Archive for the ‘#healthcare’ Tag

Real vs Fake Health Care Reform, and How to Tell the Difference | Jeffrey A. Tucker   Leave a comment

You want to know why the “freedom caucus” has balked at passing the Trump-backed Ryancare health care proposal?

Source: Real vs Fake Health Care Reform, and How to Tell the Difference | Jeffrey A. Tucker

Image result for image of freedom caucus balking at ahcaBecause the package does not address the core problem of the existing system. They are leaning – correctly – on a brilliant insight from F.A. Hayek.

Let’s think this through.

Objecting to Obamacare doesn’t have to be a matter of ideology. The contraption just didn’t work.

What was the most fundamental problem with Obamacare? It attempted to set up an artificial market that lacked the most salient feature of markets: genuine competition. Real competition. I don’t mean teams struggling for control. I mean an institutional setting in which producers can innovate. They face free entry and exit. Their well-being depends on serving the consumer.

Obamacare has flopped because it disabled what remained of the competitive system with defined benefits packages, mandates that everyone be covered, requirements that everyone must purchase, and geographic limits on service provision. All these together took health care out of the realm of markets and made it a form of central planning.

And so: Obamacare resulted in soaring premiums, soaring deductibles, shoddy access, and ever-increasing bureaucracy. It became untenable. Objecting to it doesn’t have to be a matter of ideology. The contraption just didn’t work.

The core insight of the “freedom caucus” comes from Hayek and his fascinating piece “The Meaning of Competition”:

It is only through competition that we can assume that these possible savings of cost will be achieved. Even if in each instance prices were only just low enough to keep out producers which do not enjoy these or other equivalent advantages, so that each commodity were produced as cheaply as possible, though many may be sold at prices considerably above costs, this would probably be a result which could not be achieved by any other method than that of letting competition operate …

Yet the current tendency in discussion is to be intolerant about the imperfections and to be silent about the prevention of competition. We can probably still learn more about the real significance of competition by studying the results which regularly occur where competition is deliberately suppressed than by concentrating on the shortcomings of actual competition compared with an ideal which is irrelevant for the given facts.

I say advisedly “where competition is deliberately suppressed” and not merely “where it is absent,” because its main effects are usually operating, even if more slowly, so long as it is not outright suppressed with the assistance or the tolerance of the state.

The evils which experience has shown to be the regular consequence of a suppression of competition are on a different plane from those which the imperfections of competition may cause. Much more serious than the fact that prices may not correspond to marginal cost is the fact that, with an entrenched monopoly, costs are likely to be much higher than is necessary …

Competition is essentially a process of the formation of opinion: by spreading information, it creates that unity and coherence of the economic system which we presuppose when we think of it as one market. It creates the views people have about what is best and cheapest, and it is because of it that people know at least as much about possibilities and opportunities as they in fact do. It is thus a process which involves a continuous change in the data and whose significance must therefore be completely missed by any theory which treats these data as constant.

Let me paraphrase and apply: no, there will not be a perfect world. Total freedom is not a political option right now. So what’s the priority for any reform? The most crucial institutions in any society are the signaling systems of prices that reflect existing knowledge and possibilities.

When those are malfunctioning, nothing else works. Costs go up, quality goes down, innovation stops, and the sector starts to atrophy.

Competition Restoration Means Health Care Restoration

The first priority is that competition must be restored through some measure of deregulation. The mandates must go. The pre-set benefits packages must die. Insurers must gain control over their business affairs and customers have to be able to shop and choose.

It is not about ideology. It is about a system of health care insurance that actually works to serve the common good.

We must regain flexibility to inspire innovation and achieve profitability. This must happen or else premiums will keep going up. This is a requirement. Obamacare failed because it disabled the market. Any reform must restore that market. This is more important than any other feature of reform.

Trumpcare or Ryancare or whatever you want to call it does not do that. It replaces a mandate to buy with a tax incentive to buy. Otherwise it leaves the problem of the absence of genuine competition in place. True, the alternative doesn’t do anything about the transfer of payments, but, if you follow Hayek, you know that these are less important to eliminate than are the barriers to competition.

The restoration of competition will discover for us things we do not know about service provision: treatments, plans, new institutional arrangements, new forms of insurance, new methods for serving the public. Competition will grow the market and make profitability the test of success or failure.

If that does not happen, premiums will keep increasing, quality will go down, access will continue to shrink, and public anger will grow as a result.

Now is the time. Again, it is not about ideology. It is about a system of health care insurance that actually works to serve the common good.

