Tuesday, December 31, 2013

Obama Repeals ObamaCare

Obama Repeals ObamaCare

Under pressure from Senate Democrats, the President partly suspends the individual mandate.

It seems Nancy Pelosi was wrong when she said "we have to pass" ObamaCare to "find out what's in it." No one may ever know because the White House keeps treating the Affordable Care Act's text as a mere suggestion subject to day-to-day revision. Its latest political retrofit is the most brazen: President Obama is partly suspending the individual mandate.
The White House argued at the Supreme Court that the insurance-purchase mandate was not only constitutional but essential to the law's success, while refusing Republican demands to delay or repeal it. But late on Thursday, with only four days to go before the December enrollment deadline, the Health and Human Services Department decreed that millions of Americans are suddenly exempt.
Individuals whose health plans were canceled will now automatically qualify for a "hardship exemption" from the mandate. If they can't or don't sign up for a new plan, they don't have to pay the tax. They can also get a special category of ObamaCare insurance designed for people under age 30.

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So merry Christmas. If ObamaCare's benefit and income redistribution requirements made your old, cheaper, better health plan illegal, you now have the option of going without coverage without the government taking your money as punishment. You can also claim the tautological consolation of an ObamaCare hardship exemption due to ObamaCare itself.

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Editorial board member Joe Rago on the new health-care law's latest delay—a temporary mandate exemption for those with canceled plans. Photo credit: Getty Images.
These exemptions were supposed to go only to the truly destitute such as the homeless, bankrupts or victims of domestic violence. But this week a group of six endangered Senate Democrats importuned HHS Secretary Kathleen Sebelius to "clarify" that the victims of ObamaCare also qualify. An excerpt from their Wednesday letter, whose signatories include New Hampshire's Jeanne Shaheen and Virginia's Mark Warner, is nearby.
HHS and the Senators must have coordinated in advance because literally overnight HHS rushed out a bulletin noting that exemptions are available to those who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan." A tornado destroys the neighborhood or ObamaCare blows up the individual insurance market, what's the difference?
The HHS ruling is that ObamaCare is precisely such a "significant, unexpected increase." In other words, it is an admission that rate shock is real and the mandates drive up costs well into hardship territory. HHS is agreeing with the Senators that exemptions should cover "an individual whose 2013 plan was canceled and considers their new premium unaffordable." In her reply letter, Mrs. Sebelius also observes that some people "are having difficulty finding an acceptable replacement." She means the new plans are overpriced.
The under-30 ObamaCare category that is being opened to everyone is called "catastrophic" coverage. These plans are still more expensive than those sold on the former market but they're about 20% cheaper on average than normal exchange plans because fewer mandates apply and they're priced for a healthier, younger risk pool. Liberal Democrats hated making even this concession when they wrote the law, so people who pick catastrophic plans don't get subsidies.
Health and Human Services Secretary Kathleen Sebelius Getty Images
 
What an incredible political turnabout. Mr. Obama and HHS used to insist that the new plans are better and less expensive after subsidies than the old "substandard" insurance. Now they're conceding that at least some people should be free to choose less costly plans if they prefer—or no plan—and ObamaCare's all-you-can-eat benefits rules aren't necessary for quality health coverage after all.
But the White House is shredding ObamaCare's economics on its own terms. Premiums for catastrophic products are based on the assumption that enrollees would be under 30. A 55-year-old will now get a steep discount on care courtesy of the insurer's balance sheet, while other risk-tiers on the exchanges will have even fewer customers to make the actuarial math work.
Pulling the thread of the individual mandate also means that the whole scheme could unravel. Waiving ObamaCare rules for some citizens and continuing to squeeze the individual economic liberties of others by forcing them to buy what the White House now concedes is an unaffordable product is untenable. Mr. Obama is inviting a blanket hardship amnesty for everyone, which is what Republicans should demand.
The new political risk that the rules are liable to change at any moment will also be cycled into 2015 premiums. Expect another price spike late next summer. With ObamaCare looking like a loss-making book of business, a public declaration of penance by the insurance industry for helping to sell ObamaCare is long overdue.
The only political explanation for relaxing enforcement of the individual mandate—even at the risk of destabilizing ObamaCare in the long term—is that the White House is panicked that the whole entitlement is endangered. The insurance terminations and rollout fiasco could leave more people uninsured in 2014 than in 2013. ObamaCare's unpopularity with the public could cost Democrats the Senate in 2014, and a GOP Congress in 2015 could compel the White House to reopen the law and make major changes.
Republicans ought to prepare for that eventuality with insurance reforms beyond the "repeal" slogan, but they can also take some vindication in Thursday's reversal. Mr. Obama's actions are as damning about ObamaCare as anything Senator Ted Cruz has said, and they implicitly confirm that the law is quarter-baked and harmful. Mr. Obama is doing through executive fiat what Republicans shut down the government to get him to do.

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The President declared at his Friday press conference that the exemptions "don't go to the core of the law," but in fact they belong to his larger pattern of suspending the law on his own administrative whim. Earlier this month he ordered insurers to backdate policies to compensate for the federal exchange meltdown, and before that HHS declared that it would not enforce for a year the mandates responsible for policy cancellations. Mr. Obama's team has also by fiat abandoned the small-business exchanges, delayed the employer mandate and scaled back income verification.
"The basic structure of that law is working, despite all the problems," Mr. Obama added. His make-it-up-as-he-goes improvisation will continue, because the law is failing.
 


