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Author Topic: The Politics of Health Care  (Read 194492 times)
Crafty_Dog
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« Reply #1000 on: December 03, 2012, 11:57:17 AM »

"To be clear, Republicans didn't lose the health care debate in 2009 or 2012. They lost it during the Bush era, when Republicans came to power and failed to advance free market solutions. Unlike issues like guns or taxes, there isn't a strong activist community on the right built around health care. Such activism has only traditionally been created on an ad hoc basis to respond to Democratic efforts to expand the role of government, as with Hillarycare in 1993 and 1994, and Obamacare. As long as Republicans failed to address problems with the health care system, it was inevitable that at some point Democrats would realize their dream of national health care. ... In the coming years, it will be important for conservatives and Republicans to avoid making the same mistake again. Though it's now inevitable that Americans will experience Obamacare, the battle over the future of the health care system is far from over. At some point in the future, liberals will be arguing that any ongoing problems with the health care system are a result of Democrats leaving the private sector with too much control. They'll be renewing their push for a 'public option,' with the ultimate goal of achieving single-payer health care. And if Republicans don't present compelling alternatives, that's exactly where America will end up." --The Washington Examiner's Philip Klein
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G M
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« Reply #1001 on: December 03, 2012, 04:54:35 PM »

They'll be renewing their push for a 'public option,' with the ultimate goal of achieving single-payer health care. And if Republicans don't present compelling alternatives, that's exactly where America will end up." --The Washington Examiner's Philip Klein

We'll have crashed the dollar before we get there.
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Crafty_Dog
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« Reply #1002 on: December 03, 2012, 04:58:47 PM »

Entirely possible GM, but Klein's point remains.  The Reps have been quick chicken excrement about standing up for free market solutions.
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G M
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« Reply #1003 on: December 03, 2012, 05:02:48 PM »

Yes, but the bigger problem is the emergence of the Looters and Moochers as the dominant force in American politics.
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Crafty_Dog
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« Reply #1004 on: December 03, 2012, 05:15:11 PM »

Well, part of defeating the looters and moochers requires making the case for Free Minds and Free Markets-- which is the point that Klein is making with regard to the cowardly Reps with regard to the health care market.
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G M
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« Reply #1005 on: December 03, 2012, 05:17:10 PM »

Gee, all we need to do is fix generations of indoctrination from the schools, universities and MSM.


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Crafty_Dog
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« Reply #1006 on: December 03, 2012, 05:18:20 PM »

No one ever said keeping the free republic our Founding Fathers gave us would be easy!
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Crafty_Dog
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« Reply #1007 on: December 14, 2012, 12:33:42 AM »

It's a Mad, Mad, Mad, Mad ObamaCare
The law's implementation is turning into one pratfall after another. .

For sheer political farce, not much can compete with ObamaCare's passage, which included slipping the bill through the Senate before dawn three Christmas eves ago. But the madcap dash to get ready for the entitlement's October 2013 start-up date is a pretty close second.

The size and complexity of the Affordable Care Act meant that its implementation was never going to easy. But behind the scenes, even states that support or might support the Affordable Care Act are frustrated about the Health and Human Services Department's special combination of rigidity and ineptitude.

To take one example, for the better part of a year states and groups like the bipartisan National Governors Association and the National Association of Medicaid Directors have been begging HHS merely for information about how they're required to make ObamaCare work in practice. There was radio silence from Washington, with time running out. Louisiana and other states even took to filing Freedom of Information Act requests, which are still pending.

Now post-election, new regulations are pouring out from HHS—more than 13,000 pages so far and yet nuts-and-bolts questions are still unanswered. Most of what we know so far comes from a 17-page question-and-answer document that HHS divulged this week, though none of the answers have the force of law and HHS says they're subject to change at any moment.

HHS is generally issuing rules with only 30 days for public comment when the standard is 60 days and for complex regulations 90 days and more. But the larger problem is that HHS's Federal Register filings reveal many of the rules were approved in-house and ready to go as early as May. Why the delay?

To take another example, the feds are building a data hub to determine who is eligible for Medicaid and ObamaCare's "exchanges," the bureaucracies that will dispense insurance subsidies and police the market. Many states have cut administrative costs by combining the application process for Medicaid, food stamps, cash assistance and other antipoverty programs, but HHS's privacy rules say the hub can only be used for ObamaCare. So HHS will force states to become less efficient and flatly refuses to reconsider.

In a word, HHS is treating the states not as the partners it needs to give ObamaCare any chance of success, but as serfs.

HHS did finally if "conditionally" approve the exchange blueprints of six states this week, though it has yet to release any formal objective standards for conditional approval. Some 24 states are refusing to participate, so the agency will be running a federal fallback exchange that it won't reveal how it will operate.

A federal exchange is a vast undertaking. The clearinghouses will be open to the uninsured but also to small businesses and people who already buy plans on the individual market. On average about a quarter of a state's population are expected to at least browse the exchange options, and the share will be far higher in states with large numbers of uninsured people under 65, like New Mexico (24%), Georgia (22%) and Texas (27%).

If 20% of Americans use exchanges, that's 62 million people. At a House Energy and Commerce hearing on Thursday, ObamaCare point man Gary Cohen all but took the Fifth on how he'll deal with this and other challenges.

The exchange naysayers now notably include Chris Christie of New Jersey and Bill Haslam of Tennessee. Sure, they're Republicans, but both Governors flirted with the idea and wanted to participate if it would result in a saner and more rational marketplace. The costs and risks were too high.

HHS also declared this week that states can decide either to expand Medicaid (after the Supreme Court decision made it optional), or not. But states are not allowed to make the partial expansion that many states would have considered. This all-or-nothing political gambit is meant to put the Governors in a bad political spot at home if they don't expand, but the irony is that many of them would participate if HHS gave them more flexibility to manage their own programs and control costs.

Yet HHS has made it almost impossible to qualify for Medicaid waivers. States aren't even allowed to "go green" by using digital instead of paper applications. These "maintenance of effort" rules weren't carved in stone tablets by LBJ. HHS formalized them in a regulation this February.

***
In other implementation hilarity, no fewer than 18 Democratic Senators and Senators-elect came out last week against ObamaCare's $28 billion tax on medical device sales—and not just the usual penitents from Massachusetts and Minnesota. The list includes Chuck Schumer, Dick Durbin and Patty Murray.

"With this year quickly drawing to a close, the medical device industry has receive little guidance about how to comply with the tax—causing significant uncertainty and confusion for businesses," they write about the tax most of them voted for.

The last entitlement to get off the ground was President Bush's Medicare prescription drug benefit. Those rules were tied up with a bow by January 2005, giving business and government nearly a year to prepare—and that was far simpler than re-engineering 17% of the economy. No one knows where the current magical mystery tour is headed, especially not HHS.
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DougMacG
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« Reply #1008 on: December 20, 2012, 08:58:10 AM »

http://maggiesfarm.anotherdotcom.com/archives/21212-Obama-Vs.-Little-Sisters-of-the-Poor.html

Wednesday, December 19. 2012
Obama Vs. Little Sisters of the Poor

The Little Sisters of the Poor are another example of religious based charitable organizations whose scruples and finances would be violated by Obamacare's requirement that it provide medical insurance that includes contraception and medical treatments that cause sterility or can cause abortions. Aside from its 300 sisters working in their facilities, non-users but still charged for the increased premium, the Little Sisters hires without regard to religion and cares for people without regard to religion. So, according to Obamacare, the Little Sisters of the Poor does not qualify for exemption.

Operating on the principles that are inherent in their religion and such work for the poor and operating on very thin margins, Medicaid providing half the costs of quality care, the Little Sisters of the Poor may have to cease operations in the United States. As the Daily Caller reports from Sister Constance Carolyn Veit:

    “As Little Sisters of the Poor, we are not strangers to religious intolerance,” she wrote. “Our foundress was born at the height of the French Revolution and established our congregation in its aftermath. Our sisters have been forced to leave numerous countries, including China, Myanmar and Hungary, because of religious intolerance. We pray that the United States will not be added to this list.”
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G M
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« Reply #1009 on: January 03, 2013, 05:37:30 PM »

http://hotair.com/greenroom/archives/2013/01/03/surprise-obamacare-wary-employers-not-hiring-cutting-hours/

Surprise: Obamacare-wary employers not hiring, cutting hours
posted at 1:16 pm on January 3, 2013 by Guy Benson

The real knife twist in this USA Today piece is the money quote from Mark Zandi, The One’s go-to “independent” economist:

Many businesses plan to bring on more part-time workers next year, trim the hours of full-time employees or curtail hiring because of the new health care law, human resource firms say. Their actions could further dampen job growth, which already is threatened by possible federal budget cutbacks resulting from the tax increases and spending cuts known as the fiscal cliff. ”It will have a negative impact on job creation” in 2013, says Mark Zandi, chief economist of Moody’s Analytics…The so-called employer mandate to offer health coverage doesn’t take effect until Jan. 1, 2014. But to determine whether employees work enough hours on average to receive benefits, employers must track their schedules for three to 12 months prior to 2014 — meaning many are restructuring payrolls now or will do so early next year.
How widespread will the fallout be?  Very:

About a quarter of businesses surveyed by consulting firm Mercer don’t offer health coverage to employees who work at least 30 hours a week. Half of them plan to make changes so fewer employees work that many hours. The health care law will particularly affect companies with 40 to 45 workers that plan to expand and hire. Many are holding off so they don’t cross the 50-employee threshold, says Christine Ippolito, principal at Compass Workforce Solutions, a human resource consulting firm in Melville, N.Y. Ernie Canadeo, president of EGC Group, a Melville-based advertising and marketing agency with 45 employees, planned to add 10 next year but now says he may add fewer so he’s not subject to the mandate…Others already over the 50-employee threshold plan to add more part-time workers or cut the hours of full-timers, says Rob Wilson, head of Employco, a human resource outsourcing firm. Many, he says, will hire more temporary workers, whom they won’t have to cover.

