Wednesday, October 19, 2016

A Brief Interlude of Obamacare Schdenfreude

Arghh! I let it go too long again, and the pile is huge. It's pretty clear that Obamacare is unraveling rapidly, as the death spiral makes another turn around the hole. 'Death spiral'? ObamaCare problems making coverage harder to afford, find,  ObamaCare's Death Spiral Has Begun Actually, it was started at the beginning, it's just hard to see initially. Rate Increases for Health Plans Pose Serious Test for Obama’s Signature Law. One early proponent of Obamacare,Minnesota's  Gov. Mark Dayton Declares Affordable Care Act ‘No Longer Affordable’Minnesota Could Be the First Obamacare Domino to Fall. Or should the analogy be the first penny down the hole? Minnesota Republicans to Dayton: We told you so Cold comfort. Bloomberg reports that More Than 1 Million to Lose Obamacare Plans as Insurers Quit. Make that 1.4 million, but what's another 400,000 eggs when you have an omelette to make? One of the victims has been conservative columnist Michele Malking, and she's not happy about it: Obama Lied. My Third Health Plan Just Died. But I thought you could keep your health plan if you liked it?  The Obamacare problem that Democrats don’t want to talk about, people like Michele who have to buy their health insurance without subsidies. Tenn. lawmakers, residents search for solutions after Blue Cross Blue Shield pulls out of ACAThe collapse of Obamacare in North Carolina has been nothing short of spectacular. It's not just increasing prices and cancelled plans, it's also To Keep Obamacare Viable, Insurers Are Restricting Access To Doctors. Coming next in ObamaCare: Insurance rationing?  But I thought I could keep my doctor? Socializing something always leads to rationing it. Rare agreement between House Republicans and Hillary? House Republican doctors: ‘Obamacare is collapsing’ and WikiLeaks: Hillary Wants Obamacare to ‘Unravel’ - Leaked email suggests Clinton rooting for Affordable Care Act to collapse. I suspect their approach on what to do next differs substantially. Joke: How does an insurance company make money on Obamacare? By quitting. UnitedHealth profits grow with retreat from ObamacareI Thought Obamacare was Going to FIX THIS:
“The reaction to opening a medical bill these days is often shock and confusion — for the insured and the uninsured. Prices and deductibles keep rising, policies are drowning in fine print, and doctors are jumping on and off networks. So why hasn’t the growing burden of health care gotten more attention in the presidential campaign?”
Another issue that roiling the surface is the insurance company "bailout" using tax payer moneys by executive order. Republican Senators express concern over potential Obamacare bailoutCoalition of over 50 conservative groups calls on Congress to block Obamacare bailouts, House Slaps US Gov’t With Lawsuit Against Obamacare Bailout Of Insurance CompaniesWatchdog knocks administration for misusing Obamacare funds, GAO report: HHS owes taxpayers billions in Obamacare reinsurance money and giving the last words to Ace: Oh, By the Way, Obama Looted the US Treasury to Make Illegal Payments to Insurers to Keep Obamacare Afloat, But Vote for Hillary Because We Need to "Save Our Party" or Something.

And, of course, As ObamaCare Collapses, Democrats Eye Nationalized Health Care, as Ailing Obama Health Care Act May Have to Change to Survive
The departing president, the woman who seeks to replace him and nearly one-third of the Senate have endorsed a new government-sponsored health plan, the so-called public option, to give consumers an additional choice. A significant number of Democrats, for whom Senator Bernie Sanders spoke in the primaries, favor a single-payer arrangement, which could take the form of Medicare for all.

Donald J. Trump and Republicans in Congress would go in the direction of less government, reducing federal regulation and requirements so insurance would cost less and no-frills options could proliferate. Mr. Trump would, for example, encourage greater use of health savings accounts, allow insurance policies to be purchased across state lines and let people take tax deductions for insurance premium payments.
Nancy Pelosi Confesses: 'I Wanted Single Payer'  I guess she should have read it before she helped ram it down out throats.

More Wikileaks: Clinton ally on Obamacare website: ‘in real life people would have gotten fired’
Neera Tanden, president of the Clinton-aligned Center for American Progress, sent an email to John Podesta on March 16, 2014 in which she offered her opinion that it was a mistake for the Obama administration not to fire someone. “I think it was a strategic error not to fire anyone in health care,” Tanden wrote. “carol Shea porter yelled at me about this for 10 min the other day,” she added, referring to the New Hampshire congresswoman.

“I’m trying to be artful here bc of the WH Conference but I do think in real life people would have gotten fired a long time ago,” Tanden wrote, adding, “And not just people in the agency no one cares about.”
And Rolling Justice Roberts; A Clinton ally reveals how the left played the Chief on ObamaCare.

From the mostly sensible Megan McArdle: First Lady's Garden, Like Obamacare, Will Prove Hard to Uproot
Politicians, you see, face a problem. They can pass all the splendid programs they want, but there’s always a risk that some future politician will come along and unpass them. Bureaucrats have a similar issue: spend a long career crafting careful rules, and see your successor undo them. So they tend to have a preference for programs that create what’s called “lock-in,” making them politically expensive to undo.

The easiest way to get lock-in is to create a class of beneficiaries who obtain a very large and easily quantifiable benefit from your program. A tax break that is worth $3 apiece to every voter in America has very low lock-in. A tax break that hands $3 million apiece to 15 beneficiaries, each of whom regards that as a large sum of money worth fighting for, ironically has more lock-in than the more widespread but smaller-benefit program, because those 15 people will organize and fight tooth and nail to preserve it, and the costs are spread very thin over a very large group of taxpayers who will not organize to fight them. . .

Obamacare is a good example of a program with substantial lock-in. It is not very popular, and it has created large problems in the market for individual health insurance policies. And yet it is also firmly locked in place, because its design centers around four components, all of which depend on each other to work properly:

  • Guaranteed issue: Insurers cannot turn patients away
  • Community rating: Insurers cannot charge sick patients more money
  • Mandate: People have to be insured, or pay a penalty
  • Subsidies: People who can’t afford policies get subsidies

The first two policies are broadly politically popular, and because the topic of health insurance is very emotional, they are very hard to repeal once you’ve got them. Subsidies are, as with most subsidies, popular with folks who get them and unpopular with folks who don’t. The mandate is hated by basically everyone except health-care wonks.

This creates a bit of a problem for would-be reformers on both sides. No one wants to increase the mandate, which is probably the most important step toward fixing the current problems with Obamacare. Subsidies -- which means more taxpayer cash spent on an unpopular program -- will be more popular, but not much. On the other side of the aisle, "repeal and replace" is out of the question, because the two most popular parts of the program are also the ones that will systematically destroy the market unless they’re attached to the unpopular parts.

So where do we go from here? As I wrote the other day, that’s hard to see. We’re locked into a program that doesn’t work, and no one seems to have the key.

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