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Hence some links below are broken.
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For example a broken link
http://www.trinity.edu/rjensen/Pictures.htm
can be changed to corrected link
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rjensen@trinity.edu if you really need to file that is missing

Universal Health Care Messaging
Bob Jensen at Trinity University


Introduction

The Lies and Deceptions

December 31, 2017

June 30, 2017

March 31, 2017

December 31, 2016

September 30, 2016

June 30, 2016

March 31, 2016

December 31, 2015

December 31, 2014

December 31, 2013

September 30, 2013

June 30, 2013

March 31, 2013

December 31, 2012

September 30, 2012

June 30, 2012

March 31, 2012

December 31, 2011

September 30, 2011

June 30, 2011

March 31, 2011

December 31, 2010

September 30, 2010

July 29, 2010,

July 17, 2010

June 29, 2010

June 10, 2010

May 27, 2010

May 20, 2010

May 10, 2010 

April 29, 2010

April 20, 2010 

April 8, 2010  

March 30, 2010 

March 18, 2010

March 8, 2010

February 23, 2010  

February 15, 2010 (including Health Insurance in Germany)

February 1, 2010

January 26, 2010

January 17, 2010 

January 5, 2010

December 23, 2009

December 17, 2009

December 7, 2009 

November 25, 2009

November 17, 2009

November 10, 2009 (The Most Frightening Legislation in the Shrinking History of the United States)

October 26, 2009

October 15, 2009

October 5, 2009

September 24, 2009

September 15, 2009 Update

September 3, 200 9 Update

August 26, 2009 Update

August 17, 2009 Update

August 07, 2009 Update

Canada

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 ---
https://hbr.org/2017/03/where-both-the-aca-and-ahca-fall-short-and-what-the-health-insurance-market-really-needs?referral=00563&cm_mmc=email-_-newsletter-_-daily_alert-_-alert_date&utm_source=newsletter_daily_alert&utm_medium=email&utm_campaign=alert_date&spMailingID=16826969&spUserID=MTkyODM0MDg0MAS2&spJobID=981683047&spReportId=OTgxNjgzMDQ3S0

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/blog/15-best-health-reform-blogs

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 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.

 

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

 

The End of the American Dream

Jensen Choice

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. 
"Out of the shadows," Sydney Morning Herald, February 5, 2005 --- http://www.smh.com.au/text/articles/2005/02/04/1107476799248.html 

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

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/19/AR2009111904053.html?referrer=emailarticle 

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/

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.

 

Making Sense of Health Care Reform (from the AccountingWeb on September 1, 2009) ---
http://www.accountingweb.com/topic/tax/making-sense-health-care-reform

We're old enough to remember when advocates for the Affordable Care Act promised that it would "bend the cost curve" and reduce expensive hospital visits, particularly at emergency rooms. So far, the opposite is occurring.
James Freeman, "There Goes Another ObamaCare Argument," WSJ, August 6, 2014 ---
http://online.wsj.com/articles/there-goes-another-obamacare-argument-1407242712?tesla=y&mod=djemMER_h&mg=reno64-wsj


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=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

 


"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)

. . .

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.

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.

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 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/

"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.

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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:

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."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 

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."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 


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 Groupbut 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/2014/11/gruber-should-be-fired-from-mit-for-violating-academic-integrity.html

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.

 

"Medicaid Expansion Boosted Emergency Room Visits In Oregon," by Julie Royner, NPR, January 3, 2014 ---
http://www.wbur.org/npr/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon

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


Hi Norma,

Due in heavy part that the Affordable Care Act is passing both its deductible nonpayment bad debts and its premium non-payment bad debts (two of the three months of a three-month nonpayment grace period), many hospitals like the Andersen Cancer Center and many doctors (70% in California) are refusing to serve patients insured by the exchanges. The TV networks and major newspapers seem to conspire to not report this.
 
You may not be able to choose your doctor or hospital unless you pay cash or go on a high premium Cadillac plan that, in 2015, will cease to be tax deductible by you or your employer..
 
After his gun control initiatives failed in Congress, President Obama unilaterally added very expensive mental health coverage to the Affordable Care Act without mentioning that most psychiatrists will refuse to serve patients having any type of insurance..  Psychiatrists are already in short supply in the USA. Nearly half already only serve cash-paying patients and currently won't bill any insurance companies, including Medicare or Medicaid. I think even more will reject the the exchanges.
 
I have a relative who needs psychiatric medications daily. Even though her husband is on a good state university medical insurance plan for coverage of most of her medical needs, she's dependent upon the only (overworked) psychiatrist in the area. That psychiatrist does not accept insurance.
 
Why are there so few psychiatrists?
One reason is that psychiatry is the most dangerous medical specialty. Exhibit A is the recent mass murderer James Holmes in Aurora, Colorado who was booted off campus for threatening his psychiatrist. Personally I think another reason is that doctors do not like going into a specialty having such a low proportion of cure rates and having to be on call 24/7 (usually to prevent suicides).
 
Something will have to be done to prevent passing bad bad debts onto hospitals and doctors.
Now that the GOP has given up on deficit reduction (Sen. Ryan lied by excluding interest on the debt in his budget), perhaps  legislation to Federal coverage of bad debts on to the Federal government along with assurances that doctors can bill at their full rates they charge cash paying patients. The blow to the deficit will be devastating since patients have little incentive to pay their deductibles if the government will pay those deductibles.
 
What we now have is two political parties so desperate to win elections that both are now promising nearly-free medical coverage that will explode the deficit and provide false promises about the quality of medical care in short supply to meet exploding demand.
Medical care will be almost free as long as the government fails to seriously prevent frauds in Medicaid. Medicare phony disability coverage,  and the Affordable Care Act subsidies --- all three of which are now frauds out of control due to failed government enforcement

 

"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.

  • Could regulations at the state or county level be making the insurance market so unprofitable that most companies elect not to enter those markets?

     
  • Could litigation risks may be so high in a state or county that most companies are avoiding the market?

     
  • Could there be underlying causes result in higher medical service costs that drive the competition away in some counties?  For example, some states have more county hospitals that are funded by property taxes, thereby allowing for lower priced services of the hospitals.

     
  • Could it be that some counties/states have a higher proportion of people likely to become bad debts? Remember that in case an insured person defaults on a premium, the insurance company must pay for the medical care of that person for 30 days and the health care provider must pick up 60 more days in a 90-day grace period where a person remains insured in spite of defaulting on payments under Obamacare.

     
  • Could health differences explain the reluctance of companies to enter some markets. Health differences around the country explain between 75 percent and 85 percent of the cost variations." Jordan Rau in Kaiser Health News.
    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/29/trouble-for-obamacare-in-new-hampshire/

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/2013/12/26/as-obamacare-deadline-looms-insurance-companies-pile-on-the-taxes/

. . .

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.


 

  1. The new rules in many states for extending free Medicaid on the bases of only income without tests of assets (such as students having million dollar trust funds) are huge moral hazards for millions of people to get totally free medical service and medications. My wife's long term friend (for over years) has a daughter living across the street in Longview Texas. The daughter put her share of their $200,000 plus house into her husbands name, divorced her husband, quit her job, and is now on welfare and Medicaid for herself and her children. She still lives in the house with her husband and readily admits this was a sham divorce. Her "husband" makes over $70,000. She tells the welfare folks she's living across the street with her parents --- which is a blatant lie.


    In Texas she had to sign off on her ownership of the house. In one of the states relaxing Medicaid rules she should get Medicaid and completely own the house herself. as long as her "former husband" paid the property taxes and other house expenses. In fact she could own a million dollar house and still get Medicaid's free health care.

     
  2. In order to make their premiums lower (with or without subsidies) most people are opting for bronze and silver plans where they must pay 30%-50%) of all medications and medical care. If they get hit with big bills most of these people just do not have the money to pay their deductibles. Either they will forego treatment or pass their bad debts on to doctors and hospitals .

     
  3. The ACA law should have been enacted only after rule enforcement checks were in place. I think the law should not have commenced without having the IRS matching incomes against subsidies and Medicaid expansion.

     
  4. In the past people who defaulted on premiums became uninsured people who were treated in special facilities such as county hospitals funded by taxpayers. Now people who default on premiums get a 90-day grace period where insurance companies pay their medical costs for 30 days and the doctors and hospitals have to pay for their medical care for 60 days.
     
  5. President Obama was smart to delay the employer-provided plans for a year. The main advantage of this is that employees are not yet shocked by how much more they will be paying out-of-pocket for higher premiums, higher co-pays, and hi9gher deductibles.
    "Employees will pay more for health care in 2014: New year likely to bring higher deductibles and co-pays, smaller employer contributions." by Julie Appleby, USA Today, December 19, 2013 ---
    http://www.usatoday.com/story/money/personalfinance/2013/12/19/employee-health-insurance/3958071/

 

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?v=zPxMZ1WdINs

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

Also see http://townhall.com/columnists/terryjeffrey/2011/03/16/congress_must_stop_$1055_billion_in_automatic_obamacare_spending


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 basics

I 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:

 

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).”

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

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.

Note: This is a summary only. The full article with analysis, images and citations may be viewed on the above Fact Check Websites.



Updates on August 31, 2010

"Go To the Back of the CLASS," by Ed Feulner, Townhall, August 17, 2010 ---
http://townhall.com/columnists/EdFeulner/2010/08/18/go_to_the_back_of_the_class

In Washington, politicians often give their bills clever names designed more to obscure than to reveal.

Consider the CLASS Act. It sounds like yet another federal attempt to meddle in local schools. Instead, it stands for “Community Living Assistance Services and Support.”

CLASS was a little-noticed part of the massive Obamacare bill that the president signed in March. It’s supposed to provide affordable long-term care insurance to American workers. In reality, it creates another entitlement likely to increase our exploding federal deficit.

Starting next year CLASS is scheduled to begin enrolling people and collecting premiums. If CLASS was a normal insurance program, it would invest these premiums to build reserves. These reserves would later be tapped to provide benefits for those individuals in need of long-term care services.