Do Republicans Want to Be Blamed?   Leave a comment

There’s no question that the unAffordable Care Act needs to be replaced. It is an example of why government interventions into the marketplace are not a good thing. Government starts out trying to fix something, but their very intervention necessitates following interventions to fix the problems created by their attempt for fix what they perceived as a problem.

Image result for image of gop blamed for ACA failurePretty much every analyst agrees that the insurance market under the ACA has entered a death spiral. Something must be done. And, the GOP in the House attempted to do just that with the American Health Care Act. The problem is that it was inadequate to the task assigned to it.

The ACA’s provisions are all intertwined. You cannot just tweak one or two and “fix the problem.” To avoid an even larger disaster, all of the provisions must be repealed at once. By the way, this was a known problem with the bill before it was passed.  You were warned, folks. You refused to listen. For highly political and chicken-livered reasons, the Republican establishment chose a compromise bill which keeps the requirements for pre-existing conditions coverage at community ratings, but does away with the individual mandate … sort of … replacing it with a mandatory 30% surcharge, payable to insurance companies, for those who go without coverage for longer than 60 days and then choose to purchase another plan.

Basically, the AHCA removes Obamacare’s funding mechanism while keeping the requirements that made the individual mandate necessary in the first place. Those requirements are what is now driving up the costs of medical insurance to a point where people are dumping insurance altogether. That wasn’t an unexpected outcome of the ACA, either. You were warned. You did not listen. Or, Democrats listened, but only enough to decide to create the individual mandate to punish people for not purchasing insurance … which works only so long as premiums remain less than the tax penalty for not purchasing insurance. We passed that exit some time ago.

Oddly, the surcharge will punish people who decide they now want to buy insurance. That doesn’t provide a lot of incentive for people to continuing paying huge premiums while they’re healthy, which leaves insurance providers unable to remain solvent in a massively distorted market, which will hasten the death spiral.

So, my question to the GOP is … do you WANT to be blamed for this mess?

I ask because … well,  you would have been if you’d passed the AHCA in its current form. The insurance market would have collapsed even more rapidly than it is going to under the ACA and the blowback would be pointed at your face, not the Democrats who caused this mess in the first place. The progressives who were so enthused about the ACA would insist that the chaos that followed was the fault of deregulation and the free market rather than what actually caused the problem — Obamacare.

Grow a spine, GOP! Either repeal it (I don’t care if you replace it) or stand back with your hands in the air and let the ACA fail and let the Democrats be blamed for what they caused. That is likely to happen this fall, when you can make a perfect argument for going back to more free market systems.

The Republicans promised the American people that it would repeal every word of Obamacare. You’ve passed two bills that did that, knowing that Obama would veto them. Now you have a President who has said he wants to repeal the ACA, so dust off one of those full repeal bills and send it to him. DO IT!

A real, full repeal is only the first step in repairing health care. A repeal needs to be followed by true free market reforms, with the goal of a complete separation of the health care industry and government. In the interim, the reforms recently proposed by Senator Rand Paul are a long step in the right direction. Only free markets can provide the cheapest and highest quality medical care to the largest amount of people.

How Could They Make It Worse   Leave a comment

So when Rick and I started our series, we didn’t yet know what Congress was going to propose for certain, but they came out with the House plan now (March 8), so we decided to write up our impressions.

The draft House health insurance bill fails to correct the features of Obamacare that drove up health insurance and medical care costs and mainly just tweaks Obamacare’s financing and subsidy structure.

The bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.

 

The draft bill leaves Obamacare’s costly insurance regulations in place and attempts to offset those costs with the same basic approach.

Approximately 22 million individuals currently receive subsidized health insurance coverage through the exchanges (8 million) and the Medicaid expansion (14 million). For them, Obamacare’s higher insurance costs are offset by the law’s subsidies.

About 25 million Americans with unsubsidized individual-market coverage (10 million people) or small-employer plans (15+ million people) are the ones who most need relief from Obamacare that can only be supplied by repeal, and they probably don’t care about or for replacement. Their experience of Obamacare has basically been “all pain, no gain,” as they have been subjected to significant premium increases and coverage dislocations with no offsetting subsidies.

Unfortunately, the draft House bill provides no meaningful relief for that group of middle-class Americans who are most adversely affected by Obamacare and are most supportive of repeal.

The draft bill leaves Obamacare’s costly insurance regulations in place and attempts to offset those costs with even more subsidies.

The draft bill’s new Patient and State Stability Fund is particularly problematic. It would provide grants to states of up to a total of $100 billion over the nine years, 2018-2026. What are the significant problems with this new program? They’re substantial.

