Howl

Joe Doakes from Como Park emails:

Republicans in Congress are doing their usual job of chickening out from taking effective action, preferring half-assed deck-chair-arranging and cost-can-kicking instead of risking the chance someone might call them names.  Fixing this mess requires understanding how we got into it. 

Before the Great Depression, doctors charged what the patient could afford, overcharging some to give free care to others.  Hospitals charged the patient directly.  In the Roaring 20’s, people could afford good medical care.

 During the Great Depression, people couldn’t afford doctors so they substituted nurses and midwives or went without care.  Private hospitals ran short of money.  FDR spent federal money on medical care as a stop-gap measure.  Hospitals associated with charities or religions provided reduced-fee medical care.

 When World War II loomed, FDR worried that federal contractors would gouge the government so the Office of Price Administration set wage and price controls.  When men rushed to enlist after Pearl Harbor, employers scrambled to fill positions on the now-booming assembly line but were unable to offer higher wages to entice employees.  Employers offered free health insurance to pad the offer and deducted the cost as a business expense.

 After the war, employers couldn’t drop insurance because it would be seen as a pay cut.  But as Baby Boomers aged and needed more expensive care and the economy slumped reducing profits, employers were forced to drop coverage.  The clamor for free health insurance turned to government, resulting in Obamacare. 

 The health insurance problem is just like rent control in New York – it was a temporary war-time something-for-nothing measure that was continued too long and now the addicts are screaming because they won’t get their special war-time subsidies.  They shouldn’t.  The war is over.

 The first step is to end the deduction for employer-paid health care so that more employers drop coverage, and prohibit units of government and unions from paying for health insurance, which will level the playing field as everybody becomes a health insurance consumer, same way everybody is a car insurance consumer.

 The second step is to let states decide what insurance policies are allowed to be sold.  Minnesota coverage will cost a bundle because the legislature will require every policy to cover everything.  That decision will cost us jobs as employees leave to get lower premiums elsewhere.  The laboratory of democracy eventually will find its balance.

 The third step is to means-test Social Security and Medicare.  Seniors who can afford to pay, must pay, or the system goes broke.

 The fourth step is to limit the use of welfare medical care.  People who buy health insurance have deductibles and caps so they don’t run to the doctor for every sniffle.  People who don’t buy insurance should have similar incentives to conserve resources.  Yes, this means some children will suffer and die.  If the entire system collapses, all the children will suffer and die.  We’re trying prevent that.

 The fifth step is to deregulate medicine.  Allow more drugs to be sold without prescription.  Allow non-doctors to prescribe medicine.  Allow medical providers flexibility in meeting standards.  The country doctor who had his office in the front room of his house could handle most of what came in the door, he didn’t need admitting privileges at a Level 1 trauma hospital.  That policy might also mean recruiting more health care professionals from other countries – we’d rather have them than have unskilled laborers climbing The Wall.

 The sixth step is to limit medical malpractice lawsuits to reduce malpractice insurance premiums so doctors can afford to charge patients less.  Doctors make diagnoses by using statistics to play the odds, there always will be mistakes, not every mistake is a lottery ticket.

 I know: Democrats will howl.  The media will howl.  College kids will howl.  Seniors will howl.  Everybody who wants Free Stuff will howl that they’re not getting enough Free Stuff, fast enough.  Doesn’t matter, clean up the mess anyway because (a) it’s the right thing to do and (b) if we don’t, the system will collapse and the howling will be even worse.  Time for Republicans to man up and do the right thing, for a change.

 No, I’m not holding my breath.

 Joe Doakes

Nor should you.  The cult of the government savior is ascendant.

My Obamacare Debate With Nearly Every Democrat

SCENE:  Mitch BERG is cutting brush with a sawzall.   Avery LIBRELLE walks through the alley and catches BERG unawares.

LIBRELLE:  Hey, Merg!

BERG:  Er, hey, Avery.  I’m kinda busy…

LIBRELLE:  The GOP’s Obamacare repeal will throw people off their insurance policies.

