Saturday, April 16, 2016

Some More Saturday Obamacare Schadenfreude

I'm down to about one issue of Obamacare Schadenfreude per week, as the lunacy around the presidential election has crowded it out of the news, Still, the destruction of the American system of healthcare continues under Obamacare. How you feel about that probably depends on whether you pay for your own or not:

One of America's biggest health care providers, United Healthcare has, after massive losses, decided to stop issuing Obamacare policies: UnitedHealth Makes Good on Threat to Pull Out of Obamacare
The Affordable Care Act suffered another jolt late last week with the news that UnitedHealth Group, the nation’s largest health insurer, was making good on its threat to pull out of Obamacare, beginning with its operations in Georgia and Arkansas.

UnitedHealth roiled the market last November when it revealed that it was considering exiting Obamacare after incurring hundreds of millions of dollars in losses related to ACA business. Then UnitedHealth CEO Stephen Hemsley confessed to investors meeting in New York in December that the company should have stayed out of the program a little longer to better gauge its profitability potential.

The company had cautiously tiptoed into the market in January 2015 after sitting out the first full year of Obamacare operations in 2014. “It was for us a bad decision,” Hemsley admitted to his investors. “In retrospect, we should have stayed out longer.”
The usually sensible Megan McArdle plays the two-armed economist as she tries to  analyze what this portends.
So is this a case for optimism or pessimism?

Well, other companies haven’t announced that they’re pulling out, which is a case for mild optimism (though they still have a few weeks left to pull the trigger). However, no one has yet proven to be able to reliably make money on exchange policies, and certain local markets seem to be in deep trouble, with few insurers and high premiums. So some mild pessimism is due.
. . .
What we don’t yet know is how things will evolve in other states. Will tighter regulations on special enrollment periods reduce the amount of gaming going on? Will the bigger mandate penalties mean younger and healthier people finally buy insurance -- or will the end of the temporary risk corridor program that has been defraying insurer losses mean that premiums soar still higher? Will insurers ever manage to make money on the exchanges?

If insurers can’t figure out a way to make money, more will probably pull out, and the exchanges will be in a parlous state. If they can, things will stabilize. Unfortunately there’s no way to know what will happen -- or where -- except to wait and see.
But, if this article is right, the other insurers haven't yet figured out that way to make money: Insurers warn losses from ObamaCare are unsustainable. So they're sounding like United Healthcare, to wit: Insurers signaling major ObamaCare premium hikes for 2017 — or taking a hike altogether
It turns out that younger and healthier people aren’t enthused about spending thousands of dollars a year on a product they’ll mostly never use and can only access after spending thousands more to clear the deductible threshold. HHS brags about the 12.7 million enrollments in the system, but that’s a far cry below the supposed 40 million uninsured that ObamaCare was supposed to cure. The people who have signed up tend to be those who utilize health-care services more often, and the utilization curve has not smoothed out as the ACA’s designers assumed it would.

Now we have come full circle from You’re paying too much to Your premiums were just too low. Get ready for Who needs insurance, anyway? The government will handle your health care!
The Daily Caller helpfully lists The 8 Obamacare Co-Ops Most Likely To Fail This Year.

But it's all rainbows and unicorns at the Department of Health and Human Services: Dire warnings of ObamaCare price spikes wrong

How Obamacare Is Fueling America’s Opioid Epidemic
As part of an Obama­care initiative meant to reward quality care, the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-­satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?”

To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply ­misguided––if not downright dangerous. “The government is telling us we need to make sure a patient’s pain is under control,” says Dr. Nick Sawyer, a health-­policy fellow at the UC Davis department of emergency medicine. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.”
Obamacare; is there any problem it can't create?

Politico Has No Idea What the Hobby Lobby Decision Was Even About
Quickly: what was it that Hobby Lobby objected to doing that spurred their lawsuit against the Obama administration? If you said something about birth control, congratulations, you’re more up to date on politics than one of the nation’s leading political newspapers.

Here’s how Politico’s Glenn Thrush characterized the decision in a profile of former Jeb Bush staffer Tim Miller (who is gay).
“Jeb and I were talking about Hobby Lobby,” Miller said — referring to the Supreme Court case that exempted the craft chain from some anti-LGBT laws, including a provision requiring that employers provide health plans to gay and lesbians.
Thrush was simply dead wrong. What Hobby Lobby objected to was providing certain forms of contraception its owners believed could prevent implantation, a violation of their faith. They never once suggested that they had any problem providing healthcare to their gay employees.
Truth? You want the truth? We won't give you the truth! It's all about the agenda.

And finally, this one isn't strictly Obamacare, but it gets into the central problem. The people who want these mandates always expect someone else to pay: Sanders’ supporters want universal health care, free tuition but aren’t willing to pay for it
[Vox] conducted a poll (with Morning Consult) to find out how much supporters of various candidates were willing to pay for the political revolution Sanders has been promising. Specifically, the poll asked about two different policy proposals: Universal health care and free college tuition. What the results revealed is that most GOP supporters aren’t willing to pay anything, in terms of additional taxes, to make these policy ideas happen. No surprise really since these are proposals GOP voters likely wouldn’t support.

But even among Clinton and Sanders supporters the amount of money people said they were willing to pay, in the form of additional taxes, was less than what the proposals would likely cost:
About 66 percent of Sanders supporters said they wouldn’t be willing to pay more than an additional $1,000 in taxes for universal health care. This includes the 8 percent of Sanders supporters who aren’t willing to pay anything at all…
But Sanders’s plan to pay for universal health care coverage would increase taxes on most voters by more than $1,000…
The kicker for all of this? Some analysts believe Sanders’s plan will cost twice as much as his campaign estimates.
Two points: First, I strongly suspect there is a reason Sanders’ supporters are not eager to shell out more than a little more than they are now paying. It’s because they’ve been told endlessly by Sanders, and others, that the problem is other people–corporations, the wealthy, billionaires–are not paying their fair share. So what Sanders’ supporters have been conditioned to expect is more government services that the greedy fat cats will pay for on their behalf.

Second point: Sanders’ supporters really don’t grasp that there is not an endless pool of free money floating around in the form of wealth that can be confiscated from evil corporations, billionaires, etc. If they did, if they understood that they themselves would bear a large share of the burden for these policy proposals almost immediately, Sanders would be a lot less popular. That’s not to say there wouldn’t be some folks making an argument that, long term, single-payer would be more efficient and cheaper. There are lots of people in Sanders’ camp who believe that.

No comments:

Post a Comment