  • It substitutes new funding for old Obamacare funding without adequately addressing the misguided Obamacare insurance market rules and subsidy design that made the exchanges a magnet for high-cost patients. Those Obamacare mistakes created an insupportable burden on the individual insurance market by concentrating expensive patients in only that small portion of the total market.
  • Like Obamacare, it doesn’t actually reduce premiums, but rather uses subsidies to mask the effects of Obamacare provisions that drove up premiums in the first place.
  • It creates a new entitlement for states.

Furthermore, without a resulting reduction in unsubsidized premium levels, future Congresses will likely face pressure from states and constituents to extend and expand the program. It will become a creeping Medicaid-like drain on resources that will destroy medical care access in this country. Under the Medicaid expansion, the federal government reimbursed states 100 percent of the cost of expanding Medicaid to able-bodied adults, with federal support eventually declining to 90 percent. These are able-bodied people who earn a living (in Alaska, up to $52,000 a year for a family of four) and their medical care is paid for by the taxpayers.

Yet, states continue to receive significantly less federal assistance (50 percent to 75 percent, depending on the state) for covering the more vulnerable populations (such as poor children and the disabled) that the program was intended for. That policy was both inequitable and unaffordable.

The draft bill does not correct that inequity, but rather reduces the enhanced match rate from 95 percent to 80 percent. The better approach would be to allow states to immediately cap expansion population enrollment, while also setting federal reimbursement for any new expansion enrollees at normal state match rates.

Such changes would likely limit the addition of new individuals to the program, and also substantially reduce the size of the federal revenue loss that expansion states will incur when the program terminates. That is because a significant share of current enrollees can be expected to leave the program for other coverage during the transition period.

Yet another policy mistake is the failure to take the first step toward providing more equitable tax treatment of health insurance.

The House version drops a proposed cap on the unlimited tax exclusion on employment-based health insurance contained in an earlier version, while retaining the so-called “Cadillac tax”—the 40 percent excise tax on so-called “high-cost plans”—and delaying its implementation until 2025.

Congress should kill this punitive excise tax and replace it with a cap on pre-tax funding so as to encourage employers & workers to evaluate the trade-off between higher health care spending and higher cash wages, to rethink how much of total employee compensation should be devoted to health benefits.

While the Cadillac tax would force employers to alter the health benefit plans that they provide their workers, no such effect would result from the cap on the exclusion. It would instead limit the amount of employer health benefits that constitute pre-tax income to workers, which would make the tax treatment of employer-sponsored health benefits consistent with the tax treatment of other benefits (such as retirement savings plans, group life insurance, and dependent care) offered by employers.

Workers would still be able to use after-tax income to purchase additional coverage, just as they can with other employer benefits, and the employer would still be able to offer a plan whose value exceeds the level of the cap on pre-tax funding.

This bill misses the mark primarily because it fails to correct the features of Obamacare that drove up health care costs. Congress should continue to focus on first repealing the failed policy of Obamacare and then act to offer patient-centered, market-based replacement reforms. Stop making patients into a group where things are done to them and put them back in control of their own health care.

Defining Terms & Addressing Actual Problems   6 comments

According to the media and the CBO, about 20 million (could be 24 million) Americans will lose their “health care” under the GOP plan to replace (uh, tweak) Obamacare.

Image result for image of a doctor's scaleI’d be horrified if I knew what that meant. How exactly could I, an active, healthy, middle-aged person who eats (relatively) healthily and enjoys the outdoors (in some months) “lose” my health care? It’s not a cell phone or sweater that can be stolen or left on a park bench. Health care is what I do to keep myself health – diet, exercise, avoiding risky behaviors (uh, except for going into the Alaska wilderness well-armed) and not abusing drugs, including alcohol. I did that before Obamacare was enacted and I will continue doing it after that mistake is reformed or collapses of its own bureaucratic inefficiencies. It really can’t be taken from me because it doesn’t rely on anyone else but me.

You see, health care is not medical care. The terms “healthcare”, “medical care” and “medical insurance” are often used synonymously, but they really have radically different meanings. No, we’re not talking semantics here. There are serious policy implications of using the wrong words. This sort of lazy use of language by the media and politicians leads to an entitled attitude among the people.

 

Medical care or treatment is what you seek from medical professionals when you have a medical problem and aren’t in good health. See the difference? When I become unhealthy, I seek medical care because my health care has proven inadequate.

Medical insurance is what you obtain to protect yourself financially from a catastrophic illness or injury requiring expensive medical treatment.

