive care programs that was added to the bill after it was submitted for official "scoring." So call the total cost somewhere in excess of $2.5 trillion.
Continued in article
We believe premiums would come down for several
reasons. Companies would no longer need to spend as much money on administrative
costs, to screen out people with pre-existing conditions (prohibited by all
reform bills). If they wanted to participate on the exchanges (and have access
to millions of new customers), the companies would also be forced to compete
with other private plans, and possibly a public option, encouraging them to
lower premiums and accept lower profits.
The New York Times Editorial, November 1, 2009 ---
http://www.nytimes.com/2009/11/01/opinion/01sun1.html?hp
"Health Cost Containment Troublesome Issue," SmartPros,
November 10, 2009 ---
http://accounting.smartpros.com/x68073.xml
Some Democrats and analysts are raising alarms that bills to reform the U.S. healthcare system fall short of President Obama's pledge to slow health spending.
Obama has made cost containment a key leg to healthcare reform. However, health economists say it isn't possible to know whether the bills would meet that goal, with many saying they doubt they would even come close, The New York Times reported Tuesday.
Both the House and the Senate propose cost-saving measures. The House bill, which passed Saturday, projects $440 billion in Medicare savings over 10 years. The Senate Finance Committee bill projects about $420 billion. White House officials said additional savings in the private sector would be realized as well.
Experts, even those whom the White House consulted, said the measures represent only small steps toward revising the existing fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed -- and some lawmakers are paying attention, the Times said.
"My assessment at this point," said Sen. Ron Wyden, D-Ore., and a member of the Finance Committee, "is that the legislation is heavy on health and light on reform."
Sen. Susan Collins, R-Maine, during a news conference Monday with Sen. Lamar Alexander, R-Tenn., shared her concern about the cost-containment issue. Collins said she also has met with moderate Democrats who share her view.
"I don't believe we need more pilot projects to show us that healthcare delivery reforms are necessary," Collins told the Times. "I think people are much more upset over the cost of care than the administration is acknowledging."
Jensen Comment
You can argue for coverage of all new insureds irrespective of pre-existing
conditions on the basis of social equity, but the reasoning of the NYT editorial
above is pure hogwash. If this were true at least one medical insurance company
would've added to profits by ending pre-screening expenses. Pre-existing
conditions often require the most expensive kinds of treatment for such things
as organ transplants, cataracts, kidney dialysis, etc.
Also eliminating pre-existing conditions coupled with the inevitable coverage of illegal immigrants creates moral hazard in that when Grandma Lopez in Mexico City needs an eye operation, her relatives will float her across the Rio Grande primarily for immediate $25,000 eye surgery. If she wants to return she might even walk back across the border unassisted after she can see better.
Lie: States like Texas that have capped punitive damages in
medical lawsuits probably may not keep their limiting caps according to pending
Obamacare legislation. Such caps purportedly have significantly lowered medical
insurance rates in those states.
"Pelosi Health Care Bill Blows a Kiss to Trial Lawyers," Andrew Breitbart,
October 30, 2009 ---
Click Here
The health care bill recently unveiled by Speaker Nancy Pelosi is over 1,900 pages for a reason. It is much easier to dispense goodies to favored interest groups if they are surrounded by a lot of legislative legalese. For example, check out this juicy morsel to the trial lawyers (page 1431-1433 of the bill):
Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.
So, you can’t try to seek alternatives to lawsuits if you’ve actually done something to implement alternatives to lawsuits. Brilliant! The trial lawyers must be very happy today!
While there is debate over the details, it is clear that medical malpractive lawsuits have some impact on driving health care costs higher. There are likely a number of procedures that are done simply as a defense against future possible litigation. Recall this from the Washington Post:
“Lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits, congressional budget analysts said today — a substantial sum that could help cover the cost of President Obama’s overhaul of the nation’s health system. New research shows that legal reforms would not only lower malpractice insurance premiums for medical providers, but would also spur providers to save money by ordering fewer tests and procedures aimed primarily at defending their decisions in court, Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, wrote in a letter to Sen. Orrin Hatch (R-Utah).”
Lie: The U.S. infant mortality rate is much higher than even in Cuba and Europe
Longtime readers will recall that we caught Kristof playing similar games with statistics back in January 2005, when he claimed that the U.S. infant-mortality rate was worse than communist Cuba's and much worse than European rates. We pointed out that a central reason U.S. rates are high is that American physicians make heroic efforts to save extremely premature infants, who nonetheless have a mortality rate in excess of 50%. In other countries, these babies are simply discarded and not even counted in the statistics.
Wall Street Journal Editors Newsletter, November 6, 2009
Lie: Capping punitive damages does not save a significant amount of
money in medical costs.
Here’s an academic study of over 10 million insured. Although 1-2% on average does not sound very large, it adds up if you eventually count in medical insurance costs of 200-300 million insured people.
Limiting medical malpractice punitive (as opposed to damage) awards has also been shown in Canada to greatly reduce costs of the National Health Care Plan.
The Impact of Tort Reform on Employer-Sponsored
Health Insurance Premiums
Ronen
Avraham (University of Texas at Austin, School of Law(, Leemore S. Dafny
(Kellogg School of Management, Northwestern University) and NBER Max M.
Schanzenbach, (Northwestern University, School of Law)
September 2009 ---
Click Here
http://www.kellogg.northwestern.edu/faculty/dafny/personal/Documents/Working%20Papers/ADS_9_09w_ack.pdf
Abstract
We evaluate the effect of tort reform on employer-sponsored health insurance premiums by exploiting state-level variation in the timing of reforms. Using a dataset of healthplans representing over 10 million Americans annually between 1998 and 2006, we find that caps on non-economic damages, collateral source reform, and joint and several liability reform reduce premiums by 1 to 2 percent each. These reductions are concentrated in PPOs rather than HMOs, suggesting that can HMOs can reduce “defensive” healthcare costs even absent tort reform. The results are the first direct evidence that tort reform reduces healthcare costs in aggregate; prior research has focused on particular medical conditions.
Lie: Baucus' Senate bill taxes gold plated medical insurance that's
only a tax on the rich
Yeah right! How about postal workers? This is misleading at best since the many
unions have negotiated gold plated coverage for their rank and file. Some of the
best medical insurance in the U.S. is given to some of the lowest-paid
workers in the U.S. who can ill-afford a tax on their premium insurance plans.
Unions are against this tax, so it will most certainly die in the House
negotiations and force our Keystone Cops to scurry for other taxes or borrow
more trillions from China.
Lie: In an effort to rush through Obamacare in 2009, Congress
will drop demands for a government-operated health insurance competitor in
favor of a non-profit Fannie Health Insurance Cooperative
not run by the government. (this promise no longer exists in the current
House version of the the pending legislation)
This is obvious bait and switch fraud. The
bait is to get Obamacare passed this year by
making grandiose claims about not having government health insurance to compete
unfairly with private health insurance companies. The
switch is that Fannie HIC, like Fannie Mae, is doomed from get
go and will have to be taken over by the government.
Fannie HIC will insure tens of millions of minimum-wage workers, part-time workers, the unemployable, and the otherwise unemployed. There's zero chance of having premium revenues come anywhere close to cash outflows for expanded health, mental health and social service coverage demanded in H.R. 3200. Before she even commences operation, Fannie HIC will have to become a government owned and operated and subsidized health insurance company competing with private insurance companies.
One can only hope that Congress will be so proud of Fannie HIC that this cooperative-gone-government company will provide the only health insurance coverage available to members of the House, Senate, and Executive branches of Federal and State Governments. Fat Chance!
Whereas Fannie Mae cost taxpayers hundreds of billions of dollars in toxic mortgages mandated by Rep. Barney Frank and Sen. Chris Dodd, Fannie HIC will cost taxpayers untold trillions. Well, maybe not. The economic disasters Bernanke, Geithner, and Summers are agreeing to print U.S. dollars in lieu of having to tax and borrow to fund trillion dollar government spending deficits. Isn't that a brilliant idea? --- http://blog.mises.org/archives/009457.asp
Video: David Dreman Warns About 10-12% Inflation, Simoleon Sense,
August 5, 2009 ---
http://www.simoleonsense.com/videodavid-dreman-warns-about-10-12-inflation/
For starters, $1 trillion of extra debt-financed
spending would cause the government to pay about $300 billion of extra
interest in the next decade. Moreover, the CBO's method of estimating the
cost of such a program doesn't recognize the incentives it creates for
households and firms to change their behavior. The House health-care bill
gives a large subsidy to millions of families with incomes up to three times
the poverty level (i.e., up to $66,000 now for a family of four) if they buy
their insurance through one of the newly created "insurance exchanges," but
not if they get their insurance from their employer. The CBO's cost estimate
understates the number who would receive the subsidy because it ignores the
incentive for many firms to drop employer-provided coverage. It also ignores
the strong incentive that individuals would have to reduce reportable cash
incomes to qualify for higher subsidy rates. The total cost of ObamaCare
over the next decade likely would be closer to $2 trillion than to $1
trillion.
Martin Feldstein, "ObamaCare's
Crippling Deficits The higher taxes, debt payments and interest rates needed
to pay for health reform mean lower living standard," The Wall Street
Journal, September 7, 2009 ---
http://online.wsj.com/article/SB10001424052970203585004574393110640864526.html?mod=djemEditorialPage
"Fact Check: Obama Uses Iffy Math on Deficit Pledge," SmartPros, September 10, 2009 --- http://accounting.smartpros.com/x67604.xml
President Barack Obama used only-in-Washington accounting Wednesday when he promised to overhaul the nation's health care system without adding "one dime" to the deficit. By conventional arithmetic, Democratic plans would drive up the deficit by billions of dollars.
The president's speech to Congress contained a variety of oversimplifications and omissions in laying out what he wants to do about health insurance.
A look at some of Obama's claims and how they square with the facts or the fuller story:
---
OBAMA: "I will not sign a plan that adds one dime to our deficits either now or in the future. Period."
THE FACTS: Though there's no final plan yet, the White House and congressional Democrats already have shown they're ready to skirt the no-new-deficits pledge.
House Democrats offered a bill that the Congressional Budget Office said would add $220 billion to the deficit over 10 years. But Democrats and Obama administration officials claimed the bill actually was deficit-neutral. They said they simply didn't have to count $245 billion of it - the cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts.
Their reasoning was that they already had decided to exempt this "doc fix" from congressional rules that require new programs to be paid for. In other words, it doesn't have to be paid for because they decided it doesn't have to be paid for.
The administration also said that since Obama already had included the doctor payment in his 10-year budget proposal, it didn't have to be counted again.
That aside, the long-term prognosis for costs of the health care legislation has not been good.
CBO Director Douglas Elmendorf had this to say in July: "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."
---
OBAMA: "Nothing in this plan will require you or your employer to change the coverage or the doctor you have."
THE FACTS: That's correct, as far as it goes. But neither can the plan guarantee that people can keep their current coverage. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether. The Congressional Budget Office analyzed the health care bill written by House Democrats and said that by 2016 some 3 million people who now have employer-based care would lose it because their employers would decide to stop offering it.
In the past Obama repeatedly said, "If you like your health care plan, you'll be able to keep your health care plan, period." Now he's stopping short of that unconditional guarantee by saying nothing in the plan "requires" any change.
---
OBAMA: "The reforms I'm proposing would not apply to those who are here illegally." One congressman, South Carolina Republican Joe Wilson, shouted "You lie!" from his seat in the House chamber when Obama made this assertion. Wilson later apologized.
THE FACTS: The facts back up Obama. The House version of the health care bill explicitly prohibits spending any federal money to help illegal immigrants get health care coverage. Illegal immigrants could buy private health insurance, as many do now, but wouldn't get tax subsidies to help them. Still, Republicans say there are not sufficient citizenship verification requirements to ensure illegal immigrants are excluded from benefits they are not due.
---
OBAMA: "Don't pay attention to those scary stories about how your benefits will be cut. ... That will never happen on my watch. I will protect Medicare."
THE FACTS: Obama and congressional Democrats want to pay for their health care plans in part by reducing Medicare payments to providers by more than $500 billion over 10 years. The cuts would largely hit hospitals and Medicare Advantage, the part of the Medicare program operated through private insurance companies.
Although wasteful spending in Medicare is widely acknowledged, many experts believe some seniors almost certainly would see reduced benefits from the cuts. That's particularly true for the 25 percent of Medicare users covered through Medicare Advantage.
Supporters contend that providers could absorb the cuts by improving how they operate and wouldn't have to reduce benefits or pass along costs. But there's certainly no guarantee they wouldn't.
---
Video Shocker
"Health Care Shocker: Special Democratic Voting Counties Would Get Protected Medicare Benefits," Brietbart ---
http://www.breitbart.tv/healthcare-shocker-special-democratic-voting-counties-would-get-protected-medicare-benefits/OBAMA: Requiring insurance companies to cover preventive care like mammograms and colonoscopies "makes sense, it saves money, and it saves lives."
THE FACTS: Studies have shown that much preventive care - particularly tests like the ones Obama mentions - actually costs money instead of saving it. That's because detecting acute diseases like breast cancer in their early stages involves testing many people who would never end up developing the disease. The costs of a large number of tests, even if they're relatively cheap, will outweigh the costs of caring for the minority of people who would have ended up getting sick without the testing.
The Congressional Budget Office wrote in August: "The evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."
That doesn't mean preventive care doesn't make sense or save lives. It just doesn't save money.
---
OBAMA: "If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage."
THE FACTS: It's not just a matter of being able to get coverage. Most people would have to get coverage under the law, if his plan is adopted.
In his speech, Obama endorsed mandatory coverage for individuals, an approach he did not embrace as a candidate.
He proposed during the campaign - as he does now - that larger businesses be required to offer insurance to workers or else pay into a fund. But he rejected the idea of requiring individuals to obtain insurance. He said people would get insurance without being forced to do so by the law, if coverage were made affordable. And he repeatedly criticized his Democratic primary rival, Hillary Rodham Clinton, for proposing to mandate coverage.
"To force people to get health insurance, you've got to have a very harsh penalty," he said in a February 2008 debate.
Now, he says, "individuals will be required to carry basic health insurance - just as most states require you to carry auto insurance."
He proposes a hardship waiver, exempting from the requirement those who cannot afford coverage despite increased federal aid.
---
OBAMA: "There are now more than 30 million American citizens who cannot get coverage."
THE FACTS: Obama time and again has referred to the number of uninsured as 46 million, a figure based on year-old Census data. The new number is based on an analysis by the Kaiser Commission on Medicaid and the Uninsured, which concluded that about two-thirds of Americans without insurance are poor or near poor. "These individuals are less likely to be offered employer-sponsored coverage or to be able to afford to purchase their own coverage," the report said. By using the new figure, Obama avoids criticism that he is including individuals, particularly healthy young people, who choose not to obtain health insurance.
Jensen Comment
In fairness, a single-payer medical insurance provider that covered all
Americans would probably result in cost savings in the long run. However,
President Obama realistically proclaims that such an abrupt changeover with lead
to unprecedented turmoil and inefficiencies, to say nothing of quality of care,
if the U.S. Government abruptly decided to insure 300 million Americans in one
fell swoop.
And the cost of phasing in a single-payer system would cause massive deficits, including the windfall profits that government would have to pay present medical insurance companies to operate efficiently over the years before they must operate before being terminated.
The fact of the matter is that we will be forced to live with inefficient private insurers until they are shut down or take over by government. In the meantime, government spending deficits will soar due to increased numbers of insured Americans, illegal immigrants, and expanded scope of coverage (mental health, pre-existing conditions, marriage counseling, and expanded social services).
"How Congress Is Cooking the Books," by Michael Tanner, The New York Post, September 30, 2009 --- Click Here
LAST week, the Senate Finance Committee voted 12-11 not to wait for the Congressional Budget Office to "score" its health-care bill before the committee votes on it. Imagine that: Some senators actually wanted to know how much the bill costs before voting on it.
Let them get away with something like that, and before you know it they'll be demanding honest accounting practices -- sending the whole legislative process to hell in a hand basket.
When it comes to the health-care-reform debate, you see, honest budgeting is nowhere to be seen.
Start with the simple matter of how much health-care reform will cost. The House bill, HR 3200, will cost roughly $1.3 trillion over 10 years -- or so we're told. By the same token, the Senate Finance Committee bill is supposed to cost just under $900 billion. Sure, that's a lot of money -- but it still badly understates the true cost.
The CBO provides 10- year projections of a bill's cost. But most provisions of the health bill don't take effect until 2014. So the "10-year" cost projection only includes six years of the bill.
Plus, the costs ramp up slowly. In its first year, the House bill would only cost about $6 billion; in its first three, less than $100 billion. The big costs are in the final years of the 10-year budget window -- and beyond. In fact, over the first 10 years that the House bill would be in existence (2014 to 2024), its costs would be closer to $2.4 trillion. Similarly, the real cost of the Senate bill over 10 years of operation is estimated at $1.5 trillion.
Worse, the trajectory of the costs after 10 years rises dramatically -- meaning "reform" would cost even more in its second 10 years and beyond.
Such gimmicks also infest the projections of how much reform will add to the deficit. CBO says the House bill adds $235 billion to the deficit. But that, again, cuts off arbitrarily in 2019. Beyond that date, the bill adds enormously to the deficit, about $1.5 trillion in the second 10 years. In fact, if the health-reform bill were treated like other entitlements, such as Social Security and Medicare, which are required to have a 75-year actuarial forecast, its unfunded liabilities would exceed $9.2 trillion.
Of course, the Senate Finance Bill is supposed to be deficit-neutral. But that claim relies on other forms of budgetary flimflam.
For example, the Senate bill relies on Medicare "savings" that Congress keeps refusing to make. Specifically, Medicare has long been ordered to cut 21 percent from what it pays health-care providers -- yet, each year since 2003, for reasons both good and bad, Congress has voted to defer the cuts.
Does anyone else really think that Congress is simply going to slash payments to doctors and hospitals by 21 percent across the board?
Of course, President Obama has long said we can cut Medicare by $500 billion simply by eliminating fraud, waste and abuse. That would be the same "fraud, waste and abuse" that the government has been cutting since Ronald Reagan first used the term.
The truth is that health-care reform is going to cost us a lot. And we're going to pay for it in higher taxes and more debt.
No wonder they don't want us to know.
"Medicare Part D 'Reforms' Will Harm Seniors An ObamaCare
change will cost taxpayers a bundle and lead to poorer drug coverage," Tom
Scully, The Wall Street Journal, December 7, 2009 ---
http://online.wsj.com/article/SB10001424052748704107104574569930258127214.html#mod=djemEditorialPage
There is a little-noticed provision buried deep in both the House and Senate health-care reform bills that is intended to save billions of dollars—but instead will hurt millions of seniors, impose new costs on taxpayers, and charge employers millions in new taxes.
As part of the Medicare Modernization Act in 2003, Congress created a new drug benefit—called Medicare Part D—for retirees at a cost of about $1,900 per recipient per year. Many private employers already provided drug coverage for their retirees, and the administration and Congress did not want to tempt employers into dropping their coverage. Actuaries calculated that if the government provided a subsidy of at least $800, employers would not stop covering retirees.
The legislation created a $600 tax-free benefit (the equivalent of $800 cash for employers), and it worked. Employers continued to cover about seven million retirees who might have otherwise been dumped into Medicare Part D.
It was a good arrangement for all involved. An $800 subsidy is cheaper than the $1,900 cost of providing drug coverage. And millions of seniors got to keep a drug benefit they were comfortable with and that in many cases was better than the benefit offered by the government.
But now that subsidy is coming in to be clipped. This fall congressional staff, looking for a new revenue source to pay for health reform, proposed eliminating the tax deductibility of the subsidy to employers. The supposed savings were estimated by congressional staff to be as much as $5 billion over the next decade.