But CLASS doesn’t work that way.

Similar to Social Security, all premiums that CLASS collects will be spent immediately. Its trust fund will be filled with government IOUs. Since participants need to pay five years of premiums before they’re eligible to collect any benefits, a sizeable amount of short-term revenue will be raised from CLASS. This aspect was especially useful when lawmakers were trying to find tricks to reduce the projected cost of Obamacare. By including the revenues from CLASS, politicians were able to pretend they’d reduced the cost of the bill by $70 billion.

But even Uncle Sam can’t spend your money twice. It’s impossible to spend the money today on government programs and invest the money to fund eventual benefits.

Eventually 2017 will arrive. That’s when CLASS starts paying benefits. It’s difficult to predict how soon after that the program would dive into the red and pay out more in benefits than it collects in premiums. Actuaries at the Centers for Medicare & Medicaid Services estimate it could be as soon as 2025.

Continued in article

 


Updates on October 31, 2010


"Say NO to Government Subsidies For Frivolous Litigation," by Lisa A. Ricard, Townhall, October 6, 2010 ---
http://townhall.com/columnists/LisaARickard/2010/10/05/say_no_to_government_subsidies_for_frivolous_litigation

Taxes are a major topic of debate in Washington right now. Faced with a massive federal deficit, some politicians have proposed raising taxes on individuals and businesses, despite the obvious negative effects of tax increases on economic growth and job creation. Yet at the same time, some in Washington are actually considering the creation of a new special interest tax break that will hurt economic growth, increase the deficit and fuel increased civil litigation.

The plaintiffs' bar and its allies in Congress and the administration are pushing for the adoption of a nearly $1.6 billion tax deduction for trial lawyers who take contingency fee cases. This proposed deduction would essentially provide a U.S. government subsidy to plaintiffs' lawyers to increase the number of frivolous lawsuits.

For several years, the plaintiffs' bar has been attempting to push this proposed tax break through Congress. With Congress so far unwilling to act, plaintiffs' lawyers have decided on a new approach and are now aggressively lobbying the Treasury Department to bypass Congress and create the deduction through administrative action.

The tax deduction would impose direct costs on the federal government and American taxpayers. According to the Congressional Budget Office, this trial lawyer subsidy would cost nearly $1.6 billion over ten years, all during a time of record federal deficits.

But these direct costs represent just a fraction of the proposal's potential damage. The contingency fee tax break would, in effect, subsidize ever more costly, frivolous litigation against American businesses. By some estimates, the tax deduction could subsidize as much as 40 percent of the initial plaintiffs' expenses for certain cases. With the federal government paying for such a large percentage of the up-front costs of lawsuits, plaintiffs' lawyers will be emboldened to take on the most speculative and frivolous litigation.

And in these troubled economic times, the last thing America needs is more frivolous lawsuits. As a percentage of gross domestic product, the United States spends more than twice as much on litigation as any other industrialized nation, a cost that reached $254.7 billion in 2008 according to a report by Towers Perrin.

Continued in article



June 30, 2017

From the CFO Journal's Morning Ledger on May 3, 2017

Aetna to pull back further from health exchanges
Health insurer Aetna Inc. plans to scale back its presence in the Affordable Care Act exchanges from 2018 onward. It also said it expects losses on the business this year, even though enrollment on individual plans fell.

Jensen Comment

Nearly all of Obama's startup insurance companies for the health exchanges have dropped out of the market. This left only the large established companies in the exchange markets. The one to watch is Blue Cross Anthem that is now the only insurer left in many of the exchange markets. Anthem is also threatening to pull out if Obamacare rates are not increased to cover losses. The media tends to play down this enormous problem that plagued Obamacare from get go. Low insurance rates in turn led to low reimbursement rates for providers --- which is why so many doctors and hospitals (think nearly all of Chicago) will not serve patients insured by Obamacare


"Bernie Sanders' healthcare plan would cost $13.8 trillion over 10 years," by Eric Pianin, The Fiscal Times,  January 20, 2016 ---
http://www.businessinsider.com/bernie-sanders-healthcare-would-cost-138-trillion-over-10-years-2016-1

Jensen Comment
Add to this another $10 trillion for free college education for all and you've got a monumental obligation to be paid by government. But there's really no sweat since the Fed has already proven that printing money is the best way to pay government bills to avoid taxation and debt.


No Free Lunch
"ObamaCare’s $1,200 Pay Cut:  The cost of insuring everybody's 26-year-olds is more than you thought," The Wall Street Journal, January 26, 2016 ---
http://www.wsj.com/articles/obamacares-1-200-pay-cut-1452643649?mod=djemMER

. . .

Among the law’s few popular features, even among Republicans, is the mandate to cover adult children through age 26 on the insurance plans of their parents. This benediction is sold as a gratuity, but somebody must ultimately pay, and new research suggests the hidden costs—in the form of lower take-home pay—are far higher than advertised.

In a working paper, Gopi Shah Goda and Jay Bhattacharya of Stanford and Monica Farid of Harvard exploit the fact that some 37 states had extended dependent-coverage mandates of varying rigor and comprehensiveness before the Affordable Care Act. They explore these differences to estimate the results of the uniform national mandate that was imposed in 2010.

“We find evidence that employees who were most affected by the mandate, namely employees at large firms, saw wage reductions of approximately $1,200 per year,” the researchers observe. As a wave of young adults hit the employer-based insurance rolls, the cost of coverage inevitably climbed and businesses were obliged to dial back cash wages as a share of overall compensation to accommodate the influx. Large businesses were a particular casualty because before ObamaCare they were largely exempt from state-level mandates.

The study also found that the costs of the adult-kid mandate weren’t “only borne by parents of eligible children or parents more generally.” They’re spread over all workers including other young people, the childless and late middle-aged.

No study is definitive, though the authors are careful about their methods and assumptions. The eternal lessons are that no alleged government benefit is free and people should be allowed to make the trade-offs for themselves. Another is that the next President has plenty of running room to improve the American economy, if he cares to make better decisions.


 



December 31, 2017

Surprise! How Obamacare is beginning to look a lot like Medicaid ---
https://theconversation.com/surprise-how-obamacare-is-beginning-to-look-a-lot-like-medicaid-86508

Media Keep Butchering the Facts About Obamacare ---
http://reason.com/archives/2017/07/28/media-keep-butchering-the-facts-about-ob

Fewer than half of Coloradans now get their health insurance through employers ---
https://www.bizjournals.com/denver/news/2017/09/19/fewer-than-half-of-coloradans-now-get-their-health.html

How Americans Get Health Insurance Nationwide---
http://ritholtz.com/2017/08/americans-get-health-insurance/
Only 43.3 million are on Medicare (not free even in retirement) whereas 62.4 million have Medicaid (free for basics)
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html

Historical NHE (National Health Expenditures), 2015:

·         NHE grew 5.8% to $3.2 trillion in 2015, or $9,990 per person, and accounted for 17.8% of Gross Domestic Product (GDP).

·         Medicare spending grew 4.5% to $646.2 billion in 2015, or 20 percent of total NHE.

·         Medicaid spending grew 9.7% to $545.1 billion in 2015, or 17 percent of total NHE.

·         Private health insurance spending grew 7.2% to $1,072.1 billion in 2015, or 33 percent of total NHE.

·         Out of pocket spending grew 2.6% to $338.1 billion in 2015, or 11 percent of total NHE.

·         Hospital expenditures grew 5.6% to $1,036.1 billion in 2015, faster than the 4.6% growth in 2014.

·         Physician and clinical services expenditures grew 6.3% to $634.9 billion in 2015, a faster growth than the 4.8% in 2014.

·         Prescription drug spending increased 9.0% to $324.6 billion in 2015, slower than the 12.4% growth in 2014.

·         The largest shares of total health spending were sponsored by the federal government (28.7 percent) and the households (27.7 percent).   The private business share of health spending accounted for 19.9 percent of total health care spending, state and local governments accounted for 17.1 percent, and other private revenues accounted for 6.7 percent.

·         For further detail see NHE Tables in downloads below.

Projected NHE, 2016-2025:

·         National health spending is projected to grow at an average rate of 5.6 percent per year for 2016-25, and 4.7 percent per year on a per capita basis.

o    Health spending is projected to grow 1.2 percentage points faster than Gross Domestic Product (GDP) per year over the 2016-25 period; as a result, the health share of GDP is expected to rise from 17.8 percent in 2015 to 19.9 percent by 2025.

o    Throughout the 2016-25 projection period, growth in national health expenditures is driven by projected faster growth in medical prices (from historically low growth in 2015 of 0.8 percent to nearly 3 percent by 2025). This faster expected growth in prices is partially offset by projected slowing growth in the use and intensity of medical goods and services.

·         Although the largest health insurance coverage impacts from the Affordable Care Act’s expansions have already been observed in 2014-15, the insured share of the population is projected to increase from 90.9 percent in 2015 to 91.5 percent in 2025.

o    This expectation is mainly a result of continued anticipated growth in private health insurance enrollment, in particular for employer-sponsored insurance, during the first half of the decade in response to faster projected economic growth.

·         Health spending growth by federal and state & local governments is projected to outpace growth by private businesses, households, and other private payers over the projection period (5.9 percent compared to 5.4 percent, respectively) in part due to ongoing strong enrollment growth in Medicare by the baby boomer generation coupled with continued government funding dedicated to subsidizing premiums for lower income Marketplace enrollees.

·         National health spending growth is projected to have decelerated from 5.8 percent in 2015 to 4.8 percent in 2016 as the initial impacts associated with the Affordable Care Act’s major coverage expansions fade. Medicaid spending growth is projected to have decelerated sharply from 9.7 percent in 2015 to 3.7 percent in 2016 as enrollment growth in the program slowed significantly. Similarly, private health insurance spending growth is projected to have slowed from 7.2 percent in 2015 to 5.9 percent in 2016 (also largely attributable to slowing expected growth in enrollment).