Back before Obamacare, you could save a lot of money by taking care of your health (health care). Brad and I only ever satisfied our deductibles when we had babies or when our daughter needed braces. That’s because we work hard on our health care. Not everyone does, however.

The total cost of medical care in the US would be significantly reduced if Americans simply took care of their health. Examples?

  • Overeating is estimated to cost the nation $200 billion for the treatment of diabetes and heart disease alone, not including joint problems caused by being overweight.
  • Smoking-related medical problems are estimated to cost the nation $133 billion.
  • Alcohol and drug abuse add another $350 billion.
  • Sexually-transmitted diseases add $16 billion.
  • Reckless driving and other reckless behavior add untold billions more.

And none of these figures include the cost of Social Security Disability payments or other income support for those incapable of working due to medical problems stemming from overeating, smoking, drug addiction, sexually-transmitted diseases or reckless behavior.

Using these figures, the total cost of preventable illnesses and injuries is $699 billion at the minimum. We could round it to a nice neat $1 trillion when all the other costs are included. That’s $2,184 to $3,125 per citizen. In other words, the 30% of the population that foregoes health care (by not taking care of their health) are inflicting these medical care costs on everyone else.

There are those who will insist that society has a moral responsibility to provide medical care to those who can’t afford it, but virtually nothing is mentioned about the moral responsibility of individuals to not inflict costs on the rest of society because they lack self-control and self-respect.

So why doesn’t the media cover that? Take a really good look at the advertising on media and you’ll see the reason. Notice all the commercials for drugs and snake oils to address the infirmities and conditions stemming from a lack of personal health care. They would lose advertising dollars if they addressed the real issues of health care rather than demanding that we all pay for the medical care of everyone else.

When Obamacare first came under consideration, it was designed to address the approximately 6% of the country that lacked health insurance. Many of these people were healthy and health-caring individuals who didn’t want to pay for health insurancebut we were told we had a moral obligation to force them to submit and spend money on something they didn’t feel the need to buy. It’s a lot easier to put pressure on 6% of the country than on 30% of the country. So, no politician in his right mind would dare bring up the issue of health care when he could focus on the feel-good topic of medical care.

Let’s be honest about this. Very few people need anything more than a high-deductible medical insurance policy with a health savings account. The 70% of us who take care of our health generally don’t consume a lot of medical care. Common sense dictates that you have a low-premium, high deductible policy so that you can pool risk of a catastrophic illness with others, but it’s really pretty silly that we think we can’t afford over-the-counter medications and contraception. The vast majority of us could if we spent our money wisely. Yet, here in the United States medical care/insurance ranks 5th behind housing, food, cars, and entertainment. In other words, we subsidize medical care/insurance so that the masses can buy “stuff” rather than save money toward their old age and so that old people don’t have to move in with their kids when they stop making an income.

The cowardly framers of public opinion say that medical care/insurance must be socialized (provided by the government) because it’s a fundamental necessity. Oddly, they don’t advocate the same for food, shelter, clothing and transportation. Well, there were a few Obama czars who were hardcore Marxists who might have liked to see these industries socialized for the “good of the poor”, but they knew Americans would object to being forced en mass to buy their food in government markets, live in public housing, wear a standard uniform of clothing, and ride the same model of bicycles to work. Even the Chinese have finally rejected that way of life. Still, the American poor are kept dependent upon targeted social-welfare programs, such as food stamps, housing vouchers, and free-ish medical care through Medicaid.

Of course, if you debate these folks, they will insist that medical care/insurance is different. It doesn’t have the immediacy of food, shelter, clothing, and transportation. Because it’s not something people need every day, it requires people to plan ahead, defer gratification, make trade-offs, and save for medical emergencies. Valid point. The 30% of the population that doesn’t take care of its health probably has difficulties in these areas as well.

May I submit that there are ways of addressing this sad side of human nature other than socializing the entire medical industry, engaging in massive income transfers, or hatching unwieldy centralized plans in Congress that will only serve to raise costs and make people even less willing to take care of their health. Rick and I have been hinting at this through this series, but you can also find these ideas in many other sources including medical journals.

Simply put, you don’t put the problems of the 30% of the population who are poor decision-makers on the backs of the 70% who are able to think ahead. Instead, you find a way to address just the 30% and let the 70% go on making good decisions for themselves.