It sounds smart—except that nobody asked how many employers will drop retiree drug coverage. Clearly, many will. The result is that, instead of saving money, the proposed revenue raiser will force Medicare Part D costs to skyrocket as employers drop retirees into the program.
The careful calculation that was made in 2003 to minimize federal spending and maximize private coverage will go out the window if this provision becomes law. Any short-term cost savings that Congress gets by changing the tax provision will be overwhelmed by higher costs in the long run.
Some members in the House want to mitigate the cost of this provision by mandating that employers maintain existing levels of retiree coverage despite the reduced subsidy. But it's not that simple. A mandate would increase costs on businesses, which in turn would make it harder for those businesses to hire new employees. The mandate would effectively be a tax on employers that provide retiree benefits; this in turn will simply induce some unknown number of employers to terminate their retiree drug programs before the mandate kicks in.
In short, if the changes that are proposed for employer subsidies in the current Medicare Part D program are enacted, everyone will lose. Unions will lose as employers seek ways to drop retiree drug coverage. Seniors will lose as employers drop them into Medicare Part D. Medicare and taxpayers will lose as they face higher costs. And employers will lose as they find it harder to provide benefits.
To make matters worse, accounting rules for post-retirement benefits will require companies that keep their retiree benefits to record the entire accrued present value of the new tax the day the provision is signed into law. This would cause many employers to immediately post billions in losses, which could significantly impact our financial markets.
There are many reasons to pass health-care reform. There is no reason to hurt seniors, employers and taxpayers in the process. Businesses are struggling, and the Medicare trust funds have plenty of problems as it is. It makes no sense to make these problems worse.
Mr. Scully was the administrator of the Centers for Medicare and Medicaid Services from 2001-04 and was one of the designers of the Medicare Part D benefit.
'Liberals Seek Health Care Access for Illegals: A
group of House Democrats say it's unfair to bar illegal immigrants from
paying their own way in a government-sponsored exchange," The Washington
Times, September 27, 2009 ---
http://www.foxnews.com/politics/2009/09/27/liberals-seek-health-care-access-illegals/
Fearful that they're losing ground on immigration and health care, a group of House Democrats is pushing back and arguing that any health care bill should extend to all legal immigrants and allow illegal immigrants some access, The Washington Times reported on Monday.
The Democrats, trying to stiffen their party's spines on the contentious issue, say it's unfair to bar illegal immigrants from paying their own way in a government-sponsored exchange. Legal immigrants, they say, regardless of how long they've been in the United States, should be able to get government-subsidized health care if they meet the other eligibility requirements.
"Legal permanent residents should be able to purchase their plans, and they should also be eligible for subsidies if they need it. Undocumented, if they can afford it, should be able to buy their own private plans. It keeps them out of the emergency room," said Rep. Michael M. Honda, California Democrat and chairman of the Congressional Asian Pacific American Caucus.
Honda was joined by more than 20 of his colleagues in two letters laying out the demands.
Coverage for immigrants is one of the thorniest issues in the health care debate, and one many Democratic leaders would like to avoid. But immigrant rights groups and the Democrats who sent the letters say they have to take a stand now.
Jensen Comment
The key absurdity here is the statement "pay their own way." If a foreigner
in need of a $50,000 eye implant surgeries sneak into the U.S. for the main
purpose of paying $100 in premiums for each $50,000 surgery and then return
to their home countries, these aliens have hardly "paid their own way."
They've taken on illegal alien status mainly for getting expensive health
care on the cheap.
"What disturbs Americans of all ideological persuasions is the fear that almost everything, not just government, is fixed or manipulated by some powerful hidden hand," Frank Rich wrote in Sunday's New York Times.
That manipulation should disturb us. But contrary to Rich, it is not the work of "corporatists" who have sprung up to attack progressive reforms proposed by Obama and the Democratic majority. Manipulation is what we got many years ago when we traded a more or less free market for the "progressive" interventionist state. When government is big, the well-connected always have an advantage over the rest of us in influencing public policy.
Observe: Although President Obama and big-government activists demonize health-insurance companies, the companies "are still mostly on board with the president's effort to overhaul the U.S. health-care system," the Wall Street Journal reports; and ...
Although the activists criticize Big Pharma, "The drug industry has already contributed millions of dollars to advertising campaigns for the health care overhaul through the advocacy groups like Healthy Economies Now and Families USA. It has spent about $1 million on similar advertisements under its own name," the Times reports.
Big Pharma and Big Insurance want Obama-style health-care reform?
It's not so hard to understand. "The drug makers stand to gain millions of new customers," the Times said.
And from the Journal: "If health legislation succeeds, the [insurance] industry would likely get a fresh batch of new customers. In particular, many young and healthy people who currently forgo coverage would be forced to sign up." No wonder insurers are willing to stop "discriminating" against sick people. (Forget that the essence of insurance is discrimination according to risk.)
Not that Big Pharma and Big Insurance like every detail of the Democratic plan. Drug companies don't want Medicare negotiating drug prices—for good reason. If it forces drug prices down, research and development will be discouraged. (Depending whom you believe, Obama may or may not have agreed with the drug companies on this point.)
As for the insurance companies, they worry—legitimately—that a government insurance company—the so-called public option"—would drive them out of business. This isn't alarmism. It's economics. The public option would have no bottom line to worry about and therefore could engage in "predatory pricing" against the private insurers.
But despite these differences, the biggest companies in these two industries are on board with "reform."
It illustrates economist Steven Horwitz's First Law of Political Economy: "No one hates capitalism more than capitalists." In this case, big business wants to shape—and profit from—what inevitably will be an interventionist health-care reform. Can you think of the last time a major business supported a truly free market in anything?
In light of all this, it's funny to watch Democrats and their activist allies panic over the protests at congressional town meetings around the country. Tools of the corporate interests! they cry. But anyone opposing "socialized medicine" at the meeting can't be a mouthpiece for big business because, as we've seen, big business supports government control. Conservative groups may be encouraging people to vent their anger at congressmen who pass burdensome legislation without even bothering to read it, but that's no reason to insult the protestors as pawns. What's wrong with organizations helping like-minded people to voice their opinions? Why do Democrats, such as Speaker Nancy Pelosi, dismiss citizen participation as "AstroTurf"—not real grassroots—only when citizens oppose the kind of big government they favor?
They weren't so dismissive when George W. Bush was president and people protested—appropriately—his accumulation of executive powers.
"When handfuls of Code Pink ladies disrupted congressional hearings or speeches by Bush administration officials," Glenn Reynolds writes, "it was taken as evidence that the administration's policies were unpopular, and that the thinking parts of the populace were rising up in true democratic fashion. ... But when it happens to Democrats, it's something different: A threat to democracy, a sign of incipient fascism ... House Speaker Nancy Pelosi calls the 'Tea Party' protesters Nazis. ... "
So when lefties do it, it's called "community organizing."
When conservatives and libertarians do it, it's "AstroTurf."
Give me a break.
John Stossel is co-anchor of ABC News' 20/20 and the author of Myth, Lies, and Downright Stupidity. He has a new blog at http://blogs.abcnews.com/johnstossel.Jensen Comment
So who's against Obamacare? I think of the little people who are tired of being told that it's raining when hypocrites in Congress are peeing on our shoes. I think it's the little people who know full well that Obamacare will be neither less expensive nor less wasteful of consumer/taxpayer dollars. I think of the little people who are tired of spending deficits that are paving the road to Hell. I think it's the little people who fear the hoards of foreigners sneaking across our borders for free health care. I think it's the little people who wish that genuine photo identification should be required for voting and collection of benefits.John Stossel's right. The great divide between big government and big business is a myth. We're puppets on a string being exploited by the people in glass towers who blow up our economic bubbles and pop our balloons. Obamacare is just another way of justifying lousy health care from overworked and underpaid healthcare providers. Obamacare's another way to beat down small business and competition in America.
The Lie: How to lie with statistics
These Democrats are all over the map on where
precisely Americans place in the life-expectancy rankings. We're 24th,
according to Vice President Joe Biden and Sen. Barbara Boxer; 42nd,
according to Pennsylvania Gov. Ed Rendell; 35th, according to Washington
Post columnist Eugene Robinson; and 47th, according to Rep. Dennis Kucinich.
So the U.S. may have less of a "life expectancy" problem than a "Democratic
math competency" problem. (Coulter mentions other widely varying
medical statistics reported in the media)
Ann Coulter, "Would Your Company
Like to Sponsor the Next Installment of Liberal Lies on National Health
Care?" , Townhall, October 7, 2009 ---
Click Here
The Lie: That the
ten-year cost of the current H.R. 676/3200 is $1.5 trillion as estimated by the
non-partisan Congressional Budget Office. Even without the anticipated
massive fraud that's not factored into these estimates, there is an
accounting problem. Amidst the often emotional passions for passing
universal health (and social services) legislation, the accounting for it
will frontload revenues and defer costs
such that when President Obama finally admits his Obamacare will add to the
Federal deficit, the amounts to be added will be grossly underestimated.
This deception in accounting is what has Social
Security and Medicare entitlements in such deep, deep trouble as the cost
back loading is finally catching up with revenue shortfalls. President Roosevelt in 1935 promised a Trust Fund in which social security
revenues collected in early years would set aside for recipients in their
retirement years. Congress over the years decimated the Trust Fund for
social causes that, although very worthy, were not intended to be funded by
the Social Security Trust Fund.
"The Deficit and Health Care: Falls the Shadow,"
The Economist,
July 25-31, 2009, pp. 25-26 --- "
http://www.economist.com/world/unitedstates/displaystory.cfm?story_id=14085725
Most of the red ink results from the enormous hole the recession has punched in GDP and consequently in tax revenue, the cost of bailing out the financial system, and interest on the mounting debt. Only a small part of it comes from America’s big and growing entitlements, Medicare and Medicaid (health care for the elderly and poor, respectively) and Social Security (public pensions), whose worst fiscal problems lie beyond 2019. “Unless we demonstrate a strong commitment to fiscal sustainability,” Mr Bernanke remarked, “we risk having neither financial stability nor durable economic growth.”
Mr Obama knows all this: he promises repeatedly not to leave the problem to his successors. Yet he has done little to back up the rhetoric. His willingness to veto more F-22 spending is admirable, but the $1.75 billion at stake is immaterial. He will release an updated budget outlook in mid-August, but it is unlikely to contain any notable new initiatives. There is still no sign of a path towards fiscal tightening over the medium term as the economy recovers. Quite the opposite; Mr Obama has not wavered from his position that taxes on those earning less than $250,000 will not go up. In fact, they’ve been temporarily cut. He did say in an interview this week that he might set up a commission that could look at ways of reducing entitlements spending once the recession is over.
The president has promised that health-care reform will be deficit-neutral, but this is a slippery concept. A plan may be deficit-neutral over ten years, but add significantly to it thereafter by front-loading revenue and backloading costs. The CBO figures show that this is a big problem with the House plan, whose shortfall will balloon beyond the ten-year horizon.
Jim Cooper, one of the Democrats’ most fiscally hawkish congressmen, fears that if push comes to shove, his party will not long remain stalwart on deficit-neutrality. “Health care has been such an impossible dream for so many decades that a lot of today’s Congress would overlook the deficit problems. I hear it all the time from colleagues in leadership: ‘We always find enough money for defence. We’ll find enough for health care’.” Mr Galston, though, thinks that the public’s worries about the deficit will reinforce Mr Obama’s commitment that health reform should not boost the deficit over the medium or long term. This could mean that he ends up with a plan that covers fewer of the uninsured than many had hoped.
None of this deals with the still-gaping hole in the budget. Indeed, a truly deficit-neutral health-care plan may make it tougher to fill that hole: if the rich are already being taxed more to pay for health reform, that makes it harder to use them to address the wider deficit. There are other ways to reduce the deficit, including getting rid of the mortgage-interest deduction, raising the age of eligibility for Medicare and Social Security, altering the inflation-indexation formula, or proposing some sort of tax reform that raises additional revenue. These ideas need not be implemented immediately; that would contradict the purposes of stimulus. But the knowledge that they are in the works would help reassure the public and investors that the federal debt—forecast on current policies to explode from a net $5.8 trillion last year to a net $11.7 trillion in 2019—may be tamed.
The Lie: Business firms
will be able to carry on with their present health insurance providers. The
fact of the matter is that the present house bill explicitly puts death
conditions on Erisa-enabled self insurance plans used by millions of business firms.
The cost of switching to big insurance company coverage will be massive if
they are forced to pay for all the medical and social services mandated in
the current version of Obamacare legislation.
The Lie: The insurance industry abides by state
laws by not rescinding insurance coverage even when there is no fraud on the
part of the patient in information provided to the insurance company.
This is actually a blatant lie that Bill Moyers documented quite well ---
Video:
http://www.pbs.org/moyers/journal/07312009/watch.html
The Lie: Obama's relationship with tort lawyers
is the real driver of Obamacare costs
According to a 2007
study
by McKinsey&Company, physician
compensation bumps up health care spending in America by $58 billion
annually,on average, because U.S. doctors make twice as much as their OECD
peers. And even the poorest in
specializations
like radiology and surgery
routinely rake in around $400,000 annually. Doctors—and many
Republicans—constantly carp about the costs of "defensive medicine" because
it forces providers to perform unnecessary procedures and tests to insulate
them from potential lawsuits. But excessive physician salaries contribute
nearly three times more to wasteful health care spending than the $20
billion or so that defensive medicine does. "While the U.S. malpractice
system is extraordinary," the study notes, "it is only a small contributor
to the higher cost of health care in the United States." Meanwhile, other
studies have found that doctors' salaries contribute more to soaring medical
costs than the
$40 billion or so
that the uninsured cost in uncompensated care--the president's bete noir.
Shikha Dalmia, "The
Evil-Mongering of the American Medical Association: Obama's cozy
relationship with Big Medicine will hurt patients," Reason Magazine,
August 27, 2009 ---
http://www.reason.com/news/show/135682.html
The Lie: AARP endorsed
H.R. 3200 (Obama's Press Secretary belated admitted to the lie)
"Gibbs: Obama misspoke about AARP,"
Fox News, August 12, 2009 ---
Click Here
AARP = Armed and Really Pissed
"McCain
Urges Seniors to Abandon AARP," Fox News, December 3, 2009
---
http://www.foxnews.com/politics/2009/12/03/mccain-aarp-betrayed-senior-citizens/
The Lie: AARP
perpetuates a lie that government run insurance, like Medicare, is a good
deal for patients and taxpayers.
To put the reader at ease the (AARP) article says
that government run health care can’t be so bad since, after all, Medicare
is government run health care and everybody loves it. The article omits the
fact that Medicare is $38 trillion in the red. Yes, trillion with a “tr”)
and by Obama’s own admission is overrun by $500 billion of waste, fraud and
abuse. Obama says Medicare and Medicaid are responsible for our deficits. So
what does he do? He proposes the vast expansion of the Medicare and Medicaid
programs to further balloon our deficits and our health care inflation.
Herb Dennenberg, "AARP: The
Hype, The Lies, The Facts," The Bulletin (Philadelphia's oldest
newspaper), September 21, 2009 ---
Click Here
- The AARP Bulletin (September 2009) has a front-page headline on Obamacare: “The Hype, the Lies, the Facts: How to Tune Out the Fear-mongering and Misinformation and Make Sense of the Health Care Reform.” I’d add only one amendment to that AARP headline: “If you want to avoid the hype, the lies, and get the facts on Obamacare, don’t read the biased one-sided propaganda that AARP publishes in its Bulletin.”
The article is supposed to answer the question of AARP readers, “How do I know what to believe?” Anyone who reads the article critically or studies AARP history on this matter, knows they are in the tank for Obamacare, and in the guise of fair and balanced journalism they are presenting the Obamacare party line.
The article starts out by quoting Kathleen Hall Jamieson, director of he Annenberg Public Policy Center at the University of Pennsylvania, who runs FactCheck.org, a website that examines specious claims from all sides of the political spectrum. She says that health care reform has “serious consequences to people’s lives and it would be useful if as many people as possible actually understood what the proposals are about.” But, then she identifies the rise of the Internet and the decline of the mainstream press as a prime source of information which have put that prospect at risk.
Poor, pathetic Ms. Jamieson is saying, in effect, that the public was only getting the truth when they were relying on the biased, fraudulent, dishonest, and ultra-liberal mainstream media. That poor, pathetic “expert” who is “fact checking for the public” feels the truth is threatened now that multiple points of view, some of which are the opposing point of view, are presented by the Internet and now that the public is slowly beginning to realize that you can’t trust the mainstream media. (I would agree with Bernard Goldberg that the mainstream media is no longer mainstream. Until a good alternative description emerges, I’ll call it the biased, fraudulent, dishonest, and ultra liberal mainstream media.)
So, the AARP article is doing its readers a great public service by demonstrating that you can’t trust the AARP, FactCheck.org, Ms. Jamieson, and the Annenberg Public Policy Center at the University of Pennsylvania if you want fair and balanced information about such matters as Obama and Obamacare.
The article goes on to perpetuate every fraud and deceit that people like House Speaker Nancy Pelosi and the leadership of the Democratic Party have put forth to stigmatize and demonize dissent. For example, the article asks, “Could rumor-mongering affect the outcome? Recent violent interruptions at lawmakers’ town hall meetings suggest it might.” So, the AARP, which is supposed to represent senior citizens, is joining the chorus that sees those who oppose Obamacare and who exercise their First Amendment Rights at Tea Parties as mobsters, prone to violence, Nazis, Brown Shirts and all the rest. They are proving that AARP, the Democratic leadership, and the mainstream media believe in the First Amendment only for those in agreement with its radical, far-left policies.
The AARP and its editors and officers clearly have no conscience and no sense, as they would not carry forward such blatant propagandizing for Obamacare and hurl insults at their own membership. If they are in the business of informing their diverse membership, they should provide both sides of an issue, not just give the appearance of doing so while residing in the pocket of the pro-Obamacare forces.
No wonder AARP been losing membership by the tens of thousands. Sometime ago, it was estimated at 60,000 members lost and that figure is probably much higher by now. Their stance on this did not surprise me. I have already reported in one column how they, along with AMA and others, have sold out to Obama and Company to support his vision of health care reform. I’ve also reported how the AARP is not in the business of representing the interests of senior citizens, but is, in fact, a phony membership organization in the business of selling its members insurance, credit cards, mutual funds, and other services. In fact, facing the first page of the propaganda piece in question is a full-page ad for life insurance sold by AARP. The same issue carries ads for AARP mobile home insurance, AARP Medicare insurance supplements, and AARP auto insurance.
I want to be fair to AARP and its article on health care reform. It did have four words of truth in it. The inside headline reads, “The Assault on Truth.” Of course, that was intended to characterize the critics of Obamacare. However, it perfectly characterizes the article in question and AARP. Let me give you a few examples involving the questions asked and answered by the article:
Will The Government Take Over Health Care So We End Up With Socialized Medicine?
The answer is the standard party line: “No. Neither the president nor the congressional committees have suggested anything remotely resembling a government takeover of health care.”
This answer is based on the fact that Mr. Obama says he doesn’t want the single-payer, government-takeover system that is used in Canada. The article fails to state that Obama has long been on record as favoring the discredited single-payer system and has even said we will have to get there gradually. But the article doesn’t explain that you can have a government takeover without a single-payer system.
When you look at what some of these proposals do, you will see they involve the federal government deciding what kind of policies will be written, what kind of rates will be charged, what kind of government insurance companies will be established, what kind of end-of-life counseling will be provided for senior citizens. What’s more, when you start setting up dozens of new agencies and commissions to control the health care system and to decide on what is the “best” medical practice, you don’t need single-payer to bring about a government takeover. When you grant insurance to 47 million “uninsured,” you assure a shortage of health care providers that sets the stage for rationing. As Dick Morris pointed out, contrary to the view of Obama press secretary Robert Gibbs, “You don’t have to be a medical school graduate to figure that out. That’s an elementary school problem.”
