Monday, June 29, 2015

A Funny Thing Happened on the Way to the Health Care Forum



Democrats and liberals rejoiced. The nation had embraced tolerance on social issues.

Republicans celebrated. They were now free to pursue economic and national security problems without being labeled bigots.

In Charleston, South Carolinians demonstrated what true Christianity is all about – love and forgiveness rather than hate and bigotry.

To further end the charges of Southern bigotry, the politicians of South Carolina vowed to take down the Confederate flag from the state capitol grounds and put it a museum. Mississippi and Alabama public officials made similar vows. For the South, this was a healing time.

Jonathon Martin of the New York Times (“As Left Wins, GO.P. Reflects”) wrote, “ A cascade of events suggests that 2015 could be remembered as a Liberal Spring: the moment when deeply divisive and consuming questions or race, sexuality and broadened access to health care were settled in quick succession, and social tolerance was cemented as a cornerstone of American public life.”

Which brings me to the definition of tolerance, “A fair and objective attitude towards those whose opinions differ from one’s own: freedom from bigotry."

These days far too often, resistance to mainstream liberalism is labeled “bigotry,” which politically correct circles is defined as “stubborn and complete intolerance of any freed , belief, or opinion that differs from one’s own.”

While acknowledging that the country had become more tolerant and, in some ways, culturally liberal, many Republicans contend that America is still receptive to a more conservative approach approach on economics and social security.

Obama says it’s here to stay. But it will need fixing. Last week the Republican House overwhelming passed a bill repealing the Medical Innovation Tax and the Independent Patient Payment Board. These repeals await a Senate vote. And the GOP says it will still repeal ObamaCare if it wins in 2016. And it says it will seek to passed a market patient-centered plan in 2017 0r 2018 after it repeals ObamaCare with its individual and employer mandates . In the meantime, it will chip away at ObamaCare by denying funding, prevent he bailout of insurers who lose money on subsidies, and softening the employer mandate on comapies with over 50 employees.

In an editorial today “The Fight for Health Care Isn’t Over,” the Times acidly comments on this and GOP efforts in 21 states resisting Medicaid expansion, “The Republicans, gripped by irrational hostility (italics mine) to helping the poor, would rather hurt the uninsured and damage their state economies by refusing federal money. Federal money always comes with strings attached - loss of control, compliance with federal regulations, and unforeseen expenses.


A Funny Thing Happened on the Way to the Health Care Forum

A Funny Thing Happened on the Way to the Health Care Forum
A funny thing happened this week after the Supreme Court OKed federal subsidies and gay marriage.
Democrats and liberals rejoiced that the nation had embraced tolerance on social issues. Republicans celebrated that they were now free to pursue economic and national security problems without being labeled bigots. In Charleston, South Carolinians demonstrated what true Christianity is all about – love and forgiveness rather than hate and bigotry.
To further end the charges of Southern bigotry, the politicians of South Carolina vowed to take down the Confederate flag from the state capitol grounds and put it a museum. Mississippi and Alabama public officials made similar vows. For the South, this was a healing time.
Jonathon Martin of the New York Times New York Times ( “As Left Wins, GO.P. Reflects”) wrote, “ A cascade of events suggests that 2015 could be remembered as a Liberal Spring: the moment when deeply divisive and consuming questions or race, sexuality and broadened access to health care were settled in quick succession, and social tolerance was cemented as a cornerstone of American public life.”
Which brings me to the definition of tolerance, “A fair and objective attitude towards those whose opinions differ from one’s own: freedom from bigotry.
These days far too often, resistance to mainstream liberalism is labeled “bigotry,” which politically correct circles is defined as “stubborn and complete intolerance of any freed , belief, or opinion that differs from one’s own.”

