HealthCare.fail

Declaring Victory! - Tom Maguire

We have something else for which to be thankful this weekend - Team Obama claims to have won their recent battle against HealthCare.fail:

WASHINGTON — The Obama administration said on Sunday that it had met its goal for improving HealthCare.gov so that the website now “will work smoothly for the vast majority of users.”

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Left unanswered - whom do they imagine they are kidding? Reality will overtake their BS quite quickly, and the legacy media seems to have put down the pom-poms and embraced the notion that there is a real problem here.

Obamacare's architects plugged their ears and misled public - Michael Barone

Central to the goal of Obamacare's architects, universal health insurance, was preventing the possibility of exit. Its individual mandate meant everyone had to sign up for insurance.

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If Obamacare's architects were keen on preventing exit, they blithely ignored voice. The legislation was unpopular when it was proposed, while it was passed and in the months and years afterwards.

Barack Obama seldom mentioned it in the 2012 campaign except for the provision allowing “children” under 26 to stay on mommy and daddy's policies.

The architects of Obamacare also had to deal with loyalty.

Polls have consistently shown that about 80 percent of Americans are satisfied with their health insurance and doctors. They have chosen each at one point or another and were not eager to change absent some serious aggravation.

Indemnity! Whiskey! Sexy! - James Taranto

One reason medical policies are so expensive is that their purpose is twofold. They provide not just indemnification against risk--that is, true insurance--but also payment for routine expenses. You can't buy medical "insurance" without buying an expensive service contract. That was true to some extent before ObamaCare. But that law makes the package more expensive for everybody by mandating both more services and "free" ones, and more expensive for the young in particular by jacking up their rates so as to subsidize higher-risk policyholders.

At the same time as ObamaCare raises the cost of having insurance, it reduces the risk of going without insurance--the reason why doing so "sucks!" As blogger Michael Eades points out, lacking insurance no longer makes you uninsurable. If you pass up insurance in 2014 and are diagnosed with a serious condition, you may face burdensome out-of-pocket expenses--just as you would have before. But ObamaCare promises that you'll be able to buy insurance in 2015, and at the same price as if you were still healthy.

Dr. Ben Carson on Obamacare

Dr. Benjamin Carson Addresses National Prayer Breakfast, Criticizes Obamacare - Real Clear Politics

DR. CARSON: Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account to which money can be contributed -- pretax -- from the time you're born 'til the time you die. When you die, you can pass it on to your family members, so that when you're 85 years old and you got six diseases, you're not trying to spend up everything. You're happy to pass it on and there's nobody talking about death panels.

Obamacare Ripple Effect

Remember all of those promises about being able to keep your current coverage under Obamacare? It was just baloney.

Firms to cut health plans as reform starts: survey 30% of companies say they’ll stop offering coverage - Russ Britt,

Once provisions of the Affordable Care Act start to kick in during 2014, at least three of every 10 employers will probably stop offering health coverage, a survey released Monday shows.

While only 7% of employees will be forced to switch to subsidized-exchange programs, at least 30% of companies say they will “definitely or probably” stop offering employer-sponsored coverage, according to the study published in McKinsey Quarterly.

The survey of 1,300 employers says those who are keenly aware of the health-reform measure probably are more likely to consider an alternative to employer-sponsored plans, with 50% to 60% in this group expected to make a change. It also found that for some, it makes more sense to switch.

Obamacare in Court

Obama solicitor general: If you don't like mandate, earn less money - Philip Klein

President Obama's solicitor general, defending the national health care law on Wednesday, told a federal appeals court that Americans who didn't like the individual mandate could always avoid it by choosing to earn less money.

Neal Kumar Katyal, the acting solicitor general, made the argument under questioning before the U.S. Court of Appeals for the Sixth Circuit in Cincinnati, which was considering an appeal by the Thomas More Law Center. (Listen to oral arguments here.)

Jobs and Migration

Why New York's future is fleeing - Fred Siegel

For more than 15 years, New York state has led the country in domestic outmigration: For every American who comes here, roughly two depart for other states. This outmigration slowed briefly following the onset of the Great Recession. But a recent Marist poll suggests that the rate is likely to increase: 36 percent of New Yorkers under 30 plan to leave over the next five years. Why are all these people fleeing?