The Slow Unraveling of Obamacare Continues

The Slow Unraveling of Obamacare Continues

by John Hinderaker in Obamacare
Obamacare represents, I think, the first time that the Obama administration has actually had to face reality. The stimulus was a disaster, but most people don’t care much about wasting borrowed money. Green energy has been a fiasco, but hey–it’s only money, and half the population doesn’t pay income taxes. Obama’s foreign policy has been an utter failure, but foreign policy mistakes take time to come home to roost. There have been many other failures, but the press has largely managed to cover them up, or at least minimize them.
In the case of Obamacare, that simply can’t be done. Obamacare is a rolling disaster that will continue to unfold, inexorably, over the coming year. Today’s installment comes from the Minneapolis Star Tribune, reporting on the demographics of MNSure, Minnesota’s Obamacare plan: “MNsure is counting on the young signing up, but typical enrollee is 50.” Heh.
As the deadline nears for Minnesotans to purchase health insurance for 2014 on MNsure, an unsettling question remains: Will young, healthy people sign up on the online exchange and infuse plans with the premium revenues they need to pay for all the older, sicker people?

This is relatively candid: can young people be wheedled or coerced into paying way too much for health insurance? That has always been one of the key questions about Obamacare. You can understand why Obama was optimistic: he fooled young people twice, why not fool them again? The difference is that this time, the connection to their pocketbook is obvious.
Through November, half of the enrollees who bought private health plans on MNsure were between the ages of 51 to 64, even though that age group makes up only 21 percent of the state’s non-elderly population. That was hardly the plan when the exchange was created under the federal Affordable Care Act to cover uninsured Minnesotans and improve benefit options for sick and self-employed people who didn’t have workplace benefits.
Private plans on the exchange generally set premiums with the expectation that the median age of enrollees would be closer to 40, which is what they typically saw in the plans they sold on the individual market in past years. The current median age of MNsure enrollees is 50.
“That’s kind of scary,” said Scott Keefer, vice president of policy and legislative affairs for Blue Cross and Blue Shield of Minnesota.
Scary, if you actually want this cockeyed Rube Goldberg system to work. To the extent that the pool of enrollees is worse (older or sicker) than predicted, premiums will rise next year and the year after, which will drive more healthy people out of the system and accelerate its inevitable collapse.
It turns out that Minnesota isn’t the only state where the demographics (which is to say, the economics) of Obamacare are not working out as planned:
Nine states with their own insurance exchanges under federal reform have published data showing the age ranges of the enrollees, and most of them are like Minnesota in that they are lacking younger people so far.
Young people, in general, may not be quite as stupid as the Democrats thought.
In another worrisome development–worrisome if you actually thought Obamacare had any chance of working–most people are buying cheaper Obamacare policies than government planners anticipated. The Associated Press headlines: “In ominous sign, many health plan buyers are just picking the cheapest.” Imagine that!
As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They’re picking the cheapest one.
Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they’re on the hook for most of the initial cost.
So there isn’t any free lunch…imagine that!
Obamacare is illogical. It cannot work. It is like a Soviet five-year plan. Bureaucrats can dictate whatever they want, but their dictates will not produce the desired reality. Obamacare is doomed, as many of us knew from the start.
 