BERG:  Nah, that’s what the subsidy and tax cuts and medicaid are for

LIBRELLE:   You won’t lower bills!

BERG:  Well, that’s what the free market is for.

LIBRELLE:   But you’ll throw people off their insurance.

BERG:  Nah, that’s what the subsidy and tax cuts and medicaid are for

LIBRELLE:   You won’t lower bills!

BERG:  Well, that’s what the free market is for.

LIBRELLE:   But you’ll throw people off their insurance.

BERG:  Nah, that’s what the subsidy and tax cuts and medicaid are for

LIBRELLE:   You won’t lower bills!

BERG:  Well, that’s what the free market is for.

LIBRELLE:   But you’ll throw people off their insurance.

BERG:  Nah, that’s what the subsidy and tax cuts and medicaid are for

LIBRELLE:   You won’t lower bills!

BERG:  Well, that’s what the free market is for.

LIBRELLE:   But you’ll throw people off their insurance.

BERG:   You realize you’ve  just repeated the same recursive series of denials three times?

LIBRELLE:  Misogynist!

BERG:   Er, are you a…er…

And SCENE

That Which Can’t Be Sustained, Won’t Be

Joe Doakes from Como Park emails:

Every year for the last 40 years, the United States has run short of money in the budget.  To fill the shortfall, the General Fund borrowed from the Social Security fund, but that still wasn’t enough.  To make ends meet, we borrowed even more.  The total accumulated debt is now $20,000,000,000,000.  That’s twenty trillion, with a T.

 That number does not include the cost of promises the government will be obligated to pay in the future such as Social Security and Medicare, the 20 trillion number is only the total of the promissory notes signed to fund government operations in the past.  Covering the cost of all government promises is closer to 100 trillion, give or take, depending on who you talk to.

 We’re not paying down the debt.  We’re making the minimum monthly payments on existing debt while running up ever more debt, month after month, with no end in sight.

 I don’t care whose fault it is.

 No, I really don’t care whose fault it is.  Finger-pointing and blaming is useless blather, at this point.

 I want to know what we’re going to do about it.

 The reason it comes up is because Republicans in Congress are talking about reforming Obama-care to make it affordable enough that the government can continue to offer the program, but Democrats are screaming the reforms will make the program unaffordable for individual citizens.  Both have fair points.  Both fail to address my point.

 Can government programs run in the red forever?  Can public debt be accumulated forever?  Is there literally no limit to how much debt we can run up?

If so, why?  That’s not true for private individuals or corporations.  If it’s true for government, there must be a reason why it’s true.  What’s the reason?

 Joe Doakes

Let’s ask Paul Krugman.

Symptom Of A Completely Screwed Nation

Wednesday night on national public radio, I listened to Illinois senator Dick “Turban” Durbin respond to President Trump State of the Union address.

Asked about the Democrat response to republican healthcare initiatives – in this case, the proposal to allow people to buy insurance across state lines – his response was:

“Come on. You think people are going to go to a hospital or a doctor in another state?”

And sure enough, you can see Democrats repeating this on social media today.

Do they not see the difference between “health insurance” and “healthcare”?

Faster!

The progressive chattering classes are all in a tizzy because many of Donald Trump’s cabinet nominees are long-time opponents of the departments they’ve been chosen to lead:

  • Rick Perry at Energy – who has advocated disbanding the entire department and reducing a cabinet seat
  • Ben Carson at HUD, who has criticized federal housing
  • Betsy DeVos at Education – a major proponent of school choice and degrading the government monopoly on education
  • Scott Pruitt at the EPA, an agency against whom he’s spent years litigating
  • Andy Puzder at Labor, who would oppose most “progressive” labor regulations
  • Tom Price at HHS, who advocates rolling back Obamacare.

The chattering classes are all aflutter.  Perhaps because most of these departments are nothing but make-work programs for worthless Ivy Leaguer poli sci grads like, well, themselves.

Or perhaps because the American people might just support it:

And that leads us to the really burning question: Will anyone miss those departments if they go away?

