Monday, September 29, 2014

Catch Up Obamacare Schadenfreude

Just a little taste of the continuing issues.

Obamacare creates Medicaid patients but not doctors to treat them:
Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report.

The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.

The inspector general, Daniel R. Levinson, said federal and state officials must do more to protect beneficiaries’ access to care, in view of the program’s rapid growth. Just since October, the administration says, eight million people with low incomes have enrolled. By 2016, the Congressional Budget Office estimates, one in four Americans will be on Medicaid at some time during the year.
You can give people legal access to the moon, too, but if they have no means of getting there, it's kind of an exercise in futility.

Buyer's Remorse Plague California Obamacare
California's narrow Obamacare networks have many Obamacare customers experiencing buyer's remorse over health care plans that are turning out to include far fewer doctors than they were led to believe, reports the Los Angeles Times.

"Where was the state in protecting people from these false promises?" California Obamacare customer Heidi Shurtleff, 53, told the Times. "I'm not getting what I paid for."
President Barack Obama infamously promised Americans, "If you like the doctor you have, you can keep your doctor."

But so-called "narrow networks" are a key component of Obamacare designed to limit doctor choice in an effort to drive down costs. A Times analysis found that insurers in California, which has the nation's largest number of Obamacare customers, have no intention of expanding the number of doctors available to plan holders.

"The state's largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company date," the Times reported on Sunday.
The "Fool the Rubes" model of democracy; The Rubes Revenge:
. . .let us take a brief detour into theories of representation in a democracy. The “delegation model” holds that a legislator should reflect the interests of his constituents. The “trustee model” holds that a legislator should act in the best interests of his constituents, rightly understood. Since his constituents might not have the time or ability to understand how a piece of legislation will affect them, the elected representative must act to advance the people’s true interests. He may vote against their express preferences, but only because he knows better.

Neither of these models captures the vote the 12 senators took. Obamacare was a highly salient issue, generating enough interest that the public was reasonably well-informed. The people said no, they meant no, and their no carried weight because they had thought quite a bit about the proposed law. And since the law was enacted, a vast array of problems with it have become apparent, justifying the people’s opposition and showing that the 12 senators were grossly irresponsible trustees.

It seems that the Democrats have been developing a third model of representation of late: Call it the “sneak it past the rubes” theory. Under this approach, you pre-sent yourself to your constituents as an independent voice, not in hock to the national Democratic party, so as to get elected. Then the national party allows you generally to vote with your constituents, on the understanding that when the chips are down you will vote with the liberal leadership. Then you hope that the “rubes” back home can be sufficiently distracted by the “war on women” or some other phony issue that they’ll return you to office. And if they choose not to, there will be a consolation prize: a cushy, well-connected job as a lobbyist (Blanche Lincoln) or law firm adviser (Byron Dorgan) or association CEO (Ben Nelson) or strategic adviser in PR (Kent Conrad) in Washington, where you are more at home anyway, or even a job out of town as an ambassador (Max Baucus).

This is in reference to Greg Orman's "independent" bid for Pat Robert's Kansas Senate seat.

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