Don's Tuesday column

            THE WAY I SEE IT   by Don Polson  Red Bluff Daily News   12/31/2013
           Who triumphs in courts, culture, graveyards?
The address on “Religion and Public Life in America” by R. R. Reno, editor, First Things, delivered at Hillsdale College last February, deserved more attention than I could devote last week. Overall, his observations and arguments paint a troubling scenario for the defense of religious liberty, when juxtaposed with the determination and sweep of anti-Christian agendas and attacks. When religious liberties vanish, no one has liberty or rights.
“Recent court cases and controversies suggest trends unfriendly to religion in public life.” Few will likely recall the 2012 Supreme Court case involving Hosanna-Tabor Evangelical Lutheran Church and School in Redford, Michigan. The case title included “v. Equal Employment Opportunity Commission” because the EEOC took the side of a wrongful termination lawsuit filed by a dismissed teacher for supposed disability discrimination. The school said it could fire an employee under a legal doctrine, “the ministerial exception,” which allows a church wide latitude to choose its religious leaders.
“[While legal arguments are complex and multi-layered], in this case the Obama administration’s lawyers made a shockingly blunt argument: Their brief claimed that there should be no ministerial exception. The Supreme Court rejected this argument in a unanimous 9-0 vote.” In the minds of the hard left Obama lawyers, the unique prerogatives associated with religious groups to choose their own leaders are of little merit when the state’s agencies see any form of (in their view) discrimination. While church employment, leadership and staffing decisions might not conform to every conceivable application of fairness, the state must keep its hands off the religious according to first amendment protections: “Congress shall make no law … prohibiting the free exercise (of religion).” This is especially concerning “when we remember that the Left is currently pushing to add gay marriage to the list of civil rights.”
“Concerns about the autonomy of religious institutions are also at work in the Obama administration’s tussle with the Catholic Church and her religious allies over the mandate to provide free contraceptives, sterilization and abortion-inducing drugs.” I’ve mentioned this previously but what’s crucial to understand is that the Obamacare law, as written, allowed for no religious exceptions. This prompted widespread public outcry, to which Obama’s people then allowed that only churches have that right to “opt out of the morally controversial coverage.” To religious colleges and charities, an “accommodation” was offered.
To churches and their allies, the act of the all-powerful state pronouncing or granting a narrow accommodation, is an act of “accommodating” the supreme authority of the state. “When various states such as Illinois passed laws allowing gay adoptions, they did not ‘accommodate’ Catholic charities, but instead demanded compliance …” and the Church simply shut down adoption agencies. I imagine atheists, cheering on the state’s authority in this issue, will eventually find that same state authority to be despotic when it forces conscience-violating compliance from them in other ways (Mandatory gun ownership? Mandatory military service?).
Cardinal Dolan of New York explained that (in Mr. Reno’s words) “for-profit companies are not religious in the way that Notre Dame University is religious. Nonetheless, the religious beliefs of those who own and run businesses in America should be accorded some protection. This idea the Obama administration flatly rejects. By their progressive way of thinking, economic life should be under the full and unlimited control of the federal government.” Read that again … and be very afraid.
Another way that religious liberty is undermined is in the legal doctrine that “political theorists like John Rawls have argued that our laws must be based on so-called public reason, which is in fact an ambiguous, ill-defined concept that gives privileged status to liberalism.” This hyper-rationalism has reared its head, perhaps most prominently, in the judicial activism of liberal judges from California to New Mexico to Utah, who simply reject any arguments on their face, that contend traditional, opposite-sex marriages are harmed by legal acceptance and approval of same-sex marriages. Hence, they reject the voters’ choices because they impute inherently religious convictions as motivations for voting against gay marriage—convictions simply dismissed by secular and atheist fanatics.
Reno states the following far better than I could paraphrase: “In the world envisioned by Obama administration lawyers, churches will have freedom as ‘houses of worship,’ but unless they accept the secular consensus, they can’t inspire their adherents to form institutions to educate and serve society in accordance with the principles of their faith. [‘Public reason’ allows religious freedom of speech] but when their voices contradict the secular consensus, they’re not allowed into our legislative chambers or courtrooms … What we’re seeing today is a secular liberalism that wants to expand the prohibition of establishment to silence articulate religious voices and disenfranchise religiously motivated voters, and at the same time to narrow the scope of free exercise so that the new secular morality can reign over American society unimpeded.”
Two final quick points: Courts do not exist in a cultural/political vacuum; Reno notes “the rise of the Nones (who check ‘None’ for religious affiliation)” from 3 percent to over 20 percent. They dominate elite academic culture, media, and politics; friction with religion ensues.
The long-term prospects for the ideological attackers of Christianity are not hopeful. Graveyards and cemeteries are full of people, their antagonisms and efforts to crush religion, which has somehow survived, even thrived, over millennia.

Monday, December 30, 2013

Your ObamaCare Fail of the Day [Morning Edition]

Your ObamaCare Fail of the Day [Morning Edition]

by Stephen Green


PRICY
Let’s let the Left berate us more about sustainability, shall we?

More seriously — although there was more than a nugget of truth in that gag line above — is that the $677,000,000 or billion dollars or whatever will eventually be amortized over millions and millions of paying customers. That’s up to 93 million paying customers, if the worst-case scenario comes to pass on how many people lose their current insurance. But whatever the final figure turns out to be, and I’m assuming the whole thing doesn’t blow up, that $14,196 will amortize down to less — a lot less.
Still, what are we getting for our money?
In 2008, the promise was to save each family of four an average of $2,500.
In 2009, the promise was to insure 47 million Americans who didn’t have insurance, and to save you those $2,500.
In 2010, the promise was to insure 47 million Americans who didn’t have insurance, and to save you those $2,500, and let you keep the plan you have and the doctor you like.
In 2011, the promise was maybe more like 30 millions Americans would get insured. I don’t remember any more talk about an actual dollar figure on your savings, but you could still for sure keep your doctor and your plan.
In 2012, Mitt Romney. ‘Nuff said.
In 2013, the promises, shifting though they were, all got broken. Premiums might be down, assuming you can get subsidized, but your copays and deductibles are all higher. As one smart commenter here put it a while back, the ObamaCare-approved plans are essentially catastrophic coverage at Cadillac plan prices. Instead of promising coverage to maybe 23 million Americans, the hope — and so far it is just a hope — is to get about seven million signed up by the end of next March. The official figure is 365,000 or so, but the real figure is significantly lower. How much lower is anyone’s guess, because guesswork is all this tight-lipped administration has left us. 800,000 or so have been added to the Medicaid rolls, which I suppose counts as coverage, if not actual insurance.
Your odds of keeping your current plan or your current doctor decrease with each creaking ratchet of the ObamaCare regulatory apparatus — somewhere between 5 and 5.5 million Americans have had their plans cancelled by those strictures. That number will climb.
But let’s be generous and optimistic here. We’ll spot the administration 200,000 paid customers out of the 365,000 who put something in a basket. That number is almost certainly high. Let’s tack on the 800,000 people newly enrolled in Medicaid. That’s a gain of 1,000,000 with coverage. From that we subtract the 5,000,000 (we’ll go with the low figure here, again in the holiday spirit of being generous and optimistic) who have lost their coverage. So far, ObamaCare is 4,000,000 souls in the hole.
So in order to achieve that 7,000,000 figure by March 31, the state and federal exchanges will have to get 11,000,000 or so folks registered, enrolled, and paid up.
11,000,000.
That’s assuming — I am so very generous and optimistic this morning — not one more cancellation notice goes out. For every cancelled individual plan, another person must register, enroll, and pay up on one of the exchanges.
11,000,000.
That’s the best-case number the administration faces. Based on the needs of ObamaCare’s exchanges and the number of Americans who have already been denied their existing coverage, 11,000,000 is baked in. It can go only higher. Which makes it seem almost unsportsmanlike to remind you that the financial incentive, especially for the young and healthy, is to ignore the mandate and to pay the tiny fine.
Now let us go back again to 2009-10, back when the Democrats had to pass legislation right the hell now in the dead of night without reading it, because 47 million Americans need insurance and we’re going to give it to them!
Give it to them good and hard, to borrow H.L. Mencken’s memorable phrase.
We’ve gone from 47 million to 30 million to 20-or-so million to negative four million.
In the history of broken promises by American politicians, that might just be a record.