Although Rick and I were skeptical of Rand Paul’s plan before the text was available and still believe it needs to go further, it is certainly better than what the House GOP is offering with the American Health Care Act. It’s filled with details that put good decision-makers back in control of their own health care, which includes medical insurance in case they need medical treatment.  Check it out. https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf

Penalized for Offering High-Quality Coverage   4 comments

“Would you want to be a patron of a restaurant that didn’t want you as a customer?”  John C. Goodman, Health Economist

Obamcare set up incentives for health insurers to avoid the sickest people because they would not be able to charge for pre-existing conditions.

What? You didn’t know that?

Under the individual insurance that existed prior to Obamacare, beneficiaries could buy guaranteed-renewable health insurance. If they developed a condition while insured, they could still buy health insurance at a premium that applied to the whole pool they were a member of when they originally bought insurance. Insurers were required by contract to take them even if they developed a serious condition and they also had an incentive to treat everyone on the pool well because it was bad publicity that might cost them customers if they were seen to be discriminating against people in the pool.

The political rhetoric around the (un)Affordable Care Act made it seem like insurers could toss people off policies for developing serious diseases or charge them ridiculous prices, but this was not actually true. What Obamacare did do was say that insurers could no longer charge for pre-existing conditions. Only, they figured out a way to game the system, according to a study by Michael Geruso of the University of Texas, Timothy J. Layton of Harvard Medical School, and Daniel Prinz of Harvard University. Goodman describes this as “being the restaurant that turns away customers they don’t want.” ,

Here’s a portion of their abstract:

We first show that despite large regulatory transfers that neutralize selection incentives for most consumer types, some consumers are unprofitable in a way that is predictable by their prescription drug demand. Then, using a difference-in-differences strategy that compares Exchange formularies where these selection incentives exist to employer plan formularies where they do not, we show that Exchange insurers design formularies as screening devices that are differentially unattractive to unprofitable consumer types. This results in inefficiently low levels of coverage for the corresponding drugs in equilibrium.“Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges,” NBER Working Paper #22832, November 2016.

Cato Institute health economist Michael Cannon lays out some of the implications in a recent op/ed titled “How ObamaCare Punishes the Sick,” Wall Street Journal, February 28, 2017 (March 1 for print edition.)

A long excerpt:

Predictably, that triggers a race to the bottom. Each year, whichever insurer offers the best MS coverage attracts the most MS patients and racks up the most losses. Insurers that offer high-quality coverage either leave the market, as many have, or slash their coverage. Let’s call those losses what they are: penalties for offering high-quality coverage.

The result is lower-quality coverage–for MS, rheumatoid arthritis, infertility and other expensive conditions. The researchers find these patients face higher cost-sharing (even for inexpensive drugs), more prior-authorization requirements, more mandatory substitutions, and often no coverage for the drugs they need, so that consumers “cannot be adequately insured.”

The study also corroborates reports that these rules are subjecting patients to higher deductibles and cost-sharing across the board, narrow networks that exclude leading cancer centers, inaccurate provider directories, and opaque cost-sharing. A coalition of 150 patient groups complains this government-fostered race to the bottom “completely undermines the goal of the ACA.”

It doesn’t have to be like this. Employer plans offer drug coverage more comprehensive and sustainable than ObamaCare. The pre-2014 individual market made comprehensive coverage even more secure: High-cost patients were less likely to lose coverage than similar enrollees in employer plans. The individual market created innovative products like “pre-existing conditions insurance” that–for one-fifth the cost of health insurance–gave the uninsured the right to enroll in coverage at healthy-person premiums if they developed expensive conditions.

I would follow the link, because Cannon backs up his analysis with a lot of links. He also warns policy makers who are hesitant about repealing the pre-existing condition rules:

If anything, Republicans should fear not repealing ObamaCare’s pre-existing-conditions rules. The Congressional Budget Office predicts a partial repeal would wipe out the individual market and cause nine million to lose coverage unnecessarily. And contrary to conventional wisdom, the consequences of those rules are wildly unpopular. In a new Cato Institute/YouGov poll, 63% of respondents initially supported ObamaCare’s pre-existing-condition rules. That dropped to 31%–with 60% opposition–when they were told of the impact on quality.

Really, follow the links. Learn what’s really happening. Don’t accept the Wikipedia version of this debate.

The Media’s Fake News about Obamacare | Alyene Senger   Leave a comment

Leave it to the media, which spent the latter half of 2016 highlighting how outrageously expensive Obamacare premiums were becoming, to suddenly shift gears in 2017 and stress the health law’s many “pluses.”

Such was the case in a recent interview with Heritage President Jim DeMint, in which CNN anchor Carol Costello suggested that lawmakers would need to preserve the so-called benefits of Obamacare if they repealed it.

