Four Troubled Horsemen of ObamaCare Apocalypse

Apocalyptic – Presaging imminent disaster and total universal destruction.

Random House Dictionary of English Language

Better never trouble Trouble

Until Trouble troubles you,
For you  only make your trouble
Double-Trouble when you do.

David Keppel (19^th Century Methodist-Episcopal Clergyman),   Trouble

I  do not  believe ObamaCare  will destroy the  U..S. health system.  Nor am I one who writes breathlessly about its irreversible disastrous consequences.

I believe ObamaCare  will either self-destruct short of the Apocalypse, or undergo fundamental change, or be repealed in 2016 should  Republicans win Congress and the Presidency.

I regard the latter as a long shot.

Troubles

ObamaCare is in trouble at the moment because of its structure, substance, and unworkability.

It is in trouble because of its cumbersome rollout and its millions of  cancelled health  plans.

It is in trouble because of its broken promises.

It is in trouble because it knew early on these problems were going to be broken. 

It is trouble because of its extravagant expense, three times the original estimates. 

It is in trouble because it threatens to destroy the very fabric of the American health insurance system –  self-insurance and employer-based insurance for the middle class. 

It is in trouble because of its incompetence  in spending $634 million over the course of 3 ½ years to build a website that doesn’t work and  of which it was warned wouldn’t work.   

It is in trouble because the bulk of Americans do not see any pot of gold or even any  hope at  the end of the ObamaCare rainbow.

Americans can forgive a lot of things, but broken promises,  repeated  mendacities, and sheer incompetence are not among them.

Four Horseman

And lastly it is in  trouble because of  the four horsemen of Obama – Arrogance,  Ignorance, Governance , and Extravagance.  

 These are not the four horsemen of apocalypse described in the New Testament, who represented Conquest, War, Famine, and Death. Those horsemen  rode four different colored horses – red, white, black, and pale , which were different horses with different powers.

The ObamaCare  horsemen are riding different steeds.   Thedr steeds represent  different attitudes  because of the ridetd’ political altitudes.

The first horseman has an arrogance problem.    He thinks he is empowered to transform the American political system regardless of what the opposition party or the American people think.   And he thinks he and his political followers can perform this  feat  unilaterally amd singlehandedly  without compromise or consensus.

The second horseman has an ignorance problem. He does not understand the American culture and its desires and drives for political freedoms.  These freedoms include:  freedom  to be sn entrepreneur,  freedom to pursue one’s dreams without being burdened with supporting the rest of the population, and freedom to take risks and to fail and rise again. We are a risk-taking nation.  We do not believe in absolute government assured security if that security infringes upon individial freedoms.

The third horseman has a governance problem.   He does not seem to grasp that he is responsible for what goes on under his leadership. He should know   what his subordinates are doing  and not wait for the news to tell him. He should  question and know the broad details of massive government projects. He should anticipate what might go wrong before it goes wrong.  He should  be aware of the consequences of his actions.  He should discipline or even sack those who do not deliver on results and promises.  Governance depends on delivering  promises and meeting  public  expectations.   It is about  results not  rhetoric.

The fourth horseman has an extravagance problem.   He spends over $800 billion on a stimulus package that has provided few good  jobs.  He promises  to spend only $900 billion plus $500 million in change, for a health reform package that is on track towards spending $2.7 trillion in ten years.  He parcels out a mere $634 million for a website that doesn’t work.   He raises taxes by $500 billion in penalties, fines, and taxes on businesses to pay for health.   He increases the national debt by more than $5.5  trillion to $17 trillion,  more than all of his predecessors combined.  He makes no moves to trim entitlement programs,  the main drivers of the debt.

Tweet:   Four horseman of ObamaCare apocalypse are Arrogance, Ignorance, Governance, and Extravagance. They are in the saddle and ride humankind.

Is Healthcare.Gov a Turkey?

Turkey - A poor and unsuccessful theatrical production; a financial failure; a flop; any worthless, useless, unsuitable thing.  An ineffective, incompetent, objectionable, or unlikable person or thing. As in “For all ordinary purposes, it was simply a turkey,” or “The treasury realizes this law is a turkey.”