http://pjmedia.com/vodkapundit/2013/12/13/your-obamacare-fail-of-the-day-morning-edition/?singlepage=true

Euphoria of Obamacare becomes nightmare of higher premiums and deductibles

Euphoria of Obamacare becomes nightmare of higher premiums and deductibles

From a distance of three and a half years, the events of March 23, 2010, the day President Obama signed the Patient Protection and Affordable Care Act into law, seem like something from another world.
On that day, the Democrats who gathered in the East Room of the White House for the signing ceremony could barely contain their joy. They cheered, they laughed, they shouted, they pumped their fists, they wouldn't sit down. They chanted "Fired up -- ready to go!" as they had at Obama campaign rallies. When the president recognized Nancy Pelosi, then speaker of the House, the chant turned to "Nancy! Nancy! Nancy!"Pelosi, of course, would be swept out of the speakership in the Republican landslide a few months later -- a result that was based, in part, on the voters' unhappiness with Obamacare. And today, some of the other Democrats in the East Room are now afraid for their jobs -- because of the voters' unhappiness with Obamacare.
After an effusive introduction from Vice President Biden, Obama turned almost immediately to the task ahead. "It will take four years to implement fully many of these reforms," he said, "because we need to implement them responsibly. We need to get this right."
At the time, no one had any idea just how ill-prepared Obama and his administration were to actually do the job they set for themselves. Three years later, approaching an Oct. 1, 2013, deadline for the establishment of the Obamacare exchanges, the administration was still scrambling to finish even the most basic tasks. What followed was disaster.
But on signing day 2010, it was all cheering. As the audience applauded, Obama promised the new law would "lower costs for families and for businesses." He cited the case of Natoma Canfield, an Ohio woman whose story he often told during the health care fight. Canfield, divorced and 50 years old, had had cancer but was still able to find what she called "costly, but affordable" coverage on the individual market. Then her insurance company abruptly raised her premium.
"Natoma had to give up her health coverage after her rates were jacked up by more than 40 percent," Obama said.
Now, because of Obamacare, millions of Americans in the individual market, most of whom have not had a major health crisis, are facing abrupt increases of more than 40 percent in their health insurance premiums. On top of that, they are finding deductibles rising far beyond those that troubled Canfield. (In a 2009 letter to the president, Canfield complained of having a $2,500 deductible; on Monday, the Wall Street Journal reported that under Obamacare "the average individual deductible for what is called a bronze plan on the exchange — the lowest-priced coverage — is $5,081 a year.")
Even the president's personal observations on signing day were not what they appeared. "I'm signing this reform bill into law on behalf of my mother," Obama told the audience, "who argued with insurance companies even as she battled cancer in her final days." Obama often cited his mother's story, suggesting that she had to fight to have her treatment covered. But a year after the signing ceremony, a 2011 biography of Stanley Ann Dunham revealed she had health coverage that covered the costs of her cancer treatment. Her argument was over a disability policy, which she wanted to pay her living -- not medical -- expenses. Obama never said that.
Finally the president got down to signing the bill. That, too, reflected the over-the-top enthusiasm of the day. Presidents sometimes use several pens to sign important legislation. Obama gave the Affordable Care Act a special flourish, using a total of 22 pens to sign his name.
After the ceremony, Obama went to the headquarters of the Interior Department, where he held what amounted to a duplicate ceremony for an overflow crowd. During that event, he re-stated the promises that seem so troubling now that Obamacare has actually arrived. "I said this once or twice, but it bears repeating: If you like your current insurance, you will keep your current insurance," Obama said. "Nobody is changing what you've got if you're happy with it. If you like your doctor, you will be able to keep your doctor."
If anybody had any doubts, Obama pledged, the future would prove his words to be true. "Now that this legislation is passed, you don't have to take my word for it," he told the crowd. "You'll be able to see it in your own lives."