For one thing, according to a recent survey in Chief Executive, our state has the second-worst business climate in the country. (Only California ranks lower.) People go where the jobs are, so when a state repels businesses, it repels residents, too.

Indeed, the poll also found that 62 percent of New Yorkers planning to leave cited economic factors -- including cost of living (30 percent), taxes (19 percent) and the job environment (10 percent) -- as the main reason.

Upstate, a big part of the problem is extraordinarily high property taxes. New York has the country's 15 highest-taxed counties, including Nassau and Westchester, which rank Nos. 1 and 2.

Most of the property tax goes toward paying the state's Medicaid bill -- which is unlikely to diminish, since the state's most powerful lobby, the alliance of the hospital workers' union and hospital management, has gone unchallenged by our new governor, Andrew Cuomo.

Controlling Medical Costs

Obama’s Medicare Appointee Has Accidental Encounter with Reality, Learns Nothing - Dan Mitchell

To explain, let’s start by looking at why relative prices are falling for computers, cars, TVs and telephones. This isn’t because the companies that make these products are motivated by selflessness. Like all producers, they would love to charge high prices and get enormous profits. But because they must compete for consumers who are very careful about getting the most value for their money, the only way companies can earn profits is to be more and more efficient so they can charge low prices.

So why isn’t this happening in health care? The answer, at least in part, is that consumers aren’t spending their own money so they don’t really care how much things cost. As this chart illustrates (click to enlarge), only 12 percent of every healthcare dollar is paid directly by consumers. The rest comes from third-party payers, mostly government but also insurance companies.

In other words, Berwick’s column accidentally teaches us an important lesson. When consumers are in charge and responsible for paying their own bills, markets are very efficient and costs come down. But when government policies cause third-party payer, consumers have little if any incentive to spend money wisely – leading to high costs and inefficiency.

Government Handouts

Government Cash Handouts Now Top Tax Revenues - Elizabeth MacDonald

U.S. households are now getting more in cash handouts from the government than they are paying in taxes for the first time since the Great Depression.

Households received $2.3 trillion in some kind of government support in 2010. That includes expanded unemployment benefits, as well as payments for Social Security, Medicare, Medicaid, and stimulus spending, among other things.

But that’s more than the $2.2 trillion households paid in taxes, an amount that has slumped largely due to the recession, according to an analysis by the Fiscal Times.

Also, an estimated 59% of the 308.7 million Americans in this country get at least one federal benefit, according to the Census Bureau, based on 2009 data. An estimated 46.5 million get Social Security; 42.6 million get Medicare; 42.4 million get Medicaid; 36.1 million get food stamps; 12.4 million get housing subsidies; and 3.2 million get Veterans' benefits.

And the handouts from the government have been growing. Government cash handouts account for a whopping 79% of household growth since 2007, even as household tax payments--for things like the income and payroll tax, among other taxes--have fallen by $312 billion.

Obamacare in the Courts

Florida Judge Rules Obamacare Unconstitutional - John Hinderaker

Federal district court judge Roger Vinson issued his ruling today on summary judgment motions in the Florida case, State of Florida v. United States Department of Health and Human Services, in which 26 states allege that Obamacare is unconstitutional. Judge Vinson agreed with their arguments and granted summary judgment in favor of plaintiffs.

Judge Vinson's ruling evens the score at 2-2; two federal courts have upheld the act against constitutional challenges, while two have now found it to be invalid. The ultimate decision will be made, of course, by the Supreme Court, some time in the next few years.

Judge Vinson held that the Commerce Clause cannot be stretched so far as to require individual Americans to buy health insurance approved by the government. This conclusion may not seem surprising to those who simply read the clause--It gives Congress the power "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes"--but beginning in the 1930s, broad interpretations of the clause have greatly expanded federal powers. Still, Judge Vinson was certainly correct in saying that "Never before has Congress required that everyone buy a product from a private company (essentially for life) just for being alive and residing in the United States."

Florida Ruling Requires Government to Stop Implementing Obamacare - Ilya Shapiro

As I continue digesting Judge Vinson’s ruling, I notice two key things beyond the facts that the “individual mandate is unconstitutional”:

1. In performing his severability analysis — determining which parts of the overall legislation survive — the judge threw out all of Obamacare.