We could try to answer that question by diving into the bitterly partisan political and economic debate over the size of government that’s been dividing people in this country since the days of Jefferson and Hamilton. Or we could wisely dump that academic argument and realize that the answer lies in how well the Trump team manages to make sure the changes get noticed by normal voters in a positive way. In politics, perception truly is reality.

And Trump, for all his faults, gets that better than most other Republicans.  For worse or, when it comes to slashing the size and power of the Federal Government ,much much better.

The Strib: Lowering Their Own Bar?

The Strib “reported”, after a fashion, about attitudes about Obamacare after an election where it was primarily responsible for ejecting the DFL from power in the Minnesota Senate.

DFLMinistryofTruthLARGE

And it’s either a masterpiece of selective fact, or some fairly incurious reporting:

Anxiety is greatest among Minnesotans with preexisting medical conditions. Before the ACA, insurance companies could simply deny them coverage.

Which is technically true.

After which, in Minnesota at least, they would get insurance from one of the state-subsizied high risk plans.

Before MNSure, 92% of Minnesotans were insured, via the private market, a public plan, or some combination.   It was the highest share in the nation.   Of the 8% who didn’t have insurance, the vast majority were people who didn’t want insurance – mostly young, mostly healthy.  There were exceptions – but they were few, rare, and mostly the product of poor information and a pre-Obama media who were actively pitching the “47 million uninsured Americans…” narrative.

Today, the state says half as many Minnesotans are uninsured – but networks have shrunk (in vast swathes of Minnesota, only one plan is available), premiums have skyrocketed for individual members (like me!),  people could not keep their doctor (The Lightworker’s promises notwithstanding…)

So why is the Strib story – a “Team Report” by Jeremy Olson, Christopher Snowbeck and Glenn Howatt, no less – either so slanted or uninformed?

To borrow a Glenn Reynolds phrase – if you treat them as DFL operatives with bylines, it all makes sense.

Starting Off With A Bang

As the nation – or at least the nation’s chattering classes – continue to rend their garments over Democracy giving them the leader they deserved, and with about 66 days until Donald Trump takes office, let’s take a break from the Peltschmertz and start talking policy.

Donald Trump proposed a healthcare plan.  It’s on his website.

And…it’s good.  Really good.  To paraphrase Joe Biden, it’s a big freaking deal, if he follows through on it:

  1. Repeal Obamacare. “Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to,” the plan says.
  2. Repeal the McCarran-Ferguson Act, and allow the sale of insurance across state lines. “By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up,” it says.
  3. Allow tax payers to fully deduct health insurance premium payments in their tax returns, as businesses can. The plan asks: “Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions?”
  4. Review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  5. Allow all individuals to use Health Savings Accounts (HSAs), and make those contributions tax-free and allow them to accumulate year after year. Make them part of an individual’s estate, able to be passed on to heirs without fear of any death penalty.
  6. Require price transparency from all healthcare providers, including clinics and hospitals.
  7. Block-grant Medicaid to the states. Incentivize the states to seek out and eliminate fraud, waste and abuse to preserve government resources.
  8. Remove barriers to entry into free markets for drug providers that offer safe, generic options. “Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service,” the plan says.

Speaking as a newly self-employed person for whom 3 and 5 alone would be financial lifesavers, I’ll say right now that if passing this plan is the only thing he accomplishes domestically in his first term, it’ll be a successful term indeed.

Some of these – especially “Repealing Obamacare” – are going to be difficult.  I personally authorize air strikes.

Eurasia Has Always Been At War With Eastasia

The Minnesota DFL is sending out mailers…:

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…blaming the GOP – not one of whose elected representatives voted for Obamacare – for Obamacare.

Two observations:

  1. So there’s your admission; the Democrats are officially admitting Obamacare and its children are worthless political turds
  2. Who would the Democrat be trying to reach with this piece?  The stupid, the incurious, the entitled, sufferers from Urban Liberal Privilege, the stupid…yes, I said it twice, but there would seem to be that many.

Pass it around.