http://washingtonexaminer.com/euphoria-of-obamacare-becomes-nightmare-of-higher-premiums-and-deductibles/article/2540444

Poll: Americans Want to Go Back to Previous Health Care System, Disagree With President Obama on Size and Power of Government

Poll: Americans Want to Go Back to Previous Health Care System, Disagree With President Obama on Size and Power of Government

The latest Reason-Rupe national telephone poll finds the Affordable Care Act’s troubled launch has made 47 percent of Americans less confident in government’s ability to solve problems. Forty-one percent say the troubles have made no difference and 11 percent say the health care law’s launch has given them more confidence in the government.
“This is the most transparent administration in history,”President Obama has declared. However, 57 percent of Americans tell Reason-Rupe that the Obama administration is not the most transparent administration in history, while 37 percent agree with the president’s statement.
A majority of Americans, 52 percent, say they disagree with President Obama’s views about the proper size and power of government, while 38 percent agree with the president.
Fifty-four percent of those surveyed feel government is generally a “burdensome part of society that impedes the ability of people to improve their lives,” while 41 percent feel “government is primarily a source of good and helps people improve their lives.”
Nearly three out of four Americans, 73 percent, believe members of Congress do not understand health care or how health care laws impact Americans. Just 25 percent think members of Congress understand the consequences of the health care laws they pass.
Seventy percent of Americans oppose making young people pay more for health care to help fund health care for older or less healthy Americans. Six in 10 oppose requiring younger, healthier people to help fund insurance for those with pre-existing conditions. And 57 percent believe lower cost health care plans that provide fewer benefits than required by the Affordable Care Act should be allowed.
Of the 44 percent of respondents who say that they liked the Affordable Care Act when it passed, 41 percent of them like it less now. Of the 52 percent who disliked the law when it was passed, 14 percent like it more now.
When it comes to health care overall, 57 percent of Americans disapprove of the job President Obama is doing, while 38 percent approve. Overall, however, 47 percent say they approve of the job President Obama is doing — four points better than the September Reason-Rupe poll. One in five Americans, 20 percent, approve of the job Congress is doing, down slightly from September.
Poll Results
These poll results are online here and additional Reason-Rupe poll resources are available here. This is the latest in a series of Reason-Rupe public opinion surveys dedicated to exploring what Americans really think about government and major issues. This Reason Foundation project is made possible thanks to the generous support of the Arthur N. Rupe Foundation.
The Reason-Rupe poll conducted live interviews with 1,011 adults on mobile (506) and landline (505) phones from December 4-8, 2013. The poll’s margin of error is plus or minus 3.7 percent. Princeton Survey Research Associates International executed the nationwide Reason-Rupe survey.

http://reason.com/poll/2013/12/11/poll-americans-wants-to-go-back-to-previ

Sunday, December 29, 2013

Health Care's Third-Party Spending Trap

Health Care's Third-Party Spending Trap

Contrary to "conventional wisdom," health insurance—private or otherwise—does not make health care more affordable.

Yet most of these same providers have much higher “list prices”—the official prices they list publicly—which are used to negotiate compensation contracts with health insurance companiesand other third party payers.
Examples abound of outlandish differences between the publicly posted “list prices” of providers and health care facilities and the “discounted” prices these same providers offer to uninsured patients negotiating on an individualized, “special case” basis. Irecently wrote of a patient of mine who saved $17,000 by negotiating to pay directly for his hernia operation rather than using his health insurance. In Oklahoma City, the Surgery Center of Oklahoma takes no Medicare, Medicaid, or private insurance, and provides a range of surgical services to the community for a small fraction of the prices offered by other doctors and facilities that use the conventional third party system. And they list their prices proudly on their website. This and other examples of providers who have opted out of the third party game have been recently documented at Reason.
Contrary to “conventional wisdom,” health insurance—private or otherwise—does not make health care more affordable. The third party payment system is the principal force behind health care price inflation. This should come as no surprise.
Nobel-winning economist Milton Friedman, in his masterpiece“Free to Choose,” wrote of four ways to spend money:
Category I—You spend your money on something for yourself. Here you are very careful, because it is your money, and the good or service you are buying is for you.
Category II—You spend your money on something for someone else. Here you have the same incentive as in Category I to economize, but since you are buying something for someone else, you are not quite as meticulous when it comes to the purchase meeting the needs or values of the recipient.
Category III—You spend someone else’s money on something for yourself. Here you are not concerned about how much you spend, because it is not your money. But because you are spending on yourself, you make sure you are getting what you want.
Category IV—You spend someone else’s money on something for yet another person or persons. (This is what we ask our legislative representatives to do every day.) Here you are the least incentivized to economize, or to buy something that meets the needs or values of the recipient.
Like the government does, third party payers operate under the dynamic outlined in Friedman’s Category IV. This becomes most obvious when it comes to the government acting as third party payer, e.g., Medicare and Medicaid. And it doesn’t just pertain to health care (think of $800 toilet seats for the defense department). When the government buys goods or services for other people with other peoples’ money, special interest pleading, political concerns, and cronyism run the game. And “leakage” of money through “waste, fraud, and abuse” is a given.
But private insurance companies are also spending other peoples’money—the premiums paid into a risk pool—on medical services for other people. When they negotiate compensation schedules with providers and facilities, they don’t have to bargain hard enough to reach the best price possible. They just have to reach a price that is good enough—one that allows them to charge premiums that compete well with rival insurance companies. They pass on the difference between what they could have negotiated and what they actually negotiated to their customers who pay the premiums.
Meanwhile, when the third party payer is perceived as picking up most of the tab, then health care consumers and health care providers engage in Category III spending. Neither have an incentive to take cost into consideration.
People who negotiate direct payment from providers get much better deals than the insurance companies get. In the example of my patient who saved $17,000, the hospital asked for $23,000 to use its facility for a simple outpatient surgery. He got a bid for just over $2,000 at another hospital, when he offered to pay directly as a “special case.” But insurance companies regularly agree to pay the hospitals thousands more for their facility charge. This makes complete sense when viewing the payment mechanism through the lens of Friedman’s spending categories.
When health care providers give discounts for direct payment they don’t lose money in the process. Otherwise they wouldn’t do it. And, in order to keep direct-pay patients from walking away, they need to keep their prices acceptable to the patients paying the bill. Just imagine the prices providers would offer if a much greater proportion of the population paid directly for health care. My patient would have saved more than $17,000, because all of the providers involved would be openly competing with other providers for direct-pay business. Just look at the fields of cosmetic surgery, Lasik eye surgery, and dentistry, as examples of how the absence—or minimal presence—of third party payers drive prices down and quality and service up.
This isn’t to say we don’t need health insurance. Health insurance that covers truly unforeseen, costly catastrophic occurrences makes sense for most people. As does life insurance, property and casualty insurance, and auto insurance. But health insurance that covers routine, predictable events isn’t really insurance. It’s prepaid health care. And it is driving up prices for everyone with everyone else’s money.
Policymakers need to understand that the key to “affordable health care” is not to increase the role of health insurance in peoples’ lives, but to diminish it. We need much less Category IV spending on health care, and much more of Category I.