2. In discussing whether to issue an injunction – a judicial command to do or refrain from doing something — the judge determined that his declaratory judgment in this context was the same as an injunction. That is, a federal court saying that a piece of legislation is unconstitutional is effectively the same as a decision mandating the government to act.

A judicial drubbing for Obamacare - Washington Examiner Editorial

In a rigorously reasoned decision that seemed to delight in turning the government's arguments on their head, U.S. District Court Judge Roger Vinson on Monday struck down as unconstitutional President Obama's signature legislative achievement, the Patient Protection and Affordable Care Act, aka Obamacare. In the suit brought by 26 states, Vinson found that "Congress exceeded the bounds of its authority" by including the individual mandate and held the entire act unconstitutional "because the individual mandate is unconstitutional and not severable" from the rest of the law. Vinson, who was appointed by President Reagan to the U.S. District Court in the Northern District of Florida in Pensacola, even tweaked Obama, pointing out in a concluding footnote that the president whose name is forever linked to the measure had backed a health care reform bill without an individual mandate when he was in the Senate. Vinson quoted then-Senator Obama as saying in 2008 that "if a mandate was the solution, we can try that to solve homelessness by mandating everybody buy a house."

Vinson said the government even conceded that its interpretation of the Commerce Clause to support the individual mandate "breaks new legal ground" and is "unprecedented." He concluded, "If it has the power to compel an otherwise passive individual into a commercial transaction with a third party ... it is not hyperbolizing to suggest that Congress could do almost anything it wanted. It is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place."

A moratorium needed for Obamacare until its constitutionality is decided - Tom Fitton

President Obama's signature legislative "achievement" plunged deeper into legal limbo Monday with a decision by a Florida federal judge ruling the entire law unconstitutional. This follows the Dec. 13 Virginia court invalidation of the central component of the president's health care reform law requiring individuals to buy health insurance.

Both decisions hinged upon the constitutionality of the individual mandate. This individual mandate "exceeds the boundaries of congressional power" and would "invite unbridled federal police powers," U.S. District Judge Henry E. Hudson wrote in his 42-page December opinion.

How important is this mandate to Obama's health care reform law, or Obamacare, as it is widely known?

"Without an individual responsibility provision (or mandate), controlling costs and ending discrimination against people with preexisting conditions doesn't work," wrote Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius in an editorial published in the Washington Post the day after Judge Hudson's decision.

All Your Thoughts Are Belong To U.S. - William A. Jacobson

That seems to be the import of the ruling by federal Judge Gladys Kessler in upholding the Obamacare mandate in a suit brought by a group of private plaintiffs in Mead v. Holder (pg. 45, emphasis mine):

As previous Commerce Clause cases have all involved physical activity, as opposed to mental activity, i.e. decision-making, there is little judicial guidance on whether the latter falls within Congress’s power....However, this Court finds the distinction, which Plaintiffs rely on heavily, to be of little significance. It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not “acting,” especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality.

Our thoughts are now actions. There literally is nothing the federal government cannot regulate provided there is even a hypothetical connection to the economy, even if the connection at most is in the future.

ObamaCare - April 2010

The coming primary-care physician shortage under ObamaCare - Ed Morrissey

Reimbursement rates aren’t so much the problem as the reimbursement system itself — especially for standard health-care delivery. The third-party payer system interferes with the normal pricing mechanism that allows supply to meet demand and on-time delivery. The more that primary-care business depends on arbitrary reimbursement rates at all, the less likely that doctors will choose to meet that demand, instead selecting other disciplines where their services get compensated more honestly and appropriately.

We’re about to make the problem worse by creating an even greater artificial shortage of providers than we currently have. That won’t help the people that ObamaCare purports to serve, and will only make it worse for the rest of us.

What’s the Best Fix for Health Care? - Scott Rae

Well, first of all, I’m not in favor of the government taking it over. In my view, that’s a cure that’s worse than the disease. I think that there are some fairly simple things that can be done that can make a big difference. First, there is no reason why insurance companies shouldn’t be allowed to compete across state lines. That would go a ways toward bringing the cost of insurance down. Second, the law should change so that all medical savings accounts roll over year after year — allowing for a long-term savings account rather than an annual account. There are some states where they do allow that, but we need to make that universal across the country. Third, I think we need to reconfigure how we view insurance. I don’t expect my auto insurance to pay for oil changes and tire rotations and alignment. But I do expect my auto insurance to pay for major accidents, acts of God, that kind of thing.