Dictionary of American Slang, Thomas Y. Crowell Company, 1967

The word  "turkey" is also used for fake drug capsule, easy money (turkeys are comparatively easy to catch), an easy task (a turkey shoot), a valise, a 50 cent piece (from the eagle on the coin), and a hobo’s suitcase. Turkey comes from the turkey hen, native to Turkey, which was confused with the American bird.’

Encyclopedia of Word and Phrase Origins, Checkmark Book,  1997

Is Healthcare.Gov a turkey? 

It depends on what you mean by turkey.  

·         Do you mean turkey in a financial  loss sense? 

·         Do you mean turkey as in an inept t project or production ?  

·         Do you mean turkey as a dumb with not enough sense to come in out of the rain who might otherwise drown  if left alone or suffocate when crowded together with fellow turkeys?

·         Do you mean a human turkey surrounded by incompetent followers or helpers, as in “It’s hard to soar with the eagles when you’re surrounded by turkeys?”

If we’re going to talk turkey, do you think this thing called healthcare.gov will be fixed by December 1 on a goverment wing and a prayer?

Government  is promising a fix by that date.  That’s four days after Thanksgiving, national Turkey Day.   Will government then fulfill Benjamin Franklin’s insistence  that the  turkey,a noble creature in his opinion, ought to have been  America’s national bird, not the American eagle?

According to Bree Fowler, a technology writer for Associated Press, most experts say healthcare.gov will  take more time and money to fix than the government admits. Fowler cites Bill Curtis, senior VP and chief scientist at CAST, a French software company, who says  current glitches are just the tip of the iceberg. Deeper problems reside beneath the surface.  

These problems include how to fix and bridge the glitches, subjecting the final producet  end-to-end testing, modifying government policies of rewarding contacts for individual components  to the lowest bidders, and protecting personal information from hackers.  

Curtis says,” Will it eventually work?  Yes, because they have to make it work, but it’ll be very expensive.”  By that comment,  he means money added on to  the $684 million already expended over 3 ½ years. How much longer, no one knows, (Bree Fowler, “Experts: HealthCare.Gov Fix Needs More Time, Money” Associated Press, November 21, 2013),

Will healthcare.gov eventually be a turnkey (that's turnkey not turkey)  information?  Time and money will tell.

Now to return to the question posed in my title: 

Is healthcare.gov a turkey?

When pondering this question, keep your tongue in your cheek and  these facts in mind.

Turkeys, like some independent contractors, have monocular vision.  This means their eyes are located not in the center of their head, but  on the two sides of their head so they can look at two things at once, like predators approaching from opposite sides.  But turkeys can’t focus on the same image at the same time. 

Turkeys aren’t stupid, just misunderstood. say some, though others  disagree.   Robert Hendrickson in the Encyclopedia of Word and Phrase Origins  says, :The domesticated turkey hardly knows what to eat and has to be attracted to food by colorful marbles placed in its feed; it often catches cold by getting its feed wet and frequently panics and suffocates when the flock presses together in fear.”

Because of their monocular vision, turkeys  can’t focus on the same image, or presumably, the same goal at the same time, much less at many different things simultaneously.   Domestic turkeys, bred for their heavy meat, can’t fly. They can't gain altitude for perspective.  They tend to hop around and crowd together against a fence when threatened. Loud noises spook them.  Wild turkeys can fly, and look down from tree branches.  But they tend to be more independent and resist and avoid human intervention and guidance.

I trust this information has been helpful in helping you decide whether healthcare.gov is fixable and whether its contractors are likely to behave like turkeys.   The term gobble, taking things down in a single gulp and satiating one's appetite, is not likely to apply here.  Nor will gobbledygook, another turkey-derived term, be helpful.

Turkeys and federal websites are awkward creatures, and it will take time for them or  a flock of subcontractirs,   to stand firmly on their legs or to soar to reach their final destination..

Tweet:  It’s going to take plenty of time and money to fix healthcare.gov, and the fix will not occur  after Thanksgiving and before Christmas.

 

 

Loaded Health Care Words and Terms

“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds.  It’s a word, in the political world, you just don’t use.”