“While acknowledging that the country had become more tolerant and, in some ways, culturally liberal, many Republicans contend that America is still receptive to a more conservative approach approach on economics and social security.
Obama says it’s here to stay. But it will need fixing. Last week the Republican House overwhelming passed a bill repealing the Medical Innovation Tax and the Independent Patient Payment Board. And the GOP says it will still repeal ObamaCare if it wins in 2016. And it says it will seek to passed a market patient-centered plan in 2017 0r 2018 after it repeals ObamaCare with its individual and employer mandates . In the meantime, it will chip away at ObamaCare by denying funding, prevent he bailout of insurers who lose money on subsidies, and softening the employer mandate on comapies with over 50 employees.
In an editorial today “The Fight for Health Care Isn’t Over,” the Times acidly comments on this and GOP efforts in 21 states resisting Medicaid expansion, “The Republicans, gripped by irrational hostility (italics mine) to helping the poor, would rather hurt the uninsured and damage their state economies by refusing federal money

Saturday, June 27, 2015

Headline Hunting for Supreme Court Impact on ObamaCare

I’ve gone hunting for headlines to see how media is responding to Supreme Court upholding federal health exchange subsidies.

Left-leaning publications are joyous. Right-tilting media are either furious with Chief Justice Roberts or happy Republicans are now free to pursue repeal.

Here is a sample of today’s headlines.

“Supreme Deliverance for Republicans,” Fox News



“Twisted Logic of John Roberts Ruling,” New York Post



“ Health Law Nightmare is Just Beginning,” National Interest



“Health Care Ruling a Landmark Victory for White House,” Real Clear Politics




“ No Easy Road for Health Law: Troubles Remain: Still Highly Unpopular with Significant Structural Issues,” Politico



“Krauthammer: No Question GOP Will Repeal if They Win”


“Supreme Court Allows National Health Care Subsidies,” New York Times

I was particularly interested in what the headlines were in the Wall Street Journal, long a harsh critic of ObamaCare. Here are 11 WSJ headlines and subheadings.

“High Court Saves Health Law: Justices in 6-3 Ruling Uphold Provision of Obama’s Signature Program; Republicans Vow To Continue Fight.



“Roberts Charts Own Path: Frustrated Conservatives Again”





“Insurers and Hospitals Breath Sign of Relief”



“Ruling Caps a Week of Wins for the President

“Decision Pushes Health Care to Fore of GOP Campaign”



“Companies to Take Aim at Law’s Fees”



“Disputed Ruling Has Long Backstory”



“ObamaCare Debate Begins Anew”



“The Political John Roberts: The Chief Justice Again Rewrites ObamaCare to Save It”



“ObamaCare Wins One, America Loses”



“Antonin Scalia Dissents

There you have it. For some, Supreme Court ruling is a resounding victory. For others, it is a Pyrrhic victory, destined to last only until 2016, if Republicans win. For most, ObamaCare’a structural problems still lurk - soaring premiums and deductibles, unpopularity among public, losses of choice of doctors and health plans, and negative impact on economic growth.. The decision is good in short term for Obama, uninsured, hospitals, and insurers. But it is bad in many respects for some people who want prompt access to care they need, from a doctor, hospital, and health plan they choose, at a price they can afford.

Thursday, June 25, 2015

As VA Goes, So Goes ACA?

So it goes.
Kurt Vonnegut, Jr (1922-007), Slaughter House 5

ACA critics are wont to compare ObamaCare to the VA health system. The cite the VA as an example where a single-payer government-run system might lead – a mindless unaccountable bureaucracy with rationing and long waiting lines.

The VA has the nation’s largest integrated, coordinated health system connected by a single health information system. But last year the VA’s problems became glaringly apparent, with veterans said to be dying while waiting for months to be seen and a widespread shortage of physicians, nurses, and other care givers.

Things aren’t getting any better. Demands for VA services is up 50% this year, costs are growing because of a growing population of aging veterans with dementia and chronic disease, costs of new drugs for hepatitis C and cancer are mounting exponentially, and the VA faces a $2.7 billion budget shortfall. Access has expanded with 2.7 million more appointments and authorization for 900,000 people to see physicians outside the VA system. Physician workloads have grown by an average of 21% across the system, but no supply of more physicians is in sight.

The principal VA problems are increased demand, shortages of physicians and nurses, lack of office space, and a complicated, seemingly intractable, querulous, whistle-blowing bureaucracy full of infighting and finger-pointing superimposed on a larger political debate about the size and role of government and its inherent inefficiencies.