The combination of medical savings accounts that roll over and competition for higher-deductible insurance that would protect people from catastrophes would go a long way toward controlling the costs. Part of the thing that keeps the costs inflated is that somebody else is paying for it. I would do all sorts of things for my car if somebody else was paying for it, but I don’t because I’m paying for it. I think taking the third-party payer out of it to some degree would bring incentives back to individuals to ration care for themselves. The other thing — and this is not a simple thing — but the tort system where people can basically win the lottery through malpractice lawsuits has to be changed. Doctors won’t stop practicing defensive medicine until that’s changed. I would favor some sort of cap on malpractice settlements.

Oh, THOSE Death Panels! - John Hinderaker

The New York Times explains the thinking behind Obamacare:

The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.

But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care. ...

From an economic perspective, health reform will fail if we can't sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare's long-term budget deficit will grow.

James Taranto adds:

Having taken on, over the objections of the public, the responsibility for everyone's medical care, the federal government may not be able to keep its promise: "Eventually, we may well have to decide against paying for expensive treatments with only modest benefits."

Oops, sorry about that, Gramps!

It seems as though this is a pretty strong argument against ObamaCare. But we need to encapsulate it in a pithy phrase. What would you call governmental institutions that empower bureaucrats to decide when to deny medical treatment--panels, as it were, that have the authority to determine when a patient's death is necessary for the health of the fisc?

ObamaCare - March 2010

ObamaCare’s Immediate Impact - Brad Warbiany

So there you have it, folks. Of 18 highlighted points, most or all of them will increase payments made by government or increase health insurance premiums. This is “bending the cost curve”.

Not Yours to Give - U.S. Rep. (TN) David Crockett

The power of collecting and disbursing money at pleasure is the most dangerous power that can be entrusted to man, particularly under our system of collecting revenue by a tariff, which reaches every man in the country, no matter how poor he may be, and the poorer he is the more he pays in proportion to his means. What is worse, it presses upon him without his knowledge where the weight centers, for there is not a man in the United States who can ever guess how much he pays to the government. So you see, that while you are contributing to relieve one, you are drawing it from thousands who are even worse off than he. If you had the right to give anything, the amount was simply a matter of discretion with you, and you had as much right to give $20,000,000 as $20,000. If you have the right to give to one, you have the right to give to all; and, as the Constitution neither defines charity nor stipulates the amount, you are at liberty to give to any and everything which you may believe, or profess to believe, is a charity, and to any amount you may think proper. You will very easily perceive what a wide door this would open for fraud and corruption and favoritism, on the one hand, and for robbing the people on the other.

The Parable of the Satellite Dish - Doctor Zero

Here are some lessons to ponder from the Parable of the Satellite Dish:

Never accept permanent solutions that are nearly impossible to change, when simpler and more easily modified plans are available. It’s foolish to let the advocates of permanent programs dismiss flexible alternatives before they have been tried.

A proposal that requires you to ignore both the past and the future is a swindle, not a solution.

Free people do not accept restrictions from which their government is exempt. This is one of the differences between leaders and rulers.

A demand for commitment without a guarantee of performance is domination, not service.

When free people are told something is “inevitable,” their response should be an immediate and overwhelming refusal to accept it. Inevitability is a self-fulfilling prophecy in the absence of resistance. Freedom is the never-ending quest for alternatives.

The people who loudly celebrate “diversity” keep coming up with universal plans. Their State is a giant who trims citizens to fit its bed, using rusty implements. The giant, the bed, and the implements were all equal sins in the eyes of our Founders. They come as a set.

When the State refuses to let you debate the terms of its plans individually, you can rest assured the whole is worse than the sum of its parts.

Freedom requires the courage to avoid being stampeded. You should ask more questions about something you are told is an “essential right.” Sober reflection is a hallmark of maturity. A wise State would not require its citizens to act like children.

The State cannot give you anything worth having. You’ll eventually find yourself guilty of the crime of wanting more. As the State fails to live up to its promises, it will be increasingly tempted to convict you of that crime… in advance.