If that’s not quite enough to convince you, when you populate the White House with radicals, communists, socialists and advocates of such things as compulsory abortion, compulsory sterilization, and providing medical care based on quality of life years remaining, meaning seniors will be locked out, you are setting the stage for something worse than single-payer.
The article also tries to refute the fact of government takeover by saying “socialized” medicine is also off the table. The article says socialized medicine involves government ownership of hospitals and employment of doctors, as in the United Kingdom. It says that’s not contemplated. But, again, when government and federal bureaucrats control virtually every aspect of the health care system, you don’t need formal ownership. Comprehensive control is the equivalent of government ownership, of socialized medicine, and of the discredited systems of Canada and the United Kingdom.
To put the reader at ease the article says that government run health care can’t be so bad since, after all, Medicare is government run health care and everybody loves it. The article omits the fact that Medicare is $38 trillion in the red. Yes, trillion with a “tr”) and by Obama’s own admission is overrun by $500 billion of waste, fraud and abuse. Obama says Medicare and Medicaid are responsible for our deficits. So what does he do? He proposes the vast expansion of the Medicare and Medicaid programs to further balloon our deficits and our health care inflation.
Will Private Insurance Be Outlawed Or Wither On The Vine?
Needless to say, the AARP article answers, “No. Obama and the congressional committees say their objective is to build on the current system – keeping employer-sponsored group insurance and giving more consumer protections to people who are employed by small businesses or buy insurance as individuals.”
The AARP article argues that those with employer-sponsored insurance are ineligible for the public plan. But the article forgets that many employers would stop giving coverage, as the penalty for not providing it is smaller than the cost of providing it. Even the New York Times, a lap dog for Obama, in an editorial dedicated to selling Obamacare, admitted that the public option would likely be less costly than many alternatives.
The article also ignores the fact that the public option, a government insurer, would be subject to rules made by the government, so the umpire of the marketplace would be on the side of the government insurer. That is not likely to produce a level playing field for private insurers.
Finally, the article ignores the ways proposed in Republican-sponsored bills that would encourage competition. For example, opening up a nationwide market for health insurance would be an obvious and easy way to increase competition. Now, the consumer is limited to companies admitted to do business in his state. The insurance exchanges, proposed in many bills, would also make sense, as they would ratchet up competition.
Incidentally, it is important to remember that with or without a public option or some variation of it in the form of co-ops, Obamacare still involves a government takeover. So, don’t think it is a big deal to delete the public option. The bill spells catastrophe with or without that provision.
All the other questions asked in the article also provide the wrong answers. For example, “Will Medicare be eliminated or gutted to pay for reforms?” The article answers, “No. It’s inconceivable that any lawmaker would commit political suicide by proposing to get rid of Medicare.” But the AARP article forgets that Obama has said that he would cut $500 billion in waste, fraud, abuse, and inefficiency out of Medicare. We’ve heard that line since the days of President Nixon, and we’re still waiting for that waste, fraud, abuse, and inefficiency to be eliminated. If Obama knows how to do it, what is he waiting for? Why hasn’t he proceeded to cut that waste, fraud, abuse and inefficiency out of the system to prove he knows what he’s doing and can give more than campaign speeches? He’s been in office about seven months, and yet he’s done nothing to solve this problem which he says is bankrupting the country and is responsible for the deficits. When you cut $500 billion out of Medicare and grant coverage to 47 million previously uninsured, you’re going to have to ration medical care, and that means rationing medical care for senior citizens.
The biggest barrels of red ink have been generated by Medicare and Medicaid to the tune of tens of trillions of dollars. So what does Obama do? He proposes, in effect, to vastly expand Medicare and Medicaid and to compound our problems.
The president and chief executive officer of AARP, in an editorial accompanying the article in question, endorse the lies, hype, and exaggeration in the article by writing that there has been too much fear-mongering and misinformation involved in the debate. They continue to give the false impression that they are above the fray, but then echo the party line coming from Obama and the Democratic leadership in Congress. AARP and its leadership have continued to demonstrate they are the ones getting in the way of a fair, balanced, and honest debate on heath care reform.
Meanwhile, we have the case of the Association for the Advancement of Retired Persons (AARP), and its fanciful Medicare claims. The self-styled seniors lobby is using all its money and influence to cheer on ObamaCare, even though polls show that most retired persons oppose it. AARP has spent millions of dollars on its TV ad campaign and bulletins and newsletters to its members, including eight million direct-mail letters over Labor Day. The AARP Web site claims that it is a "myth" that "health care reform will hurt Medicare," while it is a "fact" that "none of the health care reform proposals being considered by Congress will cut Medicare benefits or increase your out-of-pocket costs."
"Medicare and Gag Orders Humana gets whacked for telling the truth, AARP gets a pass for spreading falsehoods," The Wall Street Journal, September 24, 2009 --- Click Here
The Lie: "Preventative medicine as envisioned in Obamacare will make health care significantly cheaper.
So last week, CBO Director Doug Elmndorf wrote
a
letter to Congressmen explaining what cost savings they can expect from
preventive medical services: The evidence
suggests that, for most preventive services, expanded utilization leads to
higher, not lower, medical spending overall. It makes sense if you think
about what are called the “false positives”.
John Stossel, "Expanding
Preventive Care May Add to Costs, CBO Says," ABC News, August 13,
2009 ---
http://blogs.abcnews.com/johnstossel/2009/08/prevention-saves-money.html
See The Washington Post account ---
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703822.html
The Lie: H.R. 3200
proposed "Death Panels" to decide when decide when to refuse health
treatments..
False charges about Obamacare don't
help. Like the end-of-life tempest. Former Alaska Gov. Sarah Palin
popularized the term "death panels." She said: "The America I know and love
is not one in which my parents or my baby with Down syndrome will have to
stand in front of Obama's 'death panel' so his bureaucrats can decide, based
on a subjective judgment of their 'level of productivity in society,'
whether they are worthy
of health care". . .
. The House bill does deal with the issue. (The
Senate Finance Committee bill did until the provision was removed the other
day.) Section 1233 amends the Medicare law to add "advance care planning
consultation" (counseling about living wills and the like) to the list of
reimbursable
services. The provision defines "consultation,"
but nowhere does it require Medicare beneficiaries to participate or
authorize death panels. (Grassley voted for a similar provision in 2003 when
his Republican-controlled Congress added
drug coverage
to Medicare.)
John Stossel,
Townhall,
August 19, 2009 ---
http://townhall.com/columnists/JohnStossel/2009/08/19/obamacares_inevitable_logic
Jensen Comment
I agree that the "death panels" arguments were straw men. But then I do see
where the Obama was relying heavily on the cost savings attributable to
five-year health consultation plans with the aged. One has to wonder what
savings were lost with the Senate decided to drop the five-year
consultations? This seems prima facia to imply that quality of
care was intended to be reduced for the aged, including such things as hip
replacements and dialysis.
The chronically ill and those toward the end of
their lives are accounting for potentially 80 percent of the total health
care bill out here.
President Barach Obama as quoted from a David Leonhardt interview
reported in The New York Times:
The Lie: Surgeons bill Medicare $50,000 for a foot amputation.
American Academy of Orthopaedic Surgeons Responds to False Allegations of
President Obama
"Orthopedic Surgeons respond to Obama on amputation comment," by Thomas
Lifson, The American Thinker, August 16, 2009 ---
Click Here
The American Academy of Orthopaedic Surgeons (AAOS) is profoundly disappointed with President Obama's recent comments regarding the value of surgery and blurring the realities of physician reimbursements. The AAOS represents over 17,000 US board-certified orthopaedic surgeons who provide essential services to patients every day. As President Obama has said, "Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed." In that spirit, we would like to bring some clarity to his comments and underscore the value that orthopaedic surgeons bring to Americans every day of every year.
First, surgeons are neither reimbursed by Medicare, nor any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1200 which includes the follow up care the surgeon provides to the patient up to 90 days after the operation. Moreover, orthopaedic surgeons are actively involved in the preventive care he mentions. We are a specialty that focuses on limb preservation whenever possible and when it is in the best interests of the patient. Our approach to amputation follows the same careful, thoughtful approach, always with the patients best interest as the primary focus.
Continued in article
The Lie: The health insurance mandate is not a tax.
"Yes, health-insurance mandate is a tax." by Donald Lambro, Townhall, September 23, 2009 ---
http://townhall.com/columnists/DonaldLambro/2009/09/23/yes,_health-insurance_mandate_is_a_taxPresident Obama absolutely refuses to acknowledge there is a huge middle-class tax in the Senate Finance Committee's healthcare bill. The president flatly denies the legislation that the White House supports contains a stiff penalty tax that would hit uninsured middle-income people the hardest -- the very folks he promised would never see their taxes rise under his presidency.
Obama has repeatedly stated that promise throughout the healthcare debate, despite evidence to the contrary, and no one in the national news media has called him on it. That is, until George Stephanopoulos raised the issue with him Sunday on ABC's "This Week."
First, Stephanopoulos reminded the president that in his campaign for the presidency he was "against the individual mandate" that all Americans be required to buy health insurance.
"Yes," Obama replied.
Then Stephanopoulos hit him with the question no one apparently had asked him before. Pointing out that the Finance Committee plan contained just such a mandate whereby "the government is forcing people to spend money, fining you if you don't," he asked, "How is that not a tax?"
Obama replied, "No, but ... but, George, you ... can't just make up that language and decide that that's called a tax increase."
"You reject that it's a tax increase?" Stephanopoulos asked. Obama said, "I absolutely reject that notion."
But if Obama looked on page 29 of Senate Finance Committee Chairman Max Baucus' legislation -- the bill he hopes will enact his healthcare plans into law -- he would have read this line: "The consequence for not maintaining (health) insurance would be an excise tax."
What part of those two words doesn't he understand? The government imposes a raft of excise taxes on all of us: the tires for our cars, alcoholic beverages, jewelry and many other purchases. Now it wants to add health insurance to the tax-revenue list as a penalty for those who do not purchase a product the feds insist you must buy or else face fines up to $950 for an individual and up to $3,800 a year for a family.
Continued in article
The Lie: A huge portion
of Obamacare will be financed by further limiting what hospitals receive
from Medicare.
This will be a lie because it just will not work. I think
this is a wrong because it creates age discrimination that should not
be allowed. If government medical insurance pays hospitals more for younger
patients than older patients it will be age discrimination. If all
government medical insurance payments to hospitals is so tight-fisted that
the hospitals lose money on every government-insured patient (which is why
the Massachusetts hospitals are suing the Mass. universal health care plan),
then hospitals will have to rely more and more on private insurance plans to
keep those hospitals in business. This, in turn, will drive up the cost of
private insurance to a point where many businesses, especially small
businesses, will shift almost entirely to part-time workers.
Democrats are now blaming the defection of elderly voters from Obama care on the phony threats of euthanasia and rationing of treatment of older people. But this is not the underlying cause of the defection. The underlying cause is the genuine threat that government health insurance will pay less for hospital and doctor care that what is being paid for younger patients. President Obama needs to assure the elderly that hospitals and doctors will receive just as much from older patients as younger patients. Why don't Barack Obama, Nancy Pelosi, Chris Dodd, Keith Olbermann and Chris Matthews ever assure us that there will be no age discrimination in claims coverage?
Michael Moore lets the Obamacare cat out of the
bait and switch bag
Free Republic, August 11, 2009 ---
http://www.freerepublic.com/focus/f-bloggers/2313338/posts
In politics, knowing what your opposition thinks and says about you and your team is critical. But listening to what they’re saying about their own side can sometimes be even more telling.
In the latest issue of Rolling Stone, Michael Moore insists that Barack Obama’s ambitions are much farther left than he lets on. Thus, the President has been deliberately lying to us about everything from healthcare reform to the war on terror. But contrary to the Bush years, when perceived presidential deceit evoked liberal rage and a film to go with it, Moore adoringly approves of what he now sees as a necessary “rope-a-dope strategy” to advance his side’s cause.
The interview, part of a larger round table discussion also including Paul Krugman and David Gergen, asks the “three leading political observers” to analyze and discuss the first six months of the Obama presidency. The most startling perspective Moore provides is in regard to the current health care debate:
I take all of the things that make me nervous about the decisions that Obama has made, and I look and them through that lens – that it’s some kind of master plan. It’s like his continued support of a government-run option for health care. If a true public option is enacted – and Obama knows this – it will eventually bring about a single-payer system, because the profit-making insurance companies won’t be able to compete with a government plan and make the profits they want to make. At some point most of them will probably have to bow out of the business.
Michael Moore"Video: Obama Explains How His Health Care Plan Will ‘Eliminate’ Private Health Insurance," Breitbart, August 3, 2009 ---
http://www.breitbart.tv/uncovered-video-obama-explains-how-his-health-care-plan-will-eliminate-private-insurance/
The Lie: Every Obamacare Critic is a Racist
Since my post below about Obama supporters who tar all
of the President’s critics as racists, Fidel Castro has weighed in. Reuters
reports that Castro says Obama is trying to make positive changes but is being
fought at every turn by right-wingers who hate him because he is black: “(T)he
extreme right hates him for being African-American… I don't have the slightest
doubt that the racist right will do everything possible to wear him down,
blocking his program to get him out of the game one way or another, at the least
political cost," (Castro) said. More than a thousand...
John Stossel, ABC News,
August 27, 2009 ---
http://blogs.abcnews.com/johnstossel/2009/08/every-critic-a-racist.html
The Lie: The House Bill
presently states that business firms can opt out of providing health
insurance coverage for employees by paying an 8% of
gross payroll good-deal penalty to the government.
This is bait and switch fraud at its worst!
By the time the government insurance option becomes viable this will
increase to X% at whatever it takes to keep most working full-time employees
out of the government health insurance option. The reason partly is due to
the fact that it will take decades before the government option can process
the claims for between virtually the entire population of the United States
plus all the illegal aliens who will sneak into the country for health
services. The reason also is that President Obama promised to keep private
health insurance viable such that he must eventually make it virtually
impossible for employers to opt out of private medical insurance plans at
lower costs.
Two weeks ago I warned about the "bait and switch fraud" in the H.R. 3200 good news bait of an 8% of gross payroll penalty for employers who do not provide health insurance coverage for employees. In a surprising move, Congress is already switching the bait to 10% even before H.R. 3200 is passed. After its passage I look for the bait to be switched to an even higher percentage, maybe 50%, such that there is no way for employers to avoid an absolutely massive expense for health care coverage under the new rules of virtually no self insurance (policies will have to be purchased from large private insurance companies). virtually all pre-existing health issues will have to be covered instantly for each new person hired, part-time workers and illegal aliens will have to receive health insurance, and an array of social services will have to be covered including marriage counseling and family counseling.
The projected cost of employer-based health coverage is so huge that even a 10% penalty would still be cheaper. But employers should count on the bait being switched once again after Obamacare is legislated. The government medical insurance plan just will not be able to insure 200 million to 300 million people instantly if all employers opt out of health coverage by paying the X% penalty. Irrespective of the bait, the switch is inevitable!
The only reason I can see for switching the bait before H.R. 3200 is passed is to deceivingly make it look more deficit neutral and once again deceive the public and dimwitted members of Congress.
Even many Democrats are revolting against Speaker Nancy
Pelosi’s 5.4% income surtax to finance ObamaCare, but another tax in her House
bill isn’t getting enough attention. To wit, the up to 10-percentage point
payroll tax increase on workers and businesses that don’t provide health
insurance. This should put to rest the illusion that no one making more than
$250,000 in income will pay higher taxes.
"The Pelosi Jobs Tax: Workers will pay for the new health-care payroll
levy," The Wall Street Journal, July 30, 2009 ---
http://online.wsj.com/article/SB10001424052970203609204574316183688201934.html#mod=djemEditorialPage
Because of the present health care system in the United
States is unjust and inefficient, I am in favor of a National Health Plan
modeled after the Canadian National Health Plan where Canadians are taxed
for a huge portion of their health services irrespective of their levels of
income. In Canada, about 40% of taxpayer's tax dollars go
for health services. Any system that does not make users of the system share
heavily in the cost of the services will be unjust, abused, and inefficient.
Also in Canada the National Health Plan greatly restricts the size of
malpractice lawsuit lotteries for lawyers ----
http://faculty.trinity.edu/rjensen/Health.htm#Canada
USA Today
reported on July 31, 2009, Page 10A, (using OECD data for 2008) that health
care costs in Canada were $3,505 per capita Before any Obamacare legislation
for health care the per capita cost of health care in the United States was
$6,567. In large measure this due to the cost physicians, nurses, ambulance
services, and hospitals must pay for malpractice insurance. Thousands of
gynecologists in the United States dropped the obstetrics part of their
practices because of the enormous price of malpractice insurance. Many
hospitals dropped obstetrics services for the same reason.
Why Medical Malpractice Is Off Limits in Terms of Health Care Reform
The upshot is simple: A few thousand trial lawyers
are blocking reform that would benefit 300 million Americans. This is not
just your normal special-interest politics. It's a scandal—it is as if
international-trade policy was being crafted in order to get fees for
customs agents. Trial lawyers are agents, and their claims are only as valid
as those they represent. They argue, of course, that they are champions of
malpractice victims. As Anthony Tarricone, president of the trial lawyers
association (called the American Association of Justice) put it: "Trial
attorneys see first-hand the effects medical errors have on patients and
their families. We should keep those injured people in mind as the debate
moves forward." But under the current system, 54 cents of the malpractice
dollar goes to lawyers and administrative costs, according to a 2006 study
in the New England Journal of Medicine. And because the legal process is so
expensive, most injured patients without large claims can't even get a
lawyer. "It would be hard to design a more inefficient compensation system,"
says Michelle Mello, a professor of law and public health at Harvard, "or
one which skewed incentives more away from candor and good practices."
Philip K. Howard, "Why Medical
Malpractice Is Off Limits: A few thousand lawyers have a lock on
Democrats, who refuse any legal reform," The Wall Street Journal,
September 29, 2009 ---
http://online.wsj.com/article/SB10001424052970204488304574432853190155972.html?mod=djemEditorialPage
"Dean says Obamacare authors don't want to challenge trial lawyers," by: Mark Tapscott, Washington Examiner, August 26, 2009 --- Click Here
Whatever else he said Wednesday evening at the town hall hosted by Rep. Jim Moran, D-VA, former Democratic National Committee chairman and presidential candidate Howard Dean let something incredibly candid slip out about President Obama's health-care reform bill in Congress.
Asked by an audience member why the legislation does nothing to cap medical malpractice class-action lawsuits against doctors and medical institutions (aka "Tort reform"), Dean responded by saying: “The reason tort reform is not in the [health care] bill is because the people who wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on. And that’s the plain and simple truth,”
Dean is a former physician, so he knows about skyrocketing medical malpractice insurance rates, and the role of the trial lawyers in fueling the "defensive medicine" approach among medical personnel who order too many tests and other sometimes unneeded procedures "just to be sure" and to protect themselves against litigation.
Texas Gov. Rick Perry recently described in an Examiner oped the medical-malpractice caps enacted by the state legislature at his urging that reversed a serious decline in the number of physicians practicing in the Lone Star state and the resulting loss of access to quality medical care available to Texas residents. Mississippi Gov. Haley Barbor also shared some of his successes in this area in a recent Examiner oped.
Credit goes to the American Tort Reform Association's Darren McKinney for catching this momentary outbreak of political honesty by Dean. McKinney has conveniently posted an audio recording of Dean speaking here, so you can listen for yourself. Mckinney has also offered more comment here, helpfully even including a link to the Examiner's recent analysis of the degree to which trial-lawyer political contributions go to Democrats in Congress.
Those contributions are why Dean knows it would be a difficult task indeed for Obama to persuade congressional Democrats to do anything that might offend the trial-lawyers lobby. The Examiner's David Freddoso and Kevin Mooney did the reporting on this link here.