Teachers unions face moment of truth


Teachers unions face moment of truth
By: Stephanie SimonDecember 8, 2013 06:59 AM EST
It’s designed to be an impressive show of force: Thousands of unionized teachers plan to rally Monday in cities from New York to San Francisco to “reclaim the promise of public education.”
Behind the scenes, however, teachers unions are facing tumultuous times. Long among the wealthiest and most powerful interest groups in American politics, the unions are grappling with financial, legal and public-relations challenges as they fight to retain their clout and build alliances with a public increasingly skeptical of big labor.
“I do think it’s a moment of truth,” said Lance Alldrin, a veteran high-school teacher in Corning, Calif., who has split from his longtime union after serving for a decade as the local president.
(Sign up for POLITICO’s Morning Education tip sheet)
The National Education Association has lost 230,000 members, or 7 percent, since 2009, and it’s projecting another decline this year, which will likely drop it below 3 million members. Among the culprits: teacher layoffs, the rise of non-unionized charter schools and new laws in states such as Wisconsin and Michigan freeing teachers to opt out of the union.
The American Federation of Teachers has been able to grow slightly and now represents 1.5 million workers — but because many new members are retirees or part-timers who pay lower dues, union revenue actually fell last year, by nearly $6 million, federal records show.
Moreover, the membership of the NEA and AFT overlaps considerably; some 663,000 workers show up on both rolls because their locals maintain dual affiliations. That double counting inflates perceptions of the teacher lobby’s combined strength. Total union membership isn’t 4.5 million — it’s 3.8 million.
The unions and their affiliates still control huge resources. They collectively bring in more than $2 billion a year, most of it from member dues. Yet there are signs of financial strain. The NEA has cut spending by 12 percent in the last two years, in part by reducing its staff. And after years of posting surpluses, the AFT has been running deficits. It wrapped up the most recent fiscal year owing $3.7 million on its line of credit, up from $916,000 the previous year, according to records filed with the U.S. Department of Labor. (AFT officials point out that’s still just a fraction of the union’s $155 million general fund budget.)
(Also on POLITICO: Full education policy coverage)
The unions also face threats to their public image.
Former U.S. Solicitor General Theodore Olson expects to go to trial in California next month with an audacious lawsuit that aims to overturn teacher job protections, such as tenure, that unions helped muscle into state law.
His work in the courtroom will be paired with a broad PR campaign painting the teachers unions as obstructionists who protect their members at all costs.
Olson has gathered hair-raising stories about a small number of teachers who sexually harassed students, refused to plan lessons, appeared on campus under the influence, yet held onto their jobs for years because of union-backed job protections. Exhibit A: The Los Angeles Unified School District, which spent a decade and $3.5 million trying to dismiss seven teachers for poor performance — and only succeeded in ousting four. Rather than attempting to fire Mark Berndt, a veteran teacher who pleaded guilty last month to lewd acts with his students, the district paid him $40,000 to resign.
Union leaders say that Olson is distorting the picture by focusing on a few bad apples. “Parents will see through that,” NEA President Dennis Van Roekel said.
(Also on POLITICO: PISA results show ‘educational stagnation’ in U.S.)
But Olson says he intends to use tactics borrowed from his successful fight to overturn California’s ban on same-sex marriage – plus funding from Silicon Valley entrepreneur David Welch – to make sure he wins not just in the legal arena, but “in the court of public opinion.”
More bad press for unions looms on the East Coast, where former CNN anchor Campbell Brown has financed TV ads and a relentless social media campaign accusing the unions of protecting New York City teachers who sexually harass students. She’s got some vivid, cringe-inducing examples – and she’s planning to kick the campaign into high gear this winter.
Union leaders say they don’t protect bad teachers, just seek to ensure due process. And they brush off the negative publicity as a political ploy that won’t gain traction. The American public, they say, is much more interested in talking about scrapping high-stakes testing, broadening the curriculum, reducing class sizes and spreading resources equitably — all issues that unions have championed.
(Also on POLITICO: Little-known higher ed nominees raise eyebrows)
In the struggle for “hearts and minds,” unions are winning, AFT President Randi Weingarten said.
It’s not clear, however, that those alliances are deep or durable: Support for labor unions in general has fallen steadily, dipping below 50 percent for the first time in 2012 before rebounding slightly this year, Gallup polls find. Only 32 percent of Americans expressed a positive view of teachers unions (and another 25 percent were neutral) in a poll last year by the journal Education Next.
To be sure, unions still have the funding and the foot soldiers to be power players. The NEA and AFT spent more than $40 million last year on federal lobbying and electoral politics, according to the Center for Responsive Politics, plus tens of millions more in the states. And they can still splurge when it’s important to them: The AFT bought $1.2 million worth of TV, radio and print advertising this weekend to promote the National Day of Action.
But labor analysts say it’s clearly a new environment for teachers unions. “They’re much more on the defensive now,” said Katharine Strunk, an education professor who studies labor at the University of Southern California.
“This is a very, very challenging time for unions,” said John Logan, a professor of labor history at San Francisco State University.
Among the challenges: Dissent from within.