In Costello’s words:

For example, this is according to the nonpartisan Congressional Budget Office and the Federal Reserve in Dallas. Preventative care provided by Obamacare … saves money and health care costs overall. In 2015, the cost of health care services increased 0.5 percent. The typical price increase before Obamacare, it was around 3 to 4 percent. Obamacare will lower the deficit by $143 billion over the next 10 years. So, there are pluses to Obamacare. So, how do you keep the pluses and get rid of the minuses?

DeMint shot back that those “facts” could fall “under the category of fake news.” This set Costello off to correct him that the numbers had come from the Congressional Budget Office.

Well, here’s what the Congressional Budget Office actually said about the cost of preventative care in 2009:

“Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”

For Americans paying premiums, this year’s price increases speak for themselves. According to the Obama administration, on the exchanges, the average increase this year in the benchmark plan premium is 25 percent across the 39 states that use the HealthCare.gov platform. Certainly this cannot be considered a “plus,” even by the law’s most zealous supporters.

It is true that the Congressional Budget Office did originally say that the law would reduce the deficit, but that analysis was always based on questionable assumptions and the double-counting of Medicare savings.

Indeed, in 2014, the Senate Budget Committee went back and used the Congressional Budget Office’s same scoring conventions and found that Obamacare would increase the deficit by $131 billion over the next decade.

Americans now have fewer insurer options, higher insurance deductibles, and higher premiums than prior to Obamacare.

Although the details of this year’s repeal bill are not yet known, the Congressional Budget Office’s latest score of an Obamacare repeal—based on the reconciliation bill passed by the last Congress, which repealed the law’s major spending provisions and tax increases—was projected to reduce federal deficits by roughly $516 billion over the 2016-2025 period, accounting for the economic benefits that would result.

But on CNN, Costello wasn’t finished. “So, all those 20 million people enrolled in Obamacare, they’re all going broke and it’s not working for any of them?” she asked. Actually, 20 million is a debatable enrollment figure, given that it is based on survey data that can be off by millions of people.

Using actual insurer enrollment data, which is only available through the end of 2015, there was an increase in coverage of only 14 million Americans from 2013 to 2015, with the vast majority (11.7 million) being pushed into Medicaid coverage.

Moreover, the actual net increase in private coverage during this period was only 2.3 million due to a decline in employment-based coverage, which offset the increase in the individual health insurance market.

Furthermore, Costello forgot about all of the people (over 10 million) who purchase coverage in the individual market and receive no Obamacare subsidy. These people have been getting hammered by premium increases caused by Obamacare every year and have to pay the full cost on their own.

Costello asked, “How do you take care of people much better than they’re taken care of now?”

Considering that many Americans are now facing fewer insurer options, higher insurance deductibles, and higher premiums than prior to Obamacare, the need for real cost relief is immense.

The first step in providing relief is to quickly repeal the law and then do the legislative work that will allow for patient-centered reforms.

Source: The Media’s Fake News about Obamacare | Alyene Senger

Electoral Deja Vu   2 comments

This sort of looks like 2008 in reverse. Remember that was the year everyone got really upset with the sitting president and decided to elect an inexperienced half-term Senator to the presidency because we wanted to prove we weren’t racists.

Well, except for those of us who know we’re not racists and preferred someone else.

Image result for image of political slaveryNow we’ve got a political neophyte headed to the White House. The Senate is narrowly in Republican hands and the House is strongly in Republican hands. Almost exactly the opposite was true in 2008.

In 2009, Barack Obama told half the American populace to sit down and shut up because “elections have consequences”. He then jammed huge spending bills (and commensurate debt) down our throats and saddled us with a medical insurance system that will see all of us more broke and more unhealthy. Every time we protested, his followers insisted that those of us who don’t want to become Europe are old-fashioned and dying part of the country so we should be silent and just let them push our faces in the mud a little deeper. Socialism was the new future. “Shut up and take what’s good for you. We know better than you.”

Image result for election map 2008So now the electoral map looks a lot the same only red is the dominate color rather than blue. And what will President Donald Trump say? Sit down and shut up, elections have consequences? Let’s get together and make America great again?

I don’t know. Not a fan of Trump. But I did notice that he was very gracious in accepting Hillary’s concession. He said “we owe her a debt of gratitude for her service to our country.” I disagree with him on that as I disagree with him on so much, but let me suggest that Hillary (she of the “basket of deplorables”) would not have been so gracious.
I hope the Republicans take the next several weeks leading up to the inauguration to take some deep breaths and consider if they want 2017 to look like 2009 politically. Maybe they want to present a better vision for the United States, one in which the winning party is willing to listen to the losing party. I’m not saying they should allow the Democrats to keep their signature tyrannies or continue growing liberal policies, but that it might be a good idea to listen to them, to ask their opinion on how to implement the needed changes.