William M. Daley, President Obama’s former chief of staff, as quoted by John Harwood, “Don’t Dare Call the Health Law ‘Redistribution’” New York Times, and November 24, 2013

Throughout the process of creating the health care law, the Obama administration knew the law would create winners – the uninsured, the underinsured, and those with lower incomes requiring subsidies – and losers - the wealthy, the middle class, employers, and the young.   

And they knew certain words were emotionally explosive, like “redistribution”. It conjured up the image or association with “class warfare” or other terms that rendered rational or unprejudiced thought difficult. 

In other words, the idea of “bringing the poor and dispossessed “into the economic mainstream of health care had to be gingerly approached.

When it comes to health care reform and the health law, “redistribution” is not the only loaded word or expessions as well.  Politicians  and critics know them well.

They include.

·         “Fair share,”  “Fair shake.”  “Together.” As President Obama said  in his re-election campaign, “ Understand this is not a redistribution argument. This is not about taking from the rich to give to poor people.  This is about us together making investment in our country so everybody’s got a fair shot.”   That was the last time the President used the word “redistribution.”   For good reason.  His ideological opponents picked up the word and used it as a hammer against Democrats. Stephen Moore, senior economics writer for the Wall Street Journal,  devoted an entire book to the counter argument – that redistribution diminishes opportunity for the ambitious and talented,  raises taxes, burdens entrepreneurialism,  and redistributes wealth ( Stephen Moore,  Who’s the Fairest of Them All? The Truth about Opportunity, Taxes, and Wealth in America, Encounter Books, 2012).

·         “Affordability.”  “Accountability.”  “Transparency.”  These are the key words the Obama administration deployed to justify the Health Care Law and to make it palatable.  These words would make the law more”affordable” to all without being unfair to anyone. Everyone would be held “accountable” especially those who were unfairly “profiting” from providing health care, among them health plans, hospitals, physicians in the medical industrial complex.  The law would be “transparent.”  Everybody would know why, when, what, and how the left hand of government and right hand of business were doing  through the use of electronic medical records and digital monitoring  at the point of care. Costs would be lowered, quality would be raised, and economic playing field would be levelled.

·         “Single-Payer”    “Universal Health Care.”  “Socialized Medicine.”  These loaded terms were verboten. The existing system of employer-provided insurance would be preserved,  the individual insurance market would be phased out, Medicare Advantage would be gradually ended, Medicaid would be expanded, and the fears of the Middle Class would be addressed by promising you could keep their health plans,  doctors, and hospitals.  Through a hybrid plan, disruptions would be minimized and equality would be maximized. – all without a whimper of dissent. The political dice would be loaded to fall in a particular way, and no one would notice otherwise.

·         “Obamacare.”  “Accountable Care Act.”  “ACA.”  The “Accountable Care Act,” rather than the full name, “Patient Protection and Affordable Care Act,” was at first in favor.  It was neutral.   Its positive features - covering children, those with pre-existing illnesses and young adults under their parent’s plans could be emphasized.   The “ACA” shorthand never caught on, perhaps because it smacked of a bureaucratic acronym   in the beginning, policy makers and shakers did not like “ObamaCare,” too political, too pejorative, too partisan, and too narcissistic.    But the name stuck, and President Obama finally embraced it when he saw it wasn’t going away and, besides, it showed how much he “cared.”

·         “Tea Party.” “Extremists.”  “Republican  Obstruction or Opposition.”  These terms are frequently employed to explain why the health law is not selling well among the public at large and  its key subgroups – employers and business, those who have lost their plans, those reeling from “sticker shock,” independent physicians, the unemployed, residents of Red States and Governors who resist Medicaid expansion.   It does not seem to matter that these dissidents did not write the law, did not create the exchanges, did not design or have a hand in creating healthcare.gov.   Somehow “they” are responsible for the health law’s unpopularity, rocky implementation, and ensuing chaos.  Somehow “they” created the instability and uncertainties surrounding the law.  Somehow “they’ managed to hide the fact, or the “facticity,” a new word for me, that the law punishes those in good health, the young, the self-insured,  the middle class who  do not qualify for subsidies, and those who want to buy plans based on their needs, not government who needs their money to finance an unpopular law.