·         Health spending is projected to grow 5.4 percent in 2017 related to faster growth in Medicare and private health insurance spending.

·         Health expenditures are projected to grow at an average rate of 5.9 percent for 2018-19, the fastest of the sub-periods examined, as projected spending growth in Medicare and Medicaid accelerates.

·         Through the second half of the projection (2020-25), increasing medical prices are offset by projected decelerations in growth in the use and intensity of medical goods and services, leading to average growth of 5.8 percent per year for national health expenditures.

For further detail see NHE projections 2016-2025 in downloads below.

NHE by Age Group and Gender, Selected Years 2002, 2004, 2006, 2008, 2010, and 2012:

·         Per person personal health care spending for the 65 and older population was $18,988 in 2012, over 5 times higher than spending per child ($3,552) and approximately 3 times the spending per working-age person ($6,632).

·         In 2012, children accounted for approximately 25 percent of the population and slightly less than 12 percent of all PHC spending.

·         The working-age group comprised the majority of spending and population in 2012, almost 54 percent and over 61 percent respectively.

·         The elderly were the smallest population group, nearly 14 percent of the population, and accounted for approximately 34 percent of all spending in 2012.

·         Per person spending for females ($8,315) was 22 percent more than males ($6,788) in 2012.

·         In 2012, per person spending for male children (0-18) was 9 percent more than females.  However, for the working age and elderly groups, per person spending for females was 28 and 7 percent more than for males.

For further detail see health expenditures by age in downloads below.

NHE by State of Residence, 1991-2014:

·         In 2014, per capita personal health care spending ranged from $5,982 in Utah to $11,064 in Alaska.   Per capita spending in Alaska was 38 percent higher than the national average ($8,045) while spending in Utah was about 26 percent lower; they have been the lowest and highest, respectively, since 2012.

·         Health care spending by region continued to exhibit considerable variation. In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26 and 16 percent higher than the national average.   In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita ($6,814 and $6,978, respectively) with average spending roughly 15 percent lower than the national average.

·         For 2010-14, average growth in per capita personal health care spending was highest in Alaska at 4.8 percent per year and lowest in Arizona at 1.9 percent per year (compared with average growth of 3.1 percent nationally).

·         The spread between the highest and the lowest per capita personal health spending across the states has remained relatively stable over 2009-14. Accordingly, the highest per capita spending levels were 80 to 90 percent higher per year than the lowest per capita spending levels during the period.

·         Medicare expenditures per beneficiary were highest in New Jersey ($12,614) and lowest in Montana ($8,238) in 2014.

·         Medicaid expenditures per enrollee were highest in North Dakota ($12,413) and lowest in Illinois ($4,959) in 2014.

For further detail, see health expenditures by state of residence in downloads below.

NHE by State of Provider, 1980-2014:

·         Between 2009 and 2014, U.S. personal health care spending grew, on average, 3.9 percent per year, with spending in North Dakota growing the fastest (6.7 percent) and spending in Rhode Island growing the slowest (2.5 percent).

·         In 2014, California’s personal health care spending was highest in the nation ($295.0 billion), representing 11.5 percent of total U.S. personal health care spending. Comparing historical state rankings through 2014, California consistently had the highest level of total personal health care spending, together with the highest total population in the nation. Other large states, New York, Texas, Florida, and Pennsylvania, also were among the states with the highest total personal health care spending.

·         Wyoming’s personal health care spending was lowest in the nation (as has been the case historically), representing just 0.2 percent of total U.S. personal health care spending in 2014. Vermont, Alaska, North Dakota, and South Dakota were also among the states with the lowest personal health care spending in both 2014 and historically. All these states have smaller populations.

·         Gross Domestic Product (GDP) by state measures the value of goods and services produced in each state. Health spending as a share of a state’s GDP shows the importance of the health care sector in a state’s economy. As a share of GDP, Maine ranked the highest (22.3 percent) and Wyoming ranked the lowest (9.3 percent) in 2014.  

For further detail, see health expenditures by state of provider in downloads below.


One of Obamacare's biggest nightmares is back ---
http://www.businessinsider.com/obamacare-exchanges-virginia-empty-optima-2017-9

Optima — a Virginia-based health insurer — will exit a slew of Obamacare exchanges in the state for 2018, the company announced  Wednesday. 

The insurer said it would leave many rural areas of the state, following the exits of large insurers like Anthem from the same areas. The company cited the other insurer exits as well as "uncertainty in Washington" as reasons for the exit.

"The decisions we made were challenging ones given the recent changes and ambiguities in the marketplace," Optima CEO Michael Dudley said in a statement. "Our most recent filing with the state reflects these dynamic changes, as would be expected in these circumstances."

According to The Kaiser Family Foundation, a nonpartisan health policy think tank, the exit will leave 63 counties in the state with no insurer. Just over 70,000 people enrolled in Obamacare exchange plans in 2017 in these counties, per Kaiser, leaving them at risk of having no coverage next year.

Optima's exit also brings back the possibility of empty coverage areas in 2018 after states like Nevada, Indiana, and Ohio found insurers to fill their potentially barren counties.

The possibility of counties going without an insurer has long been one of the biggest potential setbacks for the Obamacare exchanges, since there is no back up option for individuals in areas without an insurer.

Continued in article


Compare Long-Term Care Costs Across the USA ---
https://www.genworth.com/about-us/industry-expertise/cost-of-care.html
Thank you for the heads up Scott Bonacker

Jensen Comment
This is an example of how to mislead with statistics. The main problem is that there are such variable alternatives for long-term care costs in any state, and the pricing may or may not vary greatly.
https://www.genworth.com/about-us/industry-expertise/cost-of-care.html
Even more variable than pricing is quality of care. Rural nursing centers often rely on minimum-wage workers who are at the bottom of the barrel in terms of skills and attitude. Many can't get local jobs anywhere else. Nursing homes are often booked to capacity such that it's necessary to travel to other towns to find an available bed. My mother had short stays in three different small Iowa town nursing centers. The fees were roughly the same for greatly (I mean GREATLY) differing quality of care. Some minimum wage workers are very caring and terrific nursing home workers. Others are lousy. Interestingly, the locals seem to know which centers to avoid but you have to dig to get those locals to reveal what they know. One problem is that often patients cannot reveal quality of care issues unless you look for their bruises and sniff for their body odors. They typically just don't know where they're living. My mother was quite bruised before we got her out of one facility. In many ways it was a relief that she passed on after only six months in nursing homes. At the time my father had to deal with troublesome issues since I was living in Texas at the time. Fortunately he himself never had to live in one of those places.

 

 

 



June 30, 2017

Finding and Using Health Statistics --- http://www.nlm.nih.gov/nichsr/usestats/index.htm

The Medicaid and Pension Monsters That Divert Funding by States for Education, Roads, and Bridges

Tapper:  Democrats' Obamacare Pitch Was Dishonest ---
Jake Tapper, CNN
http://freebeacon.com/issues/tapper-democrats-obamacare-dishonest/


The Atlantic:  The top 5 percent of Americans who spend the most on health care account for 50.3 percent of all health care expenditures in the USA
.This critical five percent of the U.S. population is key to solving the nation's health care spending crisis.  ---
https://www.theatlantic.com/projects/the-five-percent/
This article is not free

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 health care plans such as those in Canada, Denmark, Germany, and the U.K. spend a lot less (proportionately) on keeping dying patients alive.


Nate Silver's 5:38 Blog:  Obamacare’s Struggles In Iowa Could Be A Preview Of What’s To Come ---
https://fivethirtyeight.com/features/obamacares-struggles-in-iowa-could-be-a-preview-of-whats-to-come/

In an article last week looking at the health of the state insurance marketplaces set up by the Affordable Care Act, I wrote about why Iowa’s was in a dire situation. Three of its insurers recently said they may exit the Obamacare marketplaces, which threatens to leave tens of thousands of people with no way to buy the subsidized insurance promised by the law. The situation there is actually far more tenuous and could be a glimpse of what’s to come in other states. In 94 of Iowa’s 99 counties, insurers have said they may not sell new plans on the individual market at all, even outside the subsidized markets set up by the ACA.

This is a serious concern for people who buy insurance on the individual market, because as Congress debates how to repeal and replace the ACA, just about every policy scenario assumes that the individual markets will continue to exist through 2018. And although the markets were already in trouble in some places, the White House’s decision not to take actions that could stabilize them could continue to scare off insurers, resulting in more states facing a situation like Iowa’s.

People who don’t get health insurance from an employer or qualify for a public insurance program such as Medicaid or Medicare have long turned to the individual market to buy plans. Obamacare set up open marketplaces where these people could receive subsidies to buy insurance if they qualified based on income. But many insurers also sold individual plans outside of the ACA marketplace to people who didn’t qualify for subsidies.

Continued in article

Fact Checking Health-Care Hysteria:   It’s as if Democrats didn’t even bother reading the GOP bill before attacking it ---
https://www.wsj.com/articles/fact-checking-health-care-hysteria-1494455688?mod=djemMER

After the House voted last week to repeal and replace ObamaCare, Democrats quickly launched a barrage of false attacks. Minority Leader Nancy Pelosi asserted that the bill would “gut” protections for patients with pre-existing conditions. Never one to shy away from melodrama, she added: “This is deadly. This is deadly.”

Apparently the GOP proposal is the second health-care bill Mrs. Pelosi didn’t read. The legislation makes clear: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

On Fox News Sunday, the MIT economist Jonathan Gruber came from a different angle, alleging it was dangerous to grant states waivers from some ObamaCare requirements. He suggested insurers could now “literally say, just because the genes you were born with, you’re going to pay more for health insurance.”

Apparently Mr. Gruber is also averse to reading. States may seek waivers from some ObamaCare provisions, but the law explicitly prohibits waivers on pre-existing-condition protections. To receive a waiver insurers must prove it would lower or stabilize premiums, increase coverage, or expand the choice of health plans.