Jensen Comment
Reports are that the Texas cap on punitive damages has been quite successful in restraining outrageous settlements of malpractice lawsuits.The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums Ronen Avraham (University of Texas at Austin, School of Law(, Leemore S. Dafny (Kellogg School of Management, Northwestern University) and NBER Max M. Schanzenbach, (Northwestern University, School of Law)
September 2009 --- Click Here
http://www.kellogg.northwestern.edu/faculty/dafny/personal/Documents/Working%20Papers/ADS_9_09w_ack.pdf
Abstract
We evaluate the effect of tort reform on employer-sponsored health insurance premiums by exploiting state-level variation in the timing of reforms. Using a dataset of healthplans representing over 10 million Americans annually between 1998 and 2006, we find that caps on non-economic damages, collateral source reform, and joint and several liability reform reduce premiums by 1 to 2 percent each. These reductions are concentrated in PPOs rather than HMOs, suggesting that can HMOs can reduce “defensive” healthcare costs even absent tort reform. The results are the first direct evidence that tort reform reduces healthcare costs in aggregate; prior research has focused on particular medical conditions.
"The President's Tort Two-Step Special-interests and the health-care status," by Kimberly Strassel, The Wall Street Journal, September 11, 2009 --- Click Here
Tort reform is a policy no-brainer. Experts on left and right agree that defensive medicine—ordering tests and procedures solely to protect against Joe Lawyer—adds enormously to health costs. The estimated dollar benefits of reform range from a conservative $65 billion a year to perhaps $200 billion. In context, Mr. Obama's plan would cost about $100 billion annually. That the president won't embrace even modest change that would do so much, so quickly, to lower costs, has left Americans suspicious of his real ambitions.
It's also a political no-brainer. Americans are on board. Polls routinely show that between 70% and 80% of Americans believe the country suffers from excess litigation. The entire health community is on board. Republicans and swing-state Democrats are on board. State and local governments, which have struggled to clean up their own civil-justice systems, are on board. In a debate defined by flash points, this is a rare area of agreement.
The only folks not on board are a handful of powerful trial lawyers, and a handful of politicians who receive a generous cut of those lawyers' contingency fees. The legal industry was the top contributor to the Democratic Party in the 2008 cycle, stumping up $47 million. The bill is now due, and Democrats are dutifully making a health-care down payment.
During the markup of a bill in the Senate Health Committee, Republicans offered 11 tort amendments that varied in degree from mere pilot projects to measures to ensure more rural obstetricians. On a party line vote, Democrats killed every one. Rhode Island senator and lawyer Sheldon Whitehouse went so far as to speechify on the virtues of his tort friends. He did not, of course, mention the nearly $900,000 they have given him since 2005, including campaign contributions from national tort powerhouses like Baron & Budd and Motley Rice.
Even Senate Finance Chair Max Baucus, of bipartisan bent, has bowed to legal powers. The past two years, Mr. Baucus has teamed up with Wyoming Republican Mike Enzi to offer legislation for modest health-care tort reform in states. That Enzi-Baucus proposal had been part of the bipartisan health-care talks. When Mr. Baucus released his draft health legislation this weekend, he'd stripped out his own legal reforms. The Montanan is already in the doghouse with party liberals, and decided not to further irk leadership's Dick Durbin ($3.6 million in lawyer contributions), the Senate's patron saint of the trial bar.
Over in the House the discussion isn't about tort reform, but about tort opportunities. During the House Ways & Means markup of a health bill, Texas Democrat Lloyd Doggett ($1.5 million from lawyers) introduced language to allow freelance lawyers to sue any outfit (say, McDonald's) that might contribute to Medicare costs. Only after Blue Dogs freaked out did the idea get dropped, though the trial bar has standing orders that Democrats make another run at it in any House-Senate conference.
It says everything that Mr. Obama wouldn't plump for reform as part of legislation. The president knows the Senate would never have passed it in any event. Yet even proposing it was too much for the White House's legal lobby. Mr. Obama is instead directing his secretary of health and human services to move forward on test projects. That would be Kathleen Sebelius, who spent eight years as the head of the Kansas Trial Lawyers Association.
The issue has assumed such importance that even some Democrats acknowledge the harm. With bracing honesty, former DNC chair Howard Dean recently acknowledged his party "did not want to take on the trial lawyers." Former Democratic Sen. Bill Bradley, in a New York Times piece, suggested a "grand bipartisan compromise" in which Democrats got universal coverage in return for offering legal reform. The White House yawned, and moved on.
It isn't clear if Republicans would or should take that deal, but we won't know since it won't be offered. The tort-reform issue has instead clarified this presidency. Namely, that the bipartisan president is in fact very partisan, that the new-politics president still takes orders from the old Democratic lobby.
The Lie: President Obama
promises that millions of small mom and pop businesses will be able to stay
profitable and offer private insurance coverage under Obamacare. Wal-Mart is
promoting Obamacare precisely for the reason that smaller competitors will
go out of business. Small and medium sized businesses will fail do to the
added costs of coverage mandated in Obamacare legislation such as instant
coverage of expensive pre-existing health conditions and the cost of
mandated social services such as marriage and family counseling and vastly
increased costs of mental health coverage.
"What disturbs Americans of all
ideological persuasions is the fear that almost everything, not just
government, is fixed or manipulated by some powerful hidden hand," Frank
Rich wrote in Sunday's New York Times. That manipulation should disturb us.
But contrary to Rich, it is not the work of "corporatists" who have sprung
up to attack progressive reforms proposed by Obama and the Democratic
majority. Manipulation is what we got many years ago when we traded a more
or less free market for the "progressive" interventionist state. When
government is big, the well-connected always have an advantage over the rest
of us.
"Big Business for Health-Care Reform," by John Stossel,
ABC News,
August 11, 2009 ---
http://blogs.abcnews.com/johnstossel/2009/08/big-business-for-healthcare-reform.html
The Lie: President Obama
is promising that Obamacare will be so efficient that the cost of processing
government and private health claims will save billions of dollars each
year. The Congressional Budget Office is not buying his gross exaggerations
about such cost savings. It might be much more efficient if Obamacare were
equivalent to the Canada National Health Plan, but President Obama promises
to keep all the private health insurance companies in business at profitable
returns.
The Lie: President Obama
is promising that Obama care will be so efficient that it will not increase
the annual Federal spending deficit that that, without Obamacare, will in
2009 be about $2 trillion more outflow than inflow --- http://www.usdebtclock.org/
This is such a blatant lie it's almost laughable --- if it was not so
tragic!
The interest cost on the National Debt will soon be about a million dollars
a second.
The Lie: President Obama is promising that there will
be no new taxes on 98% of Americans to pay for Obamacare. However, he does
not say anything about the huge increases in the prices everybody will have
to pay at Wal-Mart, Safeway, Citgo, Exxon, Sears, Penneys, Burger King, KFC,
GM, Chrysler, Toyota, Honda, Deere, Kubota, etc. to pay for the added health care
insurance costs forced on employers due to Obamacare mandates.
The American Academy of Orthopaedic Surgeons (AAOS) is profoundly disappointed with President Obama's recent comments regarding the value of surgery and blurring the realities of physician reimbursements. The AAOS represents over 17,000 US board-certified orthopaedic surgeons who provide essential services to patients every day. As President Obama has said, "Where we do disagree, let's disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that's actually been proposed." In that spirit, we would like to bring some clarity to his comments and underscore the value that orthopaedic surgeons bring to Americans every day of every year.
First, surgeons are neither reimbursed by Medicare, nor any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1200 which includes the follow up care the surgeon provides to the patient up to 90 days after the operation. Moreover, orthopaedic surgeons are actively involved in the preventive care he mentions. We are a specialty that focuses on limb preservation whenever possible and when it is in the best interests of the patient. Our approach to amputation follows the same careful, thoughtful approach, always with the patients best interest as the primary focus.
Continued in article
Click here: Fred Thompson: Interviews
Scroll down to Betsey MacCaughhey's audio (this is a bit too biased in tone
for my liking, but Betsey did take the time and trouble to read the July
2009 House Bill in detail.
Health Care Numbers Don't Add Up ---
http://www.mpnnow.com/lifestyle/x2141125428/Health-care-reform-numbers-don-t-add-up
President Barack Obama apparently came to believe
the myth of his messiahship and has accordingly abused and squandered his
good will and political capital and possibly self-sabotaged his socialized
medicine scheme. Of all the newsworthy aspects of this desperate "reform"
effort, none is more so than the robust democratic processes it has
reinvigorated in this nation. While Democrats insist the nationwide
grass-roots movement against his Draconian measure is contrived and
illusory, it is just the opposite. Nothing could be so real as the American
people, emboldened by their passion for liberty, standing up against a
callous, dishonest government trolling for its freedoms in exchange for
false promises.
David Limbaugh, "Obama's Forfeited
Credibility Sabotaging Obamacare," Townhall, August 14, 2009 ---
http://townhall.com/columnists/DavidLimbaugh/2009/08/14/obamas_forfeited_credibility_sabotaging_obamacare
Jensen Comment
The public just isn't buying into the lie that it's possible to widen the
scope of coverage of each person's health insurance and add 50 million
uninsured to the insurance plans without increasing the Federal deficit
and/or driving small companies out of business with requirements to pay
greatly increased premiums. The public recognizes that this is a job killer
--- their jobs.
Fact Check
Desktop Users
www.factcheck.org/politics/obamas_health_care_news_conference.html
Mobile Users
http://www.factcheck.org/mobile/article.php?id=997
Sampling Only
President Obama tried to sell his health care overhaul in prime time, mangling some facts in the process. He also strained to make the job sound easier to pay for than experts predict.
- Obama promised once again that a health care overhaul “will be paid for.” But congressional budget experts say the bills they've seen so far would add hundreds of billions of dollars to the deficit over the next decade.
- He said the plan "that I put forward" would cover at least 97 percent of all Americans. Actually, the plan he campaigned on would cover far less than that, and only one of the bills now being considered in Congress would do that.
- He said the "average American family is paying thousands" as part of their premiums to cover uncompensated care for the uninsured, implying that expanded coverage will slash insurance costs. But the nonpartisan Kaiser Family Foundation puts the cost per family figure at $200.
Note: This is a summary only. The full article with analysis, images and citations may be viewed on the above Fact Check Websites.
- Obama claimed his budget "reduced federal spending over the next 10 years by $2.2 trillion" compared with where it was headed before. Not true. Even figures from his own budget experts don't support that. The Congressional Budget Office projects a $2.7 trillion increase, not a $2.2 trillion cut.
- The president said that the United States spends $6,000 more on average than other countries on health care. Actually, U.S. per capita spending is about $2,500 more than the next highest-spending country. Obama's figure was a White House-calculated per-family estimate.
December 31, 2020
Digital health startup GoodRx is going public
The startup, which provides telehealth and discount prescription services, filed paperwork for an initial public offering in August. It would trade on the NASDAQ under the ticker "GDRX."
In an updated filing on Monday, GoodRx noted that it is looking to price its public offering between $24 and $28 per share. At $26, the midpoint of that range, GoodRx and its investors stand to make $900 million.
The updated filing also noted that private equity firm Silver Lake has agreed to purchase $100 million in stock coinciding with the IPO.
GoodRx now joins the growing parade of companies in healthcare and technology that have filed to go public in 2020, marking a banner year for public offerings as markets continue to surpass all-time highs.
Digital health and telehealth companies, in particular, have seen a surge in public market activity as the coronavirus pandemic has ushered in what some are calling a new era for the healthcare industry. Coronavirus-induced shutdowns have driven wary patients from doctor's offices and waiting rooms in favor of at-home care, spurring growth in an industry that had been previously considered niche.
GoodRx's filing came just days after telehealth giant and Teladoc competitor American Well filed to go public with $100 million in funding from Google, an unusual deal that spoke to the tech giant's optimistic outlook on telehealth even once the pandemic subsides.
GoodRx is best known for pulling together cash prices for medications at different pharmacies as a price-comparison tool for people paying out-of-pocket, but recently added virtual visits and other elements of telehealth to its services. It has also been adding direct-to-consumer prescription services, like Lemonaid and Hims, to its comparisons.
Continued in article
Random
Critical Analysis on Health Care ---
https://marginalrevolution.com/marginalrevolution/2020/02/random-critical-analysis-on-health-care.htm
Walmart will begin offering health insurance to consumers ---
https://www.businessinsider.com/walmart-breaks-into-health-insurance-2020-7?IR=T&utm_medium=email&utm_term=BII_Daily&utm_source=Triggermail&utm_campaign=BII
Weekender 2020.7.10 - Marketing
The Fiscal Effects Of The Public Option ---
https://www.hoover.org/research/fiscal-effects-public-option-0
Wharton School at the University of Pennsylvania: Bernie
Sanders 'Medicare for all' plan could shrink GDP by as much as 24%
---
https://budgetmodel.wharton.upenn.edu/issues/2020/1/30/sanders-medicare-for-all
Over 85% of the non-home capital markets value is owned by the theTop 10%:
Why is this much more of a problem for Bernie Sanders and Elizabeth Warren than
if the Top 10% only owed 10% of the capital markets value instead of 85%+?
National Bureau of Economic Research
HOUSEHOLD WEALTH TRENDS IN THE UNITED STATES, 1962 TO 2016: HAS MIDDLE CLASS WEALTH RECOVERED ---
https://www.nber.org/papers/w24085.pdf
The top 10 percent of families as a group accounted for about 85 to 90 percent of stock shares, bonds, trusts, and business equity, and over 80 percent of non-home real estate. Moreover, despite the fact that almost half of all households owned stock shares either directly or indirectly through mutual funds, trusts, or various pension accounts, the richest 10 percent of households controlled 84 percent of the total value of these stocks, though less than its 93 percent share of directly owned stocks and mutual funds.
Democratic socialists like AOC, Bernie Sanders, and Elizabeth Warren want to spend over $20 trillion per year in cash (perhaps only $10 trillion annually before open borders are factored in) or green initiatives (think solar panels and batteries everywhere), Medicare-for-All (think cash for doctors, hospitals, and medications), College-for-All (think tuition plus other aid), Housing-for-All (think of all the new homes required), Guaranteed Annual Incomes, free meals for all the children of the USA, and all else that is added on for open borders when tens of millions of unrestrained immigrants pouring into USA ---
https://berniesanders.com/issues/
(for each initiative click on the Details button)
The Atlantic: Sanders is a Marxist of the old school of dialectical
materialism, from the land that time forgot ---
https://www.theatlantic.com/ideas/archive/2020/01/bernie-sanderss-biggest-challenges/605500/
These democratic socialists want to raise as much as possible
from the Top 10% before taxing the middle and lower income citizens.
Here lies the problem: If the Top10% owned only 10% of capital markets value the
capital markets might survive when Sanders or Warren wipe out the Top 10% of the
wealthy.
But in reality wiping out the Top 10% will crash over 84%
of the capital markets value!
This alone will cause most of the USA private sector labor force
to become unemployed and force Sanders or Warren to make good on promises for
government to pay all pensions of those unemployed. They promise to take on all
pension liabilities even for business firms who have not paid anything into the
government's Pension Benefit Guarantee fund ---
https://www.pbgc.gov/
Let's consider the example of the General Motors (GM) 2008 bankruptcy--- https://en.wikipedia.org/wiki/General_Motors#Chapter_11_bankruptcy
In theory the economic crash of GM shares in 2008 should not
legally have forced GM into bankruptcy when share prices crashed, but the
economic reality is that if stock values crash companies like GM that have a lot
of debt will be forced into bankruptcy. That in turn could have resulted in
unemployment for over 500,000 employees of GM factories, dealers, suppliers, and
others impacted by GM closures. In addition the Federal government would've had
to pick up the pensions of most of those employees ---
https://www.pbgc.gov/
To prevent such massive unemployment and pension impacts
the Government bailed out GM in 2008 ---
https://en.wikipedia.org/wiki/General_Motors#Chapter_11_bankruptcy
Through the Troubled Asset Relief Program the US Treasury invested $49.5 billion in General Motors and recovered $39 billion when it sold its shares on December 9, 2013 resulting in a loss of $10.3 billion.
Jensen Comment
The good news is that the USA economic crash of 2008 did not wipe out anywhere
close to 85% of the value of the capital markets of the USA. The
government bailed out GM and some other other companies. The bailouts enticed
investors, especially the Top 10%, to put more cash into capital investments
like GM shares.
But commencing to take $20 trillion annually after 2023 will out wipe out over
over 85% of those capital markets in order to pay cash for all of the
initiatives of Bernie Sanders or Elizabeth Warren ---
https://berniesanders.com/issues/
The Top 10% will not have any cash left to put into hopeless capital markets.
The real problem is that the $20+ trillion initiatives of Sanders or Warren require cash. If the government confiscated the wealth of the Top 10% and did not not need so much cash it could keep the $20+trillion iinvested in stock shares, bonds, trusts, and business equity, and non-home real estate. But having to covert all that $20+ trillion in value into cash will essentially wipe out the capital markets of the USA.
Sanders and Warren realize this and only propose taking a fraction of the wealth of the Top 10% (although AOC, Omar, and Michael Moore want to take it all and are totally unaware of the consequences). This is why Sanders and Warren know they have to get most of the needed $20+ trillion annually from the middle and lower income taxpayers.
But $20+ plus trillion per year is just too much for the USA to take on beyond
the roughly $4.5 trillion being spent currently by the Federal government.
Trying to take so much more cash out of wages and the USA capital markets will
totally destroy the USA economy with hyoer inflation. What can be worse than
living in socialist Venezuela in 2020 hyper inflation? What can be worse? The
answer is living in the democratic socialist world of Sanders or Warren in 2025
USA hyper inflation.
Inflation risk is exacerbated by having the Top 10% owning 85%+ of the capital
markets value in 2020 rather than a mere 10% rather than 85%+ --- such that
wiping out the Top 10% of investors for democratic socialist initiatives will
cause hyper inflation and destroy the USA economy.
It's no wonder that Barack Obama and the majority of the Democratic Party are trying to prevent Bernie Sanders from winning the 2020 nomination. If they're smart they will also stop other big spending, open-border advocates like Elizabeth Warren from being nominated.
Please don't make us vote for Donald Trump just to block doomsday spenders lik Bernie Sanders and Elizabeth Warren in 2020.
Open immigration can’t exist with a strong social
safety net; if you’re going to assure healthcare and a decent income to
everyone, you can’t make that offer global ---
Paul Krugman
https://www.goodreads.com/quotes/724654-open-immigration-can-t-exist-with-a-strong-social-safety-ne
And it can't exist with a $20+ trillion annual social program offer for those already in the USA
NYT: It Looks Like Health Insurance, but It’s Not. ‘Just
Trust God,’ Buyers Are Told ---
https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html
Canada will not allow spending limits on "essential health care
services" ---
https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
Jensen
Comment
It appears that the USA is not as restrictive when outlawing spending limits in
medical care relative to many other nations, although most nations may dispute
what is defined as an "essential service" or an "essential medication."
Experimental services and drugs may be declared as non-essential. Services for
the very ill may be curtailed in most nations. For example, should an insurance
company or government pay for new hips to a patient deemed to be dying from bone
cancer?
Libertarians might argue that insured customers wanting lower-cost coverage made an informed choice if the spending limits were made absolutely clear when they signed their insurance contract. It all boils down to having choices regarding both coverage and costs. Progressives might argue that no choices should be allowed when such things as medical insurance coverage and physical safety are concerned, This of course raises the costs to somebody and limits choice as to cost and quality of service.
Literally every health care insurance plan entails some service rationing and often some sharing of costs. For example, Medicare requires patients to pay 20%, and that can become quite expensive for long hospital stays. Also Medicare does not pay long-term nursing costs when the patient is released from a hospital into a nursing care facility for more than 100 days.