Interestingly, a commenter criticized the parable because "you cannot equate entertainment with health care services", but that is entirely beside the point. The purpose of the parable is not to prove that health care and entertainment are equivalent. One certainly is much more important than the other. Rather the point is that if free citizens have the right to make free decisions about a relatively unimportant issue, like entertainment, then they certainly should have that right for more important matters, like health care. And furthermore, under the Constitution the government has no right to take that freedom away.

Hospital wards to shut in secret NHS cuts - Jon Swaine and Holly Watt

Last year all English health authorities were ordered by Sir David Nicholson, the NHS chief executive, to reconsider their plans after the recession forced the Government to freeze health spending from April next year.

This left a ''black hole’’ of up to £20 billion in health budgets up to 2014, prompting the drawing up of new proposals by the 10 strategic health authorities (SHAs).

They had until Friday to submit their plans to Andy Burnham, the Health Secretary. He is under pressure from the Treasury to show how money will be saved to help bring down Britain’s record £167 billion deficit.

O-Care - A Good Government Advocate's Nightmare - cleangovernmentnow.org

The essence of O-Care is quite simple: Health insurance is now an arm of the federal government by virtue of extensive federal regulation of the terms, conditions and comparative rates health insurers can offer. The law tells insurers how to run their business and then offers to pick up the cost where conditions prove uneconomic. Hmmmm. If this all sounds a little dodgy, your instincts are correct. We tried this kind of experiment in housing with Fannie Mae and Freddie Mac, which were pressed to buy non-economic sub-prime loan dressed up to look respectable via bundling and shaky insurance.

This secondary market "nudge" by the government was a major reason for the bubble and subsequent collapse of the financial system under the weight of $2T of bogus AAA securities. Expect similar results from health insurers who will look a lot like the housing Government Sponsored Entities (GSEs) going forward. Fannie Mae and Freddie Mac started with a modest mission of helping first time home buyers and morphed into near monopolies in the residential home market.

It gets even worse with O-Care. Housing is real property with an underlying intrinsic value. Medical expenses are consumer expenditures. Extensive regulation will mean only a few "too big to fail" mega-insurers are likely to survive. With fewer competitors, the prices go only one direction: UP. Americans will not put up with rationing, and they have come to expect the best care in the world, so any pretense of cost controls is just that: pretense. O-Care only expands the cancerous dynamics of the third party payer and creates more of a sense of entitlement to be paid for by the ever diminishing "other guy".

Non-Enforcement: A Feature Or A Bug? - John Hinderaker

Quite simply, Obamacare has created a ticking time bomb for the insurance industry. Those with preëxisting conditions will be covered.....and demand continuation of the coverage at prescribed rates....and those who ignore the mandate, presumably anybody at all affected by it, face no consequences. As costs spiral out of control, premiums will have to rise and subsidies increase. Insurance companies would have to either fold or shift costs....to those covered by employers....becoming a perfect target for left wing demagoguery and vilification. The only way out as more and more of those covered by employers get pushed into the exchanges as costs get shifted to them and employers no longer offer insurance -- yet another intended consequence -- is the public "option" or outright nationalization through a single payer plan.

What's the Fuss?

The U.S. House of Representatives passes the health care bill. What's the problem? We're the richest and most powerful economy in the world. Certainly we can afford to help everyone get the medical care they need. Right?

Actually not. Take a look at The U.S. Debt Clock. This handy little page includes convenient boxes listing the U.S. National Debt (currently approaching $12 trillion) and the number of U.S. Taxpayers (currently about 108 million). But the real kicker is the total U.S. Unfunded Liabilities. This is the amount of future obligations for Social Security and Medicare which the U.S. government has taken responsibility for, but does not have the ANY money set aside to cover (hence the term "unfunded").

Folks, the current U.S. Unfunded Liabilities is a whopping $106 trillion. Yes, that's "trillion" with a 'T'. That future obligation represents a knee-buckling $1,000,000 per taxpayer. This is madness. The current total national assets is only $74 trillion. So we are already obligated 50% above our current assets.

And it's in this sort of economic situation that our Representatives in Washington have voted to saddle U.S. taxpayers to even more trillions in obligations. We are promising benefits which cannot be delivered while simultaneously burdening future generations with expenditures they cannot afford.