People in waiver states who never had insurance or let their policies lapse would be guaranteed coverage, but to keep them from gaming the system, insurers could take their health into account when determining premiums. After one year, premiums would drop to the standard rate. This rare occurrence is a long way from Mr. Gruber’s charge that people would pay “many, many multiples more.”

The bill also includes $8 billion over five years to help states with waivers set up high-risk pools to cover people with expensive illnesses. Mr. Gruber dismissed this as “trivial.” Yet the Kaiser Family Foundation found in 2011—before ObamaCare kicked in—that 35 states had high-risk pools covering 226,000 people with $2.6 billion in claims. Some $1.4 billion was covered by the premiums these patients paid, and the states had to toss in only $1.2 billion. That’s $400 million less than would be available each year under the GOP bill. Even the New York Times reported that if states tapped all the bill’s available money for high-risk pools, it would total $138 billion. And who thinks 35 states will seek waivers?

This hardly exhausts Democratic complaints. Rep. Richard Neal (D., Mass.) said last week that Republicans had voted to impose an “age tax,” because the bill would allow premiums for older ObamaCare policyholders to be five times those of younger people. (Now insurers can charge older people only three times as much.) Yet the older age group’s health expenses are, on average, nearly five times as high. Today everyone under 50 on ObamaCare is paying higher premiums to subsidize the policies of those above 50.

So in reality, Republicans are repealing the “age tax” Democrats placed on the younger 80% of ObamaCare policyholders to subsidize the older 20%. This despite that older ObamaCare policyholders are in their prime earning years and likely have higher incomes, greater wealth and lower child-rearing expenses.

There is also Mr. Gruber’s startling claim that the Republican bill will cause 24 million people to lose their insurance. How can 24 million people lose ObamaCare coverage when only 11 million people bought the policies? The claim is a distortion of the Congressional Budget Office’s estimate that abolishing ObamaCare’s individual mandate would lead 24 million people to forgo purchasing insurance in the future. Freed of ObamaCare’s penalty—a 3% tax on their income—people may decide to do something else with their money.

The CBO is notoriously bad at estimating the benefits, such as lower prices, that come from a consumer-driven system. The Republican bill would enable more competition, expand health savings accounts and promote inexpensive catastrophic coverage.

Mr. Gruber was similarly misleading in claiming “the House bill cuts Medicaid by $880 billion over the next 10 years,” hinting the program would wither away. Federal Medicaid spending this fiscal year is $389 billion. Under the GOP bill, it will be $469 billion in fiscal year 2027. The bill restrains future Medicaid growth. It doesn’t reduce spending.

From his academic bubble, Mr. Gruber said last year that ObamaCare is “working as designed” and “there’s no sense in which it needs to be fixed.” Yet since its passage, Americans have lost plans and doctors and watched as their premiums and deductibles skyrocketed.

Continued in article


"Health Care vs. Higher Ed," by Rick Seltzer, Inside Higher Ed, April 12, 2017 ---
https://www.insidehighered.com/news/2017/04/12/medicaid-funding-changes-pressure-state-higher-ed-funding?utm_source=Inside+Higher+Ed&utm_campaign=5bea54615f-DNU20170412&utm_medium=email&utm_term=0_1fcbc04421-5bea54615f-197565045&mc_cid=5bea54615f&mc_eid=1e78f7c952

. . .

When states adopted their budgets for the 2017 fiscal year, their share of Medicaid spending was expected to grow by 4.4 percent on average, according to an April report from the Kaiser Family Foundation. The increase was expected in large part because of the decrease in federal funding for Medicaid expansion.

While 4.4 percent might not sound like an overwhelming increase, Medicaid spending is a massive portion of states’ budgets. Medicaid spending across all states totaled $509 billion in the 2015 fiscal year, according to the Kaiser Family Foundation. States paid 38 percent of the costs, with the federal government picking up the rest.

That means states spent about $193.4 billion on Medicaid in 2015. That dwarfs state higher education appropriations, which totaled about $83.6 billion across the country in 2016-17.

State legislators are essentially locked into spending on Medicaid. So when costs in that program rise, lawmakers have to either raise revenue through taxes and fees or find money in their discretionary budgets to reallocate. Higher education represents one of the few big-ticket discretionary items from which they can draw.

“They’re going to get the money somewhere,” Pernsteiner said. “Where they make the cuts is higher ed.”

Within individual states that expanded Medicaid, projections show costs mounting in coming years. Kentucky’s expenditures for Medicaid expansion are projected at $77.2 million for the 2016-17 fiscal year -- a year in which the federal match rate only falls below 100 percent for six months. The expenditures under current law are expected to rise to $180.1 million in 2018, $224 million in 2019 and $306.3 million in 2020, according to state projections.

Kentucky is dealing with other budget pressures as well. By some estimates, the state has the worst-funded pension system of any state in the country -- even worse than Illinois and New Jersey. Many believe dealing with that issue will be a major drain on state coffers.

The state’s Republican governor, Matt Bevin, has already shown a willingness to take funding that would have gone to higher education and put it toward pensions, said Robert L. King, president of the Kentucky Council on Postsecondary Education. Budget pressures add up, including from Medicaid, King said.

“Because it’s a mandated expenditure, it gets paid,” King said. “So our universities have been taking cuts consistently for the last decade. I can’t tell you that they are directly caused by Medicaid, but it certainly is a contributing factor.”

King has been watching trends between Medicaid funding and higher education funding since he was chancellor of the State University of New York System in the early 2000s.

“I remember reading studies at the time that showed that there was a pretty straight-line correlation between the growth in Medicaid costs and the reduction in state support for higher education,” he said.

A 2003 Brookings report found every new dollar in state Medicaid spending was related to a decline in higher education appropriations of about 6 cents to 7 cents.

In West Virginia, which also expanded Medicaid eligibility under the Affordable Care Act, health-care costs were wrapped up in a long budget standoff that left leaders worried about higher education funding. State revenue has been declining with energy markets, causing stress on the budget and a possible pinch on higher education funding, according to a spokesman for West Virginia University.

Continued in article

Jensen Comment
Actually two non-discretionary spending burdens are overwhelming state budgets. The first is Medicaid whether or not a state expanded coverage under the ACA. The second is unfunded pensions for public employees, baby boomers that are now retiring in droves.

California Road-Tax Hike Is Really A Pension Tax ---
http://reason.com/archives/2017/04/07/california-road-tax-hike-is-really-a-pen

Gov. Jerry Brown and Democratic legislators have caused a stir with their plan, which passed the legislature on Thursday, to increase taxes to pay for the state's unquestionably decrepit infrastructure of roads and bridges. Instead of thinking of this as a new transportation tax, however, Californians should see it as a pension tax, given the extra money plugs a hole caused by growing retirement payments to public employees.

Consider this sobering news from the CalMatters' Judy Lin in January: "New projections show the state's annual bill for retirement obligations is expected to reach $11 billion by the time Brown leaves office in January 2019—nearly double what it was eight years earlier." That's the state's "annual bill," i.e., the direct costs taken from the general-fund budget. That number doesn't even include those "unfunded" pension liabilities that according to some estimates top $1 trillion.

 Continued in article

Jensen Comment
What's sad is that many of those pension timings (retire at age 50) and amounts (think over $500,000 per year) are fraudulent ---
http://cfif.org/v/index.php/commentary/61-state-issues/1415-report-multi-million-dollar-california-pension-fraud

 


Harvard:  The Cost of Drugs for Rare Diseases Is Threatening the U.S. Health Care System ---
https://hbr.org/2017/04/the-cost-of-drugs-for-rare-diseases-is-threatening-the-u-s-health-care-system?referral=00563&cm_mmc=email-_-newsletter-_-daily_alert-_-alert_date&utm_source=newsletter_daily_alert&utm_medium=email&utm_campaign=alert_date&spMailingID=16971604&spUserID=MTkyODM0MDg0MAS2&spJobID=1000756883&spReportId=MTAwMDc1Njg4MwS2

. . .

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) determines the cost effectiveness, or value, of newly approved drugs based on their impact on quality-adjusted life years. These determinations inform the National Health System’s (NHS) treatment-coverage decisions. In contrast, the FDA is prohibited from considering cost or value in its decision making, and there is no U.S. governmental equivalent of NICE.

The Institute for Clinical and Economic Review (ICER), a small Boston-based nonprofit, has taken a step towards value-based pricing by creating a NICE-like model. Development of a NICE or ICER-like post-approval value review, incorporating appropriate oversight and accountability, would help ensure coverage decisions remain fair and cost-effective, but it won’t be enough. The NHS is likely to impose care rationing because of escalating health and pharmaceutical costs. Any successful plan to manage rising drug costs must address multiple aspects of the problem, including value-based pricing, transparency, drug re-importation, and the reform of the Orphan Drug Act, to name a few.

The FDA and other federal payers, including Medicare, must be empowered to consider drug costs and outcomes, and this process should factor in federal investment in drug discovery. (Ionis and Cold Spring Harbor received federal grant funding to support the early development of nusinersen.)

Federal government payers should also be allowed to negotiate price discounts and re-import drugs (with provisions for adequate quality control). In a disappointing move, President Trump, who had promised to let Medicare negotiate bulk pricing discounts for prescription drugs, abandoned this pledge after meeting with pharmaceutical industry lobbyists and executives.

Pharmaceutical companies must be required to disclose and justify development costs, particularly those seeking the substantial benefits under the ODA. There are numerous examples of pharmaceutical companies taking advantage of ODA provisions to repurpose inexpensive medications for rare diseases, often at extraordinary, unjustified costs. Marathon proposed a price of $89,000 for deflazacort, which is already available in Europe and Canada for $1,000 to $2,000, a 6,000% price increase. (After several members of Congress complained, the launch of the drug was delayed.) Senator Chuck Grassley, chairman of the Senate Judiciary Committee, is rightly leading an inquiry into this practice and other ODA abuses.