Always keep in mind that insurance companies or national health care providers do not ultimately pay for enormous medical bills. Those expenses are passed on into rates paid by other customers or paid by taxpayers.
I
recall an instance where an insurance company was losing so much money annually
on seven mentally ill or disabled children in nursing care that it dropped
covering employees and families of the entire university. Some would argue that
a national health care plan would not have such an option. Cost of mental health
care is very high in the USA, especially long-term live-in institution costs ---
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236908/
Disputes often arise regarding how long to keep some patients artificially alive
---
https://en.wikipedia.org/wiki/End-of-life_care
Parents Fight Canadian Hospital for Child's Survival ---
https://abcnews.go.com/Health/baby-josephs-treatment-sparks-controversy-pediatric-end-life/story?id=13032001
December 31, 2019
Obamacare's Individual Mandate Ruled Unconstitutional (the requirement that
individuals must have health insurance) ---
https://www.ozy.com/opinion/donald-dossier-all-roads-lead-to-roberts/95512/?utm_term=OZY&utm_source=Sailthru&utm_medium=email&utm_campaign=PDB%20%282019-12-19%2012:43:36%29
Health insurance can now be dropped in favor of buying a Smart TV or a new car.
The
Prescription Escalator ---
https://marginalrevolution.com/marginalrevolution/2019/11/the-prescription-escalator.html
Between 1982 and 2015, for example, the US saw
the launch of 719 new drugs, the most of any country in the sample; Israel had
about half as many launches ---
https://marginalrevolution.com/marginalrevolution/2019/04/peter-thiel-on-medicine-and-longevity.html
Leading Leftist Economists Split over Feasibility of
Medicare-for-All
Lawrence Summers --- https://en.wikipedia.org/wiki/Lawrence_Summers
Paul Krugman --- https://en.wikipedia.org/wiki/Paul_Krugman
Former Harvard University President and USA Treasury
Secretary under President Obama argues that Medicare-for-All replacement of
private sector coverage is not feasible
---
https://theintercept.com/2019/11/03/joe-biden-larry-summers-elizabeth-warren-medicare-for-all/
Also see his comments on a wealth tax intended to partially fund
Medicare-for-All
https://marginalrevolution.com/marginalrevolution/2019/10/summers-on-the-wealth-tax.html
Former Princeton Nobel Economist and New York Times Columnist Paul Krugman argues that Medicare-for-All replacement of private sector coverage is feasible ---
https://www.nytimes.com/2019/11/01/opinion/did-warren-pass-the-medicare-test-i-think-so.html
Jensen Comment
By the way, the radical Paul Krugman will no longer be subjected to the
editorial restraints of the New York Times--
https://krugman.blogs.nytimes.com/2017/12/06/the-blog-moves-on/?module=BlogPost-Title&version=Blog
Main&contentCollection=Opinion&action=Click&pgtype=Blogs®ion=Body
A message for regular readers of this blog: unless something big breaks later today, this will be my last day blogging AT THIS (NYT) SITE. The Times is consolidating the process, so future blog-like entries will show up at my regular columnist page. This should broaden the audience, a bit, maybe, and certainly make it easier for the Times to feature relevant posts.
It will also, for technical reasons, make my life simpler — you’d be surprised how many hoops I have to go through to get these (NYT) things posted. But that’s not the reason.
Anyway, I expect to be doing the same sort of thing, mixing regular columns with stuff, usually wonkish, that doesn’t belong in the regular paper. Old blog posts will remain availablePaul Krugman
Jensen Comment
One of the things I don't like about Paul Krugman is his inconsistency in bending his economics to fit his political agenda.
The "social safety net" includes such things as free medical care, free education, food stamps, housing subsidies, and welfare.
Open immigration can’t exist with a strong social safety net; if you’re going to assure healthcare and a decent income to everyone, you can’t make that offer global ---
Paul Krugman
https://www.goodreads.com/quotes/724654-open-immigration-can-t-exist-with-a-strong-social-safety-net
But now that Paul Krugman wants Elizabeth Warren or Bernie Sanders to be President of the USA he changed his tune about a global offer and promotes a honey pot of safety nets to anybody who can sneak across the USA border, including free medical care, free education, food stamps, housing subsidies, and guaranteed annual income.
You can't have it both ways on global offers Paul.
Nancy Pelosi Is 'Not a Big Fan of Medicare For All’ ---
https://townhall.com/tipsheet/juliorosas/2019/11/01/nancy-pelosi-is-not-a-big-fan-of-medicare-for-all-n2555747?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=11/02/2019&bcid=b16c6f948f297f77432f990d4411617f&recip=17935167
On a state-by-state basis, the cost differential for nursing home care is far steeper, ranging from $67,525 a year on average for a private room in Oklahoma to $362,628 a year in Alaska
Cheapest States for Long-Term Care: 2019 ---
https://www.thinkadvisor.com/2019/10/29/15-cheapest-states-for-long-term-care-2019/?slreturn=20190931094107
Medicare, unlike Medicaid, does not pay for long-term nursing care, but with
years of planning many estates are siphoned off by heirs to get loved ones poor
enough for Medicaid ---
https://longtermcare.acl.gov/medicare-medicaid-more/medicaid/medicaid-eligibility/
The Atlantic: But the profits of health
insurers are not that exorbitant compared with other parts of the health-care
system. And in fact, many scholars suggest that American health care is so
dysfunctional because it simply costs too much. That’s the fault of doctors,
drugmakers, and hospitals, too, not just insurers ---
https://www.theatlantic.com/health/archive/2019/07/kamala-harris-blames-health-insurers-she-right/595252/?utm_source=newsletter&utm_medium=email&utm_campaign=politics-daily-newsletter&utm_content=20191101&silverid-ref=NTk4MzY1OTg0MzY5S0
How to Mislead With Political False Promises
Elizabeth Warren Finally Says How She'll Pay for Medicare for All
Senator Elizabeth Warren said she would fund her version of Medicare for All with taxes on large corporations and the wealthy, a tax evasion crackdown, a reduction in defense spending and by putting newly legalized immigrants on the tax rolls.
Her advisers also lowered the estimate of Medicare for All’s price-tag to $20.5 trillion over 10 years from the $34 trillion the Urban Institute predicted, by using the new Medicare-for-All negotiating power to slash administrative spending, drug prices and provider payments.
Jensen Comment
She also promises that there will be zero taxes on the middle class to pay for Medicare-for-All, Free. Plus she did not factor in the additional trillions for Green Initiatives, Free College, Guaranteed Annual Income, Reparations, and on and on and on.
Her promise of zero taxes on the middle class is misleading. Who does she think ultimately pays for the taxes on large corporations (think Walmart, Amazon, and Exxon)? Large corporations don't pay taxes. They collect taxes in prices to their customers which in most cases are the poor and the middle class customers. Warren will even collect from transactions that are exempt from sales tax such as when the Pentagon pays billions to Boeing for aircraft and Microsoft for cloud services.
And
what happens if you confiscate the wealth of Americans. They have to liquidate
their investments in stocks and real estate, thereby confiscating the pensions
and savings of the poor and middle class.
Notice that she never says how she will keep savings investments pension pension incomes viable when the stock markets crash for good!
Facts on Warren’s Wealth Tax Plan ---
https://www.factcheck.org/2019/06/facts-on-warrens-wealth-tax-plan/
. . .
How would the (wealth) tax revenues be spent?
Warren is banking on a $2.75 trillion revenue projection from Zucman and Saez to fund a host of her priorities. In speeches, she has laid out those beneficiaries:
- Universal child care for every child age 0 to 5.
- Universal pre-K for every 3- and 4-year old.
- Raise wages for all child care workers and preschool teachers “to the professional levels that they deserve.”
- Free tuition and fees for all public technical schools, 2-year colleges and 4-year colleges.
- $50 billion for historically black colleges and universities.
- Forgive student loan debt for 95% of those with such debt.
- $100 billion over 10 years to combat the opioid crisis.
- “Down payments” on a Green New Deal and Medicare for All.
The Warren campaign estimates the first three programs — dealing with child care and universal pre-K — would cost about $700 billion over 10 years. And the next three — free public college tuition, money for historically black colleges and canceling most student loan debt — would cost about $1.25 trillion over 10 years. That would leave more than about $750 billion for the Green New Deal and Medicare for All, the campaign says. That’s not enough to fully fund either one, but Warren says it is enough for a “down payment” on each.
How reliable is Warren’s $2.75 trillion revenue forecast?
Whether Warren’s plan would actually raise $2.75 trillion is a matter of debate among economists.
The $2.75 trillion forecast comes from Zucman and Saez. To estimate how much revenue the tax would generate on wealth over $50 million, the economists used data from the Survey of Consumer Finances from the Federal Reserve Board and the Distributional National Accounts recently created by economist Thomas Piketty, Saez and Zucman. To estimate the revenue from the tax on billionaires, the economists used the Forbes 400 list of the richest 400 Americans in 2018.
Zucman and Saez estimated that people would reduce their reported wealth by 15% “through a combination of tax evasion and tax avoidance.” The authors wrote that “recent research shows that the extent of wealth tax evasion/avoidance depends crucially on loopholes and enforcement. The proposed wealth tax has a comprehensive base with no loopholes and is well enforced through a combination of systematic third party reporting and audits. Therefore, the avoidance/evasion response is likely to be small.”
But some economists think that assumption is too rosy.
While neither the Tax Policy Center nor the Tax Foundation has yet released a full analysis of Warren’s plan, economists at both said there is reason to believe Warren’s revenue estimate is too high.
Kyle Pomerleau, chief economist and vice president of economic analysis at the nonprofit, pro-business Tax Foundation, said that the assumption of 15% tax evasion/avoidance is “actually the average avoidance for the entire U.S. tax system, which is primarily the income tax and payroll tax. These taxes are, in principle, much harder to avoid than a wealth tax because the transaction (income) is hard to game or hide from the tax authorities. There is a good record of how much you are being paid by your employer.”
“A wealth tax, on the other hand, is much harder to enforce,” Pomerleau said. “For one, much of the wealth tax base doesn’t have a market price. For example, we don’t really know how much a particular privately-held business is worth because equity (stocks) in that company are not regularly traded on the open market.”
Pomerleau also warned that because the wealth tax is a significant tax on savings, it will discourage people from holding on to assets. “This effect will reduce the potential tax base,” Pomerleau said, a trend that was not accounted for in Warren’s estimate.
Howard Gleckman, a senior fellow at the nonpartisan Tax Policy Center, has similar concerns.
“First, while her plan anticipates some tax avoidance, it will be very difficult for the IRS to keep up with the tax planning that highly-paid lawyers and accountants can devise,” Gleckman told us via email. “With so much money at risk, the wealthy will have powerful incentives to hire smart advisers to help avoid, or at least reduce, their tax liability.
“Second, a large share of wealth held by the high net worth taxpayers is in the form of privately held businesses,” he said. “And these are notoriously difficult to value. In effect, the IRS would have to prove that a taxpayer’s valuation is unreasonably low.”
“I suspect she would collect less revenue than she predicts, but I cannot say how much less,” Gleckman told us.
In an op-ed published in the Washington Post on April 4, Lawrence Summers, a Harvard University professor who was treasury secretary from 1999 to 2001 and an economic adviser to President Barack Obama in 2009 and 2010, and Natasha Sarin, an assistant professor of law at the University of Pennsylvania Law School and an assistant professor of finance at the Wharton School, took direct aim at the $2.75 trillion estimate.
“Common-sense revenue estimates by economists who are not very deeply steeped in revenue estimation tend to be overly optimistic,” Summers and Sarin wrote.
The two looked at the U.S. experience with estate tax data and concluded Warren’s wealth tax would only raise about 40% of the amount estimated by Saez and Zucman. And that’s being “maximally optimistic about the wealth tax’s revenue potential,” Summers and Sarin wrote.
“We suspect that to a great extent it reflects the myriad ways wealthy people avoid paying estate taxes that in some form will be applicable in any actually legislated wealth tax,” Summers and Sarin wrote. “These include questionable appraisals; valuation discounts for illiquidity and lack of control; establishment of trusts that enable division of assets among family members with substantial founder control; planning devices that give some income to charity while keeping the remainder for the donor and her beneficiaries; tax-advantaged lending schemes; and other complex devices known only to sophisticated investors. Except for reducing a naive calculation by 15 percent, Saez and Zucman do not seem to take account of these devices.”
“If our suspicion is correct, such a wealth tax will not yield the revenue that its proponents hope for, and that when actual scorekeepers score actual proposals, their estimates will disappoint advocates,” they concluded.
“In our view, the $2.75T is not realistic,” Sarin wrote to us in an email. “The closest we get based on extrapolation from the estate tax (which seems relevant because it involves a very similar population and thus many of the same evasion incentives and possibilities) is around 40% of this estimate.”
In an email response to FactCheck.org, Saez challenged the Summers and Sarin use of the estate tax to estimate the effects of Warren’s wealth tax proposal.
“It is well known that the estate tax is very poorly enforced and that the rich manage to largely avoid/evade it by giving to heirs before death, spouses, and charity, using lots of trick to discount assets,” Saez wrote.
“We have assumed an evasion rate of 15% based on the best literature on the question (as we discuss in our letter and in more detail here),” Saez added.
Saez said the Summers-Sarin estimate that the tax on those with assets worth more than $50 million would bring in just $25 billion a year implicitly assumes “that over 90% of the wealth will be hidden.” That’s not reasonable, Saez said, because “80% of the assets of the rich are publicly traded stocks, bonds, real estate for which there are clear market values
Continued in article
Urban Institutue: From Incremental to Comprehensive Health Reform: How Various
Reform Options Compare on Coverage and Costs ---
https://www.urban.org/research/publication/incremental-comprehensive-health-reform-how-various-reform-options-compare-coverage-and-costs
Brief:
Comparing Health Insurance Reform Options: From “Building on the ACA” to Single PayerBlog Post:
Don’t Confuse Changes in Federal Health Spending with National Health SpendingPolicymakers, including candidates in the 2020 presidential campaign and members of Congress, have proposed a variety of options to address the shortcomings of the current health care system. These range from improvements to the Affordable Care Act to robust single-payer reform.
There are numerous challenging trade-offs when choosing an approach to health care reform, including covering the uninsured, improving the affordability of health care, and raising the government funding required to implement them. The public and policymakers alike need more information about the potential effects of various health reform proposals.
This study, funded by the Commonwealth Fund, analyzes eight health care reforms and their potential effects on health insurance coverage and spending. Each of the analyzed reform proposals makes health insurance considerably more affordable by reducing people’s premiums and cost sharing. Some reforms also reduce US health care costs, and all require additional federal dollars.
Key findings:
· Within the existing public-private health care system, near universal coverage and improved affordability could be achieved with moderate increases in national health spending. Under one of the plans modeled in the report, which proposes a mix of private and public health insurance, everyone in the US could be covered except for undocumented immigrants. The plan would enable workers to opt for subsidized nongroup coverage instead of their employer’s insurance plan. It would also improve the ACA’s subsidies to help people afford coverage, cover people in states that have not expanded Medicaid, require everyone to have insurance with an auto-enrollment backup, offer a public insurance option, and cap provider payment rates.
Coverage and costs:
This reform plan achieves universal coverage for people legally present in the US, covering 25.6 million people who would otherwise be uninsured. However, the plan leaves 6.6. million undocumented immigrants without coverage. National spending on health care would decrease modestly, by $22.6 billion or 0.6 percent, compared with current law in 2020. Federal government spending would increase by $122.1 billion in 2020, or $1.5 trillion over 10 years.· One single-payer approach would leave no one uninsured and largely eliminate consumers’ out-of-pocket medical costs but would require much greater federal spending to finance. The modeled “enhanced” single-payer system would cover everyone, including undocumented immigrants. The reform would include benefits more comprehensive than Medicare’s—including adult dental, vision, hearing, and long-term services and supports—with no premiums or cost sharing. All current forms of insurance for acute care would be eliminated, including private insurance, Medicaid, and Medicare, and everyone residing in the US would be covered by a new public insurance program. Providers would be paid rates closer to Medicare’s. Health spending by employers would be eliminated, and household and state health spending would decline considerably while federal spending would increase significantly.
Coverage and costs:
This reform option covers the entire US population. National spending on health care would grow by about $720 billion in 2020. Federal government spending would increase by $2.8 trillion in 2020, or $34.0 trillion over 10 years.· A second single-payer approach can be constructed with lower federal and system-wide costs. In addition to the enhanced single-payer plan above, researchers examined a single-payer “lite” plan that is similar to the enhanced version but includes cost sharing for out-of-pocket expenses based on income, adds fewer new covered benefits, and only covers legally residing US residents. Single-payer “lite” lowers total national health spending, decreasing health spending by households, employers, and state governments and increasing federal government spending by less than the enhanced single-payer reform.
Coverage and costs:
This reform plan achieves universal coverage for people legally present in the US, covering 25.6 million people who were uninsured. However, the plan leaves all 10.8 million undocumented immigrants without coverage (due to the elimination of private insurance). National spending on health care would decrease by $209.5 billion, or 6 percent, in 2020. Federal government spending would increase by $1.5 trillion in 2020, or by $17.6 trillion over 10 years. The analysis demonstrates that there is more than one effective approach to achieving universal health care coverage in the United States and highlights the trade-offs of different reform strategies.The analysis demonstrates that there is more than one effective approach to achieving universal health care coverage in the United States and highlights the trade-offs of different reform strategies.
Continued in article
Rob
Rrownstein: The Eye-Popping Cost of Medicare for All According to new
figures: more than the federal government will spend over the coming decade on
Social Security, Medicare, and Medicaid combined ---
https://www.theatlantic.com/politics/archive/2019/10/high-cost-warren-and-sanderss-single-payer-plan/600166/?utm_source=newsletter&utm_medium=email&utm_campaign=politics-daily-newsletter&utm_content=20191016&silverid-ref=NTk4MzY1OTg0MzY5S0
The Urban Institute estimates that a single-payer plan would require $32 trillion in new tax revenue over the coming decade.
How big a lift is it to raise $32 trillion? It’s almost 50 percent more than the total revenue the CBO projects Washington will collect from the personal income tax over the next decade (about $23.3 trillion). It’s more than double the amount the CBO projects Washington will collect over the next decade from the payroll tax that funds Social Security and part of Medicare (about $15.4 trillion).
Jensen
Comment
And the Medicare for All Spending initiative is a relatively small part of what
most 2020 Presidential Candidates (except for Biden) want to spend on social
programs. To the average $3.2 trillion annual cost of Medicare for All the
annual cost of their Green Initiatives,
free medications, student loan forgiveness followed by free college for
everybody, guaranteed annual income for 350+ USA residents, housing-for all,
reparations for African and Native Americans, and billions for new subsidized
housing on top of existing safety nets such as food stamps and welfare and
housing.
Add to this the free medical care, free college, housing, and food advertising for poor people all over the world in cross-over-the-border invitations and you're easily talking over $20 trillion per year. Whereas President Obama deported over a million undocumented immigrants, the 2020 candidates are inviting people to cross over the USA borders.
The most misleading statement in the October 15, 2019 debates was Elizabeth Warren's comment that she will not promote any "spending program that taxes the middle class." But notice that she says nothing about destruction of the middle class pensions dependent upon stock market prices (think CREF and CalPERS). She's probably right about middle income retirees not paying more taxes. We won't have any incomes left to tax if you destroy the stock markets.
And when the stock markets are destroyed unemployment will soar because business firms will lose the ability to raise capital necessary for operating businesses. Businesses can turn to government for capital, but the cupboard will be bare due to all the social programs draining $20 trillion from the economy.
Largest Health Care Scam Ever: Fake Genetic Testing Result Scheme Results in
$2.1 Billion in Medicaid Losses ---
https://www.newsweek.com/largest-health-care-scam-ever-fake-genetic-testing-result-scheme-results-21-billion-medicaid-1461901
Jensen Comment
Essential to the scheme were unbelievably greedy doctors.