And so it goes. Whether ObamaCare is headed in the same direction is unknown. But so it goes with the VA.
Supreme Court Rule 6-3 in Favor of Federal Subsidies

Today’s Supreme Court ruling favoring federal subsidies assures ObamaCare survival until the 2016 election and beyond. The decision is a political victory for the Obama administration and a defeat for Republicans who sought to gut the law or repealed.

What does the ruling mean?

It means the Court has now ruled twice, the first time in 2012, that ObamaCare is constitutional.

It means liberals will be pleased and conservatives displeased with the decision.

It means hospitals will be pleased because some of the uninsured hospital expenses will now be paid.

It means institutional federal laws giving a legal right to health care - Medicare (1965) Medicaid (1965), Emergency Medical Treatment and Active Labor Act (EMTALA 1986) Children’s Health Insurance Program (CHIP1997), and Patient Protection and Affordable Care Act (ACA2010) – will continue to consume more federal dollars.

It means federal entitlement programs will continue go grow, as they have over the last 50 years.

It means that the 6.7 million Americans on federal subsidies will continue to receive $3,312 per recipient per annum or $222 billion in all. More people will be subsidized to consume health care at middle class taxpayer expense.

It means hospitals, which heretofore had to absorb costs of the insured who could not afford care, will have a new source of federal revenues.

It means less uncertainty for health plans, who feared a death spiral and other disruptive effects if the Court had ruled against federal subsidies
.
It means those unpopular individual and employer mandates will remain in place.

What the ruling not mean?

It does not mean the controversy over the law has ended. It will continue through the 2016 elections.

It does not mean that the law is working as intended. Yes, it reduced the number of uninsured by 16 to 17 million out of 50 million. Yes, it helped 6.7 million uninsured and low income people below 4 times the poverty rate, less than 3% of the population.

But it may not help the middle class, who in 2016, are projected to see their health premiums, deductibles, co-pays, and out of pocket costs soar by 10% to 30% and who may see their plans cancelled and their doctors and hospitals declared out-of-network.

And it does not mean America’s uninsured will jump on the health exchange bandwagon. According to a survey sponsored by the Robert Wood Johnson Foundation, 38% of insured get their medical care by paying out of pocket, 28% us fee-low-cost clinics, 26% go without care, 20% buy discount medications, 14% use the ER, 9% negotiate their bills down, and 4% go to another country for care.

The largest group of people who remain uninsured, 45% of them, forego coverage by choice, even though the law guarantees them they can get coverage on their own or through a job.

Many of the uninsured are confident they can get their care cheaper and manage it better without health insurance: 56% on doctor visits, 53% on prescription drugs, 52% on checkups, 48% on emergency care, and 42% on preventive tests or screening. Many Americans, in short, are getting their care the old-fashioned way – cash, barter, or charity. They believe they can get a better deal without insurance. They prefer to pay ObamaCare’s penalty mandates rather than enroll in Obama Care sponsored and approved health plans

Saturday, June 20, 2015

Transition from ObamaCare to Free Market Care

Senator Ron Johnson of Wisconsin, anticipating a Supreme Court rejection of federal ObamaCare subsidies in 34 states, has set forth the following proposal to transition from ObamaCare to a free market subsidies.

He stresses his proposal is not a substitute for ObamaCare, but would have support among Republicans and the American public, because it is realistic, would create a financial bridge to a new system, would lower costs, decrease impact on the $18 trillion federal deficit, would decrease premium costs and increase choice for health plans and providers for the middle class, and would protect 8 to 10 million Americans who already have subsidies.

Essentially, his plan buys time to transition to a new system

The plan, which he calls “If You Like Your Health Plan," You Can Keep It Act, contains the following elements.

• A grandfather clause allowing those with federal subsidies to keep those subsidies for 2 years.

• Ends the unpopular individual and employer mandates.

• Ends insurance company bailouts.

• Offers health care tax credits for all by equalizing tax credits for everyone.

• Allows people to shop for insurance across state lines.

Again his plan is not a panacea. It recognizes reality, that you cannot abruptly end a law that has already been implemented. You cannot immediately repeal all of its elements, such ending subsidies for 10 million or so citizens or removing provisions that protect those with pre-existing illness, said to number over 100 million.

But you can highlight the flaws in the bill, retain its benefits, and limit. its damages. And you can put forth a proposal that will unify Republicans and appeal to the majority of Americans.