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Insurance is Not Access

Doctor Leo Spaceman

from Scott Atlas at the Wall Street Journal, Repairing the ObamaCare Wreckage

Why is private health insurance so important? Insurance without access to medical care is a sham. And that is where the country is heading. According to a 2014 Merritt Hawkinssurvey, 55% of doctors in major metropolitan areas refuse new Medicaid patients. The harsh reality awaiting low-income Americans is dwindling access to quality doctors, hospitals and health care.

Simultaneously, while the population ages into Medicare eligibility, a significant and growing proportion of doctors don’t accept Medicare patients. According to the nonpartisan Medicare Payment Advisory Commission, 29% of Medicare beneficiaries who were looking for a primary-care doctor in 2008 already had a problem finding one.

Because government reimbursement for health care is often below cost, costs are shifted back to private carriers, pushing up premiums. Nationally, the gap between private insurance payment and government underpayment has doubled since ObamaCare, according to a 2014 study by Avalere Health for the American Hospital Association. Premiums for private policies will certainly continue to rise, ultimately beyond the reach of the middle class.

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Confirming Failure

Doctor Leo Spaceman

from The Volokh Conspiracy, Let’s recall why the Affordable Care Act is so messed up by David Bernstein:

Few people, including Senators and their staffs, had time to read the whole 2,700 page bill, much less note any possible weaknesses, flaws, or ambiguities. Reid and other Senate Democrats weren’t terribly worried about this. The bill was set to go to the House, then back to the Senate, then to “reconciliation” between the House and the Senate versions, and then to the president for his signature. Everyone thought there would be plenty of opportunities to make changes.

But a major impediment arose soon after the Senate bill passed. Democratic Senator Ted Kennedy had died that past summer, and the January special election to replace him was won by Republican Scott Brown, who ran as a strong opponent of Obamacare. This deprived the Democrats of their filibuster-proof majority in the Senate, and meant that the Senate would not be able to pass a revised bill. The only way to pass Obamacare at this point was to have the House vote on identical legislation to the Senate bill, while engaging in legally dubious procedural maneuvering. And that’s what the Democrats did.

The House passed the Senate bill as is, and then also passed a separate reconciliation bill with minor changes, eliminating some of the law’s most egregious flaws but leaving the rest intact….

Congress ultimately passed a Senate bill that nobody wanted, and, indeed, that likely no one had read in its entirety when the Senate passed it, and that certainly no one fully understood. Senator Max Baucus, one of Obamacare’s chief architects, not only acknowledged not reading the bill, but opined that it would have been a “waste of time” to do so, because only experts could understand it….

Obama and the Democrats, however, believed that two things would happen that would justify their actions. First, Obamacare would become increasingly popular, and, second, that the Democrats would continue to control both houses of Congress. Obama and Congressional Democrats therefore assumed that any snafus that arose because Obamacare consisted of a hastily-drafted Senate bill never meant to become law could be easily fixed by Congress.

Of course, it didn’t work out that way. The ACA has never polled well, and the Republicans took over the House and then the Senate, in part due to dissatisfaction with Obamacare. Since the Republicans have no stake in fixing a law they unanimously opposed, and the Obama Administration has no intention of reopening the legislation to major changes, the Administration has been left with using and abusing executive discretion to delay, ignore, and modify statutory provisions to get the law to work, or just to avoid the negative political consequences of it working as planned.

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Peter and Paul’s Health Care

Doctor Leo Spaceman

From Holman Jenkins at The Wall Street Journal, ObamaCare Beyond the Handouts

Excerpts:

Of the eight million who have signed up, some 87% are receiving taxpayer subsidies. In other words, they are getting health care partly or wholly at someone else’s expense. The latest data reveal that the average monthly benefit amounts to $276 per person (up from $268 in February), allowing the typical HealthCare.gov user to buy a plan for $69 per month out of pocket.

To put it another way, the annual subsidy amounts to $3,312 per recipient. Which is excellent if you’re one of the recipients.

The right question about any program is whether the benefits justify the expenditure of taxpayer money. Obama Care’s cheerleaders provide not cost-benefit analysis but benefit analysis—as if money grows on trees or is donated by Martians or can be printed in limitless quantities by the Fed.

King is a threat to ObamaCare because, without subsidies, ObamaCare is nothing. It fixes no problem in our health-care system, except to subsidize more people to consume health care at taxpayer expense. Not that subsidies are always undesirable: They help some people get necessary care. But subsidies do the most good when used sparingly, because subsidies also tend to inflate prices for everyone as well as encourage inefficient consumption that doesn’t improve health and may even endanger health.

HKO

When you rob Peter to pay Paul you can often count on Paul’s approval.

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ACA Flim Flam

From The Wall Street Journal Cliff Asness writes In Praising ObamaCare, They Bury It

Excerpts:

That more people would be insured was never in dispute. If you mandate that people buy something, penalize them if they don’t and give it away to some, more people will end up with it. The proper response to this is: Duh.

The real question is how many of those covered by ObamaCare were previously uninsured, how increased coverage is translating into more or better health care, and at what cost this comes both to public finances and personal liberties—all compared with what other alternatives? That is the stuff for serious debate.

Five years ago, opponents of ObamaCare focused on many questions. Can the government force people to buy a good or service? If ObamaCare is constitutional, is there anything the government cannot force citizens to do? Will government intrusion into the health-care market raise or lower the long-term quality of care? What will it do to innovation? Is the Rube-Goldberg structure of ObamaCare the right—or even a reasonable—way to go about this? Should we pass laws first, read them second and force the courts and agencies to fix the problems? The real issues are principles and long-term effects, not “voilà!” proof that allows one side, either side, to say “we win!” based on shoddy logic.

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Health Care’s Privileged Status

Doctor Leo Spaceman

from The New Yorker, a review on the book America’s Bitter Pill by Steven Brill.  The review is by Malcolm Gladwell.

excerpt:

Goldhill takes a far more radical position than the economic team at the White House does. He believes that most of our interactions concerning health care are actually no different from our transactions concerning anything else: if we trust people to buy cars and houses and food and clothing on their own, he doesn’t see why they can’t be trusted to do the same with checkups, tonsillectomies, deliveries, flu shots, and the management of their diabetes. He thinks that the insurance function—inserting a third party between patients and providers—distorts incentives and raises prices, and has such an adverse impact on quality that health insurance should be limited to unexpected, high-cost occurrences the way auto insurance and home insurance are. These ideas are unlikely to make their way into policy anytime soon. But, in elaborating the market critique of the health-care status quo, Goldhill helps us understand what the argument we’re having right now is about. It is not just a political battle over Obama. It’s a battle over whether health care deserves its privileged status within American economic life.