Walmart is launching its first standalone primary care clinic ---
https://www.businessinsider.com/walmart-unveils-new-primary-care-clinic-2019-9
Jensen Comment
It's not yet clear to me whether Walmart is going to provide primary care
doctors who will also make hospital rounds when you're hospitalized.
There are considerable advantages to having doctor offices attached to hospitals. One is the convenience for doctors to make hospital rounds. Two is the convenience for patients to have medical lab, X-ray, and other hospital services in the same building and on the same computer networks as the hospital itself --- that's what happens with my primary care doctor. It's also convenient to have other primary care clinics in the same hospital cover for my doctor's partnership when they're out of town for one reason or another. Our local hospital has more than one primary care clinic apart from Critical Care and Emergency Room divisions of the hospital. Conveniently under one roof there are other offices for specialists in ophthalmology, obstetrics, dermatology, orthopedics, cardiology, etc.
The rents provided by doctor offices in the hospital also help our hospital cover losses from charity medicine and limited insurance that does not cover full costs (think Medicaid). I think medical clinics in Walmart, CVS, etc. in some ways make it more difficult for local hospitals to avoid red ink --- especially when Walmart and CVS pass along all their charity patients to the local hospital. Walmart's standalone primary care clinics will skim off the easy profits at the expense of our local hospitals who serve the charity patients.
Hospital funding is complicated and variable. None of my property
tax is currently diverted to our local hospital. However, when I lived in San
Antonio a goodly share of my property tax was diverted to the Bexar County
Hospital to cover some of that hospital's enormous losses from charity medicine.
Nate Silver: Medicare For All Isn’t That Popular — Even Among
Democrats
https://fivethirtyeight.com/features/medicare-for-all-isnt-that-popular-even-among-democrats/
Jensen Comment
Having a government medical insurance option is not so unpopular, but contrary
to Bernie Sanders ranting it turns out employees really don't want to lose their
employer-funded private health insurance.
Bernie
Sanders: "You’re Damn Right We’re Going to Destroy Private Health Insurance" ---
Click Here
Nancy Pelosi on single-payer health care: "How do you pay for that?" ---
https://fivethirtyeight.com/features/medicare-for-all-isnt-that-popular-even-among-democrats/
The Future Looks Terrible for U.S. Nursing Home Costs ---
https://www.bloomberg.com/news/articles/2019-06-25/u-s-nursing-home-costs-may-get-worse-thanks-to-a-labor-shortage?cmpid=BBD062519_BIZ&utm_medium=email&utm_source=newsletter&utm_term=190625&utm_campaign=bloombergdaily
Finland’s government collapses over failed health care reform ---
https://www.politico.eu/article/finlands-government-collapses-over-failed-health-care-reform/?fbclid=IwAR3ZUM2rsGzcoIVMFVHwwTfE15MAxpo_9poClu2d7pjzFdrz84WORKZTSX0
Bernie Sanders: "You’re Damn Right We’re Going to Destroy Private Health
Insurance" ---
Click Here
And he will limit the number of doctors by regulating what they're allowed to
earn.
Reason Magazine's Really Important Concerns about Medicare-for-All
The Contradiction at the Heart of Bernie Sanders' Medicare for All Plan ---
https://reason.com/2019/04/24/the-contradiction-at-the-heart-of-bernie-sanders-medicare-for-all-plan/
There is a huge contradiction at the heart of Bernie Sanders' Medicare for All plan.
On the one hand, Sanders not only wants to expand government-provided coverage to everyone in the country, he wants that coverage to be significantly more generous than Medicare, private insurance, or comparable government-run systems in other countries. On the other hand, he wants to drastically cut payments to hospitals, many of which lose money on Medicare right now, making up for the program's relatively low payments by charging much higher prices to private insurers.
What Sanders is proposing, in other words, is that the government finance a significant increase in government services while also radically reducing the amount it pays for those services. Even making generous assumptions, it's almost impossible to see how his plan could work.
Let's start with the promises Sanders makes about Medicare for All. No networks, premiums, deductibles, or copayments. Under his plan, essentially all non-cosmetic services would be free at the point of care for everyone.
Sanders calls this Medicare for All, but what he's describing isn't Medicare as we now know it. As The New York Times noted earlier this year upon the release of a Sanders-inspired Medicare for All bill in the House, the new program would "drastically reshape Medicare itself," changing both what it pays for and how. In many ways, it would be a completely different program. Medicare for All, in other words, isn't really Medicare.
And that program would be far more expansive and expensive than nearly any other comparable system. It would cover more, and require less direct financial outlays (not including taxes), than either today's Medicare or typical private insurance plans in the U.S.
It would also be substantially more generous than the national health systems set up in other countries. Sanders likes to unfavorably contrast America's mixed public-private health care system with foreign systems where the government is more directly involved. When he announced the 2017 version of his Medicare for All plan, for example, he bemoaned the state of affairs in the United States "a time when every other major country on earth guarantees health care to every man, woman, and child." Discussions about health care policy on social media often include some variant of the question, "If every other country with a developed economy can do it, why can't the United States?"
The problem with this line of questioning is that what Sanders is proposing isn't what other countries do. Canada, for example, has a single-payer system, but it doesn't cover dental care, vision, drugs, or any number of other services. A majority of Canadians carry private insurance in order to cover those services. In Britain, which offers a fully socialized medical system where health care providers are government employees, many resident still buy private coverage. Sanders, on the other hand, would effectively wipe out private coverage in the space of just four years.
There are similar limitations on coverage in other countries, like the Netherlands. It's also true in Australia, where patients typically pay a percentage of the cost of specialty services. It's true that in these countries, government plays a more central role in health care financing. But their systems have also reckoned with costs and tradeoffs in a way that Sanders, after so many years, has not.
Indeed, the main trade-off that Sanders seems willing to discuss is the elimination of insurance companies, which he portrays as greedy middlemen driving up the cost of health care. Wiping out the industry in one fell swoop, as Sanders has proposed, would be a unprecedented and disruptive move that would have significant economic repercussions, including the probable loss of thousands of insurance industry jobs. But it still wouldn't do much to bring down the cost of health care, because so much money in the nation's health care system is tied up in provider payments, especially hospitals.
And therein lies the (first) contradiction.
Most people probably think of hospitals as places where you go to get health care services. Politically and economically, however, they also fulfill another role: They are hubs for stable middle-class jobs, paying reasonably good wages to thousands of highly trained workers, most of whom are not doctors or specialists earning stratospheric salaries.
To acquire the revenue to pay for all these jobs, hospitals rely on a mix of private and public payments. Public payments make up a somewhat larger share of total hospital budgets, but private payers are typically charged much higher prices.
Hospitals like to argue that Medicare and Medicaid payments are too low to cover their costs, and that as a result, higher private payments effectively subsidize public health coverage. Critics (with some evidence) often respond that hospitals either overstate or don't really understand their own costs, and that this is just a ploy to extract more money from government health programs and private payers.
But when considering Medicare for All, the particulars of this debate are largely beside the point, because there is simply no question that eliminating private insurance and payment for all services would drastically reduce the amount of revenue for hospitals.
Yet that is exactly what Sanders wants to do. His plan calls for paying for health care services at Medicare rates, which means that, practically overnight, hospitals would end up with far, far less revenue. Exactly how much is unclear, but one estimate indicated that payments could drop by as much as 40 percent.
That would leave hospitals with a couple of difficult choices. They could eliminate services. They could try to force some employees to take pay cuts. They could fire large numbers of workers. Or they could simply shut down. As a recent New York Times report on how Medicare for All would affect hospitals noted, rural hospitals—many of which are already struggling to stay afloat—would be particularly at risk of closing.
Whatever ended up happening, there is simply no way most hospitals would or could continue operating as they do now under the payment regime that Sanders envisions. Lots of middle class jobs would disappear. Services would be eliminated or cut back.
Yet Sanders not only imagines that hospitals would continue to operate as they do now, but that they would expand their services to even more people, since more people would have coverage. And since he also imagines a system with no deductibles or copays, those people would almost certainly end up dramatically increasing utilization of hospital services.
Studies of health insurance have consistently shown that expansions of health insurance result in increased demand for (and use of) health care services; more people with coverage means more people lining up to get care. (Relatedly, introducing even very small copays—on the order of just a few dollars—can reduce the number of visits to doctors and hospitals.) Greater utilization of health care services does not necessarily translate into measurably better physical health outcomes. But it does increase the strain on the health care delivery system—which is to say, it puts a huge amount of pressure on hospitals.
Continued in article
Jensen Comment
Another contradiction is that to pay for Medicare-for-All program Bernie Sanders
wants to tax most of what high-income workers earn, and the highest income
professionals in the USA on average are physicians. There is currently a
shortage of physicians. This shortage will become critical as medical care
becomes virtually free and often overused as a free service by hundreds of
million residents of the USA.
Here's the second contraction
Taxing physician income at 70% or more will discourage students from becoming physicians and will give existing physicians incentives to retire early or work at leisurely part-time doctoring. Far better work two days per week and pay a 30% income tax rate than to be a 60--hour week highly stressed, and overworked physician being taxed at 70% of every extra dollar earned.
Medicare-for-All is a Tragedy of the Commons ---
https://en.wikipedia.org/wiki/Tragedy_of_the_commons
Vox: The Bernie Sanders national medical plan has
lots of details about what single-payer would cover. It has less information on
how to pay for it (well over $3 trillion per year and growing for more generous
coverage than all other national health plans) ---
https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all
. . .
Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens. Private insurance plans often spring up to fill these gaps (in Canada, for example, vision and dental insurance is often sponsored by employers, much like in the United States).
The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analog among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted. . .
But who pays how much more is a key question this Sanders bill doesn’t answer yet. Until there is a version that does, we can’t know whether the health system the Vermont senator envisions could actually become reality.
Jensen Comment
The Sanders plan eliminates all private-sector medical insurance companies and
eliminates Medicare and Medicaid.
The good news for us retired folks is that long-term care insurance that is not covered presently under Medicare will cover us retired folks. Hooray for Bernie! I can eat, drink, and be merry on my long-term care savings.
Two things Bernie does not like to discuss is the impact on doctors and hospitals. At present many (most?) of the top physicians and hospitals refuse Medicaid patients because of caps placed on fees. Many also reject Medicare patients, but more of them are covered because of supplemental private insurance benefits that can be added to Medicare insurance. Presently Erica and I pay over $1,200 for supplemental benefits that will not be allowed under the Sanders' plan.
I think Sanders does not like to discuss caps that will be placed on physician billings and hospital rates because the medical profession would otherwise crank up an huge lobbying effort against his plan. The medical profession has only begun to fight.
Also Sanders does not like to discuss the shortage of physicians and hospital services that will arise when bringing tens of millions of people into his plan (think nearly 20 million undocumented residents that will be covered in rural areas already underserved with doctors and hospitals).
Also Sanders does not like to discuss the transition costs in creating the vast government bureaucracy that does not exist for processing medical insurance claims. At present Medicare and Medicaid outsource claims processing to the private sector. Bernie plans to kill that outsourcing sector.
Bernie Sanders: "You’re Damn Right We’re Going to Destroy Private Health
Insurance" ---
Click Here
And he will limit the number of doctors by regulating what they're allowed to
earn.
And Bernie plans on taxing high income earners in the USA by taking away 70% or more of what they now earn. What will be the incentive for spending years of misery to become a physician good at a craft that will be taxed to death rather than rewarded after all those years of misery?
The problem with becoming a physician is not just the cost of medical school. The problem is the ordeal --- those years of education and training needed to become masters of their crafts. The time needed varies with specialties, but you don't become a neurosurgeon without years of ordeal in training before you can bill your first paying patient. And there's a lot of blood, sweat, and tears in those training years. Even worse is that there's a lot of weekly tension and risk of burn out in the years of practice that follow. Tell that to the advocates of Medicare-for-All combined with soaring taxes!
Why did Cuba
abandon its socialist/communist dream of equality for everybody?
The Guardian: This was the
egalitarian dream of Cuba in the 1960s: For years in Cuba, jobs as varied as
farm workers and doctors only had a difference in their wages of the equivalent
of a few US dollars a month.
https://www.theguardian.com/world/2008/jun/12/cuba
Jensen Comment
Only now is Cuba backtracking from its egalitarian dream by uncapping wages and
legalizing profits while liberals in the USA want to return again to the 1960s
Cuban dream.
But is Denmark socialist? …Denmark doesn’t at
all fit the classic definition of socialism, which involves government ownership
of the means of production. It is, instead, social-democratic: a market economy
where the downsides of capitalism are mitigated by government action, including
a very strong social safety net. …The simple fact is that there is far more
misery in America than there needs to be. Every other advanced country has
universal health care and a much stronger social safety net than we do.
Paul Krugman
https://www.nytimes.com/2015/10/19/opinion/something-not-rotten-in-denmark.html
Jensen Comment
What Krugman does not mention is that Denmark is mostly a homogeneous (white)
nation of less than 6 million people. It's much more difficult and expensive to
afford and maintain a similar safety net with over 300 million highly diverse
people located on top of a very porous border with thousands trying to sneak in
daily to enjoy the safety nets.
Welfare Leads to Slower Growth in the Nordic
Nations ---
https://mises.org/wire/paul-krugman-learns-wrong-lesson-denmark
The Swedish Welfare State Leads to Poor
Immigrant Assimilation ---
https://mises.org/wire/swedish-welfare-state-leads-poor-immigrant-assimilation
Ending Jensen Comment
But don't get me wrong! Erika and I will vote for Bernie Sanders since
our possible expensive long-term health care not funded by Medicare will soon be
free. To hell with the future economic engine of the USA. Bring on the Bernie
Sanders' socialism since I'm too old to witness the chaos and economic
destruction that follows in its path. Since Democrats are promising free
everything why shouldn't Erika and I get in on the free everything?
Listen to Big Rock Candy Mountain' performed by Burl Ives ---
Big Rock Candy Mountain' Burl Ives
"But (American) virtuous
feelings have been played on by some facts with more fiction; they have been the
dupes of artful maneuvers, and made for a moment to be willing instruments in
forging chains for themselves.”
Thomas Jefferson
William J. Watkins, Jr., Winter 1999,
“The Kentucky and Virginia Resolutions: Guideposts of Limited Government,”
The Independent Review,
Vol. III, No. 3, pp. 406-407.
How to Mislead With Statistics
Here's how much money doctors across the US make ---
https://www.businessinsider.com/how-much-money-do-doctors-make-gender-pay-gap-doximity-study-2019-3
Jensen Comment
This article is a great example of how statistical reports can be misleading if
they only focus on mean averages without added information about standard
deviations and skewness and missing variables. For example, consider
neurosurgery. My wife's spine surgeon in Boston is what he calls a "big-back"
surgeon. He performs spinal surgeries that 95+% of the back surgeons in the USA
refuse to perform. He actually broke Erika's spine into three pieces and then
attached four rods from her hips to her neck. Afterwards, however, she can still
pick up a tissue off of the floor when bending her spine. Needless to say his
rates, sometimes exceeding tens of thousands of dollars per surgery, are greater
than the rates of "little-back" surgeons who also work out his office. By the
way, he's not on the faculty of the Harvard Medical School. However, every time
I've spoken with him he was followed by two or three Harvard Medical School
neurosurgery residency physicians who were what I called his "puppies."
By the way, it might be interesting to study details of his malpractice insurance premiums and lawsuits. He's amazing because he has the guts to be a "last-chance" neurosurgeon in spite of the circling lawyers. By last chance I mean when patients can no longer find a neurosurgeon who will operate on their spines he's their "last chance." Erika had over a dozen spine surgeries before she at last found this "big-back" surgeon in Boston.
There are also many other troubles with the above article. For example, malpractice insurance is very high priced in the USA relative to all other nations. And malpractice insurance costs vary greatly with specialties such as being very high for obstetrics (lawyers sue for every bad baby) versus neurosurgery versus psychiatry versus primary care physicians.
Let's consider an example. According to the study the average pay for a neurosurgeon is $617,000. But that does not account for differences in whether that salary is net of malpractice insurance premiums. Such netting out is complicated because many neurosurgeons make this much or much more without having to pay malpractice insurance premiums. My wife's spine surgeon who installed her morphine pump is an employee of the Dartmouth Hitchcock Medical Center that pays malpractice insurance for virtually all employees and medical school faculty. However, many neurosurgeons who operate in that same medical center are not employees and must pay their own malpractice insurance. Similarly, there's a nearby Veterans Hospital where VA neurosurgeons do not have to pay their own malpractice insurance. But if the VA has to outsource a particular type of surgery that surgeon's bill to the VA will include malpractice insurance.
Incomes of many specialists vary when they must pay for their own staff versus have no expenses for staff. For example, the Dartmouth Hitchcock Medical Center pays for all staff such as receptionists, nurses, technicians, accountants, etc. It even pays for lawyers when needed. The private-practice physicians who may also perform surgeries at this medical center must pay for their own office space and staff. How do you compare a salaried employee of that medical center with the profits of a private-practice physician?
I might point out a political problem related to all of this. There's an old saying: "Show me a bad doctor, and I'll show you a rich professional." The point is that even at the lowest end of the income distribution medical doctors in the USA are well paid.
The Democratic candidates for the 2020 presidential nomination have created a
paradox.
Most, not all, students are drawn to medical school in anticipation of
relatively high after-tax incomes. The
politicians advocating Medicare-for-All want to fund this $30+ trillion cost
with greatly increased taxes (think 70% of a physician's income). At the same
time more than twice as many physicians will be needed to staff
Medicare-for-All, especially with 76,000 new patients crossing the border each
month at current rates estimated by the NYT ---
https://www.nytimes.com/2019/03/05/us/border-crossing-increase.html
Eventually, the progressives will also legislate free medical school education.
But how many students will flock to medical schools even if they are free? My
guess is very few if you are gong to tax or regulate away 70% of their income
when they at long last begin to practice medicine.
The problem with becoming a physician is not just the cost of medical school. The problem is the ordeal --- those years of education and training needed to become masters of their crafts. The time needed varies with specialties, but you don't become a neurosurgeon without years of ordeal in training before you can bill your first paying patient. And there's a lot of blood, sweat, and tears in those training years. Even worse is that there's a lot of weekly tension and risk of burn out in the years of practice that follow. Tell that to the advocates of Medicare-for-All combined with soaring taxes!
If you want to double the number of physicians in the USA you not only have to make medical school free; You have to let them be the highest paid professionals on average after taxes.
PS
You can read more about Erika's ordeal with pain and surgeries at
http://www.cs.trinity.edu/rjensen/Tidbits/ErikaBob/ErikaPain/Set01/Set01.htm
I might add that the electronic pain stimulator installed eventually proved to
be worthless. The same surgeon who installed it removed it and replaced it with
a morphine pump. The pump is no magic bullet, but its more effective than the
electronic wiring up and down her spine.
March 21, 2019
Hi Elliot,,
You must also realize that when the wealthy people fund the new ventures they are also taking on highe financial risks. For some the payout is more wealth. For others there are huge losses. Bill Gates and Warren Buffet and other billionaires lost big time in Theranos. But Theranos and other more successful ventures got a chance that they would never get in Europe due to all the regulations and red tape entanglements and high taxes.
How many innovative ventures that succeeded and failed have been funded by European nations like the Nordic nations? And in China and Russia these new ventures probably could not get started without having the best ideas stolen/hacked from the USA.
You raised the question:
"At what point do most
people take Sen. Warren or Rep. AOC more seriously and consider
their solutions
as reasonable instead of fringe?"
Do you really think Warren and AOC have thought out "their solutions" even to the satisfaction of their own party?
Most Democrats consider AOC and Warren economics fringe and worry that at adding $100+ trillion in social spending might destroy the USA economic engine.
Consider Medicare-for-All.