There’s a small but noisy rebellion, flaring mostly in social media, from teachers furious that both the NEA and the AFT have endorsed the Common Core academic standards.
More significant is the demographic shift. Waves of Baby Boomer teachers have retired in recent years and been replaced by hundreds of thousands of rookies. Half of all teachers in classrooms today have been on the job for 10 or fewer years. And those newcomers have very different views from the veterans and retirees who typically dominate union politics.
More than 70 percent of teachers on the job less than a decade are interested in changing the traditional salary scale, which rewards educators for longevity rather than performance. Just 41 percent of more veteran teachers back such reforms, according to a national survey last year by the organization Teach Plus. The poll documented similar gulfs in opinion about revamping teacher evaluations and pensions.
That leaves union leaders to perform a tricky balancing act. They have, for instance, embraced local contracts that require evaluating teachers in part based on their students’ test scores. Yet Weingarten has also called for an end to “hyper-testing” students and then “sanctioning teachers and closing schools” based on those test scores.
Both Weingarten and Van Roekel say their unions’ policies will continue to evolve to reflect member views.
But change isn’t coming fast enough for many young teachers, who often see no reason to join their unions – or, if they’re required to join, see no reason to become active, said Susan Moore Johnson, an education professor at Harvard University who has studied the generational split.
The national Education Next poll, co-sponsored by Harvard’s Program on Education Policy and Governance, found a startling 31 percent of teachers held negative views of their own unions — up from 17 percent in 2011.
“It really does raise questions about what role unions will play in the future,” Johnson said.
The disillusionment is palpable. In recent months, five small local affiliates – three in California and two in Kansas – have broken away from the NEA, voting to handle collective bargaining on their own.
Rafael Ruano, the lawyer who helped the California locals, says he’s working on similar efforts with several dozen other NEA affiliates. “We’re at the beginning of what I think is potentially a major, major trend,” he said.
The National Right to Work Committee, meanwhile, plans to campaign for an end to compulsory union membership in Missouri, Pennsylvania and Kentucky in the coming months. If successful, that could have big effect. Both unions have seen moderate declines in some states that adopted opt-out provisions — and huge drops in others. In Wisconsin, for instance, the AFT has lost 65 percent of its statewide membership and the NEA is down 19 percent.
As if these threats were not enough, the political landscape is shifting under the unions.
In recent years, wealthy donors have organized networks to fund candidates willing to buck the teachers unions on issues such as charter schools and merit pay. That has eroded unions’ traditional alliances with Democrats and left them at odds with mayors in big cities such as Philadelphia, Chicago and Denver. Even longtime allies are now crossing them: California Gov. Jerry Brown, a Democrat, recently vetoed a bill about layoff protocols that the unions had strongly promoted.
The unions also face potential cuts to teacher pensions, even in heavily Democratic states like Illinois.
In response, unions have sought out allies in unlikely places, stepping up donations to Republican candidates, including some sharply conservative state legislators. The AFT has also sought strength in numbers, growing in part by absorbing locals that have nothing to do with education. The American Federation of Teachers now represents, among others, public defenders, dental hygienists, police officers, maintenance workers, nurses and even lifeguards.
The chief response, however, has been to go on the offensive.
Both the NEA and AFT have poured money into efforts meant to demonstrate that unions aren’t the problem, but a key part of the solution in public education.
The AFT is leading a novel public-private partnership to revitalize schools in impoverished McDowell County, W. Va.
NEA members voted this year to hike their own dues to raise $6 million a year for a Great Public Schools Fund, which seeks innovative ways to improve student achievement.
Both unions have teamed up with their frequent antagonist, Teach for America, on a national initiative to recruit elite college students into teaching. And both are pushing for new training and licensing requirements aimed at raising standards for the profession.
Monday’s National Day of Action gives the unions perhaps their biggest stage yet. They are circulating a statement of principles that rejects education reforms based on high-stakes testing and free-market competition and champions the neighborhood public school as the anchor of democracy.
“I believe the future for this union, and for other unions, is great,” Van Roekel said. “Yes, there are challenges, but that also brings opportunities. We’re going to find a way.”


