Laszewski and Goodman on the ACA (Obamacare)

Robert Laszewski (http://healthpolicyandmarket.blogspot.com) and John Goodman (http://healthblog.ncpa.org) each have interesting posts about Obamacare today.

Laszewski asks, "Was Obamacare Worth It? How Many of the Previously Uninsured Have Really Signed Up?" He writes

Are enough people getting coverage who didn't have it before to justify the sacrifices the people who were already covered––in the individual, small group, and large employer market––are making or will make?

He asserts it is easy enough to get the data on how many people have insurance now that didn't have insurance before the ACA. Just ask the insurance companies. It is a piece of data many proponents of ACA seem singularly uninterested in knowing.

John Goodman's, "Why Contraceptives Are Important," would be more appropriately titled, "The Politics of Medicine." Goodman observes in any one year 5 percent of the population spends 50% of the healthcare dollars and 10 percent spend 70%.

Now suppose you are a Minister of Health. Can you afford to spend half of all health care dollars on 5 percent of the voters? (Even if they survive to the next election, they are probably too sick to get to the polls and vote for you anyway!) Can you afford to spend virtually nothing on the vast majority of voters just because they happen to be healthy?

The answer is clearly “no.” The inevitable political pressure is to skimp on care for the sick in order to spend on benefits for the healthy. Put differently, the politics of medicine pushes decision makers to underprovide to the sick in order to overprovide to the healthy.

In Goodman's opinion, this is why we ended up with a law that mandates

free contraceptives but leave people exposed for thousands of dollars of out-of-pocket costs if they need bypass surgery? 

It is unfortunate the Democrats are so deeply committed to this law they refuse to admit its failure.

Mend Obamacare. How?

For years the Democrats have complained the Republicans want to end Obamacare but have no plan to replace it. Personally, I don't think you need to have a replacement plan. We ended Prohibition, and just ended it. What replacement plan was needed? The irony now is some would like to mend Obamacare, not end it, but have very little in the way of solutions. 

In my opinion, there are many problems with Obamacare, but at its core, the biggest problem was identified by Bob Laszewski:

The biggest flaw is that the product the Obama administration is trying to sell to consumers is not the product people want to buy.

And the reason is, in my opinion, is because Obamacare is a top-down government-driven product instead of a bottom-up, market-driven product. It's driven by the idea if we assemble a bunch of smart people in a room they can create a system overnight to satisfy consumer demand. We see over and over again the failure of this idea. Think Russia, Cuba. Think Amtrak, the Post Office. Think SynFuels.

And we see over and over again how markets develop products consumers want and make both the consumer and producer better off. We have iPhone's because Steve Jobs thought he could do something better than Blackberries. And he was right. We have Androids because Samsung and Google thought there was demand for a non-Apple smartphone solution. And they were right. Obama wants us to buy Blackberries. We want iPhones and Droids.

I haven't heard or read one proposed solution or mend to Obamacare. Before the supporters do that, it would be useful for them to identify what they think the problems are they are trying to fix. I think the problems are this:
1) Consumers are not offered the choices they want at prices they are willing to buy in the Obamacare health care system. Losing your plan, losing your doctor are FEATURES of Obamacare, not bugs. Consumers look at higher deductibles, higher out-of-pocket expenses and narrower networks and rationally choose to not participate or complain they are being force to buy a product they don't want.
2) Obamacare does not understand the insurance market so has redesigned it as an income re-distribution scheme.
2) The consumption of health care is disintermediated from the purchase of health care.
3) Health insurance is tied to employment, and since it is tax-advantaged results in stagnating cash wages and over-consumption of health insurance and medical care.

I don't know what Obamacare's supporters think the problems are except: web site, Republicans and the Koch Brothers. Unfortunately for them, that diagnosis doesn't result in very effective or compelling solution.

Uber

I used Uber three times today. Ivan drove us from my daughter's to a restaurant. Ivan is from the Ukraine. His entire family is here now. He owns his own car and is a driver for a living. Uber is used to supplement his income.

Our next driver was Micah. He drove us from the restaurant back to my daughter's. He drives Uber at night as a way to supplement his income. He and his wife are expecting their first baby soon. He and his wife both work full time jobs but he wants to provide more for his family, so he drives Uber a couple nights a week.

Shegiye drove me from my daughter's back to my hotel near the airport. He is from Ethiopia. He has been in the US for 11 years and is now a citizen. Uber is a second job for him to supplement his income. He loves the US. "It is the best country in the world," he told me.