Tweet:  Certain words or terms are politically correct or incorrect and effective  in selling or opposing  implementation of the health care law.

Winston Churchill Revisited and Updated on National Health Care

The inherent vise of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries.

Winston Churchill (1874-1865), Remarks at 1954 White House luncheon

I have just finished reading The Last Lion: Winston Spencer Churchill, Defender of the Realm, 1940-1965, by William Manchester and Paul Reid, 1182 pages, Little Brown, 2012). The book is the second of Manchester’s two volumes on Churchill life. Mancheser was unable to complete the second because of ill health and needed the assistance of Paul Reid. The first volume was The Last Lion, Vision of Glory, 1874-1932).

What strikes me about the second volume is:

·          World War II dismantled Britain’s Empire, much to Churchill’s chagrin.

·         Franklin Delano Roosevelt, the American President, distrusted Churchill as an imperialist who  he thought wanted to restore Britain’s Empire after the war.

·         Churchill was adamantly against socialism and fought tool and nail to reverse Clement Attlee’s socialist regime in Britain and to become Prime Minister again, which he did

In reading the book, I was interested in Churchill’s views on the National Health Service, which was inroduced in Britain in 1948.

His views produced a mixed bag of quotes

Here are a few of them

In 1944, he said,” Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the most up-to-date medical and allied services available

Yet late in 1945 campaign to retain his position as Prime Minister, he declared: “The (Socialists) hunger for controls of every kind, Socialism is, in essence, an attack not only upon British enterprise, but upon the right of the ordinary man or woman to breathe freely without having a harsh, clumsy, tyrannical hand clapped across their mouths and nostrils."

And, “Socialism is the philosophy of failure, the creed of ignorance, and the gospel of envy,”

And, “Why should the queue become a continuing, continuous feature our life? Here we see clearly what is on their minds.  The socialist dream is no longer a utopia, but Qeueutopia.”

And,  “If you have ten thousand regulations, you destroy all respect for the law."

I wonder what Churchill would say about ObamaCare .  He might say the following if I may take the liberty of paraphrasing and updating him.

“We have tried a noble experiment, and it has failed. It is not the end of the beginning, it  is not even the beginning of the end, But it is, perhaps, the end of the beginning,"

” I cannot forecast to you the actions of Obama.  ObamaCare  is a riddle wrapped into  a mystery inside an enigma."

“The Progressive Dream is no longer a Utopia,  it is a Snafutopia.

"Healthcare.gov is a superb  example of Technological Inexactitude."

“ ObamaCare  is an attack on small business enterprise and the right of the ordinary man and women to live and breathe freely without  having the heavy hand of government suppressing  their choice physicians and health plans.”

“If you have 20,000 regulations,  you  destroy all respect for the Healthcare Law.”

“Never give in, never give in, never, never, never- in nothing great or small, large or petty. – in the search for a better health system for all.”

Tweet:   Winston Churchill was a great man with strong and sometimes conflicting opinions about socialism’s role in health care and its consequences.

After ObamaCare Fails,  Right or Left

My Country, Right or Left

 George Orwell (1903-1950), Title of 1940 Essay

Perhaps the disastrous healthcare.gov rollout and millions of health plan cancellations have done us a favor.   These failings remind us that ObamaCare must be changed.  It’s current structure is to flawed to work.  It cannot meet the needs and expectations of every individual citizen.

Today’s Wall Street Journal editorial board gives these nine reasons for ObamaCare’s inevitable failure (“Manias, Panics and ObamaCare Crashes, November 23-24, 2013)

1.      Technology woes beyond Dec.1.

2.      More cancelled health plans.

3.      Small business insurance disruption.

4.      The viability of the exchanges.

5.      Rate shock round two.

6.      You can’t keep your ObamaCare plan.

7.      …or your Medicare Advantage plan.

8.      And maybe your doctor.

9.      Physician dissatisfaction.

That leaves two options.

·         Go right towards a market-driven, competition-driven system that covers the poor and those with pre-existing illnesses.  Create an alternative system  that features wider choice of plans,   tax credits for all,  shopping across state lines,   health savings accounts with low premiums and high deductibles with catastrophic ceilings, subsidized risk pools for the previously sick, tort reform.   This system must be clearly understandable, workable,, and affordable  for individuals and for the nation as a whole.