The sensible liberal press argues as follows:
The New York Times' David Brooks: ‘Medicare for All’: The Impossible Dream ---
https://www.nytimes.com/2019/03/04/opinion/medicare-for-all.html?action=click&module=Opinion&pgtype=Homepage
Washington Post: You can’t have it all — even with Medicare-for-all ---
https://www.washingtonpost.com/opinions/you-cant-have-it-all--even-with-medicare-for-all/2019/01/31/b0551dcc-24c4-11e9-ad53-824486280311_story.html?utm_term=.7d24dfad68da
If the nation were building a health-care system from scratch, single-payer might be the rational choice. Even now, with many Americans reasonably satisfied with their employer-sponsored coverage, politicians can make an argument that they’d be better off in a different system. But they should not make that argument by exaggerating the benefits or lowballing the costs of single-payer, as Medicare-for-all advocates so often do. Any system will demand tradeoffs and constraints.
Canadian doctors still make dramatically less than U.S. (and UK and
German) counterparts: study ---
https://nationalpost.com/news/canada/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study
Canadian doctors make less than the OECD average, although they do not pay
nearly as much as USA physicians for malpractice insurance, office space, and
labor assistants like office nurses ---
https://en.wikipedia.org/wiki/Physicians_in_Canada
. . .
Canada should not ignore the wage gap, as a sudden shortage of certain specialists in the States could trigger a drain from here, said Dr. John Haggie, president of the Canadian Medical Association. Canada saw a net loss of doctors to the U.S. in the 1990s, as provinces instituted doctor pay caps and tried to rein-in fee increases as a way to corral health costs.
But Dr. Haggie voiced no particular envy Tuesday at the statistics just published in the journal Health Affairs
Jensen Comment
I read where there are 72,000+ physicians employed in the Canadian health system
having 86,000 physicians. The population of Canada is 37+ million residents
spread over nearly 4 million square miles.
In the USA
Patients experience long waits (months) for doctor appointments largely due to
the shortage of Canadian physicians. Delays for elective procedures such as knee
and hip replacements are so long that many Canadians use their own savings to
get such surgeries performed in the USA.
In the USA there are over 950,000+ physicians who, on average, are the
highest paid professionals in the USA..
https://en.wikipedia.org/wiki/Physicians_in_the_United_States#Demographics
The population of the USA is nearly 10 times that if Canada if you include the
undocumented immigrants. USA residents are spread over roughly the same number
of square miles as Canada, although the distribution is not as skewed as that of
Canada is skewed toward the south.
Bernie Sanders: "You’re Damn Right We’re Going to Destroy Private Health
Insurance" ---
Click Here
And he will limit the number of doctors by regulating what they can earn.
Politico: Progressives want a government-managed single payer insurance
program to replace (in two years) all USA private sector medical insurance
companies ---
https://www.politico.com/story/2019/02/26/house-democrats-medicare-for-all-1189139
Here's one of the
problems as they also plan to cut back on what hospitals, drug companies,
physicians earn in the USA ---
https://www.businessinsider.com/highest-paying-job-in-every-us-state-2019-2
Related to the above problem is will be the shortage
of physicians and hospitals to serve the expected increase in services expected
by wider coverage and the attraction of hordes undocumented immigrants primarily
coming to the USA for needed medical services like dialysis and transplants.
How do you attract
more students to become physicians (especially in rural USA) when you plan to
cut back on what physicians earn with caps on billings and higher taxes on the
earnings of physicians.
With physicians the problem is huge because of the
long ordeal it takes to become a licensed specialist and the likelihood of early
burnout.
I'm especially aware of this problem because one of our top regional
hospital general surgeons, frightfully overworked, in these mountains just
flamed out before reaching the age of 50.
Support for Medicare-for-All will evaporate once voters become aware that
confiscating the wealthy and high earners will only pay a
tiny fraction for the cost and that, when combined with other progressive
programs like the green initiative, guaranteed income, student loan forgiveness,
housing subsidies, free college, cash reparations to African and Native
Americans, etc. the price tags aggregate way over
$100 trillion on top of the existing $100+ trillion in contracted entitlements
for Medicaid, Medicare, Veterans Benefits, Social Security, Disability Payments,
unfunded pensions, etc.
How to Mislead With Statistics
Three reasons why people fall for politicians’ lies about statistics ---
https://theconversation.com/3-reasons-why-people-fall-for-politicians-lies-about-statistics-110014
Jensen Comment
A reason for being misled (related to letting emotions rule) is hoping that the
politician will become powerful enough to make the lie come true. For example,
many people are falling for statistics cited and the promises made by promises
of guaranteed income for everybody in the USA (think AOC and Kamela Harris).
Nancy Pelosi warns of the hazards of believing those lies.
The Democratic Party is Split
“You have to make decisions that you’re going to reach certain goals, and some
of our goals we think are
achievable”
Nancy Pelosi (when criticizing Alexandria's Green New Deal and
Basic (Guaranteed) Income Medicare-for-All)
Click Here
Added Jensen Comment
I suspect
progressives will eventually make medical schools much cheaper. However, this
will not solve the problem since these same progressives also want to tax what
physicians make at 70+% and put severe caps on what they can charge for medical
services (makes me think of rent control disasters). It's like making
physicians pay their own fees
https://www.businessinsider.com/highest-paying-job-in-every-us-state-2019-2
What progressives can't do much about is to take what discourages medical students the most --- the years of ordeal it takes to master their crafts.
One almost
certain solution for the USA will be what my biologist colleague calls the
"French solution" --- which Jagdish tells us is also the "Indian solution."
Physicians commence medical school within one year out of high school (or in
some instances zero years after high school). Medical students don't have
"waste" 3-5 years as undergraduates. Johns Hopkins has a small experimental
program something like the French solution.
Another possible help to physicians that progressives are divided over is malpractice insurance and lawsuit pots of gold. The Canadians virtually cut the lawyers out of the equation (except in outlier instances) that makes malpractice insurance in Canada almost nothing compared to the USA. Medical boards in Canada pay victims for damages but no punitive damage awards.
Amazingly,
however, the State of Texas passed a constitutional amendment severely capping
punitive damages. The NYT reported that almost immediately medical school
graduates started seeking jobs in Texas.
What will make malpractice insurance relief difficult is that most of our USA federal and state legislators are lawyers. It amazed me that the lawyers in Texas let the punitive-damage pot of gold slip through their fingers in the Lone Star State.
The WSJ reports
that progressive support for eliminating private sector medical insurance
companies is waning due to the massive cost of replacing it with a government
bureaucracy.
Physicians and hospitals have barely had a chance to fight but will fight tooth
and nail if Medicare-for-All ever becomes a threat to them.
The real test
is Bernie Sanders.
He still favors eliminating the private sector in medical insurance and ignores
the fact that even Medicare and Medicaid outsource insurance claims to the
private sector that's currently geared up
with the trained employees and software to process such claims.
It's not so much that Bernie Sanders is a threat as the threat that hordes of socialists are also elected to the House and Senate if Bernie becomes wildly popular. The reason progressives like Bernie are currently vague about funding Medicare-for-All is that they know that they will lose millennial support once it's revealed that middle income and maybe even poor people will be taxed for their medical coverage or copays will be charged (as they are in many other nations like Canada).
Or some nations like Germany greatly limit what's covered in the national plan, thereby forcing those who can afford it to buy secondary medical insurance from the private sector to pay for better services (like not having to wait years for a knee or hip replacement).
Kaiser Family Foundation: People love
Medicare-for-All until they're told it'll raise their taxes to the $30+
trillion cost: Then support nosedives ---
https://www.businessinsider.com/ap-poll-support-for-medicare-for-all-fluctuates-with-details-2019-1
Jensen Comment
Virtually all nations with national health plans raise the funds needed with
taxation at all levels of income. Estimates of USA's cost run $30+ trillion over
ten years, but a lot depends upon who is covered
(severely ill or disabled immigrants crossing the border illegally for dialysis
or other expensive health care), what is covered
(think long-term nursing care). and capital costs
(will government build hospitals and medical centers?).
Wealth Tax --- https://en.wikipedia.org/wiki/Wealth_tax
Even if wildly successful Senator Warren's wealth
tax would only pay $2.75 trillion of the $30+ trillion cost ten-year cost of
Medicare-for-All
Elizabeth Warren's proposed wealth tax would raise $2.75 trillion over a
ten-year period from about 75,000 families, or less than 0.1 percent of U.S.
households ---
https://www.cnbc.com/2019/01/24/elizabeth-warren-to-propose-new-wealth-tax-economic-advisor.html
Jensen Comment
This could have all sorts of economic consequences. One is that most of those
75,000 wealthy USA families have their wealth tied up in long-term investments
like real estate (think of Trump hotels, Ted Turner's ranches in Australia,
Amazon's many shares owned by Jeff Bezos), etc. Warren's Wealth tax could
force liquidation of these long-term investments to pay the $2.75 trillion
wealth tax. If you want your top millionaires and billionaires to move out of
the USA this is a sure-fire way to wave bye bye to them
and the $2.75 trillion that becomes uncollectable.
Wealthy taxpayers are probably not worried
with a conservative Supreme Court. Arguably her
proposal requires an amendment to the USA Constitution because her wealth tax
proposal is extremely disproportional.---
https://en.wikipedia.org/wiki/Wealth_tax#United_States
You can read more about wealth taxes at
https://en.wikipedia.org/wiki/Thomas_Piketty
Why did liberal Sweden axe its wealth tax while at the same time lowering its
top income tax rate from 87% (1979) to 65% (1990) to 56% (2002)? ? ---
http://ftp.iza.org/dp11475.pdf
Elizabeth Warren would probably prefer that you do not
study experiences of all disastrous Scandinavian wealth taxes and very high
marginal income tax rates that were later greatly reduced to stimulate the
economy (called supply side (Laffer Curve) economics) ---
http://www.econlib.org/library/Enc/MarginalTaxRates.html
PS
Those 75,000 wealthy taxpayers now invest in hundreds of billions in tax-exempt
bonds (called municipal bonds) that underlie the building of most schools and
municipal buildings in the USA. The muni bond market would nosedive if most of
those 75,000 people sold their tax-exempt bonds and moved these hundreds of
billions in investments off shore on their way out of the USA. That's not a cost
that the naive Elizabeth Warren factored into her proposed wealth. What's the
incentive for a billionaire who moved to Switzerland to continue to invest
hundreds of millions of dollars in the USA muni market?
I suspect that Elizabeth Warren knows that her wealth tax would be an economic disaster. I think she's just trying to get votes from financially-ignorant voters. It's all politics and no sense other than she's trying to fend off the radical anti-capitalist "young" left wing of the Democratic Party.
Rand Study of Medicare-for-All --- A Look at the Fine Print ---
https://www.rand.org/blog/2018/10/misconceptions-about-medicare-for-all.html
Misconception 1: Health care would be free
Care would not be free in a single-payer system—it would be paid for differently. Instead of paying insurance premiums, people would pay taxes, which would be collected by a government agency and used to pay for health care on behalf of the population. Some in higher tax brackets might pay more under a single-payer system than under the current system, while others might pay less.
Many single-payer proposals, including Sen. Bernie Sanders' “Medicare for All” proposal, cover a comprehensive range of services with no or very low co-pays and deductibles. While common in many proposals (PDF), a single-payer system would not necessarily eliminate all out-of-pocket expenses. In fact, the current Medicare program, which some consider a form of single payer, has deductibles and co-pays.
Misconception 2: Health care spending would dramatically increase (or decrease).
A single-payer system could push health spending up or down, or not have much effect. Spending could increase if a national single-payer system expanded coverage to more people, leading to higher use of health services. If the single-payer plan cuts deductibles and co-pays, currently insured people would also use more services. But a single-payer system might also reduce or eliminate administrative expenses, such as insurer marketing, billing and claims processing, which would push spending down. A single-payer plan could also cut spending by negotiating lower prices with providers and drug companies.
Two recent studies estimated that in a single-payer system, total spending could decline by a few percentage points.
Two recent studies, a national-level analysis by the Mercatus Center and RAND's analysis of a single-payer proposal for New York state, estimated that total spending could decline by a few percentage points. Regardless of whether total spending goes up or down, federal spending would almost surely increase, because the government would be responsible for paying the bills.
Misconception 3: People with employer insurance would have fewer benefits covered.
If the United States adopted a single-payer plan, employer-sponsored insurance would become less relevant because people would have an alternative source of coverage. As a result, many employers would drop health insurance coverage (PDF).
However, workers would not lose access to insurance—they would have coverage through the single-payer plan. Many single-payer plans, including Sanders' “Medicare for All” proposal, cover more than most current employer insurance plans, which have an average deductible of $1,573 for single coverage.
Some single-payer proposals explicitly prohibit employers and private insurers from offering health insurance coverage, to avoid a two-tiered system in which wealthier people have access to more services and providers. Other proposals would allow private insurance to offer coverage for services not included in the single-payer plan (such as elective surgeries), or to provide faster or improved services for those who wish to supplement their benefits.
For example, in Australia (and Germany), all residents are eligible for basic health services provided through a single payer, but those with higher income are encouraged to buy additional, private coverage that provides access to private providers and hospitals.
Misconception 4: Doctors would become government employees.
None of the leading Medicare for All proposals require that doctors and other health care professionals become government employees, as is the case in the United Kingdom's National Health Service. Under Sanders' Medicare for All proposal, private practices and hospitals would continue to operate independently. Other single-payer proposals require hospitals to convert to nonprofit status (PDF), but could remain privately run.
Misconception 4: People would lose access to their doctors.
Enrollees generally would be able to choose among providers participating in the program, and—if all providers participated—there would be no need to worry about out-of-network charges. However, changes in payment rates under a single-payer system could affect doctors' willingness to supply services, and could make it more difficult to get appointments.
We see this effect in our current system—in 2015, only 45 percent of primary care physicians accepted Medicaid patients, due in part to Medicaid's relatively low payment rates. In contrast, 72 percent of primary care physicians accepted new Medicare patients and 80 percent accepted new commercial patients.
Even if overall provider payment levels were reduced, payments to each individual provider would depend on their existing mix of patients. Payment might go up for some providers, such as those who see Medicaid patients, and could be about the same for those who see Medicare patients.
Jodi L. Liu is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation. Christine Eibner is the Paul O'Neill-Alcoa chair in policy analysis at RAND and a professor at the Pardee RAND Graduate School.
This commentary originally appeared on USA Today on October 26, 2018. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.
Jensen Comment
Many (most?) people in the USA are not aware that current Medicare and Medicaid
government insurance claims are processed in the private sector rather than by
government agencies. This is important, since there will be an enormous cost for
a new government bureaucracy in the USA to be formed to process medical
insurance claims if the government does not outsource Medicare-for-All claims
processing. I don't think researchers to date have confronted the issue of the
huge startup cost of having the government process Medicare-for-All claims.
There also is the issue of the many places in the USA where medical care is substandard due to lack of physicians and hospitals and other providers. Everybody keeps saying the government will not have to build hospitals in these places and provide a sufficient number of providers to run these hospitals. Don't count on that when the lawyers start suing over unequal quality of medical care across the USA. Eventually the Federal government will have to finance new hospitals and provide health care providers in those hospitals.
Many (most?) people in the USA are not aware that they might lose their employer-provided medical insurance under Medicare-for-All insurance. Medical insurance would no longer be a fringe benefit provided by employers.
Medicare patients currently must pay 20% of their medical bills or pay for supplemental private insurance to pay part of this 20%. Costs of such supplemental insurance vary with the degree of coverage desired. For Erika and me the supplemental insurance is over $1,200 per month for our premium supplemental plans plus we have to pay over $200 per month for our Medicare Insurance itself. Even though we were taxed for Medicare since 1965 until we retired at 65 years of age, Medicare is not free in our retirement years. Most people in the USA think that Medicare coverage is free after retirement. That is a serious misconception.
Of course there are variations of the Medicare-for-All plan. 2020 Presidential Candidate Kamela Harris proposed eliminating all private medical insurance contracts and then quickly reversed herself when learning how many of the 177 million insured people in the USA were happy with their private sector insurance companies. She then proposed that public sector insurance contracts only be made available as an option in competition with private sector plans that often give more choices in choosing doctors and hospitals.
Physicians and hospitals do not have to accept Medicare Patients, Medicaid patients, Obamacare patients, or any patients wanting to pay with insurance. Medicaid and Obamacare patients are likely to have a tougher time finding physicians and hospitals than Medicare patients due primarily to severe fee restrictions on for Medicaid and Obamacare patients. Many hospitals complain that they lose money for every Medicaid patient and Obamacare patient.
Major Chicago Hospitals Not In 2017 Obamacare
Marketplace Plans ---
https://www.wbez.org/shows/wbez-news/major-chicago-hospitals-not-in-2017-obamacare-marketplace-plans/f55d6c23-d9b1-452f-8c75-73635bd83d07
Some of Chicago’s largest hospitals said they will not be part of any Cook County Affordable Care Act marketplace plans in 2017.
University of Chicago Medical Center and Rush University Medical Center both said they don’t plan to be in network for any Obamacare marketplace plans next year.
The change means patients with doctors at those hospitals will either need to find a plan off the marketplace, and lose Obamacare subsides, or find a new doctor.
Northwestern Memorial Hospital said it will also be out of the marketplace, but will have exceptions for some of its partner hospitals.
Continued in article
Personally, I think Medicare-for-All will significantly increase what is paid for medical services in the USA. Primarily this is because there is a $2+ trillion underground economy where workers are paid unreported cash for services that are not subjected to payroll taxes or income taxes. Much of this is for part-time work (think house cleaners and unregistered day care providers) although there are many full-time workers whose services are not reported to the government. I lived in San Antonio for 24 years where there are various street corners where employers meet with workers taken to jobs day-after-day such as roofing jobs, construction jobs, landscaping jobs, etc. Such workers save (illegally) on paying income and payroll taxes but also receive no benefits such as medical insurance, unemployment insurance, and Social Security contributions. This begs the question of why law enforcement does not move in to end this enormous illegal practice. The suspected reason is that closing it down those street corner opportunities will hurt millions of families with children across the USA who are vitally dependent upon such cash-payment jobs. Many of those workers, certainly not all, are undocumented immigrants who find it harder to find traditional jobs with benefits or expose themselves to ICE deportations.
Presumably millions of workers in the $2+ trillion underground economy who do not presently have health insurance would be covered under Medicare-for-All. Unreliable stimates of the undocumented immigrants in the USA are reported to be around 11 million, but realistic estimates run much higher than that. Certainly many undocumented workers do not depend upon the underground economy for jobs, but a huge proportion rely upon that underground economy.
What is not clear is whether physicians and hospitals could refuse Medicare-for-All patients. Health care providers are allowed pick and choose what insurance they will accept at the moment, and many refuse Medicaid and Obamacare patients. When we lived in San Antonio we had an outstanding dermatologist that did not accept any insurance plans. Patients paid their own bills and then were on their own when appealing for reimbursements from their insurance plans.
What nobody, including the Rand study above, seems to want to discuss is the wide range of cost possibilities for Medicare-for-All coverage. For example, the 800-lb gorilla lurking in the shadows is the cost of long-term-nursing care. Currently Medicare does not cover long-term nursing care claims. Medicaid does cover long-term nursing care but severely limits what will be paid for each day of care. As a result many Medicaid patients must accept pretty lousy nursing homes or pretty lousy home-care providers. Medicare-for-All costs will explode exponentially if long-term care is provided in quality nursing homes. Presently long-term nursing care insurance plans are very expensive luxuries.
One of the big worries is the magnetic attraction Medicare-for-All will have on very expensive long-term treatment patients. For example, one can imagine the many dialysis patients around the world who will seek to cross the USA borders just for free free kidney dialysis treatments for the rest of their lives. One can imagine all the people in the world who cannot get organ transplants or brain surgeries without crossing into the USA.