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The year of lying dangerously

The year of lying dangerously

by Scott Johnson in Obamacare, Welfare
Two thousand and thirteen proved to be the year that the foundational lies of Obamacare blew up in the president’s face. With the pending implementation of the Obamacare regime, it is a historic moment.
Even when it comes to the smallest details of implementation — the status of the Web site, the open security issues, the relevant numbers — the Obama administration jealously guards the truth from disclosure. Applying Occam’s razor to the administration’s treatment of the facts, it seems to me that only two explanations can apply to its treatment of the facts as secrets of state. The facts are embarrassing and they want to be free to lie about them.
Thus President Obama opened his year-end press conference yesterday — the White House has posted the text here — with this statement near the top:
[F]or all the challenges we’ve had and all the challenges that we’ve been working on diligently in dealing with both the ACA [Obamacare] and the website these past couple months, more than half a million Americans have enrolled through healthcare.gov in the first three weeks of December alone. In California, for example, a state operating its own marketplace, more than 15,000 Americans are enrolling every single day. And in the federal website, tens of thousands are enrolling every single day. Since October 1st, more than one million Americans have selected new health insurance plans through the federal and state marketplaces. So, all told, millions of Americans, despite the problems with the website, are now poised to be covered by quality, affordable health insurance come New Year’s Day. Now, this holiday season, there are mothers and fathers and entrepreneurs and workers who have something new to celebrate — the security of knowing that when the unexpected or misfortune strikes, hardship no longer has to.

Note the use of the term “enrolling” with respect to the federal website. Does that include payment of premiums? Of those millions who are poised to “enroll,” I wonder, exactly how many were without insurance before “enrolling”? How many have been deprived of their insurance by Obamacare itself? How many will be deprived of their insurance by Obamacare itself?
And then we have the use of the term “hardship” in the last sentence of the paragraph. On Thursday night the administration declared that Obamacare had created “hardship” for millions who had lost their insurance as a result of the law. It decreed that those millions who had lost their insurance as a result of Obamacare were exempt from the law as a result of the hardship created by the law. In its characteristically excellent Obamacare editorial on this week’s developments in rule by decree (and do read the whole thing), the Wall Street Journal puts it this way:
So merry Christmas. If ObamaCare’s benefit and income redistribution requirements made your old, cheaper, better health plan illegal, you now have the option of going without coverage without the government taking your money as punishment. You can also claim the tautological consolation of an ObamaCare hardship exemption due to ObamaCare itself.
These exemptions were supposed to go only to the truly destitute such as the homeless, bankrupts or victims of domestic violence. But this week a group of six endangered Senate Democrats importuned HHS Secretary Kathleen Sebelius to “clarify” that the victims of ObamaCare also qualify. An excerpt from their Wednesday letter, whose signatories include New Hampshire’s Jeanne Shaheen and Virginia’s Mark Warner, is nearby.
HHS and the Senators must have coordinated in advance because literally overnight HHS rushed out a bulletin noting that exemptions are available to those who “experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan.” A tornado destroys the neighborhood or ObamaCare blows up the individual insurance market, what’s the difference?
The HHS ruling is that ObamaCare is precisely such a “significant, unexpected increase.” In other words, it is an admission that rate shock is real and the mandates drive up costs well into hardship territory. HHS is agreeing with the Senators that exemptions should cover “an individual whose 2013 plan was canceled and considers their new premium unaffordable.” In her reply letter, Mrs. Sebelius also observes that some people “are having difficulty finding an acceptable replacement.” She means the new plans are overpriced.
Don’t cry for me, Venezuela.
Obama addressed this week’s development in rule by decree in response to a question from Chuck Todd toward the end of the press conference. Obama’s response came wrapped in the usual fog of deception and added this take on the numbers:
We’ve got a couple million people who are going to have health insurance just in the first three months, despite the fact that probably the first month and a half was lost because of problems with the website and about as bad a bunch of publicity as you could imagine. And yet you’ve still got 2 million people who signed up, or more. And so what that means then is that the demand is there and, as I said before, the product is good.
How do we know the product is good? The product is mandated by law subject to the Obamacare penalty. And those “couple million people” must include those who have signed up for Medicaid under the vast expansion in medical welfare under Obamacare. As of the close of year five of the age of Obama, the undeniable accomplishment of the Obama administration at home must be the expansion of federal government welfare programs including food stamps and Medicaid.
 

Saturday, December 28, 2013

Obamacare Is Falling Apart Before Our Eyes