A health care system’s goal should be to provide the best patient-centered care. Coverage decisions and resource allocations must prioritize value to patients — not insurers’ or pharma companies’ profits. If we are committed as a society to curing diseases such as SMA, dangling treatments like nusinersen just out of patients’ reach is cruel. Collectively, government, pharma, insurers, hospital systems and physicians all have a role to play in providing access to the right care at justifiable cost.

Jensen Question
Is there a study of where national health care plans like those in Canada and Finland are drawing the line on paying for very costly medications such as a cancer drug costing over $100,000 per year?


Bernie Sanders:  Medicare for All: Leaving No One Behind ---
https://berniesanders.com/issues/medicare-for-all/

Bernie estimates a cost of $1.38 trillion per year for covering doctors, hospitals, ambulances, and medications of roughly 350 million people give or take depending upon the coverage of undocumented residents.

But since Medicare and Medicaid currently costs $1.14 trillion per year Bernie must have left out all the people currently covered by Medicare and Medicaid. Adding $1.38 trillion to $1.14 trillion brings the total cost to $2.52 trillion. However, since currently Medicare only does not pay 20% of the expenses we need to add another $228 billion bringing the total estimated cost to $2.52+$0.23 = $2.75 trillion per year.

Dividing $2.75 trillion by 350 million means the estimated cost is nearly $8,000 cost per person ignoring medical expense inflation. For a family of four this would be $32,000 in average outlays per year. There are also uncertainties regarding how much of mental health, home nursing care, and nursing home care would be covered. Plus Medicare D only covers a portion of medication costs per person such that it is not unrealistic to assume that the Bernie Sanders proposal would start out costing about $10,000 on average for every man, woman, and child in the United States plus the added costs of nursing home care and long-term mental health coverage.Plus Bernie did not add in the hundre of billions paid for malpractice insurance and claims that are paid by hospitals, doctors, and liability insurance companies.

Of course my estimates are subject to a huge margin of error. However, the bottom line is that the funding proposal proposed by Bernie Sanders would only pay for a small portion of the cost extending Medicare coverage to every man, woman, and child in the USA.

On top of that the USA medical system does not have the capacity to provide anything but lowest quality care on average to 350 million people. Hospitals currently lose a considerable amount serving ACA and Medicaid patients --- which is why so many doctors and hospitals refuse to serve ACA and Medicaid patients

 

Harvard:  Where Both the ACA and AHCA Fall Short, and What the Health Insurance Market Really Needs ---
https://hbr.org/2017/03/where-both-the-aca-and-ahca-fall-short-and-what-the-health-insurance-market-really-needs?referral=00563&cm_mmc=email-_-newsletter-_-daily_alert-_-alert_date&utm_source=newsletter_daily_alert&utm_medium=email&utm_campaign=alert_date&spMailingID=16826969&spUserID=MTkyODM0MDg0MAS2&spJobID=981683047&spReportId=OTgxNjgzMDQ3S0

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.

 


"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.”

The Economist Magazine in March 2017:  Admit it: Republicans’ proposed Obamacare overhaul offers relief for some middle earners ---
http://www.economist.com/blogs/freeexchange/2017/03/obamacare-s-squeezed-middle

WHAT is the best part of House Republicans’ proposed reform of Obamacare? There isn’t one, if you believe much of this week’s commentary. The bill will benefit the young and healthy, by bringing their premiums down, but only at the cost of the old and sickly. But most writers are overlooking the help the bill would offer to one group that has clearly suffered unfairly under Obamacare. So long as Paul Ryan’s reform does not send the market into a death spiral—which is not a sure thing (see article)—this group will get some needed financial assistance under the Republican plan.

I'm talking about people who buy health insurance for themselves, rather than through an employer, and who do not get the subsidies which shield those on low incomes from Obamacare’s high premiums. It is easy to overlook this group, because the vast majority of the 10m people who buy insurance through Obamacare’s websites (or "exchanges") receive subsidies. For example, here is Jared Bernstein, Vice-President Joe Biden's former chief economist, in the Washington Post:

Of course, there’s the infamous, headline-generating 2017 premium increases in the non-group market. After growing 2 and 7 percent in 2015 and 2016, insurers in the state-based exchanges raised the cost of the benchmark plan by an average of 25 percent. To Obamacare critics, this was proof of the program’s unsustainability. But because 85 percent of participants in this market (state exchanges) receive premium tax credits to offset the cost of coverage, they do not face the full shock. 

What Mr Bernstein does not mention is that another 8m Americans buy coverage directly from insurers, without going through the exchanges. These buyers get no subsidies. But they must pay the same prices as those who do, because the law forces everybody in the individual marketplace—on or off the exchanges—into the same “risk-pool”. 

In total, there are 9m unsubsidised buyers for whom criticisms of Obamacare resonate strongly. Most of these people are not rich: a family-of-four stops receiving subsidies at an income of just under $100,000. Obamacare forced such buyers onto the same plans as a lot of people with pre-existing medical conditions who could not previously afford insurance. That pushed their premiums and deductibles up—and they have risen further over time. Here’s an example from a piece I wrote last September:

Before the law, Brian Anderson, a 30-something orthodontist from Nashville, paid $80 a month for insurance that came with a $5,000 deductible. In 2014 his insurer cancelled the plan, as it did not now comply with the law. His new plan, from healthcare.gov, provides, in his view, essentially the same coverage—the deductible is in fact higher—but costs fully $201 per month. Mr Anderson says he is glad many more people now have insurance. But the estimated 2.6m others whose plans were cancelled that year may not all be as understanding.  

Since I wrote that, Mr Anderson’s insurer has dropped out of his local marketplace, and he has had to switch to a plan costing over $400 a month. You can understand why someone who has seen their premium go up by over 300% would be disillusioned with the law.

Does this matter?  A family-of-four earning $100,000 is clearly not poor. However, they face very high prices for health insurance. In much of Arizona, for instance, they would have to pay over $22,000 per year—almost a quarter of their pre-tax income—for “silver” coverage, according to the Kaiser Family Foundation’s Obamacare calculator.  And that is before you count their out-of-pocket medical costs. When Donald Trump says that Obamacare is a “disaster”, such a family would look at their health insurance options and agree.

The House Republican plan offers this group some help. Individuals earning less than $75,000, and couples earning less than $150,000, will get a big tax credit to help them with their premiums. (Minnesota has already passed “premium relief” for such buyers).

Is that a good thing? Obamacare explicitly tries to spread the costs of health insurance around, in order to increase coverage. Unfortunately, it does so only in the individual market. The 155m Americans who get health insurance through their employers need not foot the bill for unhealthy people on the exchanges. Not only that, but this coddled group also gets a tax break on their coverage. People in the individual market have a right to feel hard done by. The best thing about Mr Ryan’s tax credit is that it begins to redress the imbalance. 

I am not suggesting that helping this group justifies removing means-tested subsidies for the poor. But I am pushing back on the idea that Obamacare's redistribution only hurt the "rich". Here is Matthew Yglesias at Vox (emphasis added):

Policy-minded conservatives have serious criticisms of President Obama’s health care law. They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put “skin in the game” in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.

Mr Yglesias portrays Obamacare's redistribution as flowing primarily from rich to poor. But his chart shows something else: that it hurts middle-income groups most. That is consistent with the experience of millions of Americans in the individual market who have seen their premiums soar while they have received no help from the government. They are treated unfairly by the system as it stands, and should not be ignored when thinking about health care reform.

Continued in article


Will 90 Become the New 60?
http://nautil.us/issue/46/balance/will-90-become-the-new-60-rp
What will this do to Social Security, Medicare, and Medicaid as well as job turnover (think tenure)?

Wharton:  Will the USA Face a Shortage of Nursing Homes for Baby Boomers?
http://knowledge.wharton.upenn.edu/article/will-u-s-face-shortage-nursing-homes-baby-boomers/
Capacity of nursing homes is on the decline (think of a changing regulatory climate that causes costs to soar) in the face of demand building up like flood water behind a dam that eventually overflow with gaga old folks.

Jensen Comment
It would seem that some national healthcare plans that fund nursing home care might have more capacity to handle increases in the aging population. However, there are some reports that in nations like Canada and the U.K. the rise in demand for funding long-term  nursing care is reaching crisis levels ahead of the USA ---
https://www.canadian-nurse.com/en/articles/issues/2016/october-2016/canadas-long-term-care-funding-crisis


.A senator found Medicare blowing hundreds of millions on a loser drug — and no one even got a slap on the wrist ---
http://www.businessinsider.com/tim-scott-letter-on-acthar-and-medicare-waste-2017-4

 

 


March 31, 2017

Bernie Sanders:  Medicare for All: Leaving No One Behind ---
https://berniesanders.com/issues/medicare-for-all/

Bernie estimates a cost of $1.38 trillion per year for covering doctors, hospitals, ambulances, and medications of roughly 350 million people give or take depending upon the coverage of undocumented residents.

But since Medicare and Medicaid currently costs $1.14 trillion per year Bernie must have left out all the people currently covered by Medicare and Medicaid. Adding $1.38 trillion to $1.14 trillion brings the total cost to $2.52 trillion. However, since currently Medicare only does not pay 20% of the expenses we need to add another $228 billion bringing the total estimated cost to $2.52+$0.23 = $2.75 trillion per year.

Dividing $2.75 trillion by 350 million means the estimated cost is nearly $8,000 cost per person ignoring medical expense inflation. For a family of four this would be $32,000 in average outlays per year. There are also uncertainties regarding how much of mental health, home nursing care, and nursing home care would be covered. Plus Medicare D only covers a portion of medication costs per person such that it is not unrealistic to assume that the Bernie Sanders proposal would start out costing about $10,000 on average for every man, woman, and child in the United States plus the added costs of nursing home care and long-term mental health coverage.Plus Bernie did not add in the hundre of billions paid for malpractice insurance and claims that are paid by hospitals, doctors, and liability insurance companies.