Nearly half of retailers, restaurants and hotels will be affected by the law, according to Mercer. They employ large numbers of part-time and seasonal employees, including many who work about 30 hours a week. Since such low-wage workers are widely available, it often hasn’t been cost-effective or necessary for employers to offer them coverage. Providing them benefits could be costly because employees must pay no more than 9.5% of their wages in insurance premiums, forcing employers to contribute significantly more than they do for higher-wage workers. ”I think you may see employees with fewer hours as a consequence,” says Neil Trautwein, vice president of the National Retail Federation.
So the law sets an arbitrary cap on the percentage of wages workers are permitted to contribute to their health benefits — the initial intent of which, presumably, was to compel employers to shell out to help cover more employees.  But instead of complying with the mandate and spending money they either (a) don’t have or (b) need for other purposes, cash-strapped small business owners are planning to shave hours and provide less work for their employees.  That’s not greed; it’s business reality in a stagnant economy.  The clumsy and meddlesome heavy hand of Big Government strikes again, hurting many of very the people it set out to “help.”  None of this should surprise anyone, of course.  Obamacare opponents have long argued that this project would spike spending and debt, deprive Americans of liberty, and destroy jobs.  These predictions are being vindicated with each passing day, hence the law’s enduring unpopularity.  And as the article notes, many of the most onerous mandates don’t cycle in until 2014, so the pain is just beginning.  For what it’s worth, the CBO has estimated that the president’s signature legislative accomplishment will kill 800,000 jobs.
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Crafty_Dog
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« Reply #1010 on: January 07, 2013, 03:51:19 PM »



U.S. Health Spending Shows Signs It Will Accelerate .
By LOUISE RADNOFSKY

U.S. health-care spending grew at a record low pace for a third consecutive year in 2011, according to federal figures released Monday, but signs are emerging that the slower growth may not last for long.

National health expenditures rose 3.9% in 2011, the same growth rate as in 2009 and 2010, when people cut back on their use of medical services amid the economic downturn. The figures were the slowest growth on record in the 52 years that government actuaries have tracked such spending.

But data published Monday also showed that the amount spent on treating individuals had already begun rising, signaling that changes in the way Americans use health care hadn't become permanent.

Growth in spending on doctors' visits and prescription drugs rose in 2011, while hospital spending continued to slow, the figures showed. Government actuaries said they believed those changes reflected people regaining health coverage through their jobs.

In 2014, Americans are expected to use more health services when millions gain health insurance and greater access to medical care as part of the federal health overhaul. The U.S. figures suggested there had been little impact on spending as a result of the law in 2011, when few of its provisions had taken effect.

Monday's figures give new insight into the drivers of health spending as policy makers wrestle with how to control its growth. Total health expenditures in 2011 were $2.7 trillion, up from $2.6 trillion in 2010. Health-care spending accounts for one-sixth of the national economy and is the biggest long-term driver of federal spending growth.

Medical providers say the impact of the recession was rapidly seen in their practices in 2009 and 2010. National surveys from the Centers for Disease Control and Prevention found around one in 10 respondents reported delaying needed medical care and prescription drugs for cost reasons in that time.

Chad Fleming, a Wichita, Kan., optometrist, said his patients started updating their prescriptions and changing frames for fashion reasons less regularly, and wearing their contact lenses a little longer. He also said that people began asking if they could postpone routine medical eye exams for cost reasons, and asking for generic eye-medicine prescriptions. Those questions started dwindling in 2011, he said.

"Things went back to 'being normal,'" he said. "There were fewer people feeling the need or the urgency to question the cost of anything."

Drug-spending growth almost halted in 2010, rising 0.4%. That was because many people stopped going to the doctor and obtaining prescriptions, said Steve Miller, chief medical officer at Express Scripts Holding Co., which manages pharmacy benefits for 100 million people.

The stall in 2010 also came as several widely used drugs including Merck MRK +0.36%& Co.'s hypertension drug Cozaar, and Aricept, an Alzheimer's disease drug from Pfizer Inc., PFE +0.08%lost their patents and became available in cheaper generic versions. Another, Pfizer's cholesterol-blocking Lipitor, saw its patent expire in 2011.

But drug spending grew 2.9% in 2011, according to the government data. That was attributed in part to the growth in specialty drugs, a group of costly medicines used to treat illnesses such as cancer, multiple sclerosis and hemophilia.

Spending on these emerging medications is soaring, around 20% per year, in sharp contrast to spending on traditional drugs, which is declining, according to Express Scripts. With few, if any, generic alternatives available due to regulatory hurdles, specialty drugs have experienced robust price inflation in recent years, Dr. Miller said.

Health-care executives have said they have detected a leveling off in the decline of doctor's visits, and the 2011 government figures found a 4.3% increase in spending on physician services. The also was an increase in Medicare spending that was attributed in part to greater use of doctors by elderly participants in the federal insurance program.

The federal actuaries noted a 0.5% increase in health-insurance enrollment in 2011 as people started getting employer-sponsored insurance again, after three years of decline from 2008 to 2010. They said that this, rather than rising premium costs, had led to an increase in the amount spent on private health-insurance premiums.

Rebecca Jaffe, a family physician in a three-doctor practice in Wilmington, Del., said some patients were starting to return for visits after regaining health insurance through new jobs, and several came with lists of health services that they had postponed for several years, such as colonoscopies.

"Now that they finally have health care they're very willing to get it done, even anxious, before the next shoe drops," she said.
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ccp
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« Reply #1011 on: January 10, 2013, 10:03:27 PM »

One economist on the politics of health care.  I would describe him as one of the more conservative members of the "politburo."  Note how he predicted that it would take a economic crash like what we saw in 08-09 to get health care reform.  The libs were ready.  Unlike the smaller minded conservatives who are caught on their heels:

http://www.nytimes.com/2012/03/06/health/policy/an-interview-with-victor-fuchs-on-health-care-costs.html?_r=o
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DougMacG
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« Reply #1012 on: January 11, 2013, 12:54:10 PM »

CCP,  I don't support his proposal but the Stanford professor of economics and health research and policy shows as much wisdom on health care as anyone I have read in a long time.  I especially like the premise that the search for a solution to the affordable health care problem is still on.

The link, one more time:
http://www.nytimes.com/2012/03/06/health/policy/an-interview-with-victor-fuchs-on-health-care-costs.html?_r=o
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ccp
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« Reply #1013 on: January 12, 2013, 02:40:20 PM »

Hi Doug and happy New Year to you and my other forum friends.

Dr. Fuchs has had many articles published in the medical journals so that is where I have seen his views before.  One clarification.  The interview I posted was March 2012.  However, his prediction that it would take some sort of major event (like a market crash) before health car policy change could be implemented politically was, I have read, one he has been making long before.  I read his almost verbatim prediction in an article dated back to 2003.  I might hazard to guess people like him were thinking the same thing after the Hillary Care failure back in the 90's.

Certainly he is correct that health care cost's are unsustainable.  He does seem to agree that whatever the changes are to be made it must take into account our country's perhaps unique political, cultural and social values to get political traction.  I am not sure he is enthusiastic about the poltical reality or just recognizing it.  I think most conservatives agree that health care costs are unsustainable and prefer market private market forces to fix them.  I think he is leaning this way vs the left ultra liberals who simply want to ram down one payor government regulated unversal health care down all our throats. 

As I have stated before I am not sure what the answer really is.  I still come to the conclusion (and hope) that modern technology will find cures, better treatments for chronic conditions that allow all of us not only to live longer but be productive longer, work longer and not simply live longer taking more social security, medicare dollars  using up nursing home space etc.

Fro example a real way to treat osteoarthritis and dementia so people can work and live productive lives longer.  Not just play golf longer while collecting their checks.
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Crafty_Dog
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« Reply #1014 on: January 24, 2013, 05:07:02 PM »

The health reform that Mitt Romney passed in 2006 in Massachusetts presaged President Obama's, and its results are showing what we can expect nationwide. The latest warning comes in a huge new tax increase proposed by Governor Deval Patrick.

Last week the second-term Democrat followed his party's recent habit and proposed an increase in the state's single-rate income tax to 6.25% from 5.25%, the first in more than 20 years. The Bay State constitution requires a flat rate, so the Governor is sticking it to all taxpayers.

Mr. Patrick will try to add progressivity by raising the personal exemption, which taxpayer groups will challenge as unconstitutional. His plan would also eliminate 45 income-tax deductions, for such things as the capital-gains exemption on the sale of a home, adoption fees and college scholarships. This is the left's idea for tax reform: raise rates and limit deductions—a revenue twofer.

To help this bad medicine go down, Mr. Patrick would lower the state sales tax to 4.5% from 6.25%. He says the sales levy "is widely regarded to be the most regressive tax that states impose," which is funny given that Mr. Patrick is the same guy who raised the rate to 6.25% from 5% in 2009. Then he said raising the rate was essential to pay state bills and wouldn't hurt the economy. Now he says it's regressive and must be cut.

Business taxes would also rise under the Patrick revenue raid, and Bay State residents would pay higher gas taxes, turnpike tolls and car taxes. All told it's a $1.9 billion a year net tax hike.

Mr. Patrick says the money will fund the usual array of liberal programs. But this is salesmanship to disguise that the state's real spending driver is the exploding cost of RomneyCare. That law was supposed to save the state money. But last August Beacon Hill was forced to impose new price controls and a cap on overall state health spending because "health-care spending has crowded out key public investments," as Mr. Patrick puts it in his budget.

He's right about that: Health care was 23% of the state fisc in 2000, and 25% in 2006, but it has climbed to 41% for 2013. On current trend it will roll past 50% around 2020—and that best case scenario assumes Mr. Patrick's price controls work as planned. (They won't.) In real terms the state's annual health-care budget is 15% larger than it was in 2007, while transportation has plunged by 22%, public safety by 17% and education by 7%. Today Massachusetts spends less on roads, police and schools after adjusting for inflation than it did in 2007.

Mr. Romney expanded coverage without a tax increase at first, but Democrats quickly passed one anyway and now they are tripling down. Call it the return of Taxachusetts, the state's old moniker from the 1970s and 1980s before a string of GOP Governors were elected to hold the line.

Republicans can offer only token resistance now because Democrats hold 127 of the 160 House seats and 36 of 40 Senate seats on Beacon Hill. But will the voters buy it? In the late 1970s Massachusetts helped launch the national tax revolt with property tax measure 2½, and as recently as 2000 59% of voters approved a ballot initiative to cut the state income tax rate to 5%.