·         Go left with government-regulated  single-payer or its equivalent,  Medicare or Medicaid for all.   Private plans, regulated with  lids on profits, acting as public utilities, could deliver health care services, as is being carried out in countries like the Netherlands and Switzerland.  It must be efficient and as free of bureaucrtic inefficiencies and burdens on individual liberties as possible.   

The right approach is probably  more workable in a  capitalistic, center-right  country like America.  The left approach  is more to the liking of President Obama and his ideological followers. Whatever evolves after ObamaCare is its present form falters will likely be hybrid  system somewhere between the two approaches.

The Wall  Street Journal’s guess is that President Obama’s approach will be,  to: “Blame others, stretch or break the law to plug the holes, and try to keep the Democrats from breaking ranks before the 2014 elections.”

I am less cynical.  I believe the American electorate will force politicians to come to their senses and to a consensus to do something that fits American culture and its peoples’ desires for individual  and affordable freedoms.  

This will require delaying , re-opening,  re-examining , and changiing  the pillars of the law.

Tweet:   Because of chaos of healthcare.gov and cancelled policies,   ObamaCare will be delayed and significantly altered  but not repealed.

 

Fees, Famine, or Freedom

There’s going to be, as we’ve already seen in this market, gut wrenching changes in this business, in an industry that’s not ready for it.  People haven’t been prepared for it. And there’s going to be a lot of disruption…There are a lot of people out there who are scared: scared by what it means to them personally; scared of what it means to their job, their company and something else.  They are scared, too, because there’s probably not going to be a place for small players as survivors.”

Interview with Richard Burke, first CEO of United Health Care, by Richard Reece, MS,  in Who Shall Care for the Sick, Media Medicus, Minneapolis, 1988

You know you’re getting old when you start quoting yourself and an nterview you conducted long ago.

Back then, in 1988, the handwriting was on the wall, Richard Burke saw it and read it clearly.

Even then, it was clear what Burke’s strategies were.

1) Win market share by offering innovative health plans with low premiums, comprehensive benefits.

2) Narrow the list of hospitals with which United would deal by guaranteeing large numbers of patients in exchange for fee discounts.

3) Narrow the list of physicians by dealing only with those doctors who were most “cost-effective” – i.e., didn't burden the plan with expensive services for patients.

4) Cut the cost of physician expenses by redistributing income from high-cost specialists to less-well paid primary care physicians.

5) Implement the strategy quietly in steps to leave HMOs in control of the system with the power to control hospitals and physicians.

      I thought of Richard Burke today when I read “Insurers Cut Doctors’ Fees in New Health-Care Plans: Move Sparks Worries Pans Will Attract Fewer Doctors,” Wall Street Journal, November 21, 2013.

      In New York City, according to confidential documents reviewed by the Wall Street Journal, these fees will be less than $40 for  office visits and  $20 for reading a mammogram.

     These fees may even be less than what doctors now receive for Medicaid;   Blue Shield of California has asked doctors to accept fees up to 30% lower than commercial rates.

      This is important because doctors now accept only 30% to 50% of Medicaid patients depending on the section of the country surveyed.   It is important too because only a fraction of doctors may accept the predicted 20 million patients expected to enroll in health exchange plans.  Twenty nine percent have not decided whether to  participate in health exchange plans.    In a September survey conducted by the Medical Group Management Association, of those doctors who had heard of wht exchange fee would be, 37% said the fees offered were lower than Medicare, and 18% were lower than Medicaid.

     What are doctors to do if fees don’t meet the cost of doing business? Should they just suck it up and stay in practice, see fewer patients from exchanges, stop seeing exchange patients all together, and go to the negotiating table with the health plans?

      The choices are fees, famine or freedom.   Freedom may come in the form of concierge practices where doctors reject third parties and charge a month or annual retainer fee.  For patients, the choices are: search for a doctor who will accept exchange fees or go to a federally supported Community Health Center.

Tweet:   Insurers are cutting doctor fees in health exchange plans. Doctors may not accept exchange patients, who will have fewer doctor choices.