Of course my estimates are subject to a huge margin of error. However, the bottom line is that the funding proposal proposed by Bernie Sanders would only pay for a small portion of the cost extending Medicare coverage to every man, woman, and child in the USA.

On top of that the USA medical system does not have the capacity to provide anything but lowest quality care on average to 350 million people. Hospitals currently lose a considerable amount serving ACA and Medicaid patients --- which is why so many doctors and hospitals refuse to serve ACA and Medicaid patients

 

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

 


"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.


 

The Economist Magazine in March 2017:  Admit it: Republicans’ proposed Obamacare overhaul offers relief for some middle earners ---
http://www.economist.com/blogs/freeexchange/2017/03/obamacare-s-squeezed-middle

WHAT is the best part of House Republicans’ proposed reform of Obamacare? There isn’t one, if you believe much of this week’s commentary. The bill will benefit the young and healthy, by bringing their premiums down, but only at the cost of the old and sickly. But most writers are overlooking the help the bill would offer to one group that has clearly suffered unfairly under Obamacare. So long as Paul Ryan’s reform does not send the market into a death spiral—which is not a sure thing (see article)—this group will get some needed financial assistance under the Republican plan.

I'm talking about people who buy health insurance for themselves, rather than through an employer, and who do not get the subsidies which shield those on low incomes from Obamacare’s high premiums. It is easy to overlook this group, because the vast majority of the 10m people who buy insurance through Obamacare’s websites (or "exchanges") receive subsidies. For example, here is Jared Bernstein, Vice-President Joe Biden's former chief economist, in the Washington Post:

Of course, there’s the infamous, headline-generating 2017 premium increases in the non-group market. After growing 2 and 7 percent in 2015 and 2016, insurers in the state-based exchanges raised the cost of the benchmark plan by an average of 25 percent. To Obamacare critics, this was proof of the program’s unsustainability. But because 85 percent of participants in this market (state exchanges) receive premium tax credits to offset the cost of coverage, they do not face the full shock. 

What Mr Bernstein does not mention is that another 8m Americans buy coverage directly from insurers, without going through the exchanges. These buyers get no subsidies. But they must pay the same prices as those who do, because the law forces everybody in the individual marketplace—on or off the exchanges—into the same “risk-pool”. 

In total, there are 9m unsubsidised buyers for whom criticisms of Obamacare resonate strongly. Most of these people are not rich: a family-of-four stops receiving subsidies at an income of just under $100,000. Obamacare forced such buyers onto the same plans as a lot of people with pre-existing medical conditions who could not previously afford insurance. That pushed their premiums and deductibles up—and they have risen further over time. Here’s an example from a piece I wrote last September:

Before the law, Brian Anderson, a 30-something orthodontist from Nashville, paid $80 a month for insurance that came with a $5,000 deductible. In 2014 his insurer cancelled the plan, as it did not now comply with the law. His new plan, from healthcare.gov, provides, in his view, essentially the same coverage—the deductible is in fact higher—but costs fully $201 per month. Mr Anderson says he is glad many more people now have insurance. But the estimated 2.6m others whose plans were cancelled that year may not all be as understanding.  

Since I wrote that, Mr Anderson’s insurer has dropped out of his local marketplace, and he has had to switch to a plan costing over $400 a month. You can understand why someone who has seen their premium go up by over 300% would be disillusioned with the law.

Does this matter?  A family-of-four earning $100,000 is clearly not poor. However, they face very high prices for health insurance. In much of Arizona, for instance, they would have to pay over $22,000 per year—almost a quarter of their pre-tax income—for “silver” coverage, according to the Kaiser Family Foundation’s Obamacare calculator.  And that is before you count their out-of-pocket medical costs. When Donald Trump says that Obamacare is a “disaster”, such a family would look at their health insurance options and agree.

The House Republican plan offers this group some help. Individuals earning less than $75,000, and couples earning less than $150,000, will get a big tax credit to help them with their premiums. (Minnesota has already passed “premium relief” for such buyers).

Is that a good thing? Obamacare explicitly tries to spread the costs of health insurance around, in order to increase coverage. Unfortunately, it does so only in the individual market. The 155m Americans who get health insurance through their employers need not foot the bill for unhealthy people on the exchanges. Not only that, but this coddled group also gets a tax break on their coverage. People in the individual market have a right to feel hard done by. The best thing about Mr Ryan’s tax credit is that it begins to redress the imbalance. 

I am not suggesting that helping this group justifies removing means-tested subsidies for the poor. But I am pushing back on the idea that Obamacare's redistribution only hurt the "rich". Here is Matthew Yglesias at Vox (emphasis added):

Policy-minded conservatives have serious criticisms of President Obama’s health care law. They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put “skin in the game” in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.

Mr Yglesias portrays Obamacare's redistribution as flowing primarily from rich to poor. But his chart shows something else: that it hurts middle-income groups most. That is consistent with the experience of millions of Americans in the individual market who have seen their premiums soar while they have received no help from the government. They are treated unfairly by the system as it stands, and should not be ignored when thinking about health care reform.


CBO’s Prophecies, Demystified The budget gnomes tend to underestimate market incentives, especially in health care ---
https://www.wsj.com/articles/cbos-prophecies-demystified-1489446596?mod=djemMER

The white smoke rose Monday afternoon from the Congressional Budget Office as the fiscal forecasters published their cost-and-coverage estimates of the GOP health-care reform bill. Awaiting such predictions—and then investing them with supposed clairvoyance—are Beltway rituals. The coverage numbers weren’t great for Republicans, but they shouldn’t allow an outfit that historically underestimates the benefits of market forces to drive policy.

The good news is that CBO estimates that the American Health Care Act would cut the budget deficit by $337 billion over 10 years as the bill replaces ObamaCare’s subsidies with tax credits, rationalizes its Medicaid expansion and repeals its tax increases. The bill would cut taxes by nearly $900 billion while cutting spending by $1.2 trillion.

The bad news is that CBO thinks 14 million people on net would be uninsured in 2018 relative to the ObamaCare status quo. How many people may “lose coverage” is the debate progressives want to have, as if that’s the only relevant question in U.S. health care.

The CBO attributes “most” of this initial coverage plunge to “repealing the penalties associated with the individual mandate.” If people aren’t subject to government coercion to buy insurance or else pay a fine, some “would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

What this finding says about the value Americans attach to ObamaCare-compliant health insurance is damning. If CBO is right, some 14 million people would rather spend their money on something else, despite the subsidies.

But CBO also has too much faith in the mandate as an effective policy tool. In ObamaCare practice, the mandate isn’t pulling “free riders” into the insurance markets. The IRS reports that in 2015 some 12.7 million taxpayers claimed one or more exemptions from the mandate, such as “hardship,” while merely 6.5 million paid the fine.

The GOP wager is that the stability of the individual insurance market would improve with better incentives and if people want to participate. Deregulation would free up insurers to offer more options at many price points that meet different needs. Instead of brute force, Republicans think more people would join the market because if it offers alternatives worth the cost.

CBO’s budget gnomes don’t share these assumptions and they don’t get built into their models. CBO models are not a writ carved in stone by a finger of light, but merely an educated economic guess about how consumers and businesses will behave differently in response to new health-care policies.

Thus this cost estimate should be part of the larger debate, not taken as gospel. Last year the more market-friendly Center for Health and Economy scored the House GOP’s “Better Way” health plan, which this bill closely resembles. The center model was designed by the University of Minnesota’s Stephen Parente, the leading expert in modeling premium support-style health reforms.

The center estimated that the individual market would grow by about a million on net compared to current law in 2018 and by 13 million in 2026. Tax credits and deregulation may well be more powerful than mandates in practice.

The center did find that per-capita Medicaid block grants would cause about four million fewer insured individuals in total by 2026, which is more modest than CBO. Over time, according to CBO, coverage losses would rise to 21 million in 2020 and then to 24 million in 2026 as states rolled back ObamaCare’s Medicaid expansion.

But there are more than a few reasons to doubt CBO’s fortune-telling, especially in health care. Precisely because its models give too much weight to government coercion and too little to free markets, its projections have often missed the mark.

In February 2013, CBO predicted that ObamaCare enrollment in the individual market would be 13 million in 2015, 24 million in 2016 and 26 million in 2017. The actual enrollment for those years were, respectively, 11 million, 12 million and 10 million. As recently as March 2016, CBO was projecting an enrollment boom of 15 million for this year.

CBO also failed to predict how many people would game ObamaCare’s insurance rules and mandates, signing up for coverage just before they need expensive procedures like knee replacements then dropping coverage. On paper they shouldn’t behave that way, but the real world works differently than CBO’s models.

CBO was also badly wrong about the 2003 Medicare prescription drug benefit, which unlike ObamaCare used incentives, markets and private competition to control public costs. The drug benefit cost about 40% less over its first decade than CBO projected.

Democrats in 2009-2010 wasted months gaming the CBO scoring process to hide the enormous true costs of ObamaCare with budget gimmicks, which is a spectacle the GOP ought to avoid. Opponents in Congress weren’t any more convinced than the public, and the delays crowded out other priorities. If Republicans try to juke the coverage estimates, they’ll be making the same mistake.

Continued in article

 

 




December31, 2016

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

Medicare Fraud is Rampant ---
 http://townhall.com/columnists/stevesherman/2016/02/05/medicare-fraud-is-rampant-n2115375?utm_source=thdaily&utm_medium=email&utm_campaign=nl&newsletterad=


Russia's Bad Health Care System Is Getting Worse ---
http://www.newsweek.com/2016/12/02/dire-russia-health-care-523380.html


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)

. . .

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.

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.

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 ---
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/

"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.


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.

 


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.


"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.