Mr. Patrick is gambling that Mr. Obama has so changed the politics of taxes that he can get away with anything. He may also figure that he may skip town soon enough for the Obama Administration—think AG after Eric Holder—that he needn't worry about the political fallout. The lesson for voters is that universal health care is going to have universally large costs. The middle class will pay the bill, as they are starting to do in Massachusetts.
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Crafty_Dog
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« Reply #1015 on: January 27, 2013, 01:46:40 PM »



Rahm's ObamaCare Brainstorm
Chicago may dump its retiree health costs on federal taxpayers. .
 
Rahm Emanuel's parting gift to national taxpayers upon leaving Washington two years ago was a $1 trillion bill for ObamaCare. Now the Chicago Mayor may add billions more to the tab by dumping his city's retirees on the federally subsidized state health exchange.

This public service announcement is brought to you by a city commission that the mayor appointed last summer to study the cost of continuing health benefits for retired workers. A 25-year-old legal settlement requiring the city and its pension funds to pay between 40% and 55% of most retirees' health costs conveniently expires this June—convenient because the city can't afford the bill.

The city is running a $370 million budget deficit, which will blow up in 2015 when a $1.2 billion balloon payment for pensions comes due. The bill for retiree health benefits is $194 million this year and will grow to $540 million by 2023. Actuaries have recommended that the city sock away $2 billion this year to finance future benefits and pay down a $23 billion unfunded liability. Meanwhile, Chicago's pension funds, which are projected to run dry by the end of the decade, are scraping the bottoms of their barrels to pay for retiree health benefits as required by the settlement.

Enter the Mayor's commission. The four-member panel issued a report this month suggesting that dumping pre-Medicare retirees onto the state's ObamaCare exchange in 2014 could be fab for retirees and city taxpayers. Nearly 60% of retirees and 94% of those who receive subsidies would pay less for their health care on the exchange. Married retirees with dependents would save an average of $4,300.

Chicago and its pension funds in turn would shed $23 billion in liabilities, assuming supplemental benefits for Medicare recipients are also cancelled. (These calculations are based on models that assume public pensions are retirees' only source of income.)

On the other hand, the cost to national taxpayers would be enormous, especially if other local and state governments joined the party. Federal subsidies for Chicago retirees would amount to $44 million in 2014 and increase as more workers retire in their early to mid-50s and health costs grow. All told, state and local governments are on the hook for between $700 billion and $1.5 trillion for retiree health benefits, and like Chicago most will soon be unable to afford even their minimum annual payments.

Offloading the costs on Uncle Sam will look attractive since retiree health benefits don't enjoy the legal protections that some states have bestowed upon pensions. Stockton, California intends to shed its $400 million unfunded liability for retiree benefits in bankruptcy.

Mr. Emanuel says the city's decision on retiree health benefits will "strike the right balance between meeting the needs of the retirees and providing them health-care choices with protecting the interests of the city's taxpayers." So, let's see. On the one hand, Chicago pays, on the other everyone else does. Which do you think he'll choose?

The Chicago report illustrates once again how ObamaCare provides a convenient mechanism and incentive for employers to transfer health-care liabilities to national taxpayers—and how the costs will explode beyond Washington's phony projections.
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DougMacG
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« Reply #1016 on: January 27, 2013, 02:15:41 PM »

"Chicago may dump its retiree health costs on federal taxpayers."

Having helped to design it himself, he should recuse himself from something, maybe citizenship.
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ccp
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« Reply #1017 on: January 27, 2013, 09:34:12 PM »

Maybe take his brothers back to Israel.   They all live, thrive and are successful capitalists.    That is good.   They are all liberal socialists in political philosophy.  That for me is bad.   Is it all a ruse?  A way to get rich?  Reminds me some of AlGOre...

http://www.washingtonian.com/articles/people/brothers-rahm-emanuel-and-his-family/
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Crafty_Dog
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« Reply #1018 on: February 01, 2013, 10:35:12 AM »

ObamaCare's Broken Promises
Every one of the main claims made for the law is turning out to be false. .
By DANIEL P. KESSLER

As the federal government moves forward to implement President Obama's Affordable Care Act, the Department of Health and Human Services is slated to spend millions of dollars promoting the unpopular legislation. In the face of this publicity blitz, it is worth remembering that the law was originally sold largely on four grounds—all of which have become increasingly implausible.

• Lower health-care costs. One key talking point for ObamaCare was that it would reduce the cost of insurance, especially for non-group insurance. The president, citing the work of several health-policy experts, claimed that improved care coordination, investments in information technology, and more efficient marketing through exchanges would save the typical family $2,500 per year.

That was then. Now, even advocates for the law acknowledge that premiums are going up. In analyses conducted for the states of Wisconsin, Minnesota and Colorado, Jonathan Gruber of MIT forecasts that premiums in the non-group market will rise by 19% to 30% due to the law. Other estimates are even higher. The actuarial firm Milliman predicts that non-group premiums in Ohio will rise by 55%-85%. Maine, Oregon and Nevada have sponsored their own studies, all of which reach essentially the same conclusion.

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David Klein
 .Some champions of the law argue that this misses the point, because once the law's new subsidies are taken into account, the net price of insurance will be lower. This argument is misleading. It fails to consider that the money for the subsidies has to come from somewhere. Although debt-financed transfer payments may make insurance look cheaper, they do not change its true social cost.

• Smaller deficits. Increases in the estimated impact of the law on private insurance premiums, along with increases in the estimated cost of health care more generally, have led the Congressional Budget Office to increase its estimate of the budget cost of the law's coverage expansion. In 2010, CBO estimated the cost per year of expanding coverage at $154 billion; by 2012, the estimated cost grew to $186 billion. Yet CBO still scores the law as reducing the deficit.

How can this be? The positive budget score turns on the fact that the estimated revenues to pay for the law have risen along with its costs. The single largest source of these revenues? Money taken from Medicare in the form of lower Medicare payment rates, mostly in the law's out-years. Since the law's passage, however, Congress and the president have undone various scheduled Medicare cuts—including some prescribed by the law itself.

Put aside the absurdity that savings from Medicare—the country's largest unfunded liability—can be used to finance a new entitlement. The argument that health reform decreases the deficit is even worse. It depends on Congress and the president not only imposing Medicare cuts that they have proven unwilling to make but also imposing cuts that they have already specifically undone, most notably to Medicare Advantage, a program that helps millions of seniors pay for private health plans.

• Preservation of existing insurance. After the Supreme Court upheld the constitutionality of health reform in June 2012, President Obama said, "If you're one of the more than 250 million Americans who already have health insurance, you will keep your insurance." This theme ran throughout the selling of ObamaCare: People who have insurance would not have their current arrangements disrupted.

This claim is obviously false. Indeed, disruption of people's existing insurance is one of the law's stated goals. On one hand, the law seeks to increase the generosity of policies that it deems too stingy, by limiting deductibles and mandating coverage that the secretary of Health and Human Services thinks is "essential," whether or not the policyholder can afford it. On the other hand, the law seeks to reduce the generosity of policies that it deems too extravagant, by imposing the "Cadillac tax" on costly insurance plans.

Employer-sponsored insurance has already begun to change. According to the annual Kaiser/HRET Employer Health Benefits Survey, the share of workers in high-deductible plans rose to 19% in 2012 from 13% in 2010.

That's just the intended consequences. One of the law's unintended consequences is that some employers will drop coverage in response to new regulations and the availability of subsidized insurance in the new exchanges. How many is anybody's guess. In 2010, CBO estimated that employer-sponsored coverage would decline by three million people in 2019; by 2012, CBO's estimate had doubled to six million.

• Increased productivity. In 2009, the president's Council of Economic Advisers concluded that health reform would reduce unemployment, raise labor supply, and improve the functioning of labor markets. According to its reasoning, expanding insurance coverage would reduce absenteeism, disability and mortality, thereby encouraging and enabling work.

This reasoning is flawed. The evidence that a broad coverage expansion would improve health is questionable. Some studies have shown that targeted coverage can improve the health of certain groups. But according to the Robert Wood Johnson Foundation's Economic Research Initiative on the Uninsured, "evidence is lacking that health insurance improves the health of non-elderly adults." More recent work by Richard Kronick, a health-policy adviser to former President Bill Clinton, concludes "there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the U.S."

The White House economic analysis also fails to consider the adverse consequences of income-based subsidies on incentives. The support provided by both the Medicaid expansion and the new exchanges phases out as a family's income rises. But, as I and others have pointed out in these pages, income phaseouts create work disincentives like taxes do, because they reduce the net rewards to work. Further, the law imposes taxes on employers who fail to provide sufficiently generous insurance, with exceptions for part-time workers and small firms. On net, it is hard to see how health reform will make labor markets function better.

Some believe that expanding insurance coverage is a moral imperative regardless of its cost. Most supporters of the law, however, use more nuanced arguments that depend on assumptions that are increasingly impossible to defend. If we are ever to have an honest debate about entitlement spending, we will need to distinguish these positions from one another—and see them for what they really are, rather than what we wish they would be.

Mr. Kessler is a professor of business and law at Stanford University and a senior fellow at the Hoover Institution.
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« Reply #1019 on: February 02, 2013, 02:48:08 PM »


http://www.nytimes.com/2013/02/02/opinion/health-cares-trick-coin.html?nl=todaysheadlines&emc=edit_th_20130202&_r=0
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« Reply #1020 on: February 06, 2013, 08:26:18 AM »



http://www.washingtontimes.com/blog/inside-politics/2013/feb/5/obama-health-law-will-cost-7-million/
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« Reply #1021 on: February 17, 2013, 07:27:17 AM »

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DougMacG
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« Reply #1022 on: February 17, 2013, 07:04:53 PM »

The deadline was Friday.
---------------------------

"The Department of Health and Human Services had encouraged states to run their own markets, or “exchanges,” that help the uninsured find coverage. Only 17 states and the District of Columbia took on the task, while seven states decided to split the duty with the Obama administration, according to a breakdown by the Kaiser Family Foundation.

http://www.washingtontimes.com/news/2013/feb/16/after-obamacare-health-exchange-deadline-passes-26/#ixzz2LCxmemrv
-----------------
http://www.usatoday.com/story/news/nation/2013/02/16/state-health-care-exchange-deadline-passed/1923257/
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« Reply #1023 on: February 19, 2013, 06:00:08 PM »



ObamaCare Crippled By States
By DICK MORRIS
Published on DickMorris.com on February 19, 2013


President Obama boasts that his ObamaCare legislation will reduce the number of uninsured by thirty million.  But recent actions by the states to reject his proposed expansion of Medicaid auger about a 25% reduction in his stated goal.
 