Image result for image of electoral map nov 9 2016We do need to make big changes — reduce/eliminate regulations, reduce spending, address the debt, make the military and the entitlement state much smaller — but that doesn’t mean that those who are opposed to such needed changes shouldn’t have a voice in how those changes are instituted.

Yes, elections have consequences, but it shouldn’t mean the enslavement of half the population to the dictates of those who won the election.

ColoradoCare Isn’t What it Seems   Leave a comment

Pierre-Guy Veer

Found on Fee

Image result for image of health care waiting listEvery few election cycles a proposition to have universal healthcare pops out. This year, Colorado voters will have to vote on Amendment 69, which would replace the present Affordable Care Act (aka Obamacare) provisions with a single public option; a kind of Medicare for all for the state.

At first, the proposition looks enticing. The present healthcare system is riddled with inefficiencies and high costs. Indeed, the U.S. spends 17.4 percent of its total GDP on healthcare; Canada is only at 10.2 percent despite universal healthcare. According tosupporters of the proposition, Coloradans would save $4.5 billion just during the first year thanks to lower bureaucratic costs, higher purchasing power thanks to bulk negotiations and less fraud. These claims are defended by the Canadian Union of Public Employees, even adding that fewer people die in a public healthcare system.

More Spending on Health, Less on Everything Else

However, by looking closely at the data one can doubt that Amendment 69 will save money in the long run. Healthcare expenditures are approaching 50 percent of the Quebec federal budget.Present trends inMedicaid – the universal healthcare program for low-income people – show that the program is taking a larger share of the states’ budgets. It therefore crowds out spending from other domains like transportation or even corrections.

Image result for image of health care waiting listSuch a crowding out is happening with universal healthcare. In the Canadian province of Quebec, nominal spending on the public healthcare system (through the Ministère de la Santé et des Service Sociaux) has increased 13.2 percent during the past 5 budgets, 46.6 percent during the past 10 years and 263 percent since the 1997-1998 budget.Excluding debt service, health care expenditures have gone from 37 percent of the budget 20 years ago to 49.6 percent of the budget. In other words, the Quebec government is becoming a huge ministry of health.

And since these healthcare expenditures are financed through general taxation – there is no dedicated tax unlike Medicare in the U.S. – the “free” care people received costs them about $12,000 a year for a family of three in Canada according to the Fraser Institute. The institute estimates that the real cost has increased nearly 48.5 percent for all households in 2015 in the past 10 years.

In Colorado, Amendment 69 proposes a $25-billion tax hike to pay for this program, which will be financed by a 10-percent payroll tax. Such a perspective discouraged Vermont to enact a similar measure just two years ago. Then-governor Peter Shumlin thought that “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

“Patients” Deserve their Names

The disruption of universal healthcare is just not economic; it’s also social.

In Quebec, despite spending all that money on health care – $33 billion for a province about as populous as New York City – waiting lists are growing. If one’s health is in immediate danger one will see a doctor as soon as one is available, but otherwise more populous regions will tend to have overcrowded emergency rooms – the only ones with physicians available on weekends. At the time of this writing, (October 21, 2016), Hôpital de l’Enfant-Jésus ER in Quebec City had an occupancy rate on the gurneys of 108 percent, with 4 patients waiting for at least 48 hours to get their own room. In Montreal, Hôpital général Juif is 200 percent full with 12 patients waiting for at least 48 hours.In order to cut on costs governments limit the number of patients doctors can see during a week.

Even for “medically necessary” procedures waiting lists test the patience of the people. The aforementioned Fraser Institute study found that, in 2014, the average waiting time for such procedures was 18.1 weeks compared to 9.3 weeks 20 years before. Those who can’t wait and can afford it will therefore travel abroad to seek the care they need. Or they will move and invite people to do the same, as Julie Lesage famously did to get the care her daughter might have never received – a doctor told her she would have a better shot in Houston, where she moved.

Why so much waiting despite a sharp increase in spending? It’s simple: in order to cut on costs, governments limit the number of patients doctors can see during a week. And they have to make a choice: either they work for the public system or they work in a private practice. They cannot do both; therefore many doctors (especially younger ones) are going into private practices. While this “migration” represents only about 2 percent of family doctors, 45,000 patients were still left without a “free” doctor.