About Those Death Panels

As we’ve noted in this space in the past – while no health insurance provider has a room with the words “Death Panel” on an embossed brass plate on the door, the notion of allocation of services, including life-saving ones, to make sure scarce supplies of life-extending medicine and treatment go to the people who’ll gain the most usable lifespan, has been around for a long time.  It’s an integral part of the HMO business model.

In other words, if they’ve got one liver available, and one person on the transplant list is a 32 year old marathon-running woman who’s never smoked, and one is a 62 year old diabetic smoker, you can guess who’s going to get the liver, and who’s going on “palliative care” right?

And while that decision may not be made by people whose job title says “Death Panelist”, if you’re the 62 year old diabetic, it’s all tomayto tomahto, right?

Anyway – to those who thought calling the above the equivalent of a “death panel’ was overreach, I present this:

About one-year ago, Gov. Jerry Brown signed the state’s assisted-suicide bill into law. It fully went into effect this June, with the opening of the first clinic. While there is no data on the number of California assisted-suicides, Oregon recorded over 130 last year as part of their legalized physician-assisted death program.

Now, one young mother says her insurance company denied her coverage for chemotherapy treatment after originally agreeing to provide the fiscal support for it, but indicated it would be willing to pay for assisted suicide instead.

No, it’s not just one woman:

Packer attends meetings with others suffering from terminal illnesses. She indicates that the tone of those meetings have changed since the California assisted-suicide law was enacted.

“As soon as this law was passed – and you see it everywhere, when these laws are passed – patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option.”

Packer attends a support group for terminally ill patients. She said legally sanctioned suicide has changed the tone of the meetings, which used to be “positive and encouraging.” With patients under new societal pressure to kill themselves, she said meetings “became negative, and it started consuming people. And then they said, ‘You know what? I wish I could just end it.’”

There’s a website for patients concerned that insurance companies under price pressure  are trying to strongarm them into killing themeselves.

Yep.  It’s come to this.

So – you can’t keep your doctor, or the plan you like, your prices are going to rise, and if your life is inconveniently expensive for your insurer, it will try to kill you.

Thanks, Obama.

You Can Keep Your Doctor, Provided Your Doctor Is A Unicorn

Obamacare’s state exchanges are melting down – some faster than others, none faster at the moment than Tennessee:

Seventy-three out of Tennessee’s 95 counties will have only one insurer on the exchange, meaning no meaningful competition whatsoever. In regions where BlueCross BlueShield is pulling out, there will be two remaining major carriers, Cigna and Humana. The only large metro area with more options will be Chattanooga.

Then there are the premiums. State regulators have already approved the highest annual rise in the nation, a weighted average of nearly 56%, according to data at ACASignups.net. The rate increases authorized in late August include an average of 62% for BlueCross BlueShield, 46% for Cigna and 44% for Humana. The latter two companies could ask to revise their rates upward depending on how many former BlueCross consumers they pick up.

The idea that Obamacare is a conspiracy designed to fail, to leave only “single payer” government healthcare as a viable option, is looking less and less like a conspiracy theory.

Blind Squirrel

Governor Dayton admits Obama care is a flaming goat rodeo.

On its surface, the story is about one of the most left of center governors in America throwing Obamacare under the bus. And that’s all interesting, don’t get me wrong.

But the governor – and depressed it’s been covering for him for six years – is counting on you,or at least the mainstream Minnesota medias audience,forgetting a few things. He overrode the legislatures decision to get out of the Obama care exchanges. Then, he presided over one of the two or three most botched attempts to build an exchange. MNSure’s gestation was protracted, obscenely costly, and a technical nightmare. And for all that, the products that delivers – with soaring prices, ballooning deductibles and lower availability and choice – are worse.

The media coverage of the governors admission that the Minnesota state exchange, and Obamacare itself, has worked out very badly, tends to portray the governor as a kindly but well meeting fellowadmitting that his ministration’s signature product has had some teething problems.

It’s much, much worse than that.

Before Obamacare and MNSure, Minnesota had the best level of health insurance in the United States; between public and private plans, 92% of the states population was covered..