The Roberts decision affirming the constitutional validity of the individual mandate in ObamaCare left the states free to decline the expansion of Medicaid specified in the legislation without facing a penalty for doing so.  ObamaCare mandated - and now suggests - that states cover people for Medicaid up to 133% of the poverty level. For a family of one, that comes to $11,490.  For a family of two it is $20, 628.  For three it is $26,000 and for a family of four it would be $31,000.
 
Now, states are going through the process of deciding if they will expand their Medicaid eligibility as Obama suggests or will opt out as the Supreme Court permits.
 
Twenty-one states -- with almost half of the U.S. population -- have either indicated that they will opt out or are considering doing so.
Obama Donor Tried to Hush My $16.5 Million ‘Mistake’ (Photos)
 
Now, at least twelve states have decided not to participate:  Maine, New Jersey, Pennsylvania, South Carolina, Mississippi, Alabama, Louisiana, Georgia, Texas, Oklahoma, South Dakota, and Idaho.  In addition, nine states are considering opting out: Florida, Wisconsin, Utah, Tennessee, North Carolina, West Virginia, Kansas, Alaska, and Indiana.
 
The combined population of the opt-out states is 86 million (28% of the nation) and the undecided states is 57 million (another 18% of U.S. population). 
 
But, the impact of these opt-outs is even greater than even these numbers would suggest. Of the thirty states (including DC) who have indicated they will participate, six already offer Medicaid to those with 133% of the poverty level.  There would be no increase in coverage for these states under the ObamaCare Medicaid provisions.  These states have a combined total of fifty million people (16% of the country).
 
So, 62% of Americans will be unaffected by the ObamaCare expansion of Medicaid!
 
In addition, twelve states who are accepting the new Medicaid eligibility standards already cover 100% or more of the poverty level.  While they will slightly increase their coverage, it would not be by much.  These states have a combined population of 68 million (22% of the population). 
 
So, here is the extent of the Medicaid expansion, one of the two key elements in ObamaCare:
 
•  States refusing expansion = 28% of U.S. Population
•  States which may refuse = 18% of U.S. Population
•  States already over 133% eligibility = 16% of U.S. Population
•  States already at 100-133% eligibility = 22% of U.S. Population
 
Total = 84% of U.S. Population
 
So, only 16% of the U.S. population stands to "benefit" from the increased Medicaid eligibility levels in ObamaCare.
 
ObamaCare advertises that it will reduce the number of uninsured by thirty million.  About ten million of them were to come from Medicaid expansion.  Now it looks like the bulk of this expansion will not happen, potentially lowering the number of uninsured covered to the 22-24 million range, effectively a one-quarter cut in the impact of ObamaCare.
                                                                 
The states are rejecting expansion of Medicaid for several reasons:
 
•  While ObamaCare promises to reimburse states for all the cost of the expansion for three years, it only reimburses 90% after that period is over.  Since the full implementation of the ObamaCare standard would increase Medicaid coverage by about 50%, these costs are likely to be severely burdensome.

•  Governors are worried that an expansion of Medicaid eligibility will trigger an influx of those now eligible into the Medicaid program.  The Kaiser Foundation estimated that half of the growth of Medicaid expected by 2022 would come from those currently eligible.  These new Medicaid recipients would be a big burden on states and the feds would only pick up an average of 60% of their cost.
 
But, Governors are on the lookout and are rapidly mitigating the effects of ObamaCare on their Medicaid costs.
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« Reply #1024 on: February 20, 2013, 11:33:06 PM »

Ezekiel Emanuel - one of the politburo's hand chosen IVY members will be a speaker at a meeting I am going to on March 8.

Anyone want me to ask him anything or have comments?

He is the ex oncologist who became a policy politburo member because he thought he could help more patients that way - so I am told.   Another Saint.  I wonder how much he gets to give the speech.  I am sure it is all for charity.
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« Reply #1025 on: February 21, 2013, 09:59:55 AM »

http://www.nytimes.com/2013/02/21/us/in-reversal-florida-says-it-will-expand-medicaid-program.html?smid=tw-share&_r=0

"Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect. "
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« Reply #1026 on: February 21, 2013, 10:11:15 AM »

CCP, I looked up Rahm's brother Ezekial and found many columns at the NYT:

http://opinionator.blogs.nytimes.com/author/ezekiel-j-emanuel/

Reading through I found him to be somewhat reasonable and restrained for a liberal.  I didn't find anything overly provocative or controversial like a Krugman for example.

For a question in a room full of doctors I would look for something where both the question and the answer might resonate with the audience.  Perhaps something along the line of asking how can we limit government's role to informing, but not interfere with or replace the judgment of the attending physician.

A not very timely and more hostile question: Given that the more an industry is controlled by government the less they are able to innovate, improve services or control costs, why do we turn over our most important industries to the entity with the worst track record for performance?

His most recent column:

February 14, 2013, 9:11 pm158 Comments
Health Care’s Good News
By EZEKIEL J. EMANUEL

THINK about it. When was the last time you heard the phrases “good news” and “health care costs” in the same sentence?

I can’t remember either.

Most of the recent talk about health care spending has been pretty bleak. Just take a look at the Rate Review Tool on Healthcare.gov and you’ll know why. Major insurers are proposing painful, double-digit premium increases in 2013. In California, Anthem Blue Cross, Blue Shield of California and Aetna all announced rate increases of 20 percent or higher for some of their customers. Many are taking this as a sign that, despite its intentions, the health care reform law is failing and costs are going up as a result.

But there is something bigger going on here, though commentators may not be shouting about it. Health care spending is still going up, but the rate at which it grows year to year has actually been declining for about a decade now.

This is truly a sea change. Look at Medicare: over the last 43 years, costs per beneficiary grew 2.7 percent faster than the overall economy. That’s why Medicare spending rose from $7.7 billion in 1970 (or 0.7 percent of gross domestic product) to $551 billion in 2012 (almost 4 percent of G.D.P.). But this trend has finally reversed; over the last three years, Medicare costs per person have grown 1.3 percent slower than growth in the overall economy. In January, a Department of Health and Human Services report showed that Medicare spending per beneficiary grew just 0.4 percent in 2012. And last week, the Congressional Budget Office lowered its 10-year Medicare spending projection by $137 billion, because “health care spending has grown much more slowly” than “historical rates would have indicated.”

This slowdown is not limited to Medicare, nor is it simply the result of belt-tightening in the wake of the Great Recession. Since 2004 — nearly four years before the economic downturn — the rate of health care inflation per person has been just 0.8 percent higher than the growth of the G.D.P. Between 1965 and 1993, for comparison, it was 3.2 percent higher.

So if the growth of spending is decelerating, why are premiums increasing? First, the big increases were in relatively small parts of the market, among individual and small-business policies. Second, like everyone else in the health care industry, insurance companies are uncertain about the future, particularly about what will happen to their margins when the new exchanges open in October. The natural response to uncertainty is caution, and for insurance companies, the cautious approach is to increase revenue and profits as much as possible in the short term in case Obamacare lowers them in the long term.

But once the exchanges begin to facilitate competition, this fear should dissipate and premiums should come down.

Regardless, the good news on health care costs shouldn’t make us complacent. Despite the slowdown, total Medicare spending is still rising, because more and more baby boomers are becoming eligible for the program every day. The number of beneficiaries is projected to grow 3 percent each year. As a result, total Medicare expenditures are projected to rise to over 4 percent of the G.D.P. by 2023 and to 6.7 percent by 2037. This is a looming threat to the nation’s long-term fiscal stability.

So what more can be done? Here is another piece of good news: there are many common sense reforms that should appeal to both Democrats and Republicans.

One example is competitive bidding. Historically, the government has effectively set prices through Medicare for wheelchairs, hospital beds and other medical equipment. But a demonstration project begun in 2011 introduced competitive bidding in roughly 100 metropolitan areas to see if market forces could bring down prices. The results have been dramatic. Prices for oxygen equipment went down 41 percent; wheelchairs, 36 percent; hospital beds, 44 percent; and the cost of diabetic testing equipment, like glucose strips, dropped by a whopping 72 percent. And research has shown no adverse effects on beneficiaries.

The Affordable Care Act will expand competitive bidding for these items to the rest of the country in 2016. But why wait? We should roll it out nationwide next year. And it shouldn’t just be for medical equipment. In his last budget, President George W. Bush recommended expanding competitive bidding for blood tests and other lab procedures. It could also work for X-rays, CT scans, pacemakers — for all medical commodities. This would drive health care spending growth closer to the increase in G.D.P.

The moderating of health care spending is fantastic news. But now we just have to work harder. If we can push the rate of growth even lower, we will come close to solving our nation’s long-term financial problems.
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« Reply #1027 on: February 21, 2013, 01:16:01 PM »

On Wednesday Florida Republican Rick Scott became the latest GOP Governor to volunteer to shoulder some responsibility for ObamaCare, which has liberal sages gloating about a resistance-is-futile shift in the GOP. The media don't want to discuss the substance, only the politics, so allow us to report how the flippers are justifying their flips.

• Take the money or run. The Governors now expanding Medicaid are candid about their flight from their own fiscal principles: They want to take political credit for taking "free" money from Uncle Sugar and for appeasing the state hospitals lobbying for federal cash. The Health and Human Services Department will pay 100% of the cost of new beneficiaries, later 90%.

Indiana Governor Mike Pence spoke for the 13 Governors so far who reject this seeming windfall when he called it "the classic gift of a baby elephant," with the feds promising to buy all the hay for only the first few years. So Governors like Mr. Scott and Ohio's John Kasich are trying to inoculate themselves on the right by creating triggers or "sunsets" that would automatically rescind their participation in new Medicaid if—make that when—Washington reneges on funding.

They're only conning themselves. HHS can simply impose a blanket "maintenance of effort" rule that prohibits opting out—or any other change.

• The cost-shift trick. Then again, why would states want to drop out, when they claim that expanding Medicaid will lower health-care costs for businesses and individuals? So-called uncompensated care "drives up the cost of everybody's health insurance," Mr. Kasich said at a recent press conference. "When they visit these emergency rooms and cannot pay, we pay for them."

