Tuesday, August 9, 2016

Olympic Sized Obamacare Schadenfreude

Time again to revisit Obamacare. It's been a while and the build up is getting painful.

I hate to say "We told you so", but we told you so: ObamaCare Is Failing Exactly The Way Critics Said It Would as Aetna announces it
was abandoning plans to expand into five other states and is reviewing whether to stay in the 15 states where Aetna (AET) current sells ObamaCare plans..
No, I don't really hate to say it. California Obamacare rates to rise 13% in 2017, more than three times the increase of last two years, but that pales in comparison to Alabama where the  Last Obamacare provider in Alabama announces 39% average rate hike for 2017. Well, who cares about Alabama anyway? Whatever happened to the $2,500 per family per year we were promised? Humana to leave key ObamaCare markets:
Humana, one of the nation’s top health insurers, is pulling out of ObamaCare plans in all but a handful of states after a year of nearly $1 billion in losses.
'It's Working:' New Analysis Shows Insurers Losing Tens of Millions Annually on Obamacare

The usually sensible Megan McArdle: Eight Possible Fates for the Obamacare Exchanges
. . . I have left out a few scenarios, like global thermonuclear war or alien invasion (see above: "meteor of death, sweet"). But short of these, the above outlines the possible futures I see for our health-care system. It’s not an accident that so few of them make one clap one’s hands in glee and say “Oh, splendid!”
On the other hand, Anthem promised to expand coverage, if the Feds granted their request to take over Cigna:
Anthem announced Wednesday that it planned to expand its Obamacare offerings into nine more states. However, that expansion is contingent on the company being allowed to complete its merger of Cigna, a pending deal which the Department of Justice recently sued to stop. Politico reports . . .
The almost invariably sensible Megan McArdle asks Who's Gaming Obamacare? Better to Ask: Who Isn't?
. . . So which is it, you may ask? Patients gaming the rules, or providers doing it? My answer is … probably both. Obamacare was conceived and enacted as an extremely complicated system, a sort of Rube Goldberg machine for taking in premiums and government subsidies, and spitting out something that could be called universal coverage at the other end.  Literally no one I ever interviewed -- except, briefly, people on the political teams in charge of passing Obamacare -- said that this was a very good system. Even its savvier defenders simply said, a little ruefully, that this incredibly complicated structure was what could be passed while meeting a bunch of politically vital goals, including keeping the headline cost of the bill below a trillion dollars over 10 years, and not alienating any important interest group. . . Individually, this is perfectly rational. At the system level, it is, of course, insane and utterly unsustainable. But just as people who ask silly questions should expect silly answers, people who build an insane system should be fully prepared for the madness that inevitably follows.
Not to mention the lawlessness: Panic prompted ObamaCare lawlessness
A report issued last week jointly by the House Ways and Means and Energy and Commerce committees explores how the administration came to unlawfully funnel $7 billion in unappropriated money to insurers through a single ObamaCare program.

The program — known as cost-sharing reduction (CSR) — requires insurers to reduce deductibles and other out-of-pocket spending for certain low-income people who signed up for coverage through health insurance exchanges. In turn, the statute authorized the administration to seek an appropriation from Congress to reimburse insurers for the cost of providing these coverage enhancements.

The congressional report chronicles how the administration determined as early as 2010 that it needed an appropriation to make CSR payments to insurers. In April 2013, the president submitted a budget to Congress formally requesting the appropriation.

But in July, the Senate Appropriations Committee, then controlled by Democrats, expressly denied the president's request. Sometime after Congress refused to fund the program, the administration contrived the theory that it could spend money without an appropriation.

Senior officials at the Office of Management and Budget (OMB) drafted a legal memorandum during late 2013 declaring that the government could make billions in CSR payments to the insurance industry without congressional approval. The administration began making the unlawful payments in January 2014.
Having royally f*cked up the privately run  health care system Semi-retired president decides the time is right to revisit the public option for Obamacare.

Donald Trump Is Right About One Thing: Our Experts Know Nothing
Think about it: how many practicing physicians helped design and implement Obamacare? How many doctors did the Obama administration consult in imposing its electronic medical records requirements on physicians? Did the Obama administration take significant input from doctors who worked within the existing system every day and knew a thing or two about how the proposed reforms might affect their industry? Hardly.

Instead, Americans were treated to the sight of ivory tower intellectuals like Jonathan Gruber with their models, charts, and theories about how wonderful Obamacare would be, and to big insurance companies and their lobbyists helping craft the Obamacare legislation. Gruber and the lobbyists never saw a patient in their lives. Never tried to get a Medicare reimbursement. Never had to comply with the onerous electronic medical records requirements.
Dr. Joy Bliss at Maggie's Farm asks Should Dissent Be Allowed in Health Care? prompted by this:
In 2009, the US Preventive Services Task Force issued guidelines recommending annual mammograms for women starting at 50 years, not 40 (as previously recommended). Needless to say, this upset many people. The American Cancer Society maintained its recommendation that preventive screening start at 40, as did the Mayo Clinic. Politicians took note, and made an exception in Obamacare for mammograms, such that the 2009 USPSTF revision was ignored when it came to Obamacare's "free" preventive care. (In January 2016, USPTF maintained its recommendation.)

We are entering a period when access to care will be centrally determined by political appointees who project an inappropriate degree of certainty when they issue their guidelines. They could at least allow dissenting experts the right be heard.
Dr. Jeff Singer, at the Cato Institute, fears the imposition of "the public option":  Medicaid For None, Not All
With the Affordable Care Act crumbling around them, Democrats will look to unveil their next healthcare plan at the National Convention in Philadelphia. President Barack Obama, his would-be successor, Hillary Clinton and the official party platform have a something specific in mind: The so-called “public option.”

Make no mistake, this would spell the end of healthcare as we know it and quickly usher in a European-style system that is essentially Medicaid for all. Democrats will deny this, but a quick look at the facts shows what’s at stake.
. . .
Medicaid is America’s longest-running experiment with the public option–and it has been an unmitigated failure for its recipients. In order to control spiraling Medicaid costs, the federal government has taken a number of drastic steps. Most disturbingly, it has cut reimbursement rates for physicians and instituted draconian limits on the care that patients can receive.

Don’t take my word for it. Medicaid’s abysmally low payment rates mean that doctors can’t afford to participate in the program and keep their doors open; 31% of doctors don’t accept it, a number that grows with every passing year. Medicaid patients often wait months to receive specialized care today. Imagine what will happen if say, 100 million more people get added to the system. Medicaid patients–and by extension, the public-option patients–will have fewer and fewer doctors to choose from, inevitably harming their health.
. . .
“Medicaid is worse than no coverage at all”

The data bear this out. Medicaid patients have significantly worse health outcomes than other patients, especially if they have more serious conditions. Medical expert Scott Gottlieb, reviewing the reams of evidence published in healthcare journals over the past few decades, recently concluded that “Medicaid is worse than no coverage at all.”

Why does the Democratic Party see ”Medicaid for all” as the future of healthcare? President Obama, Hillary Clinton and the rest of the party are now openly arguing for a healthcare system that will jeopardize Americans’ health. Surely that’s an option not worth choosing.

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