I love the stories I hear from the Uber drivers. People, many immigrants, just trying to make a better life for themselves and their family. Good people. Honest. Hard working. Devoted family people.

Technology and immigration has enabled them to be better providers for their families. And it has enabled me to spend time with my daughter. Whenever I hear the complaints of technology destroying the middle class or immigration making life more difficult for the natives, I shake my head. It does the exact opposite. It enables people, Ivan, Micah and Shegiye as producers, and me as a consumer to do more things, to live richer lives.

Harry Reid Jumps the Shark.

You probably thought Harry Reid jumped the shark when he said this:

Senate Majority Leader Harry Reid (D-Nev.) claimed Tuesday in an interview that Republican presidential candidate Mitt Romney refuses to release additional tax returns because he didn’t pay taxes for 10 years.

Reid recalled a phone call his office received about a month ago from “a person who had invested with Bain Capital,” according to The Huffington Post.

Reid said the person told him: “Harry, he didn’t pay any taxes for 10 years.”

“He didn’t pay taxes for 10 years! Now, do I know that that’s true? Well, I’m not certain,” Reid told HuffPo. “But obviously he can’t release those tax returns. How would it look?”

But I think this one is more shark-worthy

Senate Majority Leader Harry Reid (D-Nev.) on Thursday accused Republicans of holding up crucial assistance to Ukraine in order to protect the Koch brothers.

Here's the original Jumping the Shark

I really haven't decided if Harry Reid is an evil genius or a genuine dipshit.

What's A Moderate To Do?

Bill

Charlie Cook, the long term political observer and election handicapper, produced an insightful commentary in today's National Journal, the kind of left-of center publication that folks like me are fond of (in contrast say, to screeching screeds like Mother Jones or self-serving whiner fests like The Nation). Cook writes that gatherings like CPAC might make media headlines, but don't represent where large numbers of Republicans are at:

"But as the audience at the Conservative Political Action Conference became increasingly exotic, and began to represent an increasingly rarefied species of the conservative breed, the rhetoric correspondingly took on a flavor that would no longer be used in front of a “normal” Republican audience. And its value has diminished."

The problem is hardly confined to the Republicans. As Cook observes:

"Of course, all of this is true to a certain extent for Democrats as well. I don’t believe the Democratic Leadership Council is active any longer, either. This council was a highly constructive group of moderate and pro-business Democrats, headed by the irrepressible Al From, and it used to be a major political force."

The absence of a forum for moderates on either side to gather means that true believers control the argument:

"... the extremes in both parties inevitably have more energy and passion than the more moderate factions. At various times, strong personalities (such as From’s within the DLC) and highly organized and well-funded entities have tried to advance the ball closer to the ideological area inhabited by swing voters. Yet each party is still stuck in their red zones, between the goal line of extremism and the 20-yard line of hard-core ideology."

And this state of affairs turns off voters in the middle:

"It seems increasingly clear that many moderate voters simply don’t view issues and candidates through an ideological lens. They stand behind the plate like a baseball umpire, deciding whether each proposal or candidate makes sense to them, whether they believe that proposal or candidate would be good for them. These voters—remember they constitute about 41 percent of the electorate—react negatively, and may actually recoil, when they hear overheated rhetoric from either side."

So if you like this state of affairs, rejoice. It's likely to continue for a while. It's pretty clear however, that most Americans don't.

Eli

The 4th Amendment for Me, But not for Thee

Diane Feinstein has found the fourth amendment:

Senate Intelligence Committee Chairwoman Dianne Feinstein (D-Calif.) accused the CIA on Tuesday of searching her committee’s computers.

 and

Feinstein said the search may have also “violated the Fourth Amendment.”

Excellent, she has discovered there really is such a thing as the fourth amendment. But I guess it only matters to her when HER fourth amendment rights are violated. But it's a positive step.

Mend It, Or End It?

Bill,

As an observer who is deeply unhappy with Obamacare, you have a lot of company. The law is deeply and persistently  unpopular with a majority Americans, who dislike it for a variety reasons. Some of those reasons are grounded in practical self interest, some in (understandable) resentment that someone is getting something from the government that they are paying for, some in ideology. Enmity for the law is likely to make itself widely felt at the ballot box this fall, when many observers predict a Republican takeover of the Senate and expanding majority in the House.