Hmmm. This is also the justification President Obama used to impose an individual mandate to buy coverage or else pay a penalty. Does Mr. Kasich now support that too?

And do these Republicans really think that private costs will fall by expanding a government program? Unlikely, since the federal statistics put the total amount of uncompensated care due to the uninsured at $12.8 billion—or less than 0.5% of health-care spending. The Ohio Hospital Association estimates its members provide $3.2 billion in uncompensated care—but $1.3 billion is Medicaid losses, more than bad debt or charity care. Ohio price controls are so onerous that hospitals lose 17 cents for every dollar they spend treating Medicaid patients.

• False flexibility. Mr. Kasich claims the feds are granting him the running room to reform Medicaid, on the basis of a late-night phone call from President Obama's consigliere. "I want to thank Valerie Jarrett today for being willing to work with us," he said. "Now I want to be clear to you: We don't know what the details of this are going to be yet. We don't know what the cost is going to be."

When Mr. Kasich is done counting his magic beans, he might look north to Wisconsin for a better Medicaid role model. Last week Scott Walker released an innovative reform that rejects the HHS bribe and will also test the department's putative "flexibility."

Under former Democratic Governor Jim Doyle, Wisconsin greatly expanded its BadgerCare Medicaid program, opening it to everyone earning up to two times the poverty line. Enrollment climbed 73% between 2003 and 2012, state spending increased 99% and proved so expensive that Mr. Doyle was forced to cap enrollment and put eligible people on a wait list.

Mr. Walker wants to roll back Medicaid to the poverty line and use the savings to open up new BadgerCare slots so the truly poor can use the safety-net program intended for them. (Imagine that.) Wisconsin would forgo the 100% federal magic money, because ObamaCare mandates that states expand Medicaid to 138% of poverty and also in this case end the waiting list, which would grow the rolls by another 32%.

The Walker plan would dump a lot of people onto ObamaCare's subsidized insurance "exchanges," though that would happen anyway. At least he would reduce one entitlement and insulate the Wisconsin budget from Washington uncertainty.

• The counsel of despair. Some Republicans are folding apparently because trying to stop ObamaCare is too hard. Though he "never liked the Affordable Care Act," said Governor Brian Sandoval, "I am forced to accept it as today's reality and I have decided to expand Nevada's Medicaid coverage." Now there's a statement of vaulting political ambition.

The reality is that ObamaCare remains deeply unpopular with the public and it will only get worse next year when individuals and small businesses are forced to buy coverage that is 20% or 30% more expensive than what they have. Some younger people will see premium shocks as high as 150% or 200%.

HHS will manage the exchanges in 32 states starting in October but has released only 19 pages of regulatory guidance. ObamaCare is so convoluted, and HHS so incompetent, that the entitlement may explode on the launchpad. Why any Governor would climb on to this ship is a political mystery, but then they have their bad reasons
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« Reply #1028 on: February 28, 2013, 05:54:10 AM »

Doug I appreciate your thoughts.  I am a smaller government guy.  I will let the board know if anything interesting comes up at  the meeting.

Like Steve Forbes and others have said.  Better to recommend stocks then to follow one's own advice. More money to be made that way.

Ezekiel Emanuel must have thought the same thing.  Better to tell the country's health industry what to do rather than have to follow his own advise.  Less painful and certainly he must be making a much bigger bundle.

He is an Emanuel after all.   Another do-gooder who will save us from ourselves.

In April in Atlantic City I see Newt is going to speak about his thoughts on health care.  

Somehow I suspect both will say similar things . The difference will only be who enforces the transformation (rams it down our throats).   The private or public payers?   So far it is both.
« Last Edit: February 28, 2013, 05:57:06 AM by ccp » Logged
DougMacG
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« Reply #1029 on: March 06, 2013, 10:15:58 AM »

Health care merging with cognitive dissonance of the left:  Who knew that the big advances in health care would be coming from the IRS.  Rest assured their life-saving work will continue uninterrupted by the sequester.

http://thehill.com/blogs/on-the-money/domestic-taxes/286423-sequester-wont-interrupt-taxes-from-healthcare-law
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« Reply #1030 on: March 12, 2013, 11:04:50 AM »

Nancy Pelosi said that we’d have to pass the bill to find out what’s in it.  Refreshing to hear an honest liberal...

If Congress passes a statute–even one that is 1,600 pages long like Obamacare, but the law can’t go into effect as written, it is not really a law at all.  The simple proof is the photo here that Sen. Mitch McConnell’s office has released, showing the 20,000-plus pages of regulations issued so far for the implementation of Obamacare.  ”Regulation” is just a multi-syllabic word for “law,” after all.  The point is, administrators–the slightly nicer term for “bureaucrats”–now govern us much more than our elected lawmakers do.  (Powerlineblog.com)

Comply with THIS!  Regulations issued SO FAR for the implementation of Obamacare
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« Reply #1031 on: March 21, 2013, 09:21:20 PM »

ObamaCare Backlash
By DICK MORRIS
Published on TheHill.com on March 19, 2013

It's worth remembering that President Obama decided not to let his new ObamaCare scheme take effect until 2014. At the time of its passage in 2010, it seemed politically wise to delay its implementation. Republicans won the election of 2010 and lost that of 2012. But the full impact of the new law will begin to become apparent in 2014 and the effect will be horrific, deeply damaging the Obama administration and the Democrats who backed it.

The main brunt of the impact will be on premiums for health insurance coverage. They will skyrocket in very short order. The Heritage Foundation estimates the increases by state. Here's a sample:
 
State                  Premiums Rise By Percentage
 
California                     42-69%
Florida                         61%
Georgia                       61-100%
Illinois                         61%
Michigan                      35-63%
New Jersey                   39%
North Carolina              61%
Ohio                            55-106%
Pennsylvania                39%
Texas                          35-63%
Virginia                       75-82%

Why such draconian increases? Heritage ascribes it to two provisions of the new law.

The first restricts health insurers from charging any one age group more than three times the premium it charges any other one. This 3-1 ratio -- typically between the older, non-Medicare portion of the covered population and the young group -- is the brain child of the social planners. The actual figure is about 5-1 -- it costs about five times as much to insure older patients than younger ones. Because, obviously, companies are not going to cut the premiums for the older patients, they will increase them for the younger ones so they can meet the 3-1 ratio. That means big increases for younger families.

The second provision that pushes up premiums is the tendency of the new law to kill its customers with kindness by requiring all manner of illnesses and treatments to be covered, and covered generously. Mental health, dental care and such are all required in any policy. And the law restricts any effort by insurance companies to limit the utilization of these services. So the premiums will rise for everybody.

The result of this premium inflation will be that more and more employers will refuse to continue to cover their workers and will find it far cheaper to pay the penalties in the law than to underwrite the vastly more expensive policies. Tens of millions of Americans will lose their insurance and have to buy coverage from the insurance exchanges Obama is creating -- at a multiple of their current premium's cost. The ObamaCare subsidies are limited and will not begin to make up for the increased costs. And, to make matters worse, employers will be obliged to pay an annual $65 tax per employee to subsidize catastrophic coverage for the most expensive patients.

Obama's real goal, of course, is to destroy employment-related insurance and force everyone into the insurance exchanges. This will lay the basis for single-payer, government-funded, socialized medicine in the United States: his stated goal.

The political consequences of these premium increases are going to be horrific. Voters will realize how fraudulent Obama was in predicting average premium cuts of $2,500 per family. And the full dimensions of this misguided law will become apparent.

The result will be a gradual and continuing erosion of Obama's favorability until he gets his clock cleaned in the 2014 election. Normally, of course, sixth year-elections are a total wipeout for the incumbent party. FDR lost a hundred seats in the House in 1938. Truman lost control of Congress in 1946.

Eisenhower lost more than a dozen Senate seats in 1958. Nixon/Ford suffered massive losses in 1974. Reagan lost the Senate in 1988, as did Bush in 2006. Only Clinton, with Republicans self-destructing over impeachment, avoided severe losses. Obama will fall victim to the general trend, but his losses will increase as the economy fails to recover and health insurance becomes unaffordable.
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« Reply #1032 on: March 26, 2013, 05:41:59 PM »

Follow up to previous post.  Went to meeting of the New Jersey american college of physicians few weeks ago and listened to Ezekiel's talk.

Basically he starts with a bunch of charts and graphs describing what we all know - health care costs are going up and are unsustainable.

His prescription is basically for provider groups to form and control costs by monitoring what they do "outcomes" and basically what managed care has been doing for decades now.   I guess the difference is really now the politburo types are requiring we do it on industrial scale with industrial level quality control with reems of data, measurements, more data of the data more measurements and every penny counted.  He gave one example from a gourp of several hundred physcians Caremont though I don't remember where they are located and I haven't looked into it - yet.

Supposedly they cut costs while increasing the bottom line.  Thus this is a model for all.

He also explains the cost rising is down form over 2% to around 0.8%.  Of course he is suggesting he and the rest of the politburo are responsible for cost savings - not that the economy is so bad for most people they can't aford their co pays their deductables their premiums and neither can as many employers.

I only had a chance for one question so I asked him about Clay Christiansens theory that Nurse Practitioners will supplant primary care doctors and it is inevitable and no stopping it.  He said PCP's are not replaceabale by nurses and that he doesn't think that would happen - though we are clearly seeing that trend.

He doesn't believe that there is a doctor shortage.  Indeed I agree with him on that.  There probably is a shortage of a few specialties and doctors in some low income urban areas or in the boondocks but certainly not in the north east and probably the West coast.

Indded if any group feels threateneed by the low wages of illegals /legal immigrants no where is this felt more than in health care.

All we see here are doctors born everywhrere else.  The schools of course also like to play the shortage gimmack so they can get more money to churn more graduates out and the nursing programs the same.

Getting back to Emanuel his personality is the same as his brother Rahm.    He ran out after one question after mine.  I guess he had his next speaking engagement.l
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« Reply #1033 on: March 26, 2013, 05:46:23 PM »

BTW:

He just happens to have a book about three "remarkable" brothers:

www.economist.com/news/books-and-at/21573953-raising-three-remarkable-children-brother-sarms
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« Reply #1034 on: March 26, 2013, 07:44:16 PM »

http://reason.com/blog/2013/03/25/californias-910-million-obamacare-exchan

California's $910 Million ObamaCare Exchange

Peter Suderman|Mar. 25, 2013 1:41 pm

Photo credit: Scott Smith (SRisonS) / Foter.com / CC BY-NC-NDHow much does it cost to open one of ObamaCare’s state-run health exchanges? In California, the answer is nearly $910 million and counting.