Proponents of the state/federal plans claim that number is up to 96%, today.  And that maybe true – but more and more people are hanging onto that insurance – policies much bigger than they need, with higher premiums, and deductibles that in many cases will bankrupt families  (What, you could pay her $12,000 a year deductible, along with 20% coinsurance?)

And people wonder why the media obsesses about things Donald Trump said on the TV 11 years ago…

This Is DFL Government

You, the DFL voter, wanted a government-managed healthcare market?  You got it!

And we’re all paying for it!

Health insurers are hiking premiums and limiting enrollment in Minnesota’s individual market next year, with regulators saying the emergency measures were needed to avert a market collapse.

The moves are a clear sign that the market for some 250,000 people who buy coverage for themselves is dysfunctional and needs reform, said Commerce Commissioner Mike Rothman during a Friday news conference.

While rate increases of more than 50 percent aren’t fair to consumers, Rothman said, things could have been worse. He described a period this summer when all health insurers in the state seemed prepared to abandon that segment of the market.

Elections have consequences; as former New York mayor Ed Koch put it, “the voters have spoken, and now they must accept the consequences”.

It’d be nice if those consequences didn’t botch up everyone else’s life.

You Were Warned: MNA Edition

A friend of the blog writes in re a piece on the ongoing Allina nurses strike:

[Saint Paul City Councilman] Chris Tolbert said, “If a nurse in the health care industry can’t get quality health care from a health care company, we’re all in trouble.”

Well, that is what we Republicans said when the ACA was first signed into law.

History has such an ineluctable symmetry, sometimes….

Rationing

Joe Doakes from Como Park emails:

Doctors are like walleyes: everybody wants one but there aren’t enough to go around, so we must ration them.

 Walleyes are rationed by license.  Medical care traditionally has been rationed by price.  But when the government pays, there is no price, so now Britain is rationing by morality.

 It should be obvious that obese people have more medical needs than fit people, and smokers more medical needs than non-smokers.  The new rationing cannot be medically based on need; instead, it must be morally based on reward.  The unspoken rational is that fat people and smokers are lazy and  stupid so they don’t deserve medical care.

 Before you start nodding, consider that when Hillary is elected, she might change it to “Conservatives are stupid and don’t deserve medical care.”

 If we shift to a political basis for deciding who lives and who dies . . . .

 Joe Doakes

Power is always a temptation.

“You Can Keep Your Doctor” Update

Next year, if all proceeds as expected,  one out of six Americans will have exactly one option in their Obamacare exchange:

According to an analysis done for The Upshot by the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose next year. The analysis shows that there are five entire states currently set to have one insurer, although our map also includes two more states because the plans for more carriers are not final. By comparison, only 2 percent of eligible customers last year had only one choice.

The conspiracy theory that Obamacare was intentionally designed to wreck the system to make single-payer inevitable looks less and less far-fetched every day.

MNSure: All Is, Naturally, Proceeding As Predicted

The Blues are eliminating scads of individual plans.

In response Gov. Mark Dayton highlighted gains in enrolling more Minnesotans in health insurance plans since the implementation of the Affordable Care Act. He also acknowledged the BCBSM departure reflects the instability in the market for individual and family coverage.

In other words, as people have been squeezed out of the private plans they originally chose, they are dribbling in to MNSure’s more expensive plans with higher deductibles and more-constricted networks.

He thinks has been told to think it’s a win.

“This creates a serious and unintended challenge for the individual market: the Minnesotans who seek coverage there tend to have greater, more expensive health care needs than the general population,” said Dayton. “Blue Cross Blue Shield’s decision to leave the individual market is symptomatic of conditions in the national health insurance marketplace.

University of Minnesota health economist Roger Feldman called the Blues’ departure a major blow to Minnesota’s already troubled individual market.

“What this says about the individual market is that it is very unstable and it has been disrupted by a number of events and we still don’t know whether it will recover or not from those disruptions,” said Feldman.

Apparently we have to cripple healthcare before we can save it.

Pass

My mom worked at a nursing school. My niece is a NICU nurse.  I have quite a few nurses among my closest friends.  

So it’s hard not to say “I have all the sympathy in the world for the nurses that are striking at the various Alina hospitals”.