Any attempt to fix the ACA (a solution that a majority of the Americans also favor),  seems unlikely. The very idea of government assisted healthcare  was (and is) vociferously opposed by the right. At a time when a great deal could have been done to improve it. the inability to reconcile the House and Senate  versions after Scott Brown's election ensured that the unimproved version would prevail. The overconfidence of Democratic policy makers went unchecked, and the result is unhappiness all round

If Republicans take the Senate we will surely get an endless series of votes for repeal.  The President just as surely will veto any attempt to erase his signature legislation. Any effort  to actually make the thing better will be cynically avoided with the usual preening and posturing. Yet another vital task (improving the nation's dysfunctional healthcare system) will be avoided as we careen towards  2016.

This of course, is the way we like our government.

Eli.

That's not a data point that we are really collecting in any sort of systematic way

National Journal reports:

Gary Cohen, the soon-to-be-former director of the main implementation office at the Health and Human Services Department, stopped by an insurance industry conference Thursday to offer an update on enrollment. 

As I see it, Obamacare made four fundamental promises:
1) You can keep your plan.
2) You can keep your doctor.
3) Insurance premiums will decline
4) The uninsured will become insured.

The first three have been shown to be false.  The fourth promise seemed like the easiest one to meet. But even here the law is falling short. And according to Cohen, it seems like the administration doesn't care that much on counting those who become insured.

Again from the National Journal:

The Congressional Budget Office estimates that the health care law will reduce the number of uninsured people by about 24 million over the next few years, and that about 6 million previously uninsured people will gain coverage through the law's exchanges this year. So, is enrollment on track to meet that goal? Overall enrollment is looking pretty decent, but how many of the people who have signed up were previously uninsured?

"That's not a data point that we are really collecting in any sort of systematic way," Cohen told the insurance-industry crowd on Thursday when asked how many of the roughly 4 million enrollees were previously uninsured. 

The State of NY estimates 70% of its enrollees were not covered before, which seems like a number to brag about. So why would the Feds not even bother to collect in any sort of systematic way the number of enrollees who were previously not insured?

I come back to Walter Russell Mead's assessment of the ACA, The roll out of Healthcare.gov was "an act of incomprehensible incompetence," of a law that was "an ugly piece of garbage." It's a close call which is more horrible, the incompetence or the garbage.

Obama Figures Out How You CAN Keep Your Plan

The White House has figured out how to allow consumers to keep their insurance plans: Delay Obamacare.

From  TheHill.com

The White House on Wednesday announced a new ObamaCare delay that will allow some consumers to keep health plans that do not meet the law's standards until past the end of the Obama presidency.

Those are the same junk plans from a few months ago. If the junk plans are better than the alternatives, does that make the alternatives junkier?

Bob Laszewski, as usual, has an interesting view on the matter

All of these delays are just tinkering around the edges of a law that is deeply flawed.

The biggest flaw is that the product the Obama administration is trying to sell to consumers is not the product people want to buy.

Rejiggering deadlines until this thing is contorted like a pretzel is exactly the wrong thing to do.

Obamacare needs a fundamental fix. 

I have to believe that even its most ardent supporters are coming to that realization.

I agree with Bob, except for that last sentence. Even the most ardent supporters will never come to the realization their baby is stillborn. See Ezekial Emanuel for Exhibit 1.

He describes the program, often referred to as Obamacare, as “a world historical achievement, even more important for the United States than Social Security and Medicare have been.”

One in Three Hurt by ACA. Reid Calls Them Liars. Biden Says No Apologies.

From a Rasmussen poll:

Thirty-three percent (33%) now say their insurance coverage has changed because of the new law, up a point from January  and the highest finding since last July. 

Seventy-four percent (74%) of those who have health insurance rate their coverage as good or excellent. 

Just 14% of all voters now say they personally have been helped by the law, down from 16% in January. Thirty-three percent (33%) say they have been hurt by the law, up from 29% earlier this year and the highest negative rating since April 2013. Fifty percent (50%) say it has had no impact on them.

Senate Majority Leader Harry Reid (he of the party that has compassion, looks out for the little guy and the middle class. He of the party of science and logic and reason. He of the sane party) has a different opinion.

“Despite all that good news, there’s plenty of horror stories being told. All are untrue, but they’re being told all over America.”

He identifies the Koch Brothers as a source of these lies, calls them un-American also. Lies, damn lies and the Koch Brothers?

So if all the stories being told about the ACA are lies, why bother apologizing?

“I think we should not apologize for a single thing,” Biden said, calling on Democrats to tell voters, ”this is who we are. This is who we stand for. This is what we do.”

This is who we are: You can't keep your plan. This is who we stand for: You can't keep you doctor. This is what we do: premiums will decline.

And if you disagree? You are a liar, and un-American. The party of science, compassion, logic and reason. Right.