Health policy consultant Robert Laszewski notes that California has already received a little more than $909 million in federal grants—an amount that’s actually $32 million less than the state’s exchange director asked for. Does that sound like a fair price? It’s not really possible to make a direct comparison to any private sector initiative, but Laszewski provides some useful context:

For some additional perspective I took a look at what it cost to launch the private insurance marketing site, Esurance. That company sells not only health insurance but also things like homeowners and auto insurance across the country. When I put my zip code into their system along with my age, they offered me 87 different health plans from all the big players in my area. Now granted, the new health insurance exchanges are more complex because they have to interface with Medicaid and the IRS as well as calculate subsidies. But the order of magnitude difference in what it cost to launch esurance compared to the California exchange is pretty big.

Privately funded Esurance began its multi-product national web business in 1998 with an initial $5.5 million round of venture fund investment in 1999 and a second round of $34 million a few months later.

The start-up experience of other major web companies is also instructive. Facebook received $13.7 million to launch in 2005. eBay was founded in 1995 and received its first venture money in 1997––$6.7 million in 1997.

Even doubling these investments for inflation still leaves quite a gap.

So where’s all the money going? A big chunk is going to the infrastructure and information technology components—building out the website and database technology necessary to manage the law’s subsidies and facilitate enrollment in the exchange-based health plans. But a lot of it is just going to marketing and enrollment. As Laszewski notes, the state is launching a two-year, $250 million marketing campaign intended to get people to sign up for the exchange. The state is also paying 20,000 part-time "enrollers" $58 an application for each person they sign up. In contrast, California Blue Shield serves 3.5 million members with just 5,000 employees.

Despite the expense there's one thing the state likely won't be getting: a nice, stable insurance market. Few states are more supportive of ObamaCare than California, but the states insurance regulators have warned the Obama administration to expect "rate shock" and "market disruption" as part of the transition to ObamaCare. There are some things money can't buy.

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« Reply #1035 on: March 28, 2013, 11:13:52 AM »

The Morning Ledger: Restaurant Chains Cut Health-Law Tabs

Restaurant owners, many of whom have been fierce critics of the U.S. health-care overhaul, are now realizing the law may be less costly than they first thought. The primary reason is that many employees will decline company-offered insurance, the WSJ reports.  Wendy’s, for example, initially thought the law would increase the cost of operating each of their restaurants by $25,000 a year. But CFO Steve Hare has said that the estimate is down to just $5,000 a year. “That’s still significant costs that we’re adding to not only the company restaurants but to most of our franchisees, who are going to be dragged into this as well,” Mr. Hare said on a recent conference call, Maxwell Murphy reports in CFOJ
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« Reply #1036 on: April 03, 2013, 04:23:06 PM »

http://www.youtube.com/watch_popup?v=r13uYs7jglg
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« Reply #1037 on: April 08, 2013, 08:40:51 AM »

By ED MARSH
A fundamental principle in medicine is that if you get the diagnosis wrong, you'll probably apply the wrong therapy. A corollary is that if the therapy isn't working, increasing the dose may make things worse. That's where we are with ObamaCare.

There are shortcomings aplenty in the health-care field, and changes and improvements are required. But never have I seen so many good intentions leading irreversibly to hell.

Personal experience is by its nature parochial. Yet when it invalidates much of what passes for wisdom, there may be value in sharing it. Here are some facts that may illuminate:

When I graduated from medical school in 1962, the profession of medicine was for many graduates an opportunity to provide care—as distinguished from, though aligned with, treatment—and to provide it to individuals, not to populations or governmentally specified groups. Young doctors hoped to establish an independent business, enjoy lifelong intellectual excitement as knowledge and therapies expanded, and have an income sufficient to live decently and support a family. There have always been some who entered medicine, as with any vocation, to maximize income. Yet most of us who came into the profession in the early 1960s had modest financial aspirations and substantial social commitment.

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 .After eight years of postgraduate study, I opened a solo pediatrics practice in a community of 10,000 souls an hour from Boston. A number of lean years passed before I could build a robust practice. Yet the experience was exactly what I—and I think many of my colleagues—sought: a personal, direct and unimpeded relationship between me and those who chose to become my patients.

A major cause of financial stringency was that there was almost no insurance that covered pediatric care in the office setting. Many pediatricians felt denigrated because the care that they were providing was not regarded as sufficiently consequential to be covered by third parties, as was that of their brethren in internal medicine. Surveys always showed pediatricians to be the poorest-paid of all the specialties.

By current standards, the lack of third-party coverage would be impermissible. But treating patients without insurance meant that I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family's budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible.

I developed pastimes that were diverting but would permit me to be available to patients 24-7, requiring coverage by a substitute only for a two-week vacation annually. Few physicians nowadays would undertake such an onerous schedule, and yet many of the inconveniences are offset by benefits. If you are caring for your own patients, you know them and their ailments and can manage a great deal over the telephone (or by email these days), with minimal cost to them and minimal intrusion into your own life. By contrast, covering for another physician almost invariably means inefficiency—additional time to learn the patients' relevant history, and often either a direct patient encounter or an outpatient facility visit, all of which greatly add to the cost.

Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate.

Patients knew that any suggestions I might make would have negligible consequences for their own budgets, so "more" became the expectation. A sense of entitlement developed. Why would the doctor hesitate to do some procedure, or hesitate to request a test? Everything was already paid for. If I was reluctant, perhaps weighing the cost to them, patients speculated there must be some hidden reason. Perhaps I was, in some obscure way, feathering my own nest. Misgivings arose.

This mistrust heightened—and became rational—when "prepaid" group practices became more prevalent. Physician compensation is tied to "efficiencies," which means reducing the outlays and costs to the group (translation: skimp where possible) and thus generating for internal distribution a larger share of the prepaid premiums.

Second opinions proliferated, upping the costs. Patients could get two opinions for the same price: near zero. I could acquire additional knowledge from the feedback of the consultant and was better positioned should some legal controversy arise. One underexamined aspect of defensive medicine is those excessive referrals to diminish responsibility.

My income rose substantially and pediatricians in general thought that they had arrived in the Promised Land. The submission of some paper to some anonymous third party would not put a dent in any patient's grocery bills. And the consequences of profligacy disappeared, while rational income-building strategies—aka gaming the system—appeared. For instance, since telephone calls weren't reimbursable, additional office visits, which were, supervened.

"Preventive care" became the touchstone. The concept is obvious, but the evidence for its value, and especially its potential for savings, is rarely conclusive.

Insurance relationships drove practice relationships. Patients were more likely to come to me because their insurance told them to, and more likely to leave, despite our congeniality, because their insurance required it. Thus our dealings were less personally rewarding, for my patients and for me.

When it became increasingly difficult to work according to my principles, I closed my practice, first joining a "prepaid" group for 15 years, and then leaving patient care altogether. As more physicians leave active practice, it must be appreciated that a focus on the economics of health care is not the only, and perhaps not even the most important, reason for their disillusionment. The glow of the personal relationship one might have with one's patients is being extinguished.

The medical economist Rashi Fein observed in 1986 that there are only three ways to limit the extravagant demand for medical care: "Inconvenience," the practice used in the military, where one must wait interminably for care. "Rules," the third-party approach by which layers of rules and thousands of regulations are devised, most recently in a fool's quest to contain costs under ObamaCare. And "Price." This last option elicits gasps and chest-clutching from bien pensants who insist that all financial impediments to care must be removed. Yet it has one incontestably beneficial attribute: It requires the physician to study the true cost and benefits of a course of action, and then to present that data to the patient. Who is better suited than the patient to assess the value to him of the proposed treatment? Kathleen Sebelius? You gotta be kidding.

There is no shortage of evidence. ObamaCare will, deliberately and by design, destroy what—while imperfect—has served very well. We have gotten to this point after years of good intentions making bad problems worse. To double down on the very therapy that has brought the system to its present sorry pass is a toe-ticket to the morgue.

Dr. Marsh now raises Christmas trees in Ipswich, Mass.
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« Reply #1038 on: April 09, 2013, 11:16:27 PM »

Dr. Jeffrey Singer writing in the May issue of Reason magazine:


In the not-too-distant future, a small but healthy market will arise for cash-only, personalized, private care. For those who can afford it, there will always be competitive, market-driven clinics, hospitals, surgicenters, and other arrangements—including "medical tourism," whereby health care packages are offered at competitive rates in overseas medical centers. Similar healthy markets already exist in areas such as Lasik eye surgery and cosmetic procedures. The medical profession will survive and even thrive in these small private niches.

In other words, we're about to experience the two-tiered system that already exists in most parts of the world that provide "universal coverage." Those who have the financial means will still be able to get prompt, courteous, personalized, state-of-the-art health care from providers who consider themselves professionals. But the majority can expect long lines, mediocre and impersonal care from shift-working providers, subtle but definite rationing, and slowly deteriorating outcomes.

We already see this in Canada, where cash-only clinics are beginning to spring up, and the United Kingdom, where a small but healthy private system exists side-by-side with the National Health Service, providing high-end, fee-for-service, private health care, with little or no waiting.
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« Reply #1039 on: April 13, 2013, 09:33:52 PM »

http://en.wikipedia.org/wiki/richard_Blumenthal

I only recently realized that David is this guy's brother.  Another politician health care politburo brother duo like the Emanuels.
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« Reply #1040 on: April 13, 2013, 09:40:04 PM »

I wonder if brother David is also a decorated war veteran like his brother who according to Marc Levin is asking for campaign donations to fight for the gun control in the memory of the Conneticut massacre.
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« Reply #1041 on: April 17, 2013, 07:50:06 AM »



http://www.breitbart.com/Big-Government/2013/04/16/ObamaCare-Regal-Employee-hours
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« Reply #1042 on: April 17, 2013, 07:35:15 PM »

Rove: Steaming Toward the ObamaCare 'Train Wreck'
The implementation of this unpopular law is a story of missed deadlines and general bungling..
By KARL ROVE

In congressional testimony last week, Health and Human Services Secretary Kathleen Sebelius blamed Republican governors for her department's failure to create a "model exchange" where consumers could shop for health-insurance coverage in states that don't set up their own exchange.