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

Nation's Top Hospitals Refuse Obamacare-Insured Patients ---
http://www.newsmax.com/Newsfront/Obamacare-hospitals-plans-coverage/2013/11/01/id/534327/


“You’ve got this crazy (Obamacare) system where all of a sudden 25 million more people have health care and then the people are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half,” Mr. Clinton told voters. “It’s the craziest thing in the world.”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
Bill Clinton (former President of the USA)
http://www.washingtontimes.com/news/2016/oct/3/bill-clinton-bashes-obamacare-as-crazy-system-whil/?mod=djemBestOfTheWeb
Jensen Comment
All these years I've advocated the German combination of national healthcare with private insurance discretionary supplements.
I think Bill Clinton is copping my stuff at
http://faculty.trinity.edu/rjensen/Health.htm
Read the Introduction

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


ACA insurance companies are offering over-priced policies with enormous deductibles that discourage patients from having medial treatments except in emergencies. It sounds great in election campaigns to say that nearly all Americans are now insured due to the ACA. It does not sound as great to admit that most of the new insured cannot afford to use the insurance they're now paying for unless they've been added to free health care coverage on Medicaid. But that's not much help for the middle class.


PwC Study Maligned by Liberals in 2009 is Vindicated by Events of 2016

From the Left-Leaning Website Called Vox
"Obamacare was built to fail," by Avik Roy, Vox, October 7, 2016---
http://www.vox.com/the-big-idea/2016/10/7/13191250/obamacare-exchanges-crisis-arrogant-progressives

. . .

In October 2009, analysts at PricewaterhouseCoopers published a report estimating that by 2016, the Senate Finance Committee bill would increase individual-market health insurance premiums by 47 percent. Today, we would describe that figure as a lowball estimate. In fact, cumulatively, median premiums for "silver plans" have nearly doubled in the ACA’s first four plan years (49 percent in 2014, 7 percent in 2015, 11 percent in 2016, and a projected 10 percent in 2017).

But in 2009, the ACA’s cheerleaders described it in much different terms.

"We couldn’t stop intellectual saboteurs from introducing new lies into the debate," wrote Cohn. "But I think we were able to expose those lies just a little more quickly." Cohn and others slammed the PwC report as the work of corrupt health insurance lobbyists seeking to sink reform — as an example of "the insurance industry declaring war." In the Washington Post, Ezra Klein, who went on to found Vox.com, compared the PwC report to lies promulgated by the tobacco and oil industries.

What was remarkable about all this controversy is that PricewaterhouseCoopers' findings were quite reasonable. The ACA’s insurance market regulations were going to drive up the underlying cost of individually purchased insurance.

For example, forcing insurers to charge their youngest customers no less than one-third of their oldest customers meant that premiums for young people would double, because on average, 19-year-olds consume one-sixth as much health care as 64-year-olds. Mandating that insurers cover a federally-prescribed suite of health care services, regardless of whether enrollees need coverage for those services, meant that premiums would go up. Requiring that insurers charge the same prices to the healthy and the sick meant that healthy people in particular would pay more.

By contrast, the law’s individual mandate, forcing consumers to buy that costlier insurance, was going to be phased in over time. As a result, premiums would spike and enrollment would suffer.

But Obamacare’s cheerleaders, fearing that this information might sink the bill’s fate in Congress, decided to shoot the messenger. They brought in Jonathan Gruber, the MIT economist, to assure everyone that "what we know for sure the bill will do is that it will lower the [underlying] cost of buying non-group health insurance" — that is, the cost before any subsidies.

As a political matter, the aggressive critiques of PwC worked. "Within hours of [the report’s] publication," Cohn recounted, "several blogs, including this one, had published critiques … [they] circulated in Washington and provoked a backlash against the insurers. Wavering Democrats said they were offended by the effort at political sabotage; the Finance Committee went on the pass the bill, as it had originally planned."

The exchanges punish middle-income Americans

But as a matter of policy, PwC was right and the cheerleaders and Democratic policymakers were wrong. The ACA’s exchanges were designed poorly, and premiums did become unaffordable for millions. It is true that many people with incomes near the poverty line, whose premiums were nearly fully subsidized by other taxpayers, gained coverage through the law, many through the deeply flawed Medicaid program, whose health outcomes are no better than those of people without health insurance.

But millions of uninsured, taxpaying Americans don’t qualify for Medicaid or the ACA’s exchange subsidies. Still others — typically those with incomes between 250 and 400 percent of the federal poverty level — qualify for partial subsidies that don’t make up for the fact that ACA exchange insurance costs so much more. As Bill Clinton put it, "You’ve got this crazy system where … people that are out there busting it —sometimes 60 hours a week — wind up with their premiums doubled and their coverage cut in half." That’s why ACA exchange enrollment has fallen 9 million short of initial estimates.

The people who implemented the markets were ignorant and arrogant, too

And Obamacare didn’t suffer only from a flawed blueprint. It was also implemented by people with poor knowledge of how health insurance markets worked.

Continued in article


PwC Study Maligned by Liberals in 2009 is Vindicated in 2016

"Brouhaha erupts over PwC private health insurance report," AccountingWeb, October 21, 2009 ---
http://www.accountingweb.com/topic/cfo/brouhaha-erupts-over-pwc-private-health-insurance-report

PricewaterhouseCoopers (PwC) has found itself at the center of a controversy over its estimates of cost increases in private health insurance premiums if certain provisions of the heath care reform bill passed by the Senate Finance Committee become law.  PwC was engaged to conduct the study, "Potential Impact of Health Reform on the Cost of Private Health Insurance Coverage," by the American Health Insurance Plans (AHIP).  Critics have questioned the methodology used by PwC, saying it does not take into consideration some of the cost containment measures in the bill and potential behavioral responses that could affect premium increases. 

AHIP president and CEO Karen Ignagni told ABC News, "One of the most important things that should be done is for PricewaterhouseCoopers, a world class firm, to speak for itself about methodology."

PwC defends its analysis and conclusions in a statement provided to AccountingWEB, citing the specific parameters of the study, saying that "America's Health Insurance Plans engaged PricewaterhouseCoopers to prepare a report that focused on four components of the Senate Finance Committee proposal:

* Insurance market reforms and consumer protections that would raise health insurance premiums for individuals and families if the reforms are not coupled with an effective coverage requirement.
* An excise tax on employer-sponsored high value health plans.
* Cuts in payment rates in public programs that could increase cost shifting to private sector businesses and consumers.
* New taxes on health sector entities.

The study concluded that collectively the four provisions would raise premiums for private health insurance coverage.  As the report itself acknowledges, other provisions that are part of health reform proposals were not included in the PwC analysis."

By 2019, the study says, after analysis of these four provisions, the cost of single coverage is expected to increase by $1,500 more than it would under the current system and the cost of family coverage is expected to increase by $4,000 more than it would under the current system.  This amounts to an additional 18 percent increase in premiums by 2019. The overall 18 percent increase is a composite of increases by market segment as follows:

* 49% increase for the non-group (individual) market;
* 28% increase for small employers (those firms with fewer than 50 employees);
* 11% increase for large employers with insured coverage; and,
* 9% increase for self-insured employers.

The highest increase would be for individuals covered by private insurance.

In its discussion of a "Strong Workable Coverage Requirement," the study acknowledges it methodology as it does elsewhere in the report.  "The reform packages under consideration have other provisions that we have not included in this analysis.  We have not estimated the impact of the new subsidies on the net insurance cost to households.  Also, if other provisions in health care reform are successful in lowering costs over the long term, those improvements would offset some of the impacts we have estimated."  The analysis of the coverage requirement shows the potential impact on premiums for individuals without a broad coverage requirement."

PwC says that impacts identified in the study assume payment of tax on high-value plans, cost-shifting of cuts to public programs, and full pass-through of industry taxes. 

The PwC study also states that it factored in the excise tax but not any anticipated behavioral changes:  "We have estimated the potential impact of the tax on premiums," the study says.  "Although we expect employers to respond to the tax by restructuring their benefits to avoid it, we demonstrate the impact assuming it is applied."

In an earlier study based on AHIP data, PwC estimated that structural reforms, such as improved wellness and prevention, disease management, value based payment reform, improvements in health information technology, comparative effectiveness, and malpractice reform, could mitigate growth in healthcare costs by between 0.5 and 1.0 percent per year after an initial investment period.  See PricewaterhouseCoopers "A Review of AHIP Savings Estimates" in Appendix to AHIP, "A Shared Responsibility," 2008.


"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.


USA Today: The Cascade of 2017 Obamacare Premium Hikes Has Arrived ---
http://townhall.com/tipsheet/guybenson/2016/10/20/usa-today-the-cascade-of-obamacare-premium-hikes-has-arrived-n2234719?utm_source=thdailypm&utm_medium=email&utm_campaign=nl_pm&newsletterad=

. . .

Based on that chart, only a small handful of states will have the supposed 'good fortune' of experiencing single-digit hikes.  The vast majority will experience cost surges in the double-digits, with roughly half of all states getting slammed with increases of at least 20 percent.  Time magazine reviews the eight states where consumes will suffer the most next year, where regulators have imposed rate jumps of at least 30 percent.  The piece's opening sentence says it all: "The Affordable Care Act is getting a lot less affordable for many Americans."  Meanwhile, many Arizonans find themselves in Obamacare's crosshairs, getting rocked by the double-whammy of soaring costs and dwindling-to-nonexistent choices:

Continued in article


Affordable Care Act of 2010 (Obamacare) --- https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

Probably the worst whore economists was Johathon Gruber of MIT --- https://en.wikipedia.org/wiki/Jonathan_Gruber_(economist)

Jensen Comment
In addition to the dire predictions of PwC in 2009, some respected leftist-leaning media were warning against the lousy numbers of the Obama-Controlled House Budget Committee. I mean warnings from one of my favorite statistician named John Cassidy who writes for The New Yorker. Robert Pear also voiced warnings in The New York Times.

"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."


Read More At Investor's Business Daily:
http://news.investors.com/ibd-editorials-obama-care/120114-728618-the-6-biggest-whoppers-in-gruber-obamacare-comic-book.htm#ixzz3KllqGGBp

 

Emergency Room (ER) --- https://en.wikipedia.org/wiki/Emergency_department 

Emergency departments have many of the best doctors in the USA. It's common to outsource those doctors to ER practicing partnerships.  In the USA ERs, especially urban trauma centers, in hospitals are being stressed to the point of breaking. Much, albeit certainly not all, of the blame falls on the Affordable Care Act.