So I will let Larry from “Very Angry Bird” say it for me:

Normally, I am very sympathetic to anyone who is affected by the treachery and deceit of ObamaCare. The only ones who escape by shoulder to cry on are union types who supported ObamaCare when it was first being hatched. Since most unions are Democratic strongholds, the nurses union all supported ObamaCare. To put it in old west terms – they now know what it is like to be shot with their own gun.

nurses are wonderful people – but the nurses union is as hard left as the SEIU. The union jumped up and down and did cartwheels for Obama, and Obamacare, eight years ago.

Now, as the “Affordable Care Act” makes healthcare I’ll truly unaffordable for millions – exactly as predicted – the union is trying to insulate itself and its members from the policies that the union supported, worked for, and donated its members ‘money to.

Sorry, nurses. You lost me on this one.

Equitable

A friend of the blog, who works in the medical industry, notes:

Liberals often like to say that the US is ready for single payer healthcare. Then, we have something like this.

 

This is the evidence that people don’t want single payer healthcare. Allina is simply asking nurses to share the wealth. As one nurse noted, it would be like a 15% pay cut.

Allina has said that transitioning nurses to a different plan would be equitable.

 

As I see it, if this much of a fight is going to be put up over sharing the wealth in a state like Minnesota, how would it play in the rest of the country?  The only part that I don’t really understand is why people keep voting for liberal, share the wealth type policies when they clearly don’t want to themselves.

My theory:  they want the part of “single payer healthcare” that makes them feel good about doing big things with other peoples’ money.

They don’t want any actual change in their own life.

Hope we’ve cleared that up.

Modern Plagues

Joe Doakes from Como Park emails:

My health insurance company requires me to take an annual health assessment and participate in a well-being program, to get a discount on my co-pay.  They are at the forefront of trendiness, of course, and Sitting Is The New Smoking, so getting me up and moving is all the rage.  Some thoughts:

 We can’t all be rail-splitters.  Some jobs require patient, focused, concentrated examination of documents.  That’s an activity not well-suited to bouncing on an exercise ball. 

 Labor-saving devices were invented precisely to avoid having to move, lift, bend or exert physical force over inanimate objects.  How far down must civilization devolve to suit the Phy Ed fanatics?  Is it enough if I make my wife scrub our clothes by hand in a tub or must she also carry the water in a bucket from Lake Como while I forage for dandelion greens in the park across the street?

 Glenn Reynolds, the Instapundit, is fond of saying “I’ll believe it’s a crisis when the people who claim it’s a crisis start acting like it’s a crisis.”  That’s a handy way to poke fun at global warming alarmists flying private jets to exclusive conferences.  But I can go one better:

 “I’ll believe Sitting is the new Smoking when Democrats tax it to fund a stadium.” 

 Joe Doakes

Look for people with sedentary jobs to get hit with fees via Obamacare.

Today’s jokes are tomorrow’s policy.

If America Is Doomed…

…it’s because of the people in this room.

Starting with the questioner, who notes what a disaster Obamacare has been to her family, but still “wants to vote Democrat”, is a great (aka terrible, depressing, enervating) start.

And of course, Hillary, whose answer to “my healthcare costs have tripled” is “my goal will be to get them down” (without further elaboration) is deeply, corrosively depressing.

No, really – that’s what she said:

And of course, the – I don’t use the term lightly – sheeple who applauded her non-answer answer.

And as of 2012, that was 51% of your neighbors.

There’s a reason I remove all poison, sleeping pills and sharp objects from the room before I write about Democrat party politics.

What Could Possibly Go Wrong?

Joe Doakes from Como Park emails:

One of the keys to achieving a healthier citizenry is providing everyone with affordable (meaning subsidized) health insurance.  Naturally, since the government is paying for most of it, the government needs the data supporting the billings.  So all your medical records belong to the government.  But it’s okay, the data is totally secure, just like the personnel records at the Department of Homeland Security.

Joe Doakes

In all things, we must reinforce failure and reward incompentence.

With government, anyway.