Nice try, but GOP governors aren't the problem. Team Obama's tendency to blame someone else for its shortcomings is tiresome. The Affordable Care Act requires HHS to operate exchanges in states that won't operate their own. Since the act became law in March 2010, it has been abundantly clear that the agency would have to deploy a model exchange. It is Ms. Sebelius's fault there isn't one.

There is more to this failure. Even exchanges organized by Democratic and Republican governors may not be functioning by the health-law's Oct. 1 deadline, because HHS has been slow with guidance and approvals.

Last month Gary Cohen, an official with the Centers for Medicare and Medicaid Services who oversees technology for the exchanges, told members of America's Health Insurance Plans (a trade association) that he was "pretty nervous" about implementation. He hoped enrollment is "not a third world experience."

Part of this problem stems from the way the law is crafted. For example, a subsidy to help small businesses provide insurance coverage while ObamaCare ramped up was so complicated and difficult to use that only 1% of its $40 billion budget was spent.

Other provisions have been poorly executed or needlessly delayed. Ms. Sebelius's HHS has missed dozens of deadlines for major rule-making or program start dates required by the law.

For example, ObamaCare created the Small Business Health Options Programs, where small businesses could select insurance plans beginning in October with coverage starting in January. The program has been set up, but employees are offered only one plan, not a choice among many. HHS announced a full range of plans would be delayed until 2015.

Then there is President Obama's promise that no American would be denied coverage because of a pre-existing condition. The Affordable Care Act set aside $5 billion to subsidize, through 2014, coverage for an estimated 270,000 to 350,000 people with pre-existing conditions and no insurance. So far 135,000 have been covered but the $5 billion is nearly exhausted. HHS stopped signing up people in February.

A long-term care entitlement, the so-called Class Act, turned out to be so fiscally untenable that Democratic support evaporated before its 2012 start date. The entitlement program was repealed in the December fiscal cliff deal.

Then there is the Independent Payment Advisory Board, the 15-person committee charged with reducing Medicare spending to a "target level" by 2015. Its recommendations take effect automatically unless overruled by a congressional supermajority.

By law, the board cannot "raise revenues or Medicare beneficiary premiums . . . deductibles, coinsurance, and copayments, or otherwise restrict benefits or modify eligibility criteria." This means that the board would likely have to cut reimbursements to health providers who already receive roughly 80% of what private insurers pay for the same procedures for non-Medicare patients. This will discourage doctors from taking on Medicare patients.

The IPAB's first recommendations are due Jan. 1, 2014 and are supposed to take effect a year after that. The president hasn't appointed anyone to the board, and it's unlikely he can come up with 15 nominees, get them confirmed, and have them in place to deliver recommendations in time. Maybe he plans to leave the recommendations up to the secretary of HHS, which is allowed under the health law, but that ought to concern anyone who's seen Ms. Sebelius in action.

Or maybe the president will just let the deadline for IPAB recommendations slide. An ugly battle in 2014 over Medicare cuts proposed by a committee he appointed might rile up seniors in the midterm elections, leading to the defeat of House and Senate Democrats who voted for the law.

Still, the administration is eager to get one health-care program under way. ObamaCare provides $54 million to hire individuals and groups to facilitate enrollment when the exchanges begin this October.

There are rumblings in Washington that HHS believes more money is needed for these "navigators" or "helpers." The House Energy and Commerce Committee wrote Ms. Sebelius this week asking what kind of groups are eligible, how they'll be selected, what standards must they meet, how they will be trained and supervised, and what the success measures will be. This program could turn into patronage for Mr. Obama's liberal allies such as unions and community activists.

The Affordable Care Act may be unworkable in the aggregate, but it is also dogged by incompetent implementation. Even Democrats are increasingly concerned. At a hearing on Wednesday, Sen. Max Baucus expressed his frustration about a variety of problems, including whether the health-insurance exchanges will be established on time. "I just see a huge train wreck coming down," he told Ms. Sebelius.

Mr. Rove, a former deputy chief of staff to President George W. Bush, helped organize the political action committee American Crossroads.
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« Reply #1043 on: April 18, 2013, 11:53:26 AM »

http://www.wsbradio.com/ap/ap/health/top-dem-sees-train-wreck-for-obama-health-law/nXPPR/
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« Reply #1044 on: April 18, 2013, 12:35:33 PM »


"A six-term veteran, Baucus expects a tough re-election in 2014. He's still trying to recover from approval ratings that nosedived amid displeasure with the health care law in his home state."

True, the train wreck he sees coming might be his own reelection, Obama lost Montana by 14 points.

"Normally low-key and supportive, Baucus challenged Health and Human Services Secretary Kathleen Sebelius at Wednesday's hearing."

I wonder if there was also a wink from the Senator as the author of the bill got tough with the secretary in committee.  She needs him reelected too.  I wonder if she could ever get elected in Kansas again.  Obama lost Kansas by over 20 points.

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« Reply #1045 on: April 28, 2013, 03:01:30 PM »

The new health care law mandates that primary care doctors who accept Medicaid patients are guaranteed to be paid the Medicare rates for 2013 and 2014.  After that probably the states will be squeezed as we will be though the Politburo is silent at this time.

I signed up and just got credentialed.   I thought I was all set.  Usually when one signs on to a health plan there is a dozen or so pages of "rules".

Then I was sent the rules regarding Medicaid in NJ.  It is a good size box with what looks like hundreds of pages of regulations and rules and Lord knows what else.   Additionally our office was recently informed it will months before we see any money regardless.
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« Reply #1046 on: April 30, 2013, 05:03:07 PM »

Daniel Kessler: The Coming ObamaCare Shock
Millions of Americans will pay more for health insurance, lose their coverage, or have their hours of work cut back. .
By DANIEL P. KESSLER

In recent weeks, there have been increasing expressions of concern from surprising quarters about the implementation of ObamaCare. Montana Sen. Max Baucus, a Democrat, called it a "train wreck." A Democratic colleague, West Virginia's Sen. Jay Rockefeller, described the massive Affordable Care Act as "beyond comprehension." Henry Chao, the government's chief technical officer in charge of putting in place the insurance exchanges mandated by the law, was quoted in the Congressional Quarterly as saying "I'm pretty nervous . . . Let's just make sure it's not a third-world experience."

These individuals are worried for good reason. The unpopular health-care law's rollout is going to be rough. It will also administer several price (and other) shocks to tens of millions of Americans.

Start with people who have individual and small-group health insurance. These policies are most affected by ObamaCare's community-rating regulations, which require insurers to accept everyone but limit or ban them from varying premiums based on age or health. The law also mandates "essential" benefits that are far more generous than those currently offered.

According to consultants from Oliver Wyman (who wrote on the issue in the January issue of Contingencies, the magazine of the American Academy of Actuaries), around six million of the 19 million people with individual health policies are going to have to pay more—and this even after accounting for the government subsidies offered under the law. For example, single adults age 21-29 earning 300% to 400% of the federal poverty level will be hit with an increase of 46% even after premium assistance from tax credits.

Determining the number of individuals who will be harmed by changes to the small-group insurance market is harder. According to the Medical Expenditure Panel Survey, conducted by the Department of Health and Human Services, around 30 million Americans work in firms with fewer than 50 employees, and so are potentially affected by the small-group "reforms" imposed by ObamaCare.

Around nine million of these people, plus six million family members, are covered by employers who do not self-insure. The premium increases for this group will be less on average than those for people in the individual market but will still be substantial. According to analyses conducted by the insurer WellPoint for 11 states, small-group premiums are expected to increase by 13%-23% on average.

This average masks big differences. While some firms (primarily those that employ older or sicker workers) will see premium decreases due to community rating, firms with younger, healthier workers will see very large increases: 89% in Missouri, 91% in Indiana and 101% in Nevada.

Because the government subsidies to purchasers of health insurance in the small-group market are significantly smaller than those in the individual market, I estimate that another 10 million people, the approximately two-thirds of the market that is low- or average-risk, will see higher insurance bills for 2014.

Higher premiums are just the beginning, because virtually all existing policies in the individual market and the vast majority in the small-group market do not cover all of the "essential" benefits mandated by the law. Policies without premium increases will have to change, probably by shifting to more restrictive networks of doctors and hospitals. Even if only one third of these policies are affected, this amounts to more than five million people.

In addition, according to Congressional Budget Office projections in July and September 2012, three million people will lose their insurance altogether in 2014 due to the law, and six million will have to pay the individual-mandate tax penalty in 2016 because they don't want or won't be able to afford coverage, even with the subsidies.

None of this counts the people whose employment opportunities will suffer because of disincentives under ObamaCare. Some, whose employers have to pay a tax penalty because their policies do not carry sufficiently generous insurance, will see their wages fall. Others will lose their jobs or see their hours reduced.

Anecdotal evidence already suggests that these disincentives will really matter in the job market, as full-time jobs are converted to part time. Why would employers do this? Because they aren't subject to a tax penalty for employees who work less than 30 hours per week.

There is some debate over how large these effects will be, and how long they will take to manifest. However, the Bureau of Labor Statistics reports on a category of workers who will almost surely be involuntarily underemployed as a result of health reform: the 10 million part-timers who now work 30-34 hours per week.

These workers are particularly vulnerable. Reducing their hours to 29 avoids the employer tax penalty, with relatively little disruption to the workplace. Fewer than one million of them, according to calculations based on the Medical Expenditure Panel Survey, get covered by ObamaCare-compliant insurance from their employer.

In total, it appears that there will be 30 million to 40 million people damaged in some fashion by the Affordable Care Act—more than one in 10 Americans. When that reality becomes clearer, the law is going to start losing its friends in the media, who are inclined to support the president and his initiatives. We'll hear about innocent victims who saw their premiums skyrocket, who were barred from seeing their usual doctor, who had their hours cut or lost their insurance entirely—all thanks to the faceless bureaucracy administering a federal law.

The allure of the David-versus-Goliath narrative is likely to prove irresistible to the media, raising the pressure on Washington to repeal or dramatically modify the law. With the implementation of ObamaCare beginning to take full force at the end of the year, there will be plenty of time before the 2014 midterm elections for Congress to consider its options.