Howard Schultz
One interesting political event of the times is the interview with
multibillionaire Howard Schultz on CBS Sixty minutes ---
https://www.cbs.com/shows/60_minutes/video/MD3ISxVkJXgLBsH4lNDrLYsRQWmCJy_X/howard-schultz-small-satellites-big-data-jerry-and-marge-selbee/
Schultz (think Starbucks) was always viewed as a liberal Democrat. But now he's scaring Democrats by threatening to use his billions to run for President as an independent. One of the major reasons he gave for possibly running is the math of Medicare-for-All. He views Medicare-for-All as an economic disaster for the USA along with other wild spending schemes now contemplated by Maxine Waters like trillions for reparations for blacks and native Americans, free college education for all, massive spending on subsidized housing, zero-carbon regulations, open borders, etc. etc.
All these are good causes, but those politicians advocating those causes understand the math the least.
A Federal Shutdown Is an Annoyance (that can
be solved) — Interest on $22 Trillion in Debt Is a Problem (that cannot be
solved) ---
https://www.cato.org/publications/commentary/federal-shutdown-annoyance-interest-22-trillion-debt-problem
The U.S. Treasury is set to borrow $1 trillion
for a second year to finance the government's unprecedented budget deficit ---
https://www.bloomberg.com/news/articles/2019-01-28/another-year-another-1-trillion-in-new-debt-for-u-s-to-raise?cmpid=BBD012819_BIZ&utm_medium=email&utm_source=newsletter&utm_term=190128&utm_campaign=bloombergdaily
FiveThirtyEight Blog: The Young Left’s
Anti-Capitalist Manifesto: Its goal is to remake our economic system — and the
Democratic Party ---
https://fivethirtyeight.com/features/the-young-lefts-anti-capitalist-manifesto/
In my opinion, Schultz does not want to run for President. He just wants to scare the Democratic Party to come to its senses on the math.
I think he Shultz will threaten to run until the Democratic platform becomes more math sensible.
The bottom line is that the USA needs some taxpayer funded medical coverage across the USA. The worry is that, like climate change proposals, that we will become committed to programs that end up being self-defeating. It's like the family that keeps borrowing and borrowing for the big house, expensive cars, luxury cruises, etc. etc. until the day comes when they find themselves in bankruptcy court.
December 31, 2018
NYT: Choosing the Right Health Savings Account ---
https://www.nytimes.com/2018/12/07/your-money/health-savings-account-hsa.html
NYT: Fixing Medicare
https://www.nytimes.com/2011/11/21/opinion/fixing-medicare.html
Medicare for All: Administrative Costs Are Much Higher than You Think ---
https://mises.org/wire/medicare-all-administrative-costs-are-much-higher-you-think?utm_source=Mises+Institute+Subscriptions&utm_campaign=8a83a2b8d3-EMAIL_CAMPAIGN_9_21_2018_9_59_COPY_01&utm_medium=email&utm_term=0_8b52b2e1c0-8a83a2b8d3-228708937
Democrats’ 8 plans for universal health care. Here’s how they work ---
https://www.vox.com/2018/12/13/18103087/democrats-universal-health-care-sanders-jayapal
Obamacare funneled a significant amount of money to hospitals and
insurers, while a single-payer system like the one proposed by Sen. Bernie
Sanders (I-V.T.) would cut provider payments and largely put private health
insurers out of business ---
http://reason.com/blog/2018/12/12/even-democrats-are-divided-over-medicare
How to Mislead With Statistics
Left-Leaning VOX: The $21 trillion Pentagon accounting error that can’t pay
for Medicare-for-all, explained ---
https://www.vox.com/policy-and-politics/2018/12/3/18122947/pentagon-accounting-error-medicare-for-all
The US military budget is such a bloated monstrosity that it contains accounting errors that could finance two-thirds of the cost of a government-run single-payer health insurance system. All Americans could visit an unlimited array of doctors at no out of pocket cost. At least that’s a notion spreading on left-wing Twitter and endorsed and amplified by newly elected Rep. Alexandria Ocasio-Cortez, one of Democrats’ biggest 2018 sensations and an undeniable master at the fine art of staying in the public eye.
Unfortunately, it’s not true.
The idea spread like a game of telephone from a Nation article to the US Congress while losing a crucial point of detail: The Pentagon’s accounting errors are genuinely enormous, but they’re also just accounting errors — they don’t represent actual money that can be spent on something else.
Proponents of this vision have the political wind at their backs and continue to deploy the idea effectively to win intra-party arguments without really making any headway on the core obstacles to writing a Medicare-for-all bill that could become law. That said, to the extent that political power rather than concrete legislation is the goal, that’s probably for the best.
Misunderstandings fly around on Twitter all the time, and AOC’s level of policy knowledge is pretty typical for a member of Congress. But this particular flub is telling about progressive frustration over the double standard on military versus non-military spending, and also the fraught state of play regarding the push for a Medicare-for-all program.
The Pentagon’s mystery $21 trillion, explained
The underlying article by Dave Lindorff in the Nation that kicked this off is an investigative report into the Defense Department’s accounting practices. Lindorff reveals that Pentagon accounting is quite weak, that the department keeps flunking outside audits, that funds are shifted between accounts without proper oversight, and that overall documentation of what’s actually happening with the Pentagon’s vast budget is extremely poor.
Lindorff goes beyond these observations to allege that what’s happening amounts to deliberate fraud, the purpose of which is to persuade Congress to increase appropriations levels beyond what would otherwise be approved.
Continued in article
Jensen Comment
We really cannot compare proposed Medicare-for-All plan without more specific
definitions of "Medicare-for-All" and the "cared for population." For example,
Medicare currently does not pay for the enormous cost of long-term nursing care.
Medicare only pays 80% of most of the things it does cover like hospital and
doctor care.
Also Medicare has built up trust funds over the 50 years using payroll deductions from individuals and employers. The trust funds are not sustainable at predicted usage rates, but it's not like the existing Medicare program did not accumulate any finds for the elderly and disabled. A Medicare-for-All plan does not have 50 years of payroll deductions to help pay for an abrupt shock to the system.
Advocates of Medicare-for-All never mention that Medicare for all is mostly a private sector program where claims are serviced in the private sector along with private sector doctor, nursing, and medicine delivery of goods and services. Medicare is not like the U.K. system where most services are delivered by government employees.
The Nation's analysis of the Defense Department's expenses ignores the fact that even if we entirely eliminated the current Army, Navy, and Air Force the government's obligations to retired and disabled former military personnel would carry on for hundreds of billions of dollars into the indefinite future. And how long would the USA and its Medicare-for-All program survive without any Army, Navy, and Air Force?
The Nation's analysis is an example of totally irresponsible and misleading statistics.
WaPost fact-checker gives Ocasio-Cortez four Pinocchios for Pentagon claim
---
https://thehill.com/homenews/media/419730-wapost-fact-checker-gives-ocasio-cortez-four-pinocchios-for-pentagon-claim
Krugman redefines ‘Medicare for all,’ but gets it wrong ---
http://pnhp.org/news/krugman-redefines-medicare-for-all-but-gets-it-wrong/
. . .
Comment:
By Don McCanne, M.D.
“Medicare for all…would mean allowing individuals and employers to buy into Medicare – basically a big public option.” Who says? Well Paul Krugman and many others. This is not simply a debate about labels. This is a debate about fundamental policy. Are we going to accept the status quo with the tweak of a public option, or are we going to address the fundamental defects in our system that have driven up costs, perpetuated mediocrity, and left tens of millions vulnerable with impaired access to health care with all of its consequences and often with intolerable financial hardship?
This is similar to the debate that took place within the Democratic Party just before Hillary Clinton and Barack Obama began jockeying for the 2008 presidential nomination. The Democratic Party machine was in complete control of the policy debate on health care reform. The neoliberal party elite had decided that we were going to “build on what works” – employer-sponsored and union-supported plans – and reject single payer based on their concepts of what was politically feasible. Those of us advocating for the expanded and improved Medicare for all single payer approach were ejected from the conversations (often rudely so – they were in charge!).
Similarly, with the contest for the 2016 Democratic presidential nomination, the debate at the platform committee confirmed that the battle had not changed. The neoliberal leadership, represented by Neera Tanden, was successful in rejecting the single payer Medicare for all plank.
Tanden, of the Center of American Progress, has continued the fight for control of the policy debate by releasing their new proposal, “Medicare Extra For All.” Although some of the tweaks proposed seem beneficial, it basically continues the current dysfunctional, fragmented financing system, but with one important political change. They have stolen the “Medicare for all” label! This has contributed to the ubiquitous deception that the public option is Medicare for all. When the current candidates campaign on Medicare for all but behind the scenes are supporting an option to buy into Medicare while accepting campaign funds from the insurance and pharmaceutical industries, we need to call them on their deception.
It is no wonder the public is confused, even if they do not realize it. When Nobel laureate Paul Krugman jumps in and says Medicare for all is allowing individuals and employers to buy into Medicare as a public option, then we know that the political campaigns are corrupted with deceptions. How can we get the public to understand that a well designed, single payer national health program – a bona fide Improved Medicare for All – is the reform that they crave?
Bernie Care Versus Canada Care ---
https://mises.org/wire/3-ways-bernie-care-makes-canadian-healthcare-look-good-comparison?utm_source=Mises+Institute+Subscriptions&utm_campaign=08ad8fda7b-EMAIL_CAMPAIGN_9_21_2018_9_59_COPY_01&utm_medium=email&utm_term=0_8b52b2e1c0-08ad8fda7b-228708937
How to mislead with statistics
The median cost of a private nursing home room has reached $100,375 per year,---
https://www.cnbc.com/2018/10/19/this-retirement-expense-has-hit-100000-annually-and-its-continuing-to-rise.html
Actuarial models of long-term care insurance providers greatly underestimated
the rapid rise in costs and recently had to more than double the monthly rates
for such insurance. The "median cost" of $100,375 is misleading in that this
cost has a wide overall variance and a median that differs substantially between
the 50 USA states. In fairness the article touches on this point slightly
(such as pointing the high cost of nursing homes in Alaska). There's also
extreme variability in terms of quality of care. This, in part, is due to the
high worker turnover in nursing homes and the tendency for many to hire
unskilled workers at minimum wage. My point is that comparing nursing homes is a
lot like comparing sweet cherries with sour lemons.
Sadly, parents that made the most sacrifices for their adult children often are the least-supported in their own times of needs years later.
The good news is that with professional guidance more than five years in advance, heirs can legally confiscate Grandma's estate so that she's eligible later on for Medicaid-provided long-term nursing care. The bad news is that the quality of many nursing homes that accept Medicaid patients is often the worst in the USA. Maybe we should be more like the Germans who sometimes ship their gaga grandmas and grandpas to to relatively good lower-priced nursing homes in Poland.
Nursing Home and Hospital Elderly-Care Fraud
Elderly residents given intensive therapy in the last weeks of life jumped 65
percent, a study shows, raising questions about financial incentives. ---
NY Times: ‘Don’t Get Too Excited’ About
Medicare for All ---
https://www.nytimes.com/2018/10/19/opinion/sunday/medicare-single-payer-health-care.html?fb=1&recb=published-assets-bq.thompson_sampling&recid=1Bq8s0acvT5uUy8yUSJ8MCz16wy&mi_u=10527319
Jensen Comment
There are just too many uncertainties about its coverage and cost. People
advocating Medicare don't understand it. For example, Medicare claims and
services are administered by the private sector, not
the public sector. It might take more than a decade and cost over a trillion
to prepare the public sector to take on the administrative chores plus increase
the capacity of physicians, hospitals, and support staff. Secondly, there's
tremendous uncertainty about coverage. Currently Medicare does not cover the
tremendously expensive cost of long-term care either at home or in nursing
homes.
All nations that have nationalized health care are much smaller and do not have the millions of undocumented immigrants that we have in the USA. Bringing them on board will be immensely costly and, worse, will be a magnet for virtually all the sick people to enter the USA illegally. Nations that have nationalized health care do a much better job at policing their borders and do not have sanctuary cities to protect undocumented immigrants from being deported.
Government Medical Research Spending Favors Women ---
https://marginalrevolution.com/marginalrevolution/2018/08/government-medical-research-spending-favors-women.html
How Alphabet, Amazon, Apple, and Microsoft are shaking up healthcare — and
what it means for the future of the industry ---
https://www.businessinsider.com/alphabet-amazon-apple-and-microsofts-influence-in-healthcare-2018-7
How to Mislead With Statistics
American Life Expectancy vs. Europe: It's Not About "Socialized Medicine" ----
https://mises.org/wire/american-life-expectancy-vs-europe-its-not-about-socialized-medicine?utm_source=Mises+Institute+Subscriptions&utm_campaign=ecd0810c45-EMAIL_CAMPAIGN_9_21_2018_9_59_COPY_01&utm_medium=email&utm_term=0_8b52b2e1c0-ecd0810c45-228708937
Everything You Know About Obesity Is Wrong ---
https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/
Jensen Comment
Unlike Medicaid, Medicare does not provide long-term care benefits. |
However some benefits may change for the good for some Medicare patients.
From the CFO Journal's Morning Ledger on August 7, 2018
Good morning. General Motors Co. is upending the traditional benefits set up by striking a deal with Detroit-based Henry Ford Health System to offer a new coverage option to employees in an attempt to lower costs and improve care, reports the WSJ's Anna Wilde Matthews.
Cutting out the middle man: GM's new approach is a departure from the typical health-benefits arrangement in which companies hire insurers for access to a broader network of health-care providers. In those cases, insurers negotiate the prices with hospitals, doctors and other providers, and the employers rarely have access to the terms that govern their medical costs.
Lofty savings: The plan would cost employees $300 to $900 less in annual payroll contributions than GM's current cheapest plan and would require them to get all their health care, including surgeries, through Henry Ford Health System, or pay expensive out-of-network rates, reports the Detroit Free Press.
Let's make a deal: Other employers, such as Walmart Inc., have crafted limited direct deals with hospital systems to perform particular procedures, such as back surgeries. A smaller number of companies, including Walt Disney Co., Boeing Co. and Intel Corp., have taken the more-ambitious approach of having the health-care provider manage nearly all of the care of enrolled employees. And Amazon.com Inc., JPMorgan & Chase Co. and Berkshire Hathaway Inc. have joined forces to launch a venture aimed at lowering their employees health-care costs.
More to come: 11% of employers said they plan to do such broad deals with health-care providers next year, according to a survey of 170 large employers to be released Tuesday by the National Business Group on Health. That's up from 3% in last year’s poll, the group said.
Medicare Allows More Benefits for Chronically
Ill, Aiming to Improve Care for Millions ---
https://www.nytimes.com/2018/06/24/us/politics/medicare-chronic-illness-benefits.html
WASHINGTON — Congress and the Trump administration are revamping Medicare to provide extra benefits to people with multiple chronic illnesses, a significant departure from the program’s traditional focus that aims to create a new model of care for millions of older Americans.
The changes — reflected in a new law and in official guidance from the Department of Health and Human Services — tackle a vexing and costly problem in American health care: how to deal with long-term illnesses that can build on one another, and the social factors outside the reach of traditional medicine that can contribute to them, like nutrition, transportation and housing.
To that end, the additional benefits can include social and medical services, home improvements like wheelchair ramps, transportation to doctor’s offices and home delivery of hot meals.
The new law is a rare instance of bipartisan cooperation on a major policy initiative, embraced by members of Congress from both parties. The changes are also supported by Medicare officials and insurance companies that operate the fast-growing Medicare Advantage plans serving one-third of the 60 million Medicare beneficiaries.
“This is a way to update and strengthen Medicare,” said Senator Ron Wyden, Democrat of Oregon and an architect of the law, the Chronic Care Act, which was included in budget legislation signed recently by President Trump. “It begins a transformational change in the way Medicare works for seniors who suffer from chronic conditions. More of them will be able to receive care at home, so they can stay independent and out of the hospital.”
Half of Medicare patients are treated for five or more chronic conditions each year, and they account for three-fourths of Medicare spending, according to Kenneth E. Thorpe, the chairman of the health policy department at Emory University.
Under the new law and Trump administration policy, most of the new benefits will be reserved for Medicare Advantage plans, which will be able to offer additional benefits tailored to the needs of people with conditions like diabetes, Alzheimer’s, Parkinson’s disease, heart failure, rheumatoid arthritis and some types of cancer.
“This is a big win for patients,” said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.
Officials hope that combining social and medical services will produce better outcomes for patients and save money for Medicare.Continued in article
An ER patient can be charged thousands of dollars in “trauma fees” — even if they weren’t treated for trauma ---
Amazon's deal will immediately give the retail giant a nationwide drug
network, threatening to upend the entire industry ---
https://www.bloomberg.com/news/articles/2018-06-28/amazon-makes-big-foray-into-health-care-with-pillpack-purchase?cmpid=BBD062818_BIZ&utm_medium=email&utm_source=newsletter&utm_term=180628&utm_campaign=bloombergdaily
Harvard: The costs of health care are now the greatest financial
concern for most Americans—more than the costs for housing, food or retirement
---
https://hms.harvard.edu/news/hidden-savings
The
HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s
expansion of the program, California has enrolled hundreds of thousands of
ineligible adults in Medicaid. Consequently, the state has bilked the federal
government out of more than $1 billion in funding to which the state was not
entitled.
https://spectator.org/california-commits-massive-medicaid-fraud/
What Your State Spends on Your Health ---
https://247wallst.com/special-report/2018/07/25/what-your-state-spends-on-your-health/?utm_source=247WallStDailyNewsletter&utm_medium=email&utm_content=JUL262018A&utm_campaign=DailyNewsletter
In 2015, state governments across the country spent a combined $605 billion on health care, or about $1,880 per resident.
The physical and mental well-being of the population is the single largest financial obligation of state governments, and comprises well over one-quarter of total state direct spending. As is the case with most expenditures, health spending varies at the state level dramatically, from just over $1,000 per capita to well over $3,000 per person.
The major categories of health spending at the state level include Medicaid coverage, state-run hospitals and medical schools, and finally other health expenses and programs addressing needs such as community wellness, substance abuse, health inspection, and pollution control.
Among these three categories, it is Medicaid spending that accounts for the largest portion of total state expenditure, at about 80% of annual state health costs. 24/7 Wall St. reviewed health spending in all 50 states, ranked from lowest total combined state health expenditure per capita to highest. This measure includes only direct state spending, which excludes local and federal spending.
Generally, states spent more if they had more expansive Medicaid eligibility and benefits. This was particularly the case for those states that opted to expand Medicaid coverage under the Affordable Care Act. Only one of the states spending the most per capita on health care, Mississippi, did not opt to expand Medicaid. Of the 20 states that spent the least on health care, 12 have not expanded Medicaid.
Those states with more poor, disabled, and elderly residents, also often spent more per capita. Disabled people and those over 65 are the ones who most commonly need health care and receive state Medicaid spending. In all, nearly 25% of Medicaid recipients are 65 or older, institutionalized, or disabled
50. South Dakota
> 2015 state health spending: $1,022 per capita ($877 million)
> State government spending, all programs: $5,448 per capita (11th lowest)
> Population 65 and over: 15.9% (23rd highest)
> Population with a disability: 12.2% (19th lowest)
> Population with health insurance: 91.3% (21st lowest)
49. Nebraska
> 2015 state health spending: $1,186 per capita ($2.2 billion)
> State government spending, all programs: $5,511 per capita (12th lowest)
> Population 65 and over: 14.9% (13th lowest)
> Population with a disability: 11.9% (16th lowest)
> Population with health insurance: 91.4% (22nd lowest)
. . .
2. New York
> 2015 state health spending: $2,911 per capita ($57.6 billion)
> State government spending, all programs: $9,376 per capita (7th highest)
> Population 65 and over: 15.3% (22nd lowest)
> Population with a disability: 11.5% (11th lowest)
> Population with health insurance: 93.9% (17th highest)
1. New Mexico