This migration away from government-paid health care is also happening in the U.S. Since Medicaid only pays 60 percent of what private insurers will pay, more and morenew patients will likely have a hard time finding a doctor if Medicaid is their only means to pay. And with an aging doctor population (52 years old in 2014, compared to 50 in 2010) that will eventually retire, finding a doctor will become increasingly harder.

It would likely be even harder in Colorado. Since ColoradoCare would be financed through taxes there would have to be some limitations on healthcare spending so income tax brackets don’t look like Quebec’s – the highest marginal bracket is at 25.75 percent, and that’s not including the federal one at 29 percent. Therefore doctors’ reimbursement would be lower, likely creating dissatisfaction and a shortage.If competition works in markets for things like TVs and computers – both are cheaper andmore efficient – why can’t it work for healthcare? 

So if Coloradans want their fellow citizens to have access to better and cheaper healthcare, there is one simple solution: laissez-faire. By abolishing the monopoly of employment supported by the American Medical Association, by abolishing the thousands of pages of regulations on how and when to provide care, in short by letting market forces act as they should cost will very likely decrease.

If it works in (relatively) free markets like TVs and computers – both are cheaper and more efficient – why can’t it work for healthcare?Such a market is already expanding with concierge doctors – they deal directly with patients rather than through a third party like an insurance company. Costs are affordable for middle-class households – $4-5 per day – and, according to a peer-review study, their approach decreases hospitalizations.

Source: ColoradoCare Isn’t What it Seems

No, the Rest of the World Doesn’t Use ‘Single Payer’ | Eli Lehrer   Leave a comment

There’s plenty of reason for free marketers to be skeptical of proposals, like the ones emanating from Democratic presidential candidate Bernie Sanders and hinted at by Republican Donald Trump, that would create a single-payer healthcare coverage system in the United States.

But, if only because these proposals have resonance with the public, they’re certainly worth debating. A rational debate depends on getting the facts straight and there’s one fact that both left and right often get wrong: “single payer” healthcare of the sort Bernie Sanders proposes isn’t universal in the developed world and the US system isn’t particularly free-market by the standards of peer nations.

Although definitions vary slightly, a single payer healthcare system is one where a single entity — a government-run insurance plan — pays all bills for a variety of medical care, and private payment for these same services is more-or-less banned.

Source: No, the Rest of the World Doesn’t Use ‘Single Payer’ | Eli Lehrer

Trump Announced Health Plan   2 comments

And, it’s actually good. I don’t trust that’s what he’d actually do when in the office of President, but the promise sounds good.

Anyone with even a basic understanding of economics knows that the ACA is going to collapse under its own weight sooner rather than later. It appears to have been designed that way, probably to usher in fully socialized medicine and claim that manipulation is the “only way to save medical care in the United States.” Which is BS, but ….

So, I’m still not voting for him, but I will give him credit for this. His team should probably get credit for co-opting Ben Carson’s plan; I don’t see Trump actually having thought this through on his own. He’s more of a “big picture” thinker. Although I suppose it’s possible that he was listening in the debates when Ben Carson got to speak on the issue.

Five main points –

  1. Eliminates the individual mandate. Yay! For those of us who are healthy, being forced to spend thousands of dollars every year when we really only need to spend hundreds is draconian invasion into the lives of Americans. (I would note that Trump liked the mandate just a month or so ago during a CNN townhall.)
  2. Open insurance up across state lines. Yay! “As long as a plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state.” This creates competition which will drive insurance costs down and improve customer satisfaction. Going nationwide and providing price transparency worked for auto insurance in the 1980s.
  3. Tax deduction of insurance premiums. Poor people would now be able to afford their premiums. This was a Ben Carson idea, but it works.
  4. Health Savings Accounts that become part of individual estates and can be used by any member of a family. This allows the contributions to be passed on without being subject to the estate tax. This was another Ben Carson idea that I believe could eliminate insurance for most of the population.
  5. Federal block grants to states for Medicaid programs. Which would give states more discretion in spending and allow some innovative solutions. Alaska is not New York. “State governments know their people best and can manage the administration of Medicaid far better without federal overhead.” I still think this is an entitlement that is helping to drive federal and state debt and will eventually destroy the national economy, but it’s the current elephant in the medical office, so it did need to be addressed.

Trump also called for reforms that the presidency and Congress doesn’t really have control over — drug prices and mental health programs.

I hope he doesn’t, but I wonder how long it will be before Ben Carson speaks out in favor of Donald Trump’s health plan and throws his support behind Trump.

 

Posted March 3, 2016 by aurorawatcherak in politics, Uncategorized

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