For those like Health and Human Services Secretary Kathleen Sebelius, who told a gathering a few weeks ago at the Harvard School of Public Health that she has been "surprised" by the political wrangling caused so far by ObamaCare, there are likely to be plenty of surprises ahead.

Mr. Kessler is a professor of business and law at Stanford University and a senior fellow at the Hoover Institution.
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« Reply #1047 on: May 09, 2013, 12:20:32 PM »



Thousands of would-be entrepreneurs are itching to start their own businesses, but many are shackled to their current employer by health-care benefits they don't think they could otherwise afford. Economists call this phenomenon "job lock," or "entrepreneurship lock."

But the pressure some Americans feel to cling to a corporate job chiefly for the health insurance could, conceivably, ease in coming years. Under provisions of the health-care law, new-business owners will be able to get coverage through public marketplaces, or "exchanges," beginning in October, for policies that will take effect starting in January.

If the law, known as the Affordable Care Act, is implemented as intended, these exchanges could let entrepreneurs buy insurance at reasonable rates, regardless of their health histories. That's far from a sure bet, however, given evidence that premiums for some people—particularly the young and healthy—could rise under the law.

The Obama administration has touted a boost for entrepreneurship as one of the health-care law's key benefits. The Kauffman-RAND Institute for Entrepreneurship Public Policy in Santa Monica, Calif., says the law could increase the number of new U.S. businesses by as much as 33% over several years.

Laura Stoll is among those who dream of living the entrepreneurial life—if robust, affordable coverage becomes available. The 38-year-old Chicagoan left a corporate job with good health coverage in 2006 to start a new business. Along with her husband, Jay Sukow, a 42-year-old improv actor, she founded the Riot Act, a company that integrated sketch comedy into corporate-training programs.

Health insurers denied them coverage while they were self-employed because the couple suffered from allergies and asthma. For five years they avoided doctors and hospitals as much as possible, Ms. Stoll says.

But once Ms. Stoll was ready to start a family, in 2011, she says she decided it would be smarter to return to the corporate world to get insurance for herself, her husband and her future children. "I needed the safety and security of a corporate blanket," she says.

So she and her husband closed their business, and Ms. Stoll accepted a position that year at Ernst & Young, where she now works as an organizational-development consultant. Earlier this year, she gave birth to her first child, a boy.

Many workers, like Ms. Stoll, believe that as independent business owners they might not be able to afford insurance that covers all their medical needs, such as maternity or mental-health care. Other workers say they are stuck in corporate jobs by pre-existing conditions that make them ineligible for insurance on their own.

To be sure, the law's effect on entrepreneurship could be diluted if getting coverage through insurance exchanges involves big administrative headaches. It remains to be seen what types of health plans the exchanges will offer, and what the costs to entrepreneurs will be.

"To see that 33% bump" in entrepreneurship, "people would need to get a plan on the exchanges that is just as good as what they could get from employers," says Susan Gates, director of the Kauffman-RAND Institute. "And at least in the short run, the exchanges likely won't be as good," she says.

Even as state and federal officials prepare to roll out the exchanges, Brian Hassan, founder of BayPoint Benefits, a San Francisco-based health-insurance consulting firm for technology startups, says he has met with budding entrepreneurs at large tech firms who put their startup plans on hold after crunching the numbers. "They kind of hold back a bit when they see the cost of benefits," he says.

Some insurance brokers say insurance premiums for some entrepreneurs won't be cheaper under the law. UnitedHealth Group Inc. UNH +4.29% told brokers in February that rates for some consumers buying their own plans could rise as much as 116% while small-business rates could go up 25% to 50%. And Aetna Inc. AET -0.13% told them last fall that rates on individual plans not being grandfathered under the law could go up 55%, on average, and small-business rates could rise 29%.

UnitedHealth said its figures represent a high-end scenario, not an average, and some consumers could see rate decreases.

A spokesman for Aetna said its estimates represent the average impact in a typical state.

"There are very few people that I speak to who are expecting small-group rates to come down," says Parker Conrad, co-founder of Zenefits, a San Francisco health-insurance broker for startups and small businesses.

Of course, the world doesn't need more bad business ideas, and leaving a secure job to start a business is like "buying a lottery ticket" says Shikhar Ghosh, a senior lecturer at Harvard Business School who studies startup failures. Current failure rates suggest 50% to 75% of entrepreneurs likely won't succeed, and may lose their savings.

Ms. Stoll, the Ernst & Young employee, says she is taking a wait-and-see approach. She isn't likely to jump ship immediately to restart her business, she says, in part because she worries the insurance exchanges might offer coverage that isn't as attractive as what she gets at the accounting firm. Only when the exchanges are established, she says, can she assess the coverage offered. That process, she adds, could take years.
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« Reply #1048 on: May 13, 2013, 10:40:16 AM »

Some very interesting implications here.  If this piece is right, we had best learn its logic lest Obamacare receive credit to which it is not entitled.
========================

The Health Spending Decline
Why costs have been slowing, at least until ObamaCare kicks in.

To the surprise of both political parties and planners of all types, American health-care spending appears to be slowing down. The health growth rate has flattened out at about 3.9% over the last three years—a record low since the 1960s and down from the old normal of 6.2% to 9.7% in the 2000s.

This is rare good economic news, given that health cost growth sends federal entitlement spending soaring and erodes middle-class wage increases. Can this trend last? Maybe, though not with the Affordable Care Act looming to quash any progress.

At first most observers assumed the slowdown was temporary, an artifact of the 2007-2009 recession and weak recovery. As people lost jobs and thus their insurance, or simply had less income, health spending fell in tandem.

Reflecting this view, the Kaiser Family Foundation and the Altarum Institute recently estimated that underlying economic conditions are responsible for 77% of the current health spending deceleration and that this dip will end when GDP rebounds. Yet health spending growth rates started to decline in 2002, and a provocative paper in the New England Journal last summer suggested that a robust moderation began in mid-2005.

Now comes new evidence that the moderation is durable, and that it is structural—the result of permanent changes in the health system itself rather than the business cycle. These papers look at the historical relationship between GDP and the share of the economy devoted to health care and were published last week in the journal Health Affairs.

The Harvard economist and sometime White House adviser David Cutler and Nikhil Sahni argue that the slowdown has been larger and longer than it should otherwise be. By their model, the recession explains only 37% of the slowdown, and other variables 8%, not Kaiser's 77%.

President Obama naturally says he deserves most of the credit for the slowdown, even though it began well before ObamaCare passed in 2010. His Council of Economic Advisers argues in its 2013 report to Congress that the economy explains just 18% and that the balance includes "early responses to the Affordable Care Act."

But the White House also says that everything that goes wrong in health care is still the fault of Republicans or of private insurers, even though the law was passed (with zero Republican votes) to end the industry's alleged abuses.

A more plausible explanation is offered by Michael Chernew and some Harvard colleagues. Their model suggests that market choice and competition helped produce the slowdown, especially among Mr. Obama's preferred villains. Hide the children: the insurers.

Dr. Chernew investigated changes in the insurance mix at large businesses from 2008 to 2011. Even as these firms did better than their smaller counterparts, their workers shared more of the costs of their own care through higher deductibles, co-pays and new benefit designs. "Rising out-of-pocket payments," he writes, "appear to have played a major role in this decline, accounting for approximately 20% of the observed slowdown."

In a word, patients make better decisions when they have the right incentives and information. Old-style first-dollar insurance coverage is declining in the private economy because employees prefer cash wages and employers can't afford to finance ever-more expensive benefits. One way commercial insurers have responded is with plans that steer consumers to higher-value hospitals, doctors and other providers in return for lower out-of-pocket costs. Think of the way drug formularies encourage generic pharmaceuticals over name brands.

Mr. Obama's economists speculate instead that regulations are requiring providers to be less inefficient, which would be the first time in history that is true. ObamaCare also outlaws most of the experimentation and innovation that is the most likely driver of the slowdown.

Large businesses that self-fund employee benefits operate mostly free of regulations and taxes under a law known as Erisa. Erisa plans cover 60% of the 149 million Americans with job-based coverage, up from 54% in 2005 and 49% in 2000 as businesses have fled government micromanagement.

But everyone else—Medicare, Medicaid and the individual and small-business insurance markets—is now under federal control, and many more will join them if ObamaCare inspires businesses to dump workers into its subsidized "exchanges." The law's actuarial rules and benefit mandates prohibit what the government defines as excessive cost sharing, even as trillions of dollars in subsidies will be pumped into the system to inflate spending growth again.

That will be terrible for the fisc—Dr. Cutler estimates entitlement spending will be $770 billion lower over a decade if the current slowdown holds—and it is another reminder of what a squandered opportunity "health-care reform" was. It increasingly looks as if ObamaCare passed amid a national correction in the health markets that no one in Congress or the White House understood, much less noticed, so naturally Washington moved to create new problems when the old ones were starting to fix themselves.
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« Reply #1049 on: May 13, 2013, 07:25:46 PM »

http://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523

Insurers predict 100%-400% Obamacare rate explosion

May 13, 2013 | 3:02 pm


Paul Bedard

Washington Secrets
The Washington Examiner


Internal cost estimates from 17 of the nation's largest insurance companies indicate that health insurance premiums will grow an average of 100 percent under Obamacare, and that some will soar more than 400 percent, crushing the administration's goal of affordability.

New regulations, policies, taxes, fees and mandates are the reason for the unexpected "rate shock," according to the House Energy and Commerce Committee, which released a report Monday based on internal documents provided by the insurance companies. The 17 companies include Aetna, Blue Cross Blue Shield and Kaiser Foundation.
 

The report found that individuals will face "premium increases of nearly 100 percent on average, with potential highs eclipsing 400 percent. Meanwhile, small businesses can expect average premium increases in the small group market of up to 50 percent, with potential highs over 100 percent."

One company said that new participants in the individual market could see a premium increase of 413 percent when new requirements on age rating and required benefits are taken into account, said the report. "The average yearly cost for a new customer in the individual market grows from $1,896 to $3,708 -- a $1,812 cost increase," it added.

The key reasons for the surge in premiums include providing wider services than people are now paying for and adding less healthy people to the roles of insured, said the report.

It concluded: "Despite promises that the law will lower costs, [Obamacare] will in fact cause the premiums of many Americans to spike substantially. The broken promises are numerous, and the empirical data reveal that many Americans, from recent college graduates to older adults, will not be able to afford the law's higher costs."
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