American College of Emergency Room Physicians
The Uninsured: Access to Medical Care Fact Sheet ---
http://newsroom.acep.org/fact_sheets?item=30032   

Jensen Comment
Here are a few tidbits in the above report.:

Emergency care is the safety net of the nation’s health care system, caring for everyone, regardless of ability to pay.

Emergency physicians provide the most uncompensated care for uninsured and underinsured patients of all physicians.

America’s emergency departments are under severe stress, facing soaring demands. They are essential to every community and must have adequate resources.

Having health insurance does not mean you have access to medical care.

. . .

The federal government estimates that the number of uninsured in the United States has declined by about 15 million since 2013[iii].  In the first three months of 2015, 29 million people were uninsured.  That was seven million fewer than in 2014. While the uninsured are expected to drop to about 23 million by 2023 as a result of the ACA, according to the Centers for Medicare & Medicaid Services, many American will still not be able to afford their healthcare needs. [iv]

24.3 percent of the uninsured are Hispanic

15.9 percent are black

9.8 percent are white

9.8 percent of children younger than 19 in poverty

7 percent of children under 19 who are not in poverty

. . .

Hospitals and physicians shoulder the financial burden for the uninsured by incurring billions of dollars in bad debt or “uncompensated care” each year. Hospitals provided over $50 billion in uncompensated care in 2013.

In the past, hospitals shifted uncompensated care costs to insured patients to make up the difference. However, cost shifting no longer is a viable option because managed care and other health plans have instituted strict price controls, leaving little margin to shift costs. More than one-third of emergency physicians lose an average of $138,300 each year from EMTALA-related bad debt, according to a May 2003 American Medical Association study.]

. . .

With projections that health care costs will double the nation is faced with how it will continue to provide care for all Americans, not just the disadvantaged. Emergency departments provide an essential community service, similar to fire departments, police departments, and public utilities. The nation cannot afford to allow the emergency care system to collapse because of a lack of funding. It is too high a price to pay in terms of public health effects and human suffering.

Medicaid patients are having Analysis of hospital financial reporting and member surveys from hospital associations indicates that, through 2014, payer mix is shifting in ways that will likely reduce hospital uncompensated care costs, according to the Dept. of Health and Human Services (HHS). Moreover, a projection model developed by ASPE suggests that the large observed declines in the uninsured and increases in Medicaid coverage have led to substantial declines in hospital uncompensated care in 2014.

Medicaid expansion states account for $5 billion of the estimated $7.4 billion reduction in uncompensated care costs attributed to ACA coverage expansions.

. . .

Most undocumented immigrants are unable to obtain health insurance and this means many are
unable to pay – contributing to uncompensated care, especially in Border States, such as California,
Texas and Arizona. Billions of dollars of uncompensated care has resulted in the closure of hundreds
of emergency departments in America, which is reducing capacity and threatening everyone’s access
to lifesaving care.

. . .

People who cannot afford physicians’ fees and who do not have health insurance are often turned away from private offices and urgent care clinics. With no other options, they turn to emergency departments, which serve as a vital part of America’s health care safety net. Emergency departments are mandated by law to medically evaluate and provide stabilizing treatment of emergency conditions for everyone. Language and economic barriers also often limit undocumented immigrants’ access to health care. Furthermore, many undocumented immigrants become migrant farm workers and their transient living arrangements jeopardize residency requirements for some community health clinics.  In addition, fear of detection by immigration authorities may account for why as few as one-fourth of them use other health services.  ACEP opposes initiatives to require physicians or health care facilities to report suspected, undocumented persons to immigration authorities

. . .

See the reference links at the end of the article

Jensen Comment
The above report judiciously avoids mentioning that one of the major stresses on ER departments and their doctors is the high cost of malpractice insurance now being heavily funded by the middle class. You need only watch the constant stream of advertisements on television of law firms seeking medical punitive damages to know that some law firms are totally depend on punitive damages settlements, except in Texas. Early on the many lawyers in the USA Congress warned that the Affordable Healthcare Act would never pass if the ACA messed with the law firm gravy train of punitive damages. National healthcare plans such as those in Canada and Scandinavia limit malpractice settlements to actual damages. This greatly reduces the cost of malpractice insurance in those national plans. But this will never happen in the USA (except for Texas where punitive damages unbelievably are limited by a constitutional amendment) ---
http://www.nytimes.com/2007/10/05/us/05doctors.htm

Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas. “It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before. Ralph Blumenthal, "More Doctors in Texas After Malpractice Caps," The New York Times, October 5, 2007.

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.

 

 


President Obama's End Run on the Separation of Powers:  Attempts to Spend Billions Not Appropriated by the Congress
The Administration will do anything to rescue its flailing Affordable Care (Obamacare) Act, and nothing so meager as the law will interfere. This damage to the separation of powers, not a health-care bill, will be President Obama’s abiding legacy ---
http://www.wsj.com/articles/an-illegal-bailout-for-obamacare-1475276262?mod=djemMER

Bob Jensen's universal health care messaging --- http://faculty.trinity.edu/rjensen/Health.htm 


ObamaCare’s Meltdown Has Arrived ---
http://www.wsj.com/articles/obamacares-meltdown-has-arrived-1475709560?mod=djemMER

Tennessee is ground zero for ObamaCare’s nationwide implosion. Late last month the state insurance commissioner, Julie Mix McPeak, approved premium increases of up to 62% in a bid to save the exchange set up under the Affordable Care Act. “I would characterize the exchange market in Tennessee as very near collapse,” she said.

Then last week BlueCross BlueShield of Tennessee announced it would leave three of the state’s largest exchange markets—Nashville, Memphis and Knoxville. “We have experienced losses approaching $500 million over the course of three years on ACA plans,” the company said, “which is unsustainable.” As a result, more than 100,000 Tennesseans will be forced to seek out new coverage for 2017.

BlueCross is only the latest insurer to head for the exits. Community Health Alliance, the insurance co-op established under ObamaCare, is winding down due to financial failure, leaving 30,000 people without coverage. UnitedHealthcare said in April it is departing Tennessee’s exchange after significant losses. That’s another 41,000 people needing new plans.

All told, more than 60% of our state’s ObamaCare consumers will lose their coverage heading into 2017. When they go in search of a replacement plan, they will confront two unfortunate realities: a dearth of options and skyrocketing costs.

Seventy-three out of Tennessee’s 95 counties will have only one insurer on the exchange, meaning no meaningful competition whatsoever. In regions where BlueCross BlueShield is pulling out, there will be two remaining major carriers, Cigna CI -0.80 % and Humana. HUM 0.33 % The only large metro area with more options will be Chattanooga.

Then there are the premiums. State regulators have already approved the highest annual rise in the nation, a weighted average of nearly 56%, according to data at ACASignups.net. The rate increases authorized in late August include an average of 62% for BlueCross BlueShield, 46% for Cigna and 44% for Humana. The latter two companies could ask to revise their rates upward depending on how many former BlueCross consumers they pick up.

The bottom line is that Tennesseans on ObamaCare must choose from fewer, and increasingly unaffordable, options. Some exchange buyers, those covered by subsidies, will bear only part of this additional cost. For the roughly 30,000 Tennesseans who are ineligible for subsidies, the higher price will come completely out of their own pockets. Not to mention that all ObamaCare consumers face rising deductibles, which aren’t covered by subsidies and can range up to $6,850 for the most “affordable” family plans.

It’s easy to imagine Commissioner McPeak’s fear of an outright exchange collapse coming true in the near future. The more unaffordable plans become, the angrier consumers will get. BlueCross BlueShield’s $500 million losses won’t disappear when the company leaves the market. Instead, the red ink will flow toward the remaining insurers as they pick up those customers. Cigna and Humana have not publicly said whether their exchange plans have turned a profit.

Naturally, this chain of events has Tennessee lawmakers clamoring for change. One of the loudest demands—coming from Democrats like Nashville’s U.S. Rep. Jim Cooper—is that the state double down on ObamaCare by expanding Medicaid. But this is a cure worse than the disease, since it would force many Tennesseans into a second-class health-care system while jeopardizing state finances for years to come.

More important, ObamaCare’s unraveling shows the danger of a one-size-fits-all federal program. What’s happening in Tennessee is only a nationwide harbinger. Every single neighboring state will have less competition on its ObamaCare exchanges next year. The entire state of Alabama will have only one insurer. Almost all are facing double-digit premium increases: in Mississippi a weighted average of 16%; in Kentucky 25%; in Georgia 33%.

 Continued in article

 


From the CFO Journal's Morning Ledger on September 29, 2016

Why the $600 EpiPen costs $69 in Britain
The EpiPen allergy shot costs less than its leather case in Britain, Bloomberg reports. The price of an EpiPen two-pack has surged to more than $600 in the U.S., sparking a political outcry. While the manufacturer, Mylan NV, says it takes home about $274, in the U.K. a similar pair of injectors costs the state-funded National Health Service $69. The numbers highlight the stark differences in the way drugs are priced in the U.S. and Britain, where the government negotiates with pharmaceutical companies to limit costs.

Jensen Comment
Such pricing would never work worldwide because somebody has to pay for Mylan's corporate jets and conferences in Ritz hotels around the world. "Cost Plus" pricing all depends upon what outlays are included in what you call "cost." Accountants are notoriously creative when it comes to "measuring" cost.

From The Wall Street Journal on September 27, 2016
"Mylan Clarifies EpiPen's Profit"

. . .

Testifying before a congressional committee last week, CEO Heather Bresch said Mylan's profit was $100 for a two-pack of injectors, despite a $608 price in the USA (versus $69 in the U.K.)

Continued in article

Jensen Comment
As usual USA prices include all the allocations of corporate jets